Eligibility

Cal. INS § 12693.70

California Statutes

To be eligible to participate in the program, an applicant shall meet all of the following requirements: (

a) Be an applicant applying on behalf of an eligible child, which means a child who is all of the following:

(1) Less than years of age. An application may be made on behalf of a child not yet born up to three months prior to the expected date of delivery. Coverage shall begin as soon as administratively feasible, as determined by the board, after the board receives notification of the birth. However, no child less than months of age shall be eligible for coverage until days after the enactment of the Budget Act of 1999.

(2) Not eligible for no-cost full-scope Medi-Cal or Medicare coverage at the time of application.

(3) In compliance with Sections 12693.71 and 12693.72.

(4) A child who meets citizenship and immigration status requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, except as specified in

Section 12693.76.

(5) A resident of the State of California pursuant to

Section of the Government Code; or, if not a resident pursuant to

Section of the Government Code, is physically present in California and entered the state with a job commitment or to seek employment, whether or not employed at the time of application to or after acceptance in, the program. (6) (

A) In either of the following: (

i) In a family with an annual or monthly household income equal to or less than percent of the federal poverty level. (ii) (

I) When implemented by the board, subject to subdivision (

b) of

Section 12693.765 and pursuant to this section, a child under the age of two years who was delivered by a mother enrolled in the Access for Infants and Mothers Program as described in

Part 6.3 (commencing with

Section 12695). Commencing July 1, 2007, eligibility under this subparagraph shall not include infants during any time they are enrolled in employer-sponsored health insurance or are subject to an exclusion pursuant to

Section 12693.71 or 12693.72, or are enrolled in the full scope of benefits under the Medi-Cal program at no share of cost. For purposes of this clause, any infant born to a woman whose enrollment in the Access for Infants and Mothers Program begins after June 30, 2004, shall be automatically enrolled in the Healthy Families Program, except during any time on or after July 1, 2007, that the infant is enrolled in employer-sponsored health insurance or is subject to an exclusion pursuant to

Section 12693.71 or 12693.72, or is enrolled in the full scope of benefits under the Medi-Cal program at no share of cost. Except as otherwise specified in this section, this enrollment shall cover the first months of the infant’s life. At the end of the months, as a condition of continued eligibility, the applicant shall provide income information. The infant shall be disenrolled if the gross annual household income exceeds the income eligibility standard that was in effect in the Access for Infants and Mothers Program at the time the infant’s mother became eligible, or following the two-month period established in

Section 12693.981 if the infant is eligible for Medi-Cal with no share of cost. At the end of the second year, infants shall again be screened for program eligibility pursuant to this section, with income eligibility evaluated pursuant to clause (i), subparagraphs (

B) and (C), and paragraph (2) of subdivision (a). (II) Effective on October 1, 2013, or when the State Department of Health Care Services has implemented

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, whichever is later, eligibility for coverage in the program pursuant to this clause shall terminate. The board shall coordinate with the State Department of Health Care Services to implement

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, including transition of subscribers to the AIM-Linked Infants Program. The State Department of Health Care Services shall administer the AIM-Linked Infants Program, pursuant to

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, to address the health care needs of children formerly covered pursuant to this clause. (

B) All income over percent of the federal poverty level but less than or equal to percent of the federal poverty level shall be disregarded in calculating annual or monthly household income. (

C) In a family with an annual or monthly household income greater than percent of the federal poverty level, any income deduction that is applicable to a child under Medi-Cal shall be applied in determining the annual or monthly household income. If the income deductions reduce the annual or monthly household income to percent or less of the federal poverty level, subparagraph (

B) shall be applied. (

b) The applicant shall agree to remain in the program for six months, unless other coverage is obtained and proof of the coverage is provided to the program. (

c) An applicant shall enroll all of the applicant’s eligible children in the program. (

d) In filing documentation to meet program eligibility requirements, if the applicant’s income documentation cannot be provided, as defined in regulations promulgated by the board, the applicant’s signed statement as to the value or amount of income shall be deemed to constitute verification. (

e) An applicant shall pay in full any family contributions owed in arrears for any health, dental, or vision coverage provided by the program within the prior months. (

f) By January 2008, the board, in consultation with stakeholders, shall implement processes by which applicants for subscribers may certify income at the time of annual eligibility review, including rules concerning which applicants shall be permitted to certify income and the circumstances in which supplemental information or documentation may be required. The board may terminate using these processes not sooner than days after providing notification to the Chair of the Joint Legislative Budget Committee.

