Public or Subsidized Health Insurance

State and federal programs such as Medicaid and Healthy Families provide coverage for many low-income children, their parents, and aged, blind or disabled individuals. These programs provide comprehensive benefits at low or no cost for those who qualify. There are sometimes extensive, complicated rules about who qualifies.

Programs for Low/Modest-Income Individuals and Families

Medicaid. Medicaid provides comprehensive publicly funded health insurance coverage to low-income residents who meet specific eligibility criteria. Individuals may qualify for fully subsidized Medicaid if they meet income guidelines and fall into one of the following categories:

  • Aged, blind, or disabled according to Social Security rules.

  • Children and pregnant women.

  • Individuals with specific healthcare needs including dialysis, tuberculosis services, intravenous nutrition services and short-term nursing home stays.

Individuals who exceed income limits may still be eligible for Medicaid, but are required to pay a share of the cost of their health services. Undocumented immigrants do not qualify for Medicaid, except for emergency and pregnancy-related services and some nursing home care. Medicaid is jointly funded by the state and federal governments.

For those receiving Supplemental Security Income/State Supplemental Payments (SSI/SSP), Medicaid coverage is automatic. Others may apply for Medicaid at their local county welfare office or at one of the many hospitals and clinics where county eligibility workers are outstationed.

Healthy Families. The Healthy Families Program is a state and federally funded health insurance program for children with family incomes above the level eligible for no-cost Medi-Cal and below 250 percent of the federal income guidelines (in 2011, $46,332 for a family of three, according to the Department of Health Care Services).

Children’s Health Insurance Program. CHIP is part of the country’s efforts to increase medical coverage of pregnant women and their infants. CHIP provides low-cost insurance to women and newborns whose family is not eligible for Medicaid.

Health Insurance Premium Payment (HIPP) Program. Under HIPP, your state pays private health coverage premiums for some Medicaid beneficiaries. By purchasing health coverage premiums, the program defers the cost for medical care to private health insurance carriers or private health plans. To enroll in this program, employees must meet all of the following criteria:

  1. Be eligible for Medicaid

  2. Have a high-cost medical condition (pregnancy, HIV/AIDS, organ transplant and so on).

  3. Currently have private medical coverage or be covered under an employer-sponsored medical plan (including COBRA).

  4. Have filed an application in a timely manner allowing sufficient time to process the application and start payment of premium.

Programs for Low-Income Children

Kaiser Permanente Cares for Kids. Kaiser Permanente offers the Child Health Plan for uninsured children from families with incomes between 250 and 300 percent of the federal income guidelines, and who do not qualify for government-sponsored programs..

Programs for “Medically Uninsurable”

The Pre-Existing Condition Insurance Plan, is still in effect for those already enrolled, but cut off new enrollees in February until further notice.

Programs for Seniors

Medicare. Individuals over 65, regardless of income, qualify for coverage under the federal Medicare program. Medicare also covers some disabled people under 65 years of age.