What does Healthy Families cover?

Healthy Families offers low-cost health, dental and vision care through contracts with selected insurance plans. Each county in California has different plans to choose from.

Benefits

The Healthy Families Program offers comprehensive health, dental and vision coverage through insurance plans. The benefits in all Healthy Families’ insurance plans are similar. The benefits may be administered differently.

Enrolled children are eligible for all covered services that are medically necessary. Healthy Families will not deny coverage based on a person’s health condition. You will be notified of the date that your child can begin receiving services.

Please see the Immunization Schedule for a schedule of recommended childhood immunizations and the Preventive Health Screenings chart to review guidelines for preventive pediatric health care services.

See the Summary of Benefits to know which health, vision and dental services are offered by the plans that participate in Healthy Families.

California Children's Services

California Children’s Services (CCS) is a statewide program that treats children under 21 years of age (under age 19 if enrolled in Healthy Families) with certain physical limitations and chronic medical, dental, or vision conditions or diseases.

If a medical, dental, or vision provider suspects that an eligible condition exists, a referral will be made to the local CCS program in your county. CCS can authorize and pay for specific services and equipment provided by CCS-approved specialists.

CCS will determine if a member has an eligible condition. CCS will provide all treatment and services for that condition. The member will remain enrolled in the Healthy Families Program for all other medical, dental, and vision care.

If your child already receives services from CCS, contact your medical, dental, or vision care provider when you enroll that person in the Healthy Families Program.

Your provider should refer you to CCS for eligible services. You can also contact CCS directly and request an evaluation of a potentially eligible medical, dental, or vision condition or disease. Talk to your family’s medical, dental, or vision care provider if you have questions about CCS.

For more information about the CCS program, contact your county health department or go to www.dhs.ca.gov/pcfh/cms/ccs.

Are Mental Health Services Covered?

Children enrolled in the Healthy Families Program receive mental health services through two delivery systems:

• Health Plan
  Children receive basic mental health services through participating health plans
  
• Local County Department of Mental Health
  Children needing specialized mental health services for a Serious Emotional Disturbances (SED) condition may receive care from their local county department of mental health.
  
  If your child’s provider suspects that a SED condition exists, your child will be referred to the county mental health department for assessment. If your child is determined to have a SED condition, care for the SED condition will be provided by the county mental health department. Your child will remain enrolled in the health plan and will continue to receive all other medically necessary care not related to the SED condition from the Healthy Families Program.
  
  If your child already receives services from the local county department of mental health, please contact your health providers after you have enrolled in the Healthy Families Program. Your health plan and provider will coordinate care with the local county mental health department. If you have questions about mental health services, talk to your child’s health provider.

Pregnancy Covered

Healthy Families members are eligible for pregnancy-related services under the program. To apply for the baby a new Healthy Families application must be submitted. See “What if you are pregnant?"

Pregnant members of the Healthy Families Program may qualify for no-cost Medi-Cal coverage for their pregnancy-related services. The baby will be insured by no-cost Medi-Cal for the first year. For information on no-cost Medi- Cal, call your local County Department of Social Services, a local Medi-Cal provider, or call 1-866-848-9166.

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