Healthy Families Program

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The Healthy Families Program (HFP) provides low-cost health insurance for many low-income children. With Healthy Families, a family pays a small amount each month to receive health care for their children. In the future, parents, related adults and foster parents caring for children may also be able to get this insurance.

Community organizations, including the Korean Resource Center, provide assistance with HFP applications.

Contents

Eligibility

Am I eligible?

To be eligible the applicants must be low-income, uninsured California resident children, ages 1 to 19, who are not eligible for free Medi-Cal (Medi-Cal without a "Share of Cost") and who have had no other health insurance. The child must be without employer or private health insurance for at least three months before the application, with some exceptions. The child can obtain three months of retroactive Medi-Cal prior to becoming eligible for Healthy Families, or can be on "Share of Cost" Medi-Cal. Eighteen-year-olds can apply on their own. The child stays eligible for 12 months continuously once it is decided that he or she is eligible, even if the income changes.

Income Limits

To be eligible for Healthy Families, the monthly income must be between the amounts in the chart below:

Family Size Age 0-1 Age 1-5 Age 6-18
1 $1,635-$2,042 $1,088-$2,042 $818-$2,042
2 $2,201-$2,750 $1,464-$2,750 $1,101-$2,750
3 $2,768-$3,459 $1,841-$3,459 $1,385-$3,459
4 $3,335 -$4,167 $2,218-$4,167 $1,668-$4,167
5 $3,901 -$4,875 $2,595 -$4,875 $1,951-$4,875

The cost of the items you own ("resources") does not count against you.

Residency Requirements

You must sign a statement that each person who is applying for Healthy Families intends to stay in California with no plans to leave. Immigrant children can be eligible if they are "qualified" immigrants.

What Does It Cost?

Depending on your income and which plan you choose, you will pay a premium of $4 to $9 per month for each child. However, you will never pay more than $27 a month, no matter how many children are covered. Also, if a family pays three months of premium in advance, they will get a fourth month of coverage for free. If a family pays 9 months in advance, they get 12 months of coverage. Except for the first month, you can pay your premiums at Rite Aid stores.

There is also a $5 so-payment for most outpatient services such as doctor's office visits, but not for preventive services like immunizations and dental check-ups. However, there is a "cap" or upper limit for these co-payments of $250 per family per year, so all receipts should be kept.

What Are the Benefits?

The program offers health, dental, mental health, and vision services. You can not get the same amount and kind of services form Healthy Families as you can from Medi-Cal, especially for mental health and substance abuse treatment. If your family is eligible for Medi-Cal with a Share of Cost, consider carefully what services your children need before choosing Healthy Families. You may have "Share of Cost" Medi-Cal and Healthy Families at the same time.

Keeping HFP While Your Child Qualifies for Medi-Cal

If your child is found to be ineligible for Healthy Families at the annual re-determination (e.g. because your family income goes down), your child should keep Healthy Families coverage for up to 2 months while the information is send to the county (with your permission) to determine of your child is eligible for no-cost Medi-Cal. This is called the "Bridging Program." You should not be required to apply separately for Medi-Cal or to provide any information again, unless the county needs more information from you to determine eligibility.

What is the application process?

  1. Find assistance
  2. Complete all parts of the application, which includes:
    1. Choosing a health insurance company and primary care provider (From April 15 to May 31 every year, you can change your health insurance plan by using an Open Enrollment Form.)
    2. Paying the monthly premium (Pay to order: "Healthy Families." One month free with 3 months pre-paid)
    3. Attaching a document showing immigration status and proof of income.
  3. Mail in the application.
  4. Wait for response.
    • After 20 days of mailing in the application, you will receive a letter or phone call from the Healthy Families office regarding approval or denial of the application. If approved, after 40 days, you will receive cards for the primary care provider and dentist. You can use these cards to access services.
    • If you do not receive a card or letter from the Healthy Families Program, you should contact the office at 1-800-880-5305 extension 18. If you are connected with the automatic answering system, you can input the numbers from the bar code at the bottom left side of your application to check your application status. If you are connected with an assistant, you can give the number directly.
    • If you are denied services or mistreated, you can appealwithin 60 days. You should write your Healthy Families Member Number on the appeal letter. Send the letter of appeal to: Healthy Families, Program Review, P.O. Box 138005, Sacramento, CA 95813-8005, FAX: 1-866-848-4974.
    • You can also request the reason for denial by calling 1-866-848-9166 (Mon-Fri 8am-8pm, Sat 8am- 5pm). A lot of cases are denied because of income. You can contact the Healthy Families Program again and send a new proof of income for review.
  5. Continue your benefits.
    You will receive an Annual Eligibility Review (AER) form every year. To continue benefits, complete and return the form.
  6. Expand your benefits for new children.
    To add a newborn child, complete an "Add a Person" form and submit it.

How can I get more information?

  • Call: 1-800-880-5305, if you do not already have a child enrolled in Healthy Families Program.
  • Call: 1-866-848-9166, if you have a child enrolled in Healthy Families Program.
  • You can call Monday-Friday, 8 a.m.-8 p.m., or Saturday, 8 a.m.-5 p.m. The call is toll-free.
  • You can also e-mail HealthyFamilies@MAXIMUS.com

How can I download documents related to HFP?

http://www.healthyfamilies.ca.gov/Downloads/default.aspx#forms

Get assistance applying

To get assistance from KRC in applying for Healthy Families, please make an appointment request here or by calling us at 323-937-3718.



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