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Effective Date: November 1, 2009 November 1, 2009 November 1, 2009 • Per capita payments to Native Americans from proceeds held in trust and/or arising from use of restricted lands; • Agent Orange Payments; • Title IV Student Assistance; • Energy Assistance Payments to Low Income Families; • Relocation Assistance Payments; • Victims of Crime Assistance Payments; • Spina Bifida Payments; and • Any other federal income deduction required for a federal means tested program. Some federal income deductions, such as Earned Income Tax Credit and Japanese Reparation Payments, apply only to certain federal programs and not all federally means tested programs, including Title XXI. In cases where the income deduction does not apply to Title XXI, this income will be counted. Further, the Healthy Families program will share eligibility files with Medi- Cal on an ongoing basis to check for children enrolled in both programs. Employer Sponsored Insurance Coverage. The application will ask parents about their access to employer sponsored insurance coverage. Children who have been covered under such coverage in the prior 3 months will be determined ineligible. COUNTY CHILDREN’S HEALTH INSURANCE PROGRAM (C-CHIP) All county expansion programs included in this state plan amendment proposes to follow the same screening procedures at the initial and annual eligibility review as those followed in the Healthy Families Program. Rules on income disregards, resource disregards and the three month separation period from employer sponsored insurance coverage all apply to C-CHIP enrollees. Initial applications and annual review applications that include a child who is applying for C-CHIP coverage but who may be eligible for no cost Medi-Cal Approval Date: HFP Family Contribution Increase HFP Co-Payment Increase HFP Limited Dental Plan Choice for New Subscribers

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