Statutes, codes, and regulations
California Code Of Regulations
Title 10 - InvestmentChapter 5.6 - Access for Infants and Mothers Program
Article 2 - Eligibility, Application, and Enrollment
Section 2699.200 - Basis of Eligibility

Cal. Code Regs. tit. 10 § 2699.200

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Current through Register 2024 Notice Reg. No. 45, November 8, 2024
Section 2699.200 - Basis of Eligibility
(a) All eligibility requirements contained herein shall be applied without regard to race, creed, color, sexual orientation, health status, national origin, occupation, or occupational history of the individual applying for the program.
(b) To be eligible for the program, an individual shall meet the requirements of either (1) or (2):
(1) Meet all of the following requirements:
(A) Be pregnant and have a reasonable good faith belief that the pregnancy is not beyond the 30th week of gestation as of the application date; and
1. If the application is not complete a letter will be mailed to the applicant indicating the required information and documentation, if necessary, needed to complete the application. In addition, a telephone call will be placed to the applicant to request the missing information and documentation, if necessary. The applicant must provide all information and documentation, if necessary, needed for the application to be completed within 17 calendar days from the date the application was received by the program and prior to the 30th week of gestation, and the applicant will be so notified.
2. If the application submitted is not complete and it is not completed within seventeen (17) calendar days and prior to the 30th week of gestation, the application shall be denied. The applicant shall be sent a notice indicating that the application is denied on the basis that the program could not make an eligibility determination because of missing information or documentation.
3. If the application is complete it will be reviewed for an eligibility determination pursuant to Section 2699.203; and
(B) Be a resident of the state of California; and
(C)
1. For eligibility that takes effect before January 1, 2014, have a monthly household income after income deductions that is above 200 percent of the federal poverty level but does not exceed 300 percent of the federal poverty level at the time of application; or
2. For eligibility that takes effect on or after January 1, 2014, have a MAGI that is above 200 percent of the federal poverty level but does not exceed 300 percent of the federal poverty level at the time of application, as those percentages may be adjusted as required by Section 1902(e)(14)(A) of the Social Security Act (42 U.S.C. 1396a(e)(14)(A)).
(D) Pay the first portion of the subscriber contribution, which shall be fifty dollars ($50), except that this pre-payment requirement shall not apply to applications received on or after January 1, 2014, and agree to the payment of the complete subscriber contribution; and
(E) Not be reimbursed by any health care provider or any state or local governmental entity for payment of the subscriber contribution and not have any health care provider or state or local governmental entity pay the subscriber contribution; and
(F) Not be a beneficiary of either no-cost Medi-Cal or Medicare Part A and Part B as of the application date; and
(G) Not be covered for maternity benefits in a private insurance arrangement as of the application date. A pregnant woman in a private insurance arrangement with a separate maternity only deductible or copayment greater than $500 shall be deemed not covered for maternity benefits for purposes of determining eligibility.
(2) Be an infant of less than two (2) years of age born to a program subscriber who was enrolled prior to July 1, 2004, and reside in California.

Cal. Code Regs. Tit. 10, § 2699.200

1. New section filed 12-12-91 as an emergency; operative 12-12-91 (Register 92, No. 10). A Certificate of Compliance must be transmitted to OAL 4-10-92 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-12-91 order transmitted to OAL 4-8-92 and filed 5-20-92 (Register 92, No. 21).
3. Amendment of subsection (b)(1)(E) filed 6-8-92 as an emergency; operative 6-8-92 (Register 92, No. 24). A Certificate of Compliance must be transmitted to OAL 10-6-92 or emergency language will be repealed by operation of law on the following day.
4. Amendment of subsection (b)(1)(G) filed 10-28-92 as an emergency; operative 10-28-92 (Register 92, No. 44). A Certificate of Compliance must be transmitted to OAL 3-1-93 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 6-8-92 order transmitted to OAL 9-24-92 and filed 11-5-92 (Register 92, No. 45).
6. Certificate of Compliance as to 10-28-92 order transmitted to OAL 2-9-93 and filed 3-24-93 (Register 93, No. 13).
7. Amendment of subsection (b)(1)(C) filed 8-29-94 as an emergency; operative 9-1-94 (Register 94, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-30-94 or emergency language will be repealed by operation of law on the following day.
8. Certificate of Compliance as to 8-29-94 order transmitted to OAL 12-9-94 and filed 1-23-95 (Register 95, No. 4).
9. Amendment of subsections (b)(1)(C) and (b)(1)(E) filed 8-29-95 as an emergency; operative 8-29-95 (Register 95, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-95 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 8-29-95 order transmitted to OAL 12-11-95 and filed 1-22-96 (Register 96, No. 4).
11. Amendment of subsections (b)(1)(C) and (b)(1)(G) filed 3-17-2000 as an emergency; operative 3-17-2000 (Register 2000, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-17-2000 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 3-17-2000 order transmitted to OAL 6-12-2000 and filed 7-10-2000 (Register 2000, No. 28).
13. Amendment filed 5-20-2003; operative 5-20-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 21).
14. Amendment of subsection (b)(2) filed 7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27). Pursuant to Section 80, A.B. 1762 (Chapter 230, Stats. 2003) a Certificate of Compliance must be transmitted to OAL by 12-28-2004 or emergency language will be repealed by operation of law on the following day.
15. Certificate of Compliance as to 7-1-2004 order transmitted to OAL 11-24-2004 and filed 1-7-2005 (Register 2005, No. 1).
16. Amendment of subsection (b)(1)(B) and amendment of NOTE filed 12-1-2009 as an emergency; operative 12-1-2009 (Register 2009, No. 49). A Certificate of Compliance must be transmitted to OAL by 6-1-2010 or emergency language will be repealed by operation of law on the following day.
17. Certificate of Compliance as to 12-1-2009 order transmitted to OAL 5-28-2010 and filed 7-1-2010 (Register 2010, No. 27).
18. Redesignation and amendment of former subsection (b)(1)(C) as new subsection (b)(1)(C)1. and new subsection (b)(1)(C)2. filed 11-13-2013 as an emergency; operative 11-13-2013 (Register 2013, No. 46). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
19. Amendment of subsection (b)(1)(A), new subsections (b)(1)(A)1.-3. and amendment of subsections (b)(1)(C)2.-(b)(1)(D) filed 12-27-2013 as an emergency; operative 12-27-2013 (Register 2013, No. 52). A Certificate of Compliance must be transmitted to OAL by 6-25-2014 or emergency language will be repealed by operation of law on the following day. This filing is deemed an emergency and is exempt from review by OAL pursuant to Assembly Bill 82, Chapter 23, Statutes of 2013, section 77.
20. Certificate of Compliance as to 11-13-2013 order transmitted to OAL 5-7-2014 and filed 6-16-2014 (Register 2014, No. 25).

