Chapter 4A - Maternal and Child Health Access
Contents
1. Note that the authorization will have to be completed for each agency that works with the client LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 1 Getting Started APPLICANT AND HOUSEHOLD INFORMATION The primary informant entered in the beginning of the application must indicate if Are there other members in the household she or he is a member of the household Adult s age 19 or older Childfren younger than age 19 M Pregnant Women Application and Household Information Please select all that apply Are you a member of the household yes O No You must indicate if there are other Adults Children or Pregnant Women in the same household The One e App system has the intelligence to create separate family budget units so that separate family units from the same household may be entered on the same application if you wish One e App then sends separate applications to each program LA County One e App User Manual o Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Tell us about yourself T First Name N Middle Name Last Name Suffix 7 gt other names Email Home Phone 213 4444 Cell Phone 213 1111 Work Phone 323 2222 x 222 Message Emergency Poon What language do you speak best What language do you read best English English Tell us more about N2. If you locate a person in the search results there may already an open case for that person Refer to the Resource section to learn how to check the status of a case for the various programs 52 RESULTS The search will provide all possible matches in the One e App system among all agencies working with One e App in Los Angeles After you verify that your client is not in the search results you can begin a new application If your search comes back with a match and you can verify that it is the same person You can utilize the Clipboard function Clipboard The Clipboard function is a tool that can be used to add persons to an application that already exists in the One e App data base This function can help with creating renewing and modifying applications by avoiding re typing personal information such as name date of birth gender etc If the person is already known to One e App and is in the submitted application workload the person can be pasted to the clipboard and them be added to a new renewal or modified application Click on the Clipboard icon next to the clients name and then click on Begin New Application Clicking on the Clipboard icon will pre populate the clients information in the new application You should verify that the information is still current Scroll to the bottom of the page and click on Begin New Application You have the choice of Interview mode or Data Entry mode
3. coverage for herself or himself LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Adute s eNanseRige OO OTHER ADULTS Tell us about the adult s in the household Indicate if the other adults are applying for health care coverage First Name Charl Whenever you see a green link called a mer eens hyperlink it is a shortcut to adding What is this person s Last Name Rigetti gt eens information that already has been Suffix Do you use any O Marital Status M Yes No provided other names Spouse s First Name Gender male Female Spouse s Middle Name Date of Birth os 03__ 1970 _ E Spouse s Last Name Suffix demographic information Enter the next adults name and Place of Birth Select first ONE that applies California County vegas il If there are no more adult s in the Other Country household check no Ethnicity White Are there any more Adult s in the household O Yes O No THINGS TO CONSIDER Remember that any adult who needs Medi Cal coverage quickly for medical expenses in the last three months or for a medical need should apply directly with a DPSS worker see Resources One e App does NOT submit Medi Cal applications for adults at this time unless pregnant LA County One e App User Manual 59 Help Desk 1 866 429 1979 Progr
4. If the client refuses to give permission to is required it is a good practice to give a copy of the share data you cannot process the completed document to the client for their records application using the One e App system You will need to use the appropriate paper application or the Health e App for Medi Cal or Healthy Families LA County One e App User Manual 93 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 1 Getting Started PRIMARY INFORMANT Primary Informant The Primary Informant is the person providing the information for the application Please provide the name of the primary informant He or she does not need to be a member of First Name Lola the household Middle Name Last Name Martinez LA County One e App User Manual 54 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 1 Getting Started SIGNATURE OPTION One of the first things you must do is select Please select a method for submitting our signature from the options below a method for submitting a signature You 1 will use an electronic signature tablet must have an electronic signature tablet Twill print the Rights amp Declarations and fax them with the fax cover sheet provided at the end of the and software to select the electronic application process signature option Signature Option Notes LA County One e App User Manual 99 Help Desk 1 866 429 1979 Program Appl
