Any woman who thinks she is pregnant and whose family income is under a certain amount is eligible for Medi-Cal Presumptive Eligibility (PE) for Pregnant Women. However, she must seek this care through a participating provider and they will determine if you are eligible for this program. Ask your provider if he/she offers this coverage and how to apply. Medi-Cal Presumptive Eligibility
Medi-Cal offers year around enrollment. Medi-Cal doesn’t compensate us to help you, so if you have other family household members who need coverage, we can help you enroll in Covered CA – (get a complementary quote, subsidy and benefits calculation) and MCAP.
If you only want MCAP just contact Medi-Cal directly.
- Covered CA Pregnancy Quick Sheet
- MCAP Website
- Western Law & Poverty Center
- Medi-Cal Explained Fact Sheet: Maternity Care (PDF)
- Medi-Cal Explained Fact Sheet: Paying for Maternity Services (PDF)
- Innovation Landscape: Maternity Care in Medi-Cal
- Insure Me Kevin.com *
- CA Health Line 4.18.2016
- CA State Disability Insurance
Covered CA will now offer full Medi-Cal to pregnant women per SB 857 , even if they don’t want Medi-Cal, but answer yes to being pregnant in the Covered CA application.
Husbands, boyfriends and children can get coverage through Covered CA or Direct. Get a quote. No extra charge for us to help you.
Medi Cal & MCAP Maternity Coverage
See Covered CA Job Aid for more detail & explanation
- Medi Cal Explained CHCF
- Historical Guide 2006 CHCF 174 pages
- CalAIM California Advancing and Innovating Medi-Cal — is a far-reaching, multiyear plan to transform California’s Medi-Cal program and to make it integrate more seamlessly with other social services. The goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs.
- 10 Essential Health Benefits
- Our Webpage on Medi & Denti Cal Benefits
- Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Our Webpage on
The Breast and Cervical Cancer Treatment Program (BCCTP) provides cancer treatment and services for eligible low-income California residents 200% of FPL – Federal Poverty Level rather than standard 138% View FPL Chart,
To qualify you must be screened by the Cancer Detection Program:
program and found to be in need of treatment for breast and/or cervical cancer.
Learn More ==>
Group health plans, insurance companies and health maintenance organizations (HMOs) must provide coverage for reconstructive surgery after mastectomy for breast cancer and prohibits “drive through” mastectomies, where breast cancer patient’s hospital stays were limited by their carriers. The required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema. Wikipedia *
WHCRA amended the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act (PHS Act) and is administered by the Departments of Labor and Health and Human Services
In 2003, the FDA approved a screening test for Human Papillomavirus (HPV).
Our Comments Section on another page about costs & coverage for breast cancer
Technical & Research Links
§ 1185b Required coverage for reconstructive surgery following mastectomies
Cornel Law Website
Code on Plastic Surgery.com
Section §10123.18 of the Insurance Code
Help with short-term housing near the cancer treatment center
Sometimes cancer treatment is given far from home. Many treatment centers have short-term housing centers or discount programs set up with nearby motels and hotels. The clinic social worker or oncology nurse might know about low-cost housing during hospital or clinic treatment.
The American Cancer Society Hope Lodge® program can offer families a free place to stay when cancer treatment is given far from home. Contact us to find out if there’s a Hope Lodge location near your treatment center.
Another option for adults or children with cancer is the Healthcare Hospitality Network. This group of nearly 200 non-profit organizations throughout the US provides free or low-cost family-centered lodging to families getting medical treatment far from home. You can call 1-800-542-9730 or check online at hh network.org to see if there’s a location that works for you.
Many treatment centers also have other short-term housing possibilities or discount arrangements with nearby motels and hotels. The clinic social worker or oncology nurse may have ideas for low-cost housing during hospital or clinic treatment.
People who have Medicaid may be entitled to help with travel to medical centers and doctors’ offices for cancer treatment. This may take the form of payment or being paid back (reimbursed) for gas, payment of bus fare, or may mean using a vanpool. County departments of social services in each state arrange for help with transportation, but families must ask for it by talking to their Medicaid case worker.
