DPSS ePolicy

CHDP Gateway Pre-Enrollment Requirements

Children 0-19 Years of Age

• Child must reside in California;
• Child must be 19 years old or under;
• Child must not be enrolled in zero SOC full-scope MC or Child must be enrolled in full-scope MC with a SOC; and
• Family income must not exceed 266% FPL.

DE Infants

• Infant is under one year old; and
• Infant’s mother received MC benefits during the infant’s birth month.
  

In addition, the following information is also required from the infant’s mother:

• Date of birth; and
• Benefit Identification Card (BIC) number or Social Security Number (SSN).
  

Infants who do not meet the DE requirements will be evaluated following the requirements for children 0-19 years of age.

CHDP Gateway Pre-Enrollment Process

When a child visits a CHDP provider’s office for a health assessment, the provider will conduct a screening to ensure that the child meets the pre-enrollment requirements.  The provider will utilize the Department of Health Care Services (DHCS) 4073, CHDP Program Pre-Enrollment Application to capture and enter the information to DHCS to obtain an eligibility determination.

The CHDP provider receives an immediate response from MEDS that includes the following:

• Results of the eligibility determination for pre-enrollment; and
• Child’s Client Index Number (CIN).
  

If approved, the child will receive CHDP Gateway benefits for a period of 60 days.

Request for a Medi-Cal Application

If the parent(s) indicate on the DHCS 4073 that they would like to apply for ongoing MC, DHCS will send an application to them via regular mail (application can be used to apply for child(ren) and household).  Once completed, the application can be submitted to DPSS via any of the existing application channels or Covered California.

1. If the application is submitted within two months (60-day period) of pre-enrollment, MEDS will continue with the CHDP Gateway benefits until the application for MC is dispositioned (approved/denied).
2. If the application is not returned within two months (60-day period), MEDS will automatically discontinue the CHDP Gateway benefits at the end of the two months.  No further action will be taken at this point.

Benefit Identification Card

Children who are not known to MEDS at the time of pre-enrollment through the CHDP Gateway Program are automatically mailed a BIC.  If a BIC was previously issued to the child, a new BIC is not issued unless requested on the pre-enrollment application.

Notices of Action (NOA)

Pre-enrollment eligibility granted through the CHDP Gateway Program:

1. Does not require a ten-day notice when CHDP Gateway benefits are terminated; and
2. The applicant has no right to an administrative appeal hearing when benefits are discontinued.

However, once an eligibility determination for MC is completed for the child, the appropriate MC approval/denial NOA must be sent.

Presumptive Eligibility Enrollment Period Limits

Effective July 31, 2015, the CHDP Gateway Program began limiting the number of Presumptive Eligibility (PE) enrollment periods an individual may receive within a 12-month period.  The number of allowable PE periods vary by age and program.

The following table provides the number of PE periods allowed for CHDP and other programs: