ABOUT SANTA CLARA FAMILY HEALTH PLAN

Santa Clara Family Health Plan provides comprehensive, affordable health coverage for low- to moderate-income residents of Santa Clara County, who otherwise would not be able to obtain health care for themselves or their families. The health plan acts as a bridge between the health care system and those who need care.

SCFHP is a public, not-for-profit health plan that operates solely in Santa Clara County. An independent public agency, its Governing Board is made up of consumers, medical professionals and Santa Clara County representatives.

Health plan members have access to a full spectrum of medical services, including primary care, specialist care, hospitalization, prescription drugs, family planning, mental health and substance abuse treatment, health education and 24-hour nurse advice lines. SCFHP provides services to members in the language they speak. The plan’s staff and network providers are members of the communities they serve, and are sensitive to the diversity of these communities.

SCFHP’s Family Resource Center, located in East San Jose, provides a broad range of services to area residents. These include school- and community-based enrollment outreach efforts, insurance program application assistance, advocacy for health plan members, referrals to community resources, and health education classes.

Health Insurance Programs

SCFHP offers four health insurance programs: Medi-Cal managed care, Healthy Families, Healthy Kids and Healthy Generations. Medi-Cal, Healthy Generations and Healthy Families are public insurance programs, funded with state and federal monies. Healthy Kids is a locally funded health insurance program.

Medi-Cal

Medi-Cal, launched in 1966, is the primary safety-net public insurance program in California. The Medi-Cal managed care program is free for children from birth to age 19, parents and pregnant women.

Parents, pregnant women and children may be eligible if they are:

· U.S. citizen or legal immigrant;

· California resident;

· Within annual family income guidelines (between 100 percent and 200 percent of the Federal Poverty Level)

Healthy Families

Healthy Families, launched in 1998, provides low-cost insurance coverage to children of moderate-income families that earn too much to qualify for Medi-Cal. Children are covered from birth to age 19; cost is $4 to $15 a month per child, with a maximum of $45 per family.

Children may be eligible if they are:

· U.S. citizen or legal immigrant;

· California resident;

· Not covered by Medi-Cal;

· Not covered by private health insurance in the past three months;

· Within annual family income guidelines (up to 250 percent of the Federal Poverty Level)

Healthy Kids

Healthy Kids, launched in 2001, is a locally funded health insurance program that fills in the gaps for those children who do not qualify for Medi-Cal or Healthy Families. The program––the first of its kind in the nation––is an essential component of SCFHP’s efforts to make health insurance accessible to all children in Santa Clara County.

Healthy Kids was created by a public-private partnership, which included SCFHP. It is funded entirely through local and foundation money. SCFHP administers Healthy Kids and oversees fundraising for the program through the Santa Clara Family Health Foundation.

Healthy Kids functions like any other managed health care plan. It is regulated by the California Department of Managed Health Care, and offers the same benefits and SCFHP provider networks as the Healthy Families program. It covers children in families with incomes up to 300 percent of federal poverty levels––and unlike the government-run Medi-Cal and Healthy Families programs, Healthy Kids accepts members regardless of their immigration status. Children are covered from birth to age 19; cost is $4 to $6 a month per child, with a maximum of $18 per family.

Children may be eligible if they are:

· Santa Clara County residents;

· Not covered by Medi-Cal or Healthy Families;

· Not covered by private health insurance in the past three months;

· Within annual family income guidelines (up to 300 percent of the Federal Poverty Level)

Healthy Generations

Healthy Generations is a Medicare Advantage Special Needs plan, with coverage starting January 1, 2007. Healthy Generations helps Santa Clara County residents coordinate the benefits they are eligible for from both Medicare and Medi-Cal (Medicaid). Including Medicare Part D coverage, the plan helps simplify health care and provides excellent coverage that is affordable for the county’s elderly and disabled residents.

Healthy Generations members benefit from a single set of providers who accept both Medicare and Medi-Cal patients. In addition to the coverage provided through the Medicare and Medi-Cal programs, Healthy Generations offers additional benefits, including health-related classes and resources, annual physical exams, six routine podiatry appointments annually and a home health assessment done by a medical professional.

In keeping with Santa Clara Family Health Plan’s commitment to outstanding personal service, each member is assigned a specific Care Partner, who available to help the member with any health-related need.

As a Special Needs Plan, Healthy Generations does not have a limited enrollment period, and accepts enrollments and changes all year.

Santa Clara Family Health Plan History

In 1993, the state of California announced plans to place the majority of the state’s Medi-Cal recipients, primarily children and parents, in managed care health insurance programs. These recipients would have the choice between two health plans: a commercial plan and a not for profit, community-based plan.

In 1995, the Santa Clara County Board of Supervisors established the Santa Clara County Health Authority. This new public agency, distinct from the County, established its community-based health plan––Santa Clara Family Health Plan––which would provide coverage to Medi-Cal Managed Care recipients.

SCFHP began operations in 1997. In 1998, it began service as the Community Provider plan for the Healthy Families program. In 2001, a public-private partnership that included SCFHP launched the Healthy Kids program.

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