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OHC for Foster Care/Adoption Assistance Children
The current process of posting OHC codes to MEDS does not take into consideration access to care and inappropriate disclosure issues for children in Foster Care (FC) and the Adoption Assistance Program (AAP).
OHC Coding Changes
In May 2010, the State made modifications behind the scenes to prevent the OHC code from being overlaid when OHC information is reported for a child receiving MC benefits under a FC or AAP Aid Code.
The new logic will automatically change the OHC code to “N” on MEDS to indicate no coverage and enter “Y” as the OHC-SOURCE. The reported OHC code will be posted in the ORIGINAL-OHC code fields on the [INQC] screen until the child becomes ineligible for MC benefits under either the FC or AAP program.
SSI Children
For FC/AAP children who are on SSI, staff must request the Third Party Liability Branch-OHC Unit to modify the OHC for these children.
Recording OHC
The OHC information reported by the FC/AAP child must be entered in CalSAWS to ensure the OHC data is interfaced to MEDS ORIGINAL-OHC fields.
This is necessary so that when the child leaves FC/AAP and transitions into a regular MC program, MEDS will already have the OHC data and can update the code to reflect the appropriate OHC without delay.
Related Topics
Overview of the Managed Care Two-Plan Model
Health Care Options Enrollment Contractor
Managed Care for Mental Health Services
Coordinated Care Initiative - Cal MediConnect
Health Insurance Premium Payment (HIPP) Program
Removal of OHC Codes for Victims of Domestic Violence
Repayment for Medical Services