C. HEALTH INSURANCE PREMIUM PAYMENT PROGRAM(HIPP), MINOR CONSENT, AND RELEASE OF MEDI-CAL INFORMATION

 

CDHS
Regulation

 

The California Department of Health Services (CDHS) is authorized to pay health coverage premiums on behalf of Medi-Cal beneficiaries whenever it is cost effective.Paying these premiums for high cost medical users will result in reducing Medi-Cal costs.

 

Information from the Health Insurance Questionnaire (Form DHS 6155) is used to assist the California Department of Health Services (CDHS) in evaluating a client for potential eligibility to the HIPP program.The CDHS will notify the County if it will be paying the health care premiums.†††

 

Qualifications for

HIPP

A person is potentially qualified for HIPP if:

 

       There is current Medi-Cal eligibility.

 

       There is a Medi-Cal share of cost of $200 or less.

 

       There is a high cost medical condition for which the average Medi-Cal covered monthly cost is twice the amount of the monthly health insurance premium.

 

       There is a current private or group health insurance coverage, or COBRA coverage, or a conversion policy, in effect or available.

 

       Application is made in a timely manner.

 

       The policy does not exclude the high cost of medical condition.

 

       The premiums are not the responsibility of the absent parent.

 

       There is no enrollment in a Medi-Cal related pre-paid health plan.

 

       The clientís health insurance policy must not be issued through the California Major Risk Medical Insurance Board.

 

 

HIPP County Responsibility

Issue a Form DHS 6155 to the client to complete during the application and re-determination process when the client indicates:

 

       That group or employer related health insurance is available, but has not been applied for, or

 

        That he/she is about to terminate health insurance coverage, or

 

        That his/her health insurance coverage has lapsed.

 

Retain a copy of the Form DHS 6155 in the case folder.

 

Advise the client that private health insurance must be used prior to using Medi-Cal.

 

Inform the client that CDHS may require that Medi-Cal eligibles with existing third party coverage participate in HIPP if it is cost effective for the department.

 

Mail the Form DHS 6155 within 5 days to:

 

††††††††††††††† California Department of Health Services

††††††††††† ††† HIPP/EGHP

††††††††††† ††† P.O. Box 1287

††††††††††† ††† Sacramento, CA 95812-1287

 

Note:Indicate in red that this is a HIPP referral in the upper right-hand corner of the Form DHS 6155.

 

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Confidential Ė Minor Consent

To assure confidentiality, MEDS requires that all minor consent Medi-Cal Paper ID cards be issued by an on-line transaction on a MEDS terminal using pseudo numbers rather than actual Social Security numbers.This means a minor consent case cannot be granted ongoing eligibility on MEDS.Each month that a minor consent Medi-Cal card is needed, an on-line issuance must be done by the County, which will then update the MEDS eligibility history file.

 

To ensure the minor consent eligible persons do not receive a Beneficiary Explanation of the Medi-Cal Benefits and Services (BEOMBS) or other mailings from the CDHS, the minorís home address should not be submitted to the CDHS via MEDS.††

 

Minor Consent Medi-Cal ID

Minor Consent Services Medi-Cal Paper ID cards are always produced in the FRCs.These cards are not to be mailed unless requested in writing by the minor on form 07-42 DSS.

 

Minors Included in

Parentís Case

If the minor is included in the parentís AU, the HSS will issue a Paper ID card.Use the parentís case serial number for the minor.Place form 14-1 HHSA in an envelope marked ďConfidentialĒ and forward it to the appropriate HSS to be filed in the parentís case.No entry is to be made in the case narrative.

 

Release of Medi-Cal Information to Providers

The confidentiality of records was developed to protect applicants and recipients from the release of information identifying them as having applied for or having received public assistance.Health and Human Services Agency (HHSA) staff is encouraged to respond to inquiries by providing information regarding HHSA policies and procedures.Care must be taken, however, to preserve the confidentiality of HHSA records, including those stored electronically.

 

Medi-Cal confidentiality regulations limit the amount of information that HSSs may give to Medi-Cal providers.Medi-Cal providers include hospitals, Primary Care Clinics (PCC) and private providers.Medi-Cal Provider Consultants are people licensed by the State who may act as the agent of a Medi-Cal provider (including hospitals) for certain authorized activities.When a Medi-Cal provider (dentist, doctor, hospital, pharmacies, etc.) requests beneficiary information, HHSA will obtain the providerís name, phone number and enough information to identify the beneficiary.HHSA staff is authorized to release only the following beneficiary information:

 

       County ID number;

       Date of birth;

       Other health care coverage;

       Any restricted status;

       Medi-Cal coverage;

       Eligibility status for month(s) requested including eligible, ineligible, share of cost amount, and long term care (LTC) status.

 

For more detailed information regarding confidentiality and release of information, please refer to the CalWORKs Program Guide section 19-000, Confidentiality of Records.

 

 

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