This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).

New Application Assistance Payment Available for Enrollment Entities

The Enrollment Entity (EE) Reimbursement Program for application assistance has been providing payments to EEs since July 2005. In the past, EEs received payments when an assisted application (i.e., paper or HeApp) resulted in a child being enrolled in the Healthy Families Program (HFP), given Accelerated Enrollment into the no-cost Medi-Cal Program, or for assisted Annual Eligibility Reviews (AERs) which resulted in a child’s continued enrollment in the Healthy Families Program for another year.

EEs will soon receive an additional $50 payment when assisted AERs result in at least one or more children determined to be income too low for the Healthy Families Program during the AER. If the AER results in one child qualifying for HFP for another year and at least one child or added child on the AER Form determined income too low for HFP, the EE will be paid $100.

The first payments to include this new payment type will be sent to EEs in July 2008. The new AER payments will be retroactive and will include any AERs resulting in a child being determined income too low for the HFP at AER back to January 1, 2007. This means that any assisted AER applications from January 1, 2007, forward with a payment denial reason for Healthy Families due to income too low where the child was either bridged to Medi-Cal or given PE will result in payments to the EEs.

For more information on the criteria for the Reimbursement Program, see the Healthy Families website at http://www.healthyfamilies.ca.gov/EEs_CAAs/Reimbursement.aspx.