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10 CCHIP is available in Santa Clara, San Francisco, and San Mateo counties. These children receive coverage that is benchmarked to California’s state employees under the California Public Employees Retirement System (CalPERS).

In Santa Clara, San Francisco, and San Mateo counties, CCHIP enrolled children receive health coverage from a Medicaid health plan that participates in CCHIP, and has a contract with the counties to provide the services. Specialized services are carved out for CCS, as is also carved out for Medicaid and MCAIP children. Under the CCHIP model, children diagnosed with an eligible CCS condition will be referred to the CCS program for a full eligibility determination, including financial eligibility. In the CHIP Program, enrolled children with an eligible CCS condition are “deemed” to meet the financial eligibility requirements. In CCHIP, children that do not meet all the CCS eligibility criteria have all their medical needs met by the health plan as occurs today under the CalPERS. Children enrolled in the CCHIP also receive comprehensive dental and vision coverage also designed after the CalPERS.

CCHIP is administered by the counties on behalf of DHCS. Application screening to assure children are not eligible for no-cost Medi-Cal is done via CalHEERS. CCHIP covers children with income above 261 percent of the Federal Poverty Level (FPL) up to and including 317 percent of the FPL. This is consistent with the CS7 in Attachment 1.

DHCS is responsible for review and ongoing monitoring of each of the CCHIP expansions to assure compliance with federal Title XXI regulations and California’s approved state plan.

POPULATION 2/UNBORN OPTION (LOW INCOME POPULATION RECEIVING MEDI-CAL BENEFIT)

The Unborn Option offers prenatal care, prescriptions, labor and delivery, dental care, and services for other conditions that may complicate the pregnancy to pregnant women whose income is from 0 to 208 percent of the FPL. This is consistent with the CS9 template in Attachment 1. Postpartum coverage is also included and lasts until the end of the month of the 60th day following the end of the pregnancy. Infants are eligible for Medi-Cal at birth with no family income limit for the first year of life.

POPULATIONS 3 MEDI-CAL ACCESS PROGRAM (MCAP)/ POPULATION 4 MEDI-CAL ACCESS INFANT PROGRAM (MCAIP)

MCAP provides comprehensive health benefits for targeted low income unborn children with household incomes above 208 percent up to and including 317 percent of the FPL. This is consistent with the CS9 template in Attachment 1. Pregnant women are not eligible for MCAP if they are on Medi-Cal or have employer-sponsored coverage