5. Interview mode is recommended when working directly with a client e Data Entry mode is recommended when taking an application over the phone or when agencies have a dedicated person entering data after the client interview or application is complete LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 1 Getting Started DATA SHARING In order to submit an application using One e App a client must give Data Sharing Do you give permission to share your personal information from this application with the following agencies permission to share his or her data with ERR AS partnering agencies You can tell the California Department of Health Services California Managed Risk Medical Insurance Board client that the information will only be LA Care Health Plan Los Angeles County Department of Health Servic i inthis i H ie Ciy Depa ee OF FE Health used in eligibility determination No 2 ee es Cet ea ee ee ee personal information will be shared with anyone else This is a very important a Sereen for you to explain to the ist family You should give a copy of the Data Sharing screen to the client for his her records You can do this by clicking on the Print icon The data sharing screen can be printed in Cambodian Chinese English Farsi Spanish and Vietnamese THINGS TO CONSIDER Vietnamese Anytime there is a need to give consent or a signature
6. User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS Search Results To retrieve and continue with an application click on the applicant s name Applications that you are authorized to coauthor are highlighted Applications in Progress Nancy Smith 2 2 1960 Vishnu Katta 11 27 2006 200633000274 31900001331069 65 90 Determined Applications Pending Submission Nanc Suresh Medi Cal for i th 2 2 1969 og jy 21 17 2006 Children and Fax 200632000119 31900017320064 64 70 mith ovindarajalu Pregnant Woman Expired or Program Closed Applications No matching records were found Submitted Applications Juanito 6 14 1991 ETA Healthy 00634400 NEE a ES 70 zj Kulkarni Dan Ruiz 10 20 1965 Juana Felix 12 13 2006 N A 0063460024713190007634606 SCE 70 75 Medi Cal for Joel Sarah Children Deutch 1 1 1937 Detach 11 7 2006 d 00631000391 Ei a 8 30 2006 12 13 2006 j Fax 00634600247 31900079346064 P 55 00 Note Each R indicates a renewal application Note Each Q indicates a renewal application which has started and not completed through final eligibility review Note Each indicates Program Closed application s person s Note Each O is a link to a person s application summary Note Each 5 is a link to add a person to the clipboard 8 Searg Begin New ApplicatioN Renew Modify view Clipboard next D Reporta uo ma Data Entry THINGS TO CONSIDER
7. household screen The household summary screen will look slightly different when the Primary Informant does not live in the household Please make any necessary changes To remove a person from the application check the box next to that person s name and click the Remove button below Primary Informant Ana luna No matching records were found Child ren O Pretty Luna C Dark Luna LA County One e App User Manual 63 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Missy Smith O Maria Smith 31900110345067 10 10 1970 71 25 Mary Smith 31900057345062 4 19 1981 70 30 The person is not known to One e App Marky Mark Gary Mark 31900099311064 1 1 1976 Lake Male 73 80 The person is not known to One e App Carol King No matching records were found ee The person is not known to One e App Next you will be moved to clear other people listed in the household fee ree J i200 Sarah Boehm 11 16 2006 200631900368 31900014321065 Jaa ial Name Carey Grant Gender Male Date of Birth 01 01 2000 lil Place of Birth Belize 64 PERSON CLEARANCE The One e App System will conduct another match with the information that was entered in order to minimize duplicate records If multiple records are found applications with the same first and last name you can point your curser on the name of the client That will pro
8. income Carefully review the income ensure it has been inputted correctly and make any changes needed If no other income verification is available click on the sample Self Affidavit of Income Letter The applicant must handwrite the income affidavit unless there is a physical or literacy issue that prevents them from doing so If an applicant is unable to handwrite the income affidavit it may be written by someone else but that person must have his her printed name and signature on the affidavit as a witness Clicking on the Sample Profit and Loss Statement will generate three useful forms e Sample Profit and Loss Statement e Blank Profit and Loss Statement e How Healthy Families Calculates Income sheet LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 3 Household Expenses In this section you will provide POOS Evan a a Oe eae L Notes information on any care expenses such as child care adult dependent care or child support payments made by each adult from the pull down menus provided Gross amount billed to Nancie Rigetti is Does Nancie Rigetti have any more expenses O Yes No Once you have completed the ia ed ha Household Care Expenses section you will be navigated to a summary page of all the information entered Nancie Rigetti n No matching records were found Charlie Rigetti i Carefully review the
