Medi-Cal

Medi-Cal is a state and federally funded health coverage program that includes coverage for infants less than one year of age with family incomes up to 200% of the federal income guidelines, children between the ages of one and six with family incomes up to 133%, and children between 6 and 19 with family incomes below 100%. 

This program is available to children up to age 19 who are California residents. There are no limitations to the amount of property/assets that the family can have for children’s coverage. Children who are U.S. citizens, nationals or eligible qualified immigrants can receive no-cost comprehensive health, dental and vision insurance.
 
Children who do not meet the citizenship/immigration criteria listed above can receive no-cost restricted benefits that cover emergency and pregnancy-related services only. Other Medi-Cal programs may be available for families with incomes less than 100% of the federal poverty guidelines, but property and assets are considered.


Healthy Families

The Healthy Families Program is a state and federally funded health coverage program for children with family incomes above the no cost Medi-Cal income level and still below 250% of the federal income guidelines ($3,578 per month for a family of three). Healthy Families is available to children under the age 19, who are California residents, and either U.S. citizens, nationals, or eligible qualified immigrants.

Healthy Families is a low-cost comprehensive health, dental and vision insurance with monthly premiums ranging from $4 per child to a maximum of $45 per family. Families may pay 3 months in advance and receive the fourth month free. There are no co-payments for preventive services (such as immunizations) and only a $5 co-payment for non-preventive services (such as going to the doctor due to illness). Click here for the Healthy Families Website.


Healthy Kids

The Healthy Kids program is a locally funded health insurance product unique to Santa Clara County. This program was created by a public-private partnership and is run by the Santa Clara Family Health Plan. Healthy Kids is designed to provide comprehensive health insurance for those who do not qualify for existing programs and are financially unable to purchase coverage. This program is available to children under the age 19, who are residents of Santa Clara County (regardless of immigration status), whose families earn 300% FPL ($61,956 for a family of four) or less, and are ineligible for Medi-Cal or Healthy Families.

Healthy Kids is a low-cost comprehensive health, dental and vision insurance with monthly premiums ranging from $4 per child to a maximum of $36 per family. Premium assistance is available for families experiencing financial hardship. Families may pay 3 months in advance and receive the fourth month free, or, pay for 9 months in advance and receive the next three months free. There are no co-payments for preventive services (such as immunizations) and only a $5 co-payment for non-preventive services (such as going to the doctor due to illness).


Kaiser Permanente Child Health Plan (KPCHP)

The Kaiser Permanente Child Health Plan provides affordable healthcare coverage to children who are not eligible for government sponsored healthcare coverage such as Medi-Cal, or healthcare coverage that is paid by an employer. Uninsured children under 19 years old, who live in an eligible Kaiser Permanente service area in California, and are within KPCHP income guidelines are eligible for this healthcare plan.

Immigration status is not used to determine eligibility for KPCHP. Family income must be between 0% and 300% of the federal income guidelines to enroll.

There is a monthly premium of $8 or $15 per month per child, depending on te family's income. Families only have to pay for the first three children and any additional children will be covered at no cost. A $5 copayment is charge for most services. Emergency services require a $35 co-payment (waived if admitted directly to the hospital). There are no co-payments for some services such as prenatal care, well-baby care, immunizations, and all lab tests.


Access for Infants and Mothers (AIM)

Access for Infants and Mothers is a low-cost healthcare coverage program for pregnant women. To be eligible pregnant women must not be more than30 weeks pregnant, must be uninsured for their pregnancies or have maternity deductibles over $500, must meet income limits (between 200% and %300 federal income guidelines), and not be receiving Medicare Part A and Part B at the time of their applications. Immigration status does not matter. The total cost is 1.5% fo the the family's annual income.


Programs with Special Focus

  • Child Health and Disability Preventions (CHDP) - Provides free health check-ups for infants, children, teens, and young adults in low-income families.
  • CHDP Gateway Enrollment Process - Allows families to temporarily enroll their children info Medi-Cal through an online automated system.
  • California Children's Services (CCS) -Provides medically necessary care and case management to infants, children, and adolescents with certain physical limitations, chronic health conditions, or diseases who meet program eligibility requirements.