CHDP Gateway Presumptive Eligibility Enrollment Limitation

In July 2015, a Title XIX State Plan Amendment (SPA) took effect stipulating that individuals 19 years of age or younger may only receive up to two Presumptive Eligibility (PE) enrollment periods in a 12-month period from any of the PE programs or combination of programs, such as the Breast and Cervical Cancer Treatment Program (BCCTP), Child Health and Disability Prevention (CHDP) program, Hospital PE program or PE for Pregnant Women program.

The following CHDP Gateway Internet and Point of Service (POS) device response message was implemented to reflect the SPA requirements:

You are not eligible for PE because you have already received two PE enrollments within the past 12 months. Children under 19 years old are limited to two PE enrollments within the past 12 months.

If a family applies for PE for a child who has received two PE enrollment periods within the past 12 months, the child will be denied a third PE enrollment. Since the child is not eligible for PE, the family must be referred to apply for Medi-Cal for the child. The application will be reviewed for Medi-Cal eligibility and the family will be notified of the determination. Families may apply for Medi-Cal in the following ways:

• Online using the Single Streamlined Application at www.coveredca.com;
• Call the toll-free number to apply by telephone at 1-800-300-1506; or
• Contacting their local social services agency.

The CHDP Gateway continues granting CHDP eligibility to children who already have emergency Medi-Cal coverage. Individuals who meet the following criteria are eligible for emergency Medi-Cal coverage:

• 19 years of age or younger
• At or below 200 percent of the federal poverty level
• Not enrolled in, but meet the eligibility requirements for emergency Medi-Cal

After establishing emergency Medi-Cal coverage for the child, families may reapply for and enroll the child in the state-only CHDP program through the CHDP Gateway. CHDP program services are limited to well-child health assessments and immunizations in accordance with the most current CHDP periodicity schedule.

Providers should continue to encourage parents and guardians of children receiving presumptive eligibility benefits through the CHDP Gateway to apply for Medi-Cal for their children using the application options listed above.