EEs & CAAs
- Contact Information
- Reference Manual
This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
Enrollment Entity (EE) Reimbursements
The 2005 California Budget Act allocated $14.5 million ($5.9 million General Fund) for the restoration of EE reimbursements for application assistance that was successful in enrolling uninsured children into the Healthy Families Program (HFP) and/or the no-cost Medi-Cal Program (MC). The reimbursement level is $50 per successful initial application per program (HFP & MC). There is a $25 reimbursement per successful HFP Annual Eligibility Review (AER) process, which helps enrolled HFP subscribers maintain eligibility for another year.
The effective date of the budget act restoration is July 1, 2005.
UPDATE: Effective July 1, 2006, the reimbursement level was increased to $60 per successful initial application submitted via Health-e-App. In addition, any AER assisted applications leading to eligibility for another year will be reimbursed at a rate of $50 per application.
UPDATE: Effective January 1, 2007, EEs are eligible for a $50 reimbursement for AER assisted applications even when the child is determined to have income below the HFP income guidelines. A payment is now made to the EE when:
- A child qualifies for no-cost Medi-Cal at AER even if the applicant does not give authorization for the HFP to send the form to Medi-Cal (one $50 payment)
- A child qualifies for no-cost Medi-Cal at AER and another child in the same household re-qualifies for the HFP (two $50 payments = $100 maximum)
- A child re-qualifies for the HFP (one $50 payment)
EE Reimbursement Eligibility
- EE must have completed an updated Invitation to Participate (ITP) agreement and updated their tax information (W-9 Tax Form).
- EE is an eligible organization for reimbursement.
- EE’s linked Certified Application Assistant (CAA) provides application assistance on a successful application for HFP/ MC or successful HFP AER form that was received by the HFP on or after July 1, 2005.
- EE's CAA must complete the CAA sections of the HFP application and the HFP Annual Eligiblity Review Form (including EE number, CAA number, applicant's signature, CAA signature and the date).
- the CAA sections information (EE number, CAA number, applicant's signature, CAAs signature and the date) must be complete at the time submitted and cannot be completed subsequently after submission.
EE Reimbursement Payment Process
- Reimbursement payments will be paid on a monthly basis
- Average payment cycle process takes approximately 30-45 days (reimbursement payments for July 2005 should go out in early September 2005)
- EE will receive single monthly reimbursement checks for all the successful applications assisted by the organization.
- EE can access individual application payment status information through the State’s Health-e-App web site and may request hard copy payment status (pdf 48 KB) information if so desired.
- EE will need to establish a user profile by contacting the Health-e-App Help Desk at 1-866-861-3443. Once this is completed, the EE can log onto the web site (https://www.healtheapp.net/).
EE Reimbursement Discontinuance
EEs that have met the eligibility requirements to receive reimbursement payments from the Healthy Families Program have the right to request NOT to receive any future payments. If an EE chooses not to receive reimbursement based on receiving grant monies or other funds from application assisted activities, an EE must complete and submit to the HFP the EE Reimbursement Discontinuance Request Form (pdf 42 KB). This form must be completed by the authorized contact for an EE. Upon receipt of this form, the Healthy Families Program will set a Do Not Pay status for the Enrollment Entity. If an EE has already submitted a written request to discontinue reimbursements, the Healthy Families Program will contact the EE to verify the information provided and/or request additional information.
Please complete and return the form to:
Healthy Families Program
625 Coolidge Drive, Suite 100
Folsom, CA 95630
Or, you may fax the form to 1-916-673-4500, attention EE/CAA Help Desk.
Research on a Reimbursement Transaction
EE's wishing to request research on a reimbursement transaction should submit a Reimbursement Research Request Form (pdf 48 KB) to Healthy Families.