This notification shall articulate the specific reasons for the termination and shall include all relevant data elements that are applicable to document the reasons for the termination. Upon the request of the Chair of the Joint Legislative Budget Committee, the board shall promptly provide any additional clarifying information regarding implementation of the processes required by this subdivision.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 12693.70
Date2014-06-20
Typestatute
Languageen
SourceCA_STAT
IdentifierINS12693.70.20143135

Eligibility

Cal. INS § 12693.70

California Statutes

Eligibility

Cal. INS § 12693.70

California Statutes

To be eligible to participate in the program, an applicant shall meet all of the following requirements: (

a) Be an applicant applying on behalf of an eligible child, which means a child who is all of the following:

(1) Less than years of age. An application may be made on behalf of a child not yet born up to three months prior to the expected date of delivery. Coverage shall begin as soon as administratively feasible, as determined by the board, after the board receives notification of the birth. However, no child less than months of age shall be eligible for coverage until days after the enactment of the Budget Act of 1999.

(2) Not eligible for no-cost full-scope Medi-Cal or Medicare coverage at the time of application.

(3) In compliance with Sections 12693.71 and 12693.72.

(4) A child who meets citizenship and immigration status requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, except as specified in

Section 12693.76.

(5) A resident of the State of California pursuant to

Section of the Government Code; or, if not a resident pursuant to

Section of the Government Code, is physically present in California and entered the state with a job commitment or to seek employment, whether or not employed at the time of application to or after acceptance in, the program. (6) (

A) In either of the following: (

i) In a family with an annual or monthly household income equal to or less than percent of the federal poverty level. (ii) (

I) When implemented by the board, subject to subdivision (

b) of

Section 12693.765 and pursuant to this section, a child under the age of two years who was delivered by a mother enrolled in the Access for Infants and Mothers Program as described in

Part 6.3 (commencing with

Section 12695). Commencing July 1, 2007, eligibility under this subparagraph shall not include infants during any time they are enrolled in employer-sponsored health insurance or are subject to an exclusion pursuant to

Section 12693.71 or 12693.72, or are enrolled in the full scope of benefits under the Medi-Cal program at no share of cost. For purposes of this clause, any infant born to a woman whose enrollment in the Access for Infants and Mothers Program begins after June 30, 2004, shall be automatically enrolled in the Healthy Families Program, except during any time on or after July 1, 2007, that the infant is enrolled in employer-sponsored health insurance or is subject to an exclusion pursuant to

Section 12693.71 or 12693.72, or is enrolled in the full scope of benefits under the Medi-Cal program at no share of cost. Except as otherwise specified in this section, this enrollment shall cover the first months of the infant’s life. At the end of the months, as a condition of continued eligibility, the applicant shall provide income information. The infant shall be disenrolled if the gross annual household income exceeds the income eligibility standard that was in effect in the Access for Infants and Mothers Program at the time the infant’s mother became eligible, or following the two-month period established in

Section 12693.981 if the infant is eligible for Medi-Cal with no share of cost. At the end of the second year, infants shall again be screened for program eligibility pursuant to this section, with income eligibility evaluated pursuant to clause (i), subparagraphs (

B) and (C), and paragraph (2) of subdivision (a). (II) Effective on October 1, 2013, or when the State Department of Health Care Services has implemented

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, whichever is later, eligibility for coverage in the program pursuant to this clause shall terminate. The board shall coordinate with the State Department of Health Care Services to implement

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, including transition of subscribers to the AIM-Linked Infants Program. The State Department of Health Care Services shall administer the AIM-Linked Infants Program, pursuant to

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, to address the health care needs of children formerly covered pursuant to this clause. (

B) All income over percent of the federal poverty level but less than or equal to percent of the federal poverty level shall be disregarded in calculating annual or monthly household income. (

C) In a family with an annual or monthly household income greater than percent of the federal poverty level, any income deduction that is applicable to a child under Medi-Cal shall be applied in determining the annual or monthly household income. If the income deductions reduce the annual or monthly household income to percent or less of the federal poverty level, subparagraph (

B) shall be applied. (

b) The applicant shall agree to remain in the program for six months, unless other coverage is obtained and proof of the coverage is provided to the program. (

c) An applicant shall enroll all of the applicant’s eligible children in the program. (

d) In filing documentation to meet program eligibility requirements, if the applicant’s income documentation cannot be provided, as defined in regulations promulgated by the board, the applicant’s signed statement as to the value or amount of income shall be deemed to constitute verification. (

e) An applicant shall pay in full any family contributions owed in arrears for any health, dental, or vision coverage provided by the program within the prior months. (

f) By January 2008, the board, in consultation with stakeholders, shall implement processes by which applicants for subscribers may certify income at the time of annual eligibility review, including rules concerning which applicants shall be permitted to certify income and the circumstances in which supplemental information or documentation may be required. The board may terminate using these processes not sooner than days after providing notification to the Chair of the Joint Legislative Budget Committee.

This notification shall articulate the specific reasons for the termination and shall include all relevant data elements that are applicable to document the reasons for the termination. Upon the request of the Chair of the Joint Legislative Budget Committee, the board shall promptly provide any additional clarifying information regarding implementation of the processes required by this subdivision.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 12693.70
Date2014-06-20
Typestatute
Languageen
SourceCA_STAT
IdentifierINS12693.70.20143135