9. CHAPTER 4 Program Application FROM INTERVIEW THROUGH SUBMISSION one app One Stop Access to Health Ca 90 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS Begin Application Renew Modify Application Conduct Application Search Contact Management Search Disenrolled Persons O Retrieve Fax Cover Sheets View Assistor Workload Update Applicant Data Search for an Application Before beginning a new application you must perform a search to find out whether the applicant s already exists in the system Please specify at least two criteria or a unique identifier by which you would like to search Person Detail First Name Pablo Middle Name Last Name Ruiz Suffix Select One Gender Male Female Date of Birth 51 Begin Application When you begin a new application One e App will always prompt you to conduct an application search for the primary informant and or household members This search will assist in eliminating duplicate applications in the system Later you will search for other people on the application When you conduct searches for an application enter at least two of the following criteria e Applicant s name e Gender or e Date of birth During the initial application search it is not necessary to fill out criteria beyond the Person Detail You can also search by Application Assistor LA County One e App
10. Living in the Home yes No International or Rural Address O Yes No Identity Known Yes O No Address 1 Ginna Address 2 Father s Middle Name Father s Last Name Montoya Select One THINGS TO CONSIDER Information on the absent parent is required in Medi Cal in order for the custodial parent not the child to receive benefits There are some exceptions to this rule for good cause such as when there is a belief of threat to the custodial parent or to the child s well being by the absent parent see Resources The child s eligibility is not affected if the custodial parent refuses to provide this information for any reason Information on the absent parent should not be requested for a pregnant woman if she is the custodial parent until after the 60 day postpartum period 61 CHILDREN continued Enter the child s parents information and whether they are living in the home Hyperlinks are highlighted in green and can be used as a Short cut to add information that was previously given For example Father s Information has a hyperlink By clicking on the link you can pre populate the information without retyping it LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Aduilt s Nancie Rigetti Charlie Rigetti CHI LD R E N CO nti n ued Child ren Janie Montoya En
11. am Application APPLICATION PROCESS STEP 2 Your Household Aduit s Nancie Rigetti Charlie Rigetti C H I L D R E N Tell us about the child ren in the household B Notes Indicate if the child named is applying for health care coverage Is this person applying for health care coverage O yes O Ng First Name Janie Enter the child s name demographic patoi SSN Optional Oves No information and place of birth Last Name Montoya SSN Pseudo SSN Optional Suffix Do you use any O yes No What is this person s pig The child s Social Security Number other names relationship to you is optional Gender Male Female Marital Status Never Married Date of Birth 05 05 BE Spouse s First Name Spouse s Middle Name Place of Birth Sefect first ONE that applies California County Suffix US State Spouse s Last Name Spouse s Middle Name Place of Birth Sefect first ONE that applies Spouse s Last Name California z County Suffix US State v or Other Country Mexico v Ethnicity Hispanic v Generate Universal Summary Report a Bug Make a Suggestion View Current Session Contents Application ID 200633300054 THINGS TO CONSIDER Medi Cal Deemed Eligible Infants Babies born to a mother on Medi Cal and who still reside with the mom do not need to have a Medi Cal application submitted The babi
12. ancie Rigetti Homeless O Yes No re home and mailing address the same Yes ONo Home Address do not use PO Box Delivery Type Street Address Street Number 123 Prefix Street Name Post Direction timber City Los Angeles State Zip 90057 SPA 4 County Los Angeles v erify E Notes Is this person applying for health care coverage Yes O No Gender O male Female Date of Birth 02 02 Place of Birth Sefect first ONE that applies California County Los Angeles i or US State or Other Country Ethnicity Generate Universal Summary Marital Status Married Spouse s First Name Charlie Spouse s Middle Name Spouse s Last Name Rigetti Suffix 58 PRIMARY INFORMANT Enter the applicant s name and demographic information Carefully select the language preference to ensure that Notification documents are sent in the language of choice Currently One e App has notification letters in English and Spanish Any other language is defaulted to English If the client is applying for Medi Cal this choice should ensure that all notices are sent in the appropriate language You are required to click on the verify button to validate the address with the U S Postal Service before you can continue Indicate whether the applicant or informant is applying for health care
13. ation If Medi Cal ends up covering medical services that are required because of an accident or injury Medi Cal s costs may be taken out of a lawsuit settlement if the client receives money Medi Cal may be able to help pay for medical expenses the client incurred paid or was billed for in the three months before the date of applications Healthy Families does not provide any retroactive coverage Even if the applicant appears to be income eligible for Healthy Families he she can request retroactive Medi Cal coverage that may have a Share of Cost Any adult who needs Medi Cal coverage quickly for medical expenses in the last three months or for a medical need should apply directly with a DPSS worker see Resources LA County One e App User Manual 10 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 5 Preliminary Eligibility Determination 5 PRELIMINARY Preliminary Eligibility Determination Notes To see which programs or coverages the applicant s may potentially be eligible for click the Calculate button DETE RM NATIONS below This is only a preliminary determination The application is NOT being submitted at this point a When you click on the Calculate icon calculate D you will receive a Preliminary Determination of the programs for which the client s may be eligible based on the information entered The Preliminary Eligibility results will list Preliminary Eligibility Results all
