CHDP Gateway Program

The Child Health and Disability Prevention (CHDP) Program provides preventive health assessments to 2.1 million children statewide. Services are limited to physical examinations, vision and hearing screening, laboratory tests, and immunizations. Approximately half of these children are MC beneficiaries. The remaining children are from families with income at or below 200% of the federal poverty level (FPL) and whose CHDP services are covered by state-only funds. It is estimated that many of these children would be eligible for MC if they applied.

Note: CHDP referral procedures have not changed. EWs must continue to inform families of the availability of CHDP screening for children under 19 years of age and ensure all cases containing children under age 21 are coded with the appropriate CDS entry.

Pre-Enrollment by CHDP Providers

The CHDP Gateway Program allows CHDP providers to pre-enroll children into temporary, full-scope, zero share-of-cost (SOC), fee-for-service MC based upon income screening for zero SOC MC).

CHDP Screening Process

When a child visits a CHDP provider’s office for a health assessment, the 250% income screening test is applied. If the child meets the income criteria and is under 19 years of age, the provider submits a “Child Health and Disability Prevention (CHDP) Program Pre-Enrollment Application” (DHCS 4073) via the internet or a point-of-service (POS) device, and existing eligibility for MC is automatically checked through MEDS. The DHCS 4073 is the electronic internet-based application used by CHDP providers to complete pre-enrollment into MC through the Gateway. In addition, a brochure explaining CHDP and the CHDP Gateway is provided to the client during the office visit.

Note: Children whose family income is above the applicable FPL limits for zero SOC MC are not eligible for CHDP services or pre-enrollment through the CHDP Gateway.

CHDP Gateway Aid Codes

Children who meet the requirements to be pre-enrolled through the Gateway are automatically given full-scope, zero SOC MC for the month of screening and the following month in one of the Aid Codes below:

Aid Code	Description
8W	CHDP Gateway MC up to 150% FPL
8X	CHDP Gateway MC above 150% up to and including 250% FPL
8Y	A child currently eligible on MEDS in an Aid Code linked to undocumented immigration status. (CHDP STATE-ONLY PROGRAM)

Child Qualifies for Pre- Enrollment

When the electronic CHDP Gateway application is submitted to MEDS, and the child meets the
pre-enrollment requirements, the CHDP provider receives an immediate response, indicating the child’s existing or newly assigned Client Index Number (CIN).

If the Child is...	Then the Child Receives...
Not known to MEDS, or has SOC MC,	A CHDP Exam Temporary full-scope MC
Known to MEDS - Currently active on restricted benefits,	Emergency /Pregnancy Only MC CHDP exam Not eligible for temporary full-scope MC
Known to MEDS - Currently active on full scope zero SOC MC,	CHDP Exam A referral to MC Managed Care 800# and to the local CHDP Program 800# for information about child health services.
Not eligible for a CHDP Exam,	No pre-enrollment into MC.

Children Without Satisfactory Immigration Status (SIS)

Children who are currently active on MEDS in a restricted MC Aid Code due to undocumented immigration status cannot be pre-enrolled in MC through the CHDP Gateway. These children are only entitled to state-funded CHDP services, for the month of screening and the following month.

Note: Undocumented children who are NOT currently active on MEDS may be pre-enrolled through the Gateway.

CHDP Eligibility and SOC MC

A child who is already receiving MC with a SOC and has met his/her SOC in the month of the CHDP visit is already MC eligible and cannot be pre-enrolled for that month.

CHDP Eligibility and Other Health Coverage (OHC)

When MEDS indicates a child has OHC, the child is still pre-enrolled through the CHDP Gateway and is able to receive services regardless of their OHC status. A new MEDS enhancement overrides the OHC code on MEDS at the time of pre-enrollment through the CHDP Gateway as follows:

CHDP Eligibility and OHC

If...	Then...
The child is determined eligible under the CHDP accelerated enrollment aid code 8W or 8X,	The OHC indicator code is changed to “N” regardless of whether MEDS shows an active OHC code.
The child is determined eligible under the State-only CHDP Aid Code 8Y and MEDS shows an active OHC code,	The MEDS OHC code is changed to an ‘A’ (pay and chase).

CHDP Eligibility and Retroactive MC

Individuals applying for MC through the Gateway may request retroactive MC coverage to cover the pre-enrollment period.

BIC Card

Children who are not known to MEDS at the time of pre-enrollment through the Gateway are automatically mailed a BIC card within two working days. If a BIC was previously issued to the child, a new BIC is not issued unless requested on the pre-enrollment application.

Eligibility Determination for MC

If the applicant indicates on the CHDP application that he or she wants to apply for MC for the child, SPE sends an MC 321 HFP to the parents of children who are pre-enrolled in MC through the Gateway. The MC 321 HFP is sent in the appropriate language, along with a self-addressed, postage paid envelope with instructions to mail the application back to SPE for processing.

Parents are required to submit the completed application form to SPE for ongoing coverage to continue. The CHDP Gateway program application process is as follows:

If the Completed Application is...	Then...
Returned to SPE within the initial two months of presumptive eligibility, and that information is reported to MEDS,	SPE conducts a full file clearance and reports to MEDS that the application has been received.
	SPE extends the pre-enrollment period, and the child continues to receive full-scope, zero SOC MC coverage until eligibility for ongoing MC is determined.
	SPE screens the application and sends to the county for an eligibility determination.
	SPE sends an informing notice to the client explaining that pre-enrollment has been extended until eligibility for MC is determined. This notice is available in 11 languages.
Not returned to SPE within the initial two months of presumptive eligibility,	The child’s eligibility for full scope zero SOC coverage is not extended beyond the second month. Note: There is no requirement to provide a 10-day NOA when pre-enrollment ends.
Submitted directly to the Intake office, instead of mailed to SPE,	The Intake EW must ensure that: Receipt of the application is reported to MEDS via an AP 18 on-line transaction, for the child’s pre-enrollment eligibility to be extended. The application is processed following existing procedures.

Note: A child can be eligible for an additional period of presumptive eligibility in the future, if CHDP services are requested again and they are in accordance with the allowable CHDP time frames.

Notice of Action

Pre-enrollment eligibility through the CHDP Gateway is granted before a full MC eligibility determination is made; therefore, there are no appeal rights or notice of action (NOA) requirements for the
pre-enrollment period. However, once an eligibility determination for MC is completed for the child, the EW must send the appropriate MC approval or denial NOA.