California Code of Regulations › Title 10 - Investment › Chapter 5.8 - Managed Risk Medical Insurance Board Healthy Families Program › Article 2 - Eligibility, Application, and Enrollment › Section 2699.6607 - Determination of Eligibility

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as specified in Section
				2699.6605, the program shall
				complete the application review process within ten (10) calendar days of
				receipt of the complete application or Add a Person Form unless the program is
				waiting for necessary information pursuant to Subsection
				2699.6606(b)(1) and
				(2) or is requesting information pursuant to
				Subsection
				2699.6600(c)(1)(BB)(1).
				For those applications, the program shall complete the application review
				process within twenty (20) calendar days of receipt of the original application
				or Add a Person Form.
(1) The program shall
				determine eligibility for each person age 18 or under based upon the criteria
				specified in Insurance Code Sections
				12693.70,
				12693.73
				and
				12693.76
				and this section.
(2) The program
				shall determine eligibility for each person age 19 and over based on the
				criteria specified in this section. Notwithstanding any other provision of this
				Chapter, the first date on which any person age 19 or over shall be eligible
				for the program is the parental coverage start date. In addition to the
				criteria applicable to all potential subscribers, to be a child-linked adult
				eligible to participate in the program, a person age 19 or over must meet all
				the following requirements:
(A) Is not
				eligible for no-cost full-scope, or pregnancy-related, Medi-Cal or Medicare
				Part A and B at the time of enrollment in the program.
(B) Is a resident of the State of California
				pursuant to Section
				244 of the
				Government Code; or is physically present in California and entered the state
				with a job commitment or to seek employment.
(C) Is in a family with an annual or monthly
				household income after income deductions of up to and including 200 percent of
				the federal poverty level. Any income deduction that is applicable to a child
				under Medi-Cal shall be applied in determining the annual or monthly household
				income.
(D) If a person age 19 or
				over for whom enrollment in the program is requested has an annual or monthly
				household income after income deductions of 100 percent of the federal poverty
				level or below, a letter or Notice of Action from the County Welfare Office
				issued within the last two (2) months must state that the individual is not
				eligible for no-cost Medi-Cal for a reason other than:
1. failure to provide information requested
				by Medi-Cal or
2. termination from
				no-cost Medi-Cal at his or her own request.
(E) Notwithstanding 2699.6607(a)(2)(D), legal
				guardians applying to the program for coverage with an annual household income
				after income deductions of 100 percent of the federal poverty level or below do
				not need to provide a Notice of Action from the County Welfare
				Office.
(F) Meets the definition of
				child-linked adult as defined in Section
				2699.6500.
(G) Has a qualifying event as defined in
				Section 2699.6500 or applies pursuant to
				Section 2699.6631 for the first year
				following the parental coverage start date.
(3) If the program does not have the
				documentation required by Subsection
				2699.6600(c)(1)(T),
				the person shall be temporarily deemed to meet citizenship or immigration
				criteria until such documentation is submitted or until the time for submitting
				documentation established in Subsection
				2699.6600(c)(1)(T)
				has expired, whichever is sooner.