It's often so much easier and simpler to just read your Evidence of Coverage EOC-policy, then look all over for the codes, laws, regulations etc! Plus, EOC's are mandated to be written in PLAIN ENGLISH!
- Find your own Individual EOC Evidence of Coverage
- It' important to use YOUR EOC not just stuff in general!
- Employer Group Plans
- Medi-Cal HMO – Managed Care Providers
- Our Webpage on Evidence of Coverage
- Plain Meaning Rule - Plain Writing Act
Steve Explains how to read EOC
Group Employer Plans
Maternity coverage is mandatory on GROUP and INDIVIDUAL policies beginning in July 2012 in CA(Siders , “Capitol Alert,” Sacramento Bee, 10/6). californiahealthline.org SB 222 AB 210 Insurance Code 10123.865
Maternity in most cases can’t be excluded as a Preexisting Condition in a Group policy. Nor can a newborn who has applied for coverage … within 30 days of birth; or A child who is adopted … within the 30 days. Insurance Code §10708 d3 26 U.S.C.A. section §9801(d)3; Cal. Health and Safety Code section §1357.51 g 3
Federal & State Family Leave Act
No individual or group policy of health insurance that is issued, amended, renewed, or delivered on or after July 1, 2003, that provides maternity coverage shall contain a copayment or deductible for inpatient hospital maternity services that exceeds the most common amount of the copayment or deductible contained in the policy for inpatient services provided for other covered medical conditions or contain a copayment or deductible for ambulatory care maternity services that exceeds the most common amount of the copayment or deductible contained in the policy for ambulatory care services provided for other covered medical conditions. CA Insurance Code 10119.5. (a) SB 1411 2002
The Newborns’ and Mothers’ Health Protection Act of 1996 new protections for mothers and their newborn children with regard to the length of the hospital stay following childbirth Q & A Page 31 CA Health & Safety Code § 1367.69(a)…obstetrician gynecologists- must be eligible as primary care physicians (PCP) – that means you can schedule an appointment with your OB/GYN without going to your PCP first, in the same Medical Group/IPA. Provider Finder Standards relating to benefits for mothers and newborns IRS Code § 9811.
Do you need health_insurance_order information?
California AIM (Access for Infants and Mothers) provides coverage for women who are already pregnant and need maternity insurance coverage. You can apply up to the 30th week. Even if you have other Health Insurance, as long as it has a deductible or Co Pay of at least $500.CA Insurance Code 12695 et seq. AIM Program Handbook: 50 pages and includes the five-page Application. Be sure to put in our Agent’s Information How much is the Premium? aim.ca.gov/Costs/ embrace a child.org/
ACCESS FOR INFANTS AND MOTHERS GENERAL PROVISIONS AND DEFINITIONS
General ……………………………….. 12695-12695.24
POWERS AND DUTIES OF THE BOARD Administration …………………………. 12696-12696.20
Advisory Panel ……………………………….. 12696.5
PARTICIPATING HEALTH PLANS ……………… 12696.7-12697.15
SUBSCRIBER ELIGIBILITY AND ENROLLMENT
Eligibility and Coverage ………………… 12698-12698.35
Unfair Competition and Labor Practices …. 12698.50-12698.56
PERINATAL INSURANCE FUND …………………. 12699-12699.05
OPERATION OF PROGRAM 10123.865. (a) Commencing no later than July 1, 2012, every Including Grandfathered plans Per Blue Cross email dated 4.19.2012 individual health insurance policy shall provide coverage for maternity services for all insured’s covered under the policy. (b) For purposes of this section, “maternity services” include prenatal care, ambulatory care maternity services, involuntary complications of pregnancy, neonatal care, and inpatient hospital maternity care, including labor and delivery and postpartum care.
This definition of “maternity services” shall remain in effect until such time as federal regulations and guidance issued pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148) aka Obamacare define the scope of benefits to be provided under the maternity benefit requirement of that act, after which time the definition of that term under the federal act and associated regulations and guidance shall apply for purposes of this section. Bookmarks