The board shall encourage all plans, including those receiving purchasing credits, that provide services under the program to have viable protocols for screening and referring children needing supplemental services outside of the scope of the screening, preventive, and medically necessary and therapeutic services covered by the contract to public programs providing such supplemental services for which they may be eligible, as well as for coordination of care between the plan and the public programs. The public programs for which plans may be required to develop screening, referral, and care coordination protocols may include the California Children’s Services Program, the regional centers, county mental health programs, substance use disorder programs administered
by the State Department of Health Care Services, and programs administered by local education agencies.
Healthy FamiliesLinkages with Public Programs
Section § 12693.68
This law encourages health plans that serve children to create methods for identifying and directing kids who need additional services beyond what's covered by their health contract. These plans should connect children to public programs they might qualify for, such as California Children's Services or county mental health. The goal is to ensure there's smooth communication and care coordination between the health plans and these public programs.
health plans screening protocols referral protocols
Section § 12693.69
If a child in the Healthy Families Program needs medical treatment for a condition covered by the California Children’s Services (CCS) Program, but their family doesn't meet the CCS financial eligibility, the CCS Program will still cover their treatment costs. Counties won't have to pay for these services, as the state will use federal Title XXI and state funds to cover the expenses.
A child enrolled in the Healthy Families Program who has a medical condition that is eligible for services pursuant to the California Children’s Services Program, and whose family is not financially eligible for the California Children’s Services Program, shall have the medically necessary treatment services for their California Children’s Services Program eligible medical condition authorized and paid for by the California Children’s Services Program. County expenditures for the payment of services for the child shall be waived and these expenditures shall be paid for by the state from Title XXI funds that are applicable and state general funds.
Healthy Families Program California Children’s Services Program medical condition
