Unavailable OHC

Unavailable OHC should not be entered in CalSAWS, and if the information is already in MEDS, it must be removed. OHC is considered unavailable in the following situations:

• Any coverage to which a child may be entitled, if the child is applying for Minor Consent Services.
• Coverage to which a child may be entitled when:
  • The parent or guardian refuses to provide the necessary insurance information due to a “good cause” claim in the medical referral process.
  • The absent parent cannot be located, and
  • The child is applying for MC independently and would be in a separate MFBU from the custodial parent or guardian, or
  • The child is applying for MC independently and has no custodial parent or guardian (i.e., child under age 18 applying as an adult).
• Any private PHP/HMO plan which is limited to a specific geographical service area and the client must travel more than 60 miles or 60 minutes to receive care.

Related Topics

Overview of the Managed Care Two-Plan Model

Health Care Options Enrollment Contractor

HCO Referrals

Managed Care for Mental Health Services

Coordinated Care Initiative - Cal MediConnect

Other Health Coverage (OHC)

Client Responsibility

EW Responsibility

Health Insurance Premium Payment (HIPP) Program

OHC Identification by DHCS

Cost Avoidance

PHP, HMO, Triwest

OHC Information in MEDS

Removal of OHC Codes for Victims of Domestic Violence

OHC for Foster Care/Adoption Assistance Children

Repayment for Medical Services

Third Party Liability (TPL)

Kaiser Dues Subsidy Program