14. dicate if anyone in the household is pregnant Date You will need to indicate if each female is pregnant and if so include the due date and number of babies expected The number of babies expected will increase the family size if twins the family size will increase by two THINGS TO CONSIDER Pregnant women with income over 200 of the Federal Poverty Level who are less that 30 weeks pregnant may be eligible for the Access for Infants and Mothers AIM program see Resources One e app does NOT submit applications for AIM See resource section for information on obtaining an AIM application LA County One e App User Manual 65 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Adult s Nancie Rigetti Charlie Rigetti HOUSEHOLD _Child ren Janie Montoya Martin Rigetti R E LATI O NS HI PS Household Relationships for Charlie Rigetti The system will then prompt you to select the correct relationship between Charlie Rigetti is Seppe Sof Janie Montoya household members This helps to Charlie Rigetti is Parent of Martin Rigetti create family budget units for Medi Cal Aduit s Nancie Rigetti Charlie Rigetti Child ren Janie Montoya Martin Rigetti Household Relationships for Janie Montoya Janie Montoya is Step Sibling of Martin Rigetti LA County One e App User Manual 66 Help Desk 1 866 429 1979 Program A
15. ealth program about the need for care coordination for the child LA County One e App User Manual 62 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Household Summary E Notes HOUSEHOLD SUM MARY ease make any necessary changes p en a person from the application check the box next to that person s name and click the Remove button household section you will be navigated a to a summary page of all the a ad information you just provided Nancie Rigetti Cl Charlie Rigetti Review the Household Summary to E Janie Montoya ensure that all the family members Cl martin Rigetti appear on this screen Applying for coves You can add or remove someone from Wadd additional household members select Yes for Adult s and or CPMdfren and click tnext button below the Household by clicking on the box Are there any more adult s in the household O Yes No 4re there any more childfren in the household O ves yg next to the name of the person being removed and clicking remove You can modify information for a person You also have the ability to add a child or an adult by clicking on person s name that was not added by clicking on the Yes button You will then be navigated to a screen where you can enter the missing child or adult s information The system will display an alert if relationships entered are not consistent with the information already entered on the
16. es are Deemed Eligible One of the following methods for reporting the birth can be used until the infant is a year old at which point the infant s income eligibility needs to be redetermined 1 Call the mom s Eligibility Worker to report the birth if she does not have her Eligibility Worker contact information she can call 877 597 4777 2 The MC 330 Newborn Referral Form can be filled out by an assistor signed by a parent and faxed over to a central fax number 213 763 8666 Including the mom s CIN BIC or Social Security number on this form really helps See resource section for copy of Newborn Referral Form 3 A Child Health and Disability Prevention CHDP exam will also serve to report the birth provided that the CHDP Pre Enrollment Application form DHS 4073 is correctly and completely filled out to match the mother s name and date of birth Having the mom s CIN BIC or SS number really helps LA County One e App User Manual 60 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household Aduit s Nancie Rigetti Charlie Rigetti Child ren Janie Montoya i Tell us more about Janie Montoya s parents Mother s Information Mother s Address Mother Living in the Home International or Rural Address O Yes No Identity Known Address 1 Mother s First Name N Address 2 Mother s Middle Name City Mother s Last Name State Suffix Zip Father s Information ath Address Father
17. expenses or payments included and make any changes needed To change any expenses click on the person s name LA County One e App User Manual 69 Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 4 Other Information If the child listed on the application attends a school or preschool you will be prompted to select a school from the list This information is optional Additional Household Information Notes Does any child listed on this application attend a school or preschool yes O No School Name Janie Montoya Advanced Education Vista Del Rio Junior Senior Hi v Martin Rigetti Aeolian Elementary v The last two questions on this screen are optional and will not affect your l l l Di l eligibility but are included to help the Has anyone filed a lawsuit because of an accident or injury on behalf of the child ren Oves No a a il i atl state to get additional federal money to i ie dee aa ae e peata ir ee Oona i pay for health care programs They are also asked on the joint MC 321 Medi Cal Healthy Families application Additional Household Information Notes Is there more than one car in the household of those you are applying for yes O No Is there more than 3 150 cash in bank accounts in the household of those you are O applying for Yes No THINGS TO CONSIDER The questions on this screen will provide additional household inform
