The state of California makes it possible for children in families with low to middle income to obtain medical coverage through programs like Medi-Cal and Healthy Families. Government-funded plans offer an array of affordable health care services to children up to age 18. Even more coverage has been made accessible through health insurance reforms among private insurers, giving young residents of California many options for staying safe and healthy.
If you need help for any reason with your application, there are many Certified Application Assistants throughout the state who can guide you through the process. Located at public health centers and other offices, these individuals are trained to help you fill out your application properly and get you coverage sooner. View a list of centers with CAAs.
California Children’s Health Insurance Programs
Children ages 0-18 in families with income up to 250 percent of the Federal Poverty Level (FPL), or about $57,625 for a family of four, qualify for either Medi-Cal or Healthy Families. Healthy Families is the State Children’s Health Insurance Program (CHIP) offering coverage to those with higher income levels than Medi-Cal, California’s Medicaid program. Both offer the same excellent level of coverage, and either free or inexpensive services. However, these programs do have a requirement for legal citizenship of the child applying.
- Medi-Cal covers a wide variety of services to lower income children in California. This health plan offers 100 percent coverage on all approved medical serviceswith no copays, premiums, or deductibles.
- Healthy Families is designed for those who have income over the Medi-Cal limits but still cannot afford to purchase coverage from an individual health insurance company. The same coverage as Medicaid is included for a small fee.
If a child is ineligible for either of these programs for reasons regarding immigration, they may be able to obtain coverage through several other insurance programs.
- Healthy Kids offers a large number of health care services in addition to dental and vision care for children who do not meet the criteria for Medi-Cal or Healthy Families.
- CaliforniaKids is available in several counties and provides affordable primary care services only to children in low-income families. While there is no hospital coverage, this plan at least covers some essentials.
- Child Health Disability and Prevention Program (CHDP Gateway) provides no-cost preventive health assessments to eligible infants, children, and youth when families go to participating providers. Visit your local health department‘s website or contact their office to find out more.
- Kaiser Permanente Child Health Plan is offered by our favorite California health insurer for children up to age 19, who are unable to get any other form of health insurance. Their plans are extremely affordable for children and offer a fair alternative to not using a government plan. Check their website for enrollment details in your area.
If a child is Native American, they may be eligible for free coverage through the Indian Health Program. The Indian Health Program, like Medi-Cal, provides 100 percent coverage on a large number of medical services ranging from primary care to hospital coverage and special needs.
California Family Planning & Maternity Coverage
- Access for Infants and Mothers (AIM) covers necessary prenatal and maternity services for women during the course of their pregnancy and 60 days of postnatal care after giving birth. When the baby is born, they automatically qualify for and can be enrolled in Healthy Families for up to two years.
- Family PACT offers coverage for family planning services to low income men and women living in California. With a broad provider network, members have access to family planning services at no cost if their health insurance does not cover these services.
Preexisting Condition Coverage for Children
- California Children’s Services is a public program for children up to age 21 with preexisting conditions, such as asthma, diabetes, or any other chronic illness. Regardless of the illness, children have access to diagnostic and treatment services from trained doctors and specialists, in addition to case management and physical and occupational therapy.
- Pre-Existing Condition Insurance Plan (PCIP) offers health insurance similar to an individual plan to those who have been uninsured for six months and cannot get private coverage due to a condition, which does not apply to children under 19.
- Private Health Insurance: Children under age 19 cannot be rejected for their health by any California insurer due to health reform laws. Consider enrolling during the open enrollment period for group coverage as premiums will be much more cost effective than any other time. Open enrollment periods take place for 60 days after January 1 each year, as well as the month after a child’s birthday, and after certain events such as losing group coverage. Individual health insurers are also offering coverage year-round to children with conditions, and beginning in 2014 cannot increase premiums because of health.
Health Reform & Children’s Coverage
Young adults up to age 26 are able to obtain coverage through their parent’s health plan, whether private or public, in California. This new law has already helped thousands of individuals stay healthy and maintain their insured status. The health reform law will also bring more options for all residents, including children, in 2014 through the state exchange. The California Health Benefit Exchange will bring more options for health insurance coverage at a reasonable cost. Families and individuals of any income level can qualify for coverage through the exchange, and many may be eligible for subsidies to help cut premium costs.