The San Mateo County web site is currently being upgraded for an improved user experience. The County Home page and a few departments are implementing the new "look and feel" along with an improved search and other new features. Please be aware that a number of departments will continue to retain the former user interface during this transition period.

Health Programs and Insurance Products for San Mateo County Residents

Printer Friendly View

Need help finding the program that is right for you? Call (650) 573-3595 for assistance. Families and Individuals Medi-Cal Healthy Families WELL Program Family PACT (Planning, Access, Care & Treatment) Program Women ACCESS for Infants and Mothers (AIM) Breast Cancer Early Detection Program Breast & Cervical Cancer Treatment Program Seniors and Persons with Disabilities Medicare MEDI-CAL San Mateo County Human Services Agency  State of California site http://www.medi-cal.ca.gov/ Medi-Cal, California's Medicaid program, provides health care coverage for low-income families and individuals who lack health insurance. Not everyone who has low income or who needs health services qualify for Medi-Cal. However, one can have both Medi-Cal and private insurance. In general, to qualify for Medi-Cal one must be linked into one of the following categories: Children under age 21 Aged (age 65 and over) Blind or disabled Pregnant Families who have at least one child who is under 21 and one parent is absent, deceased, disabled, incapacitated or working less than 100 hours per month. Persons in a skilled nursing facility Refugees Persons receiving CalWORKS & SSI/SSP Individuals can have different types of Medi-Cal insurance: Full-scope Medi-Cal (FREE Medi-Cal) Share-of-Cost Medi-Cal Restricted/Emergency Medical Individuals without legal immigration status are eligible for restricted Medi-Cal services. Children enrolled in Medi-Cal have a 1 year continuous eligibility regardless of changes in income or family size. Assets (i.e. property, savings, etc.) are waived for children and pregnant women. Families that have children on Medi-Cal do not need to fill out a quarterly report form. Medi-Cal can cover unpaid medical expenses for up to three months retroactively. Income does not affect eligibility. It only affects whether one will pay for a part of the Medi-Cal services. More information on Medi-Cal eligibility in San Mateo County HEALTHY FAMILIES http://www.healthyfamilies.ca.gov/ The Healthy Families Program is California's version of CHIP (Children's Health Insurance Program). Healthy Families provides a low-cost comprehensive medical, dental, and vision insurance for children whose family income is below 250% FPL. With Healthy Families, a family pays a small amount each month to receive health care for their children. Who is eligible? Uninsured children from birth to age 19 who are not eligible for no-cost Medi-Cal. Children must be U.S. citizens or legal permanent residents to qualify. Children who have not had any private insurance coverage from an employer during the three months before she or he applies for Healthy Families, with some exceptions. What are the income limits? Eligibility for Healthy Families depends on the child's age, family size and family income. Children birth through 1 are eligible if the family's gross monthly income is between 200% to 250% FPL. Children age 1 trough 5 are eligible if the family's gross monthly income is between 133% to 250% FPL. Children ages 6 to 18 are eligible if the family's gross monthly income is between 100% to 250% FPL. What are the benefits? Comprehensive medical, dental and vision services including preventive care and immunizations, office visits, prescription drugs, hospitalization, diagnostic x-ray and laboratory, mental health, emergency health services, and physical, occupational and speech therapy. How do children access services? Services are provided through private health plans. For San Mateo County, the available health plans are Health Plan of San Mateo, Blue Cross-EPO, Blue Shield-HMO, Health Net and Kaiser Permanente. Kaiser is currently NOT accepting new members for San Mateo County. How much does it cost? Premiums: paid every month $4 to $9 per child. Monthly premium determined by family income, family size, and insurance plan combination (health dental and vision). A family will never pay more than $27 per month no matter how many children they enroll into the program. Co-payments: paid for some non-preventive services $5 for some services $250 annual maximum for health benefits for each family No co-payments for preventive services (like immunizations) ACCESS FOR INFANTS & MOTHERS (AIM) http://www.mrmib.ca.gov/MRMIB/AIM.html AIM (Access for Infants and Mothers) is California's insurance for mid-income pregnant women. Funded by tobacco tax revenues, AIM provides health care coverage for uninsured pregnant woman throughout her pregnancy and for 60 days after her pregnancy ends. To qualify, families must earn between 200% to 300% FPL and must not be more than 30 weeks pregnant. What does AIM cost? Two percent of qualifying income pays for the pregnant woman's coverage and her baby's first year (Example: For a family of three making $43,896/month, the cost for AIM enrollment is $878.) Baby's second year of coverage is $50 if baby is current on immunizations and $100 if not. There are NO monthly premiums, co-pays or deductibles. AIM participants in San Mateo County will have Kaiser as their health provider. WELL PROGRAM WELL (Wellness Education Linkage Low Cost) Program is San Mateo County's low-cost program for the medically indigent. WELL provides low-cost medical services to San Mateo County residents who are NOT eligible for coverage through Medicare, Medi-Cal, private insurance or other third party payers. WELL is NOT an insurance program and is only available at San Mateo County Health Center and its satellite clinics. To qualify, families must make at or below 200% FPL. There are also property and asset limits similar to Medi-Cal. The annual enrollment fee for WELL is $200 for an individual, $300 for 2 or 3 family members and $50 for each additional family member. BREAST CANCER EARLY DETECTION PROGRAM The BCEDP (Breast Cancer Early Detection Program) Program provides FREE breast cancer screening services to women over 40 who cannot afford breast exams and mammograms. To qualify, the family income must be at or below 200% FPL. BREAST & CERVICAL CANCER TREATMENT PROGRAM The Breast and Cervical Cancer Treatment (BCCTP) Program provides immediate Medi-Cal coverage for women and men diagnosed with breast and cervical cancer regardless of their immigration status. To qualify, the family income must be at or below 200% FPL. Proof of income and property is not required. FAMILY PACT (Planning, Access, Care & Treatment) PROGRAM Family PACT (Planning, Access, Care & Treatment) Program provides FREE comprehensive family planning services, including contraception, testing, counseling, sterilization and education to low income men and women (under 200% FPL). Covered services include: Contraceptive Services i.e. IUD, birth control pills, depo-provera, morning after pill, etc. Pregnancy testing and counseling Female and Male Sterilization Limited Infertility Services Female and Male Reproductive Health Counseling and Education Female and Male Screening for Sexually Transmitted Infections Hepatitis B vaccine for Male and Females Screening for Breast and Cervical Cancer MEDICARE http://www.medicare.gov/ Medicare is a payroll tax funded federal health insurance for those who are at least 65 years old and for some disabled people who are under age 65. Part A Medicare pays for hospital care and some follow-up skilled nursing home, hospice, and/or home health care. Part B Medicare pays for out patient doctor's services, laboratory tests, ambulance services, medical equipment and supplies and other services such as physical therapy. UPDATED 08/22/2002