18. he application to the program THINGS TO CONSIDER Healthy Families has a separate Authorized Reprehensive form available at http www healthyfamilies ca gov English Publications AuthorizedRepForm pdf CAAs are allowed a limited amount of time to contact Healthy Families on the applicant s behalf until the application is processed 56 LOS ANGELES APPLICANT AUTHORIZATION FOR PROCESSING APPLICATIONS This authorization allows the applicant to give you and your agency permission to process the application for the applicant and to contact agencies on the client s behalf This permission may or may not be accepted by the health program agencies Medi Cal often but not always requests the Authorized Representative Form good for up to a year see Resources You should discuss the amount of time the client wants you and your agency to have this permission The client may make the authorization open ended by leaving the date range blank or may choose to limit the amount of time If at a later time the applicant chooses to work with another agency your permission is ended Tips for Phone Applications If you are working with someone over the phone print the authorization along with other documents that need a signature and mail them to the applicant with a pre stamped envelope if possible or fax them The application will have to be suspended while this process takes place see Suspending an Application page 91
19. ication APPLICATION PROCESS STEP 1 Getting Started Los Angeles Applicant Authorization for Processing Application Applicant Permission for Agency Application Assistance 2 1 2007 I Pablo Ruiz give permission to Certified Application Assistors from the Enrollment Entity listed below to process an electronic health benefits application for my child ren using the One e App system I also give permission to Test Organization to contact agencies where my child s or children s application s is are being processed to address any issues about their application s Enrollment Entity Test Organization EE I understand that this permission will remain active unless an end date is indicated batfw or I decide to cancel this permission at any time by notifying this agency Test Organization From 7 To I have been told that if I seek assistance from agencies other than Test Organization that I will have to complete this authorization process again On the day I signed this agreement I was assisted by Certified Application Assistant Liz Ramirez CAA 123456 Applicant Signature Date If you have questions about your application please call us at4213 749 4261 I decline to sign the above declaration For System Use Please enter the date the declaration was signed You must enter the date the authorization is signed You can skip the date to allow for phone applications but it must be signed before submitting t
20. mbers of your household may be potentially eligible for the programs in the table below Eligibility will be i i based on the additional information you provide page and the list of programs for which the applicant maybe eligible Potential Eligibility for Additional Programs E Notes Preliminary Eligibility for Programs Nancie Rigetti Medi Cal for Children and Pregnant Women This is done prior to including O Janie Montoya Medi Cal for Children and Pregnant Women Immigration status as a factor of marin rise Healthy Faris eligibility which is why multiple programs are listed LA County One e App User Manual 12 Help Desk 1 866 429 1979
21. pplication APPLICATION PROCESS STEP 3 Household Income Tell us about Nancie Rigetti s Income B Notes J Earnings from job v Monthly v 1 700 00 Employer Name I Watch Your Kids D Employer City Los Angeles mployer Telephone Number 213 252 2222 Does Nancie Rigetti have any more incomeA Oves No THINGS TO CONSIDER If the family s income will increase or decrease within the next few months explain on a separate sheet of paper that will be faxed with documentation see Checklist on Fax Cover Sheet for each program Income Deeming Rules income is deemed or counts ONLY from e Legally married spouse to spouse e Biological adopted parent to child Child Support is income for the child not the parent 67 In this section you will provide the income information for each of the household members The system requires you to choose income type from a pull down menu lt will automatically generate a sample of a Self Affidavit form when you choose earnings from a job or cash income The applicant must provide this affidavit handwritten unless there is a physical or literacy issue that prevents doing so In cases where applicants are not able to handwrite their income affidavit it may be written by someone other than the applicant and must include that person s printed name and signature as a witness In case no paycheck proof exists you may choose to u