Note: Authority cited: Section 12696.05, Insurance Code. Reference: Sections 12696.05, 12698(b), 12698(c), 12698.05, 12698(c) and 12698.06, Insurance Code; and Maternal and Child Health Access, Petitioner, vs. Managed Risk Medical Insurance Board, et al., Respondents (Superior Court of the State of California, City and County of San Francisco, Case No. CPF-08-508296).

1. New section filed 12-12-91 as an emergency; operative 12-12-91 (Register 92, No. 10). A Certificate of Compliance must be transmitted to OAL 4-10-92 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-12-91 order transmitted to OAL 4-8-92 and filed 5-20-92 (Register 92, No. 21).
3. Amendment of subsection (b)(1)(E) filed 6-8-92 as an emergency; operative 6-8-92 (Register 92, No. 24). A Certificate of Compliance must be transmitted to OAL 10-6-92 or emergency language will be repealed by operation of law on the following day.
4. Amendment of subsection (b)(1)(G) filed 10-28-92 as an emergency; operative 10-28-92 (Register 92, No. 44). A Certificate of Compliance must be transmitted to OAL 3-1-93 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 6-8-92 order transmitted to OAL 9-24-92 and filed 11-5-92 (Register 92, No. 45).
6. Certificate of Compliance as to 10-28-92 order transmitted to OAL 2-9-93 and filed 3-24-93 (Register 93, No. 13).
7. Amendment of subsection (b)(1)(C) filed 8-29-94 as an emergency; operative 9-1-94 (Register 94, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-30-94 or emergency language will be repealed by operation of law on the following day.
8. Certificate of Compliance as to 8-29-94 order transmitted to OAL 12-9-94 and filed 1-23-95 (Register 95, No. 4).
9. Amendment of subsections (b)(1)(C) and (b)(1)(E) filed 8-29-95 as an emergency; operative 8-29-95 (Register 95, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-95 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 8-29-95 order transmitted to OAL 12-11-95 and filed 1-22-96 (Register 96, No. 4).
11. Amendment of subsections (b)(1)(C) and (b)(1)(G) filed 3-17-2000 as an emergency; operative 3-17-2000 (Register 2000, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-17-2000 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 3-17-2000 order transmitted to OAL 6-12-2000 and filed 7-10-2000 (Register 2000, No. 28).
13. Amendment filed 5-20-2003; operative 5-20-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 21).
14. Amendment of subsection (b)(2) filed 7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27). Pursuant to Section 80, A.B. 1762 (Chapter 230, Stats. 2003) a Certificate of Compliance must be transmitted to OAL by 12-28-2004 or emergency language will be repealed by operation of law on the following day.
15. Certificate of Compliance as to 7-1-2004 order transmitted to OAL 11-24-2004 and filed 1-7-2005 (Register 2005, No. 1).
16. Amendment of subsection (b)(1)(B) and amendment of Note filed 12-1-2009 as an emergency; operative 12-1-2009 (Register 2009, No. 49). A Certificate of Compliance must be transmitted to OAL by 6-1-2010 or emergency language will be repealed by operation of law on the following day.
17. Certificate of Compliance as to 12-1-2009 order transmitted to OAL 5-28-2010 and filed 7-1-2010 (Register 2010, No. 27).
18. Redesignation and amendment of former subsection (b)(1)(C) as new subsection (b)(1)(C)1. and new subsection (b)(1)(C)2. filed 11-13-2013 as an emergency; operative 11-13-2013 (Register 2013, No. 46). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
19. Amendment of subsection (b)(1)(A), new subsections (b)(1)(A)1.-3. and amendment of subsections (b)(1)(C)2.-(b)(1)(D) filed 12-27-2013 as an emergency; operative 12-27-2013 (Register 2013, No. 52). A Certificate of Compliance must be transmitted to OAL by 6-25-2014 or emergency language will be repealed by operation of law on the following day. This filing is deemed an emergency and is exempt from review by OAL pursuant to Assembly Bill 82, Chapter 23, Statutes of 2013, section 77.
20. Certificate of Compliance as to 11-13-2013 order transmitted to OAL 5-7-2014 and filed 6/16/2014 (Register 2014, No. 25).