elig chdp Eligibility: CHDP Services 1

This section explains which children and youth are eligible for Child Health and Disability Prevention (CHDP) program health assessment services.

Notice: Beginning July 1, 2017, many CHDP policies are shifting to align with Medi-Cal policies. The changes mostly affect billing codes and claim types. However, information in this manual section may be affected. To stay current with CHDP program changes, providers should 1) read the CHDP Transition to HIPAA Standards section in this provider manual 2) refer to 2017 monthly update bulletins 3) review CHDP articles posted in the NewsFlash area of the Medi-Cal website and 4) consult the CHDP Frequently Asked Questions Web page on the Medi-Cal website.

Eligible Children Children and youth who reside in California and who meet the and Youth following criteria are eligible to receive CHDP health assessments.

Full-Scope Medi-Cal Medi-Cal recipients younger than 21 years of age are eligible to receive initial and periodic CHDP health assessments according to their age, sex and health history if they are verified to be eligible for full-scope Medi-Cal on the day services are provided.

Note: Health assessments for this recipient group are reimbursed fee-for-service by the Medi-Cal program, unless the child or youth is enrolled in a Medi-Cal managed care plan in which CHDP services are capitated.

Children and youth who are pre-enrolled in Medi-Cal through the Gateway are eligible for CHDP health assessments. Refer to the Gateway section in this manual for eligibility requirements and pre-enrollment procedures.

No Full-Scope Medi-Cal Individuals younger than 19 years of age whose family income is at or below 266 percent of the federal poverty guidelines and who have no health insurance coverage for well-child care are eligible to receive no-cost initial and periodic CHDP health assessments.

CHDP services also may be rendered to Medi-Cal recipients younger than 19 years of age who have no coverage through Medi-Cal for CHDP health assessments on the date of service. These individuals include those who have:  Limited scope Medi-Cal (emergency services or pregnancy-related services only).  A Share of Cost (SOC) that has not been met for the month of service.

These children and youth are only able to access CHDP services through the Gateway.

Eligibility: CHDP Services CHDP 152 June 2017 elig chdp 2

Head Start or Children who are enrolled in Head Start or State Preschool programs State Preschool are eligible for CHDP services when they are either a Medi-Cal recipient or the family’s income meets CHDP program guidelines.

Ineligible Recipients Children and youth are not eligible for CHDP services if they are:  Members of a family whose gross income is more than 266 percent of the federal poverty guidelines  Non-Medi-Cal recipients who are 19 years of age or older  Not residents of California

Income Eligibility The following chart is used to determine whether a CHDP applicant’s Guidelines gross family income is at or below the program income limits. “Gross income” refers to income before taxes and other deductions. This chart is updated annually.

Income Eligibility Guidelines 266 Percent of the 2017 Federal Poverty Guidelines Effective January 1, 2017, through December 31, 2017 (For determinations of CHDP Gateway aid codes 8W and 8X only)

Number of Persons in the Household Monthly Income Annual Income 1 $2,674 $32,080 2 $3,600 $43,199 3 $4,527 $54,318 4 $5,453 $65,436 5 $6,380 $76,555 6 $7,307 $87,674 7 $8,233 $98,793 8 $9,160 $109,912 9 $10,086 $121,030 10 $11,013 $132,149

For households of more than 10 persons, $927 $11,119 for each additional person, add:

Note: Federal poverty guideline incomes are adjusted annually.

Eligibility: CHDP Services CHDP 152 June 2017 elig chdp 3

Eligibility CHDP health assessment providers must verify eligibility at each Verification scheduled CHDP health assessment visit.

Medi-Cal Eligibility If a recipient presents a Benefits Identification Card (BIC), the provider verifies Medi-Cal eligibility through the POS network, which includes the POS device, Automated Eligibility Verification System (AEVS), the Medi-Cal Web site at www.medi-cal.ca.gov and state-approved software.

If the child or youth is not eligible for no Share of Cost, full-scope Medi-Cal on the date of service, the family will need to complete the Child Health and Disability Prevention (CHDP) Program: Pre-Enrollment Application (DHCS 4073) to receive CHDP health assessment services.

Periodicity A child or youth is eligible for a complete CHDP health assessment only if a scheduled examination is within the CHDP periodicity schedule or meets one of the criteria for a Medically Necessary Interperiodic Health Assessment (MNIHA). (See the Periodicity Schedule for Health Assessment Requirements by Age Groups in the Appendix of this manual.)

Note: Refer to the Health Assessments section in this manual for MNIHA information.

Eligibility: CHDP Services CHDP 40 February 2008