22. se the affidavit see next page Employer information Including employer information is optional and should only be included if you have the family s permission Employer information is NOT required for a self affidavit It implies permission to call the employer and some clients might have concerns about such calls You can access the sample income Affidavit when you are on the Household Income Summary screen on the next page LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 3 Household Income Household Income Summary Nancie Rigetti Self Affidavit of Income Letter oD Earnings from job Monthly 1 700 00 1 700 00 Charlie Rigetti Self Affidavit of Income Letter Earnings from job Every 2 Weeks 850 00 1 841 95 Janie Montoya No matching records were found Martin Rigetti No matching records were found 9 Remove Generate Universal Summary La Sample Profit and Loss Statement Report a Bug Make a Suggestion Application ID 200717000059 PROFIT amp LOSS STATEMENT EXAMPLE ONLY ABC Landscaping Companr IGO First Sireee Sacramentoa CA Eld 916 233 1234 January 2006 February 2006 Aferch 2 Cash Draw Tg Cash Draw Cash Draw Total Espez 3 Ge Total Expeesas 3 600 Total Expecsss Wet Income 2 one PL0 Met Income 68 Once you have completed the Household Income section you will be navigated to a summary page of the household
23. ter the child s other health care coverage If any Tell us more about Janie Montoya B Notes Does Janie Montoya have Medi Cal O yes No Does Janie Montoya have other health vision or dental insurance O yes No Does Janie Montoya currently have employer paid insurance j KREATA O Yes covered now O Not now but during the past 90 days No Is Janie Montoya enrolled in the California Children Services program O yes No Has Janie Montoya ever applied for Healthy Kids before O yes No Are there any more children in the household Yes O No THINGS TO CONSIDER Answering yes to any of the above questions does not mean that the child will be denied health care coverage If the families have health insurance that they pay for themselves it should not cause a Medi Cal or Healthy Families denial You can have other health coverage and still qualify for Medi Cal With dual coverage the other insurance pays first and Medi Cal becomes the secondary coverage You can have Share of Cost Medi Cal dental or vision coverage and still be eligible for Healthy Families or Healthy Kids Employer Paid Insurance in the last 90 days does not always disqualify the child exceptions include lost job company no longer provides benefits family has moved and no insurance is available and COBRA coverage has ended Providing information about California Children Services will alert the other h
24. the programs for which your client may be eligible in One e App Based on the information you have provided the following members in your household may be eligible for the FSIenInGipReararie e Medi Cal for children under 19 and pregnant women Healthy Families CHDP Periodicity Schedule Healthy Kids In addition to the programs listed above you or members of your hot eee y be eligibl Nor additional programs It will be necessary to collect some additional information for the people in the table low to determine e CHDP their preliminary eligibility Potential Eligibility for Additional Programs Nancie Rigetti Medi Cal for Children and Pregnant Women Healthy Kids or Medi Cal for Children and Pregnant Women Martin Rigetti Healthy Families or Healthy Kids CHDP Referrals Based on these results your client may choose to make a CHDP appointment for medical need or for a required exam for school entrance sports or camp physical If so click on the icon to print the CHDP Referral The form will be pre populated with demographic information provided during the interview If the client needs a CHDP provider call 1 800 993 CHDP 1 800 993 2437 or http lapublichealth org cms chdp provider_finder asp LA County One e App User Manual a Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 5 Eligibility Determination POTENTIAL ELIGIBILITY This is the first preliminary eligibility You or me
25. vide you with additional information specific to that case to help determine if it is a duplicate record If a duplicate record is found an application started for your applicant at a different agency you can provide unique information like a Social Security Number of anyone in the household That will give you and anyone in your agency the ability to access and submit that application Select the individual from the list OR if the right person is not found select the circle below the box that says The person is not known to One e App Repeat these steps for each individual At this point the system assigns a Person Identification Number A Person Identification Number is a Unique Identifier for each individual that can assist you in locating an individual in the One e App system To learn more about Unique Identifiers refer to the Menu Section Conduct Application Search LA County One e App User Manual Help Desk 1 866 429 1979 Program Application APPLICATION PROCESS STEP 2 Your Household HOUSEHOLD PERSON Person details for the application are summarized below D ETAI LS Adult s The system will then provide another Household Summary which includes Date of Birth Person ID and an indication if the person is applying for coverage Household Person Details The One e App system will list all Pregnant Persons in the Household females of childbearing age in the household broadly Please in
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