Genetically Handicapped Persons Program - Draft
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The Genetically Handicapped Persons Program (GHPP) is a health care program for adults with certain genetic diseases such as Sickle Cell Anemia. GHPP helps cover expenses for acute hospital stay, outpatient medical care services, medications prescribed by your doctor, and more.
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Karra Gardin
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03-10-2017
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03-10-2017
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N/A
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How To Contact
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General Contact
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MS 8100, P.O. Box 997413
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Sacramento
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CA
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More Information
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06-26-2018
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06-26-2019
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fee
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0.00
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California Department of Health Care Services
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95899
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Helpful Links
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Detailed Information
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Eligibility:
-Diseases of the blood such as Thalassemia, Sickle Cell Disease
-Diseases of the Brain and Nerves
-Diseases of the Protein Metabolism
-Diseases of Carbohydrates Metabolism
-Disease of Copper Metabolism
-Von Hippel-Lindau Disease (VHL)
-Cystic Fibrosis
Residential Eligibility
Applicants must be residents of California. Proof of California residency includes any of the following:
-California Driver’s License or California State Identification Card
-Voter’s Registration
-Rental Agreement (if you are renting an apartment, house or room)
-Utility bill statements such as PG&E, telephone, and Sacramento Munincipal Utility District (SMUD)
Financial Eligibility
There is no income limit for GHPP eligibility. However, applicant may be required to apply for Medi-Cal. Some clients may also be required to pay an annual enrollment fee to GHPP. The amount of enrollment fee is based on income and family size.
The GHPP will require you to submit the following financial information:
a. Copy of the 1040 taxes of the previous calendar year
b. Copy of the 540 taxes of the previous calendar year
c. If you were a dependent on your parent’s previous year’s tax return, you must submit the following:
-Joint income taxes of both parents
-If you are living with one parent, a copy of income tax return of the parent that claimed you as a dependent
d. If you had no source of income for the previous year, you must submit the following:
-A letter stating what finances you lived on; for example include the dollar amount that you received for transportation, housing, and food expenses.
-The letter must be notarized.
Age Criteria
Applicants must be 21 years of age or older. Persons younger than 21 years of age must:
-Apply first to California Children's Services
-Submit a financial eligibility denial from CCS
-Submit proof showing out of pocket expenses are less than 20% of family income
What does GHPP cover?
An acute hospital stay is a benefit of the GHPP. Continued authorization of hospital stay is subject for review. However, the following admission will not be covered by the GHPP:
-Sub acute facility admission
-Skilled nursing home admission
-Intermediate care facility admission
Outpatient medical Care
Outpatient medical care services consist of:
-Primary care physicians (PCPs)
-Specialty physicians such as cardiologists, endocrinologists, orthopedists
-Infusion centers
-Transfusion centers, such as for blood transfusions
-Diagnostic Centers, such as X-ray, MRI, etc
These services must be coordinated with the client’s special care center. With the exception of the PCP, all other services must have a referral submitted by the Special Care Center. The provider of the outpatient care must have a Medi-Cal provider ID number.
Pharmaceutical Services
Pharmaceutical benefits include the following:
-Medications prescribed by your doctor (Oral, topical, Subcutaneous, etc)
-Home infusion therapy, such as intravenous antibiotics
Surgeries
Surgeries include:
-In-patient surgeries, such as hip repair
-Out-patient surgeries, such as cyst removal
-Organ transplants, such as a lung transplant
Approval for surgery will be reviewed individually for medical necessity. The GHPP may not cover a surgery if there is no documented medical need.
Nutrition Products and Medical Foods
Approval of nutrition products is based on criteria of which all must be met first before these products are authorized.
Nutrition products include:
-Replacement formulas/products, such as Phenex-2, Phenyl Free-1
-Elemental formulas, such as Peptamen Jr
-Calorie dense products, such as Ensure, Boost plus, Two Cal HN
-Nutrition additives, such as Polycose, MCT oils, Duocal
-Medical foods, such as low protein foods
-Metabolic formula and medical foods are only a benefit for clients with a metabolic disorder.
Durable Medical Equipments (DMEs)
GHPP benefits includes the rental, repair, or purchase of durable medical equipments. Example of DME’s include:
-Home oxygen delivery, such as oxygen concentrator, portable tanks
-Medical DME, such as portable commode, feeding pumps, Intrapulmonary Percussive Ventilator machines
-Rehab DME, such as wheelchairs, scooters
-Orthotics such as Ankle Foot Orthosis
Each DME has different criteria for approval. The provider of the DME must have a Medi-Cal provider ID number.
Other Services
Other services that are covered by the GHPP are:
-Home health services, such as skilled nursing visits
-Therapy services, such as Physical Therapy, Occupational Therapy, and Speech Therapy
-Mental health services, such as psychotherapy counseling
-Medical supplies, such as insulin syringes, diapers, etc.
These services also have criteria to be followed for approval. The provider of these services must have a Medi-Cal provider ID number
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Eligibility Information
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- Alameda County
- Contra Costa County
- Marin County
- Napa County
- Sacramento County
- San Francisco County
- San Joaquin County
- San Mateo County
- Solano County
- Sonoma County
- Yolo County
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- Alameda, CA
- Castro Valley, CA
- Emeryville, CA
- Pinole, CA
- San Leandro, CA
- San Pablo, CA
- Walnut Creek, CA
- Oakland, CA
- Livermore, CA
- Dublin, CA
- Berkeley, CA
- Concord, CA
- Antioch, CA
- Lafayette, CA
- Pleasanton, CA
- Hayward, CA
- Albany, CA
- Fremont, CA
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- Adult
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Files
Referral Form GHPP Referral Form (Spanish).pdf 06-26-2018 Referral Form GHPP Referral Form (English).pdf 06-26-2018 Application Form GHPP Application (Spanish).pdf 06-26-2018 Application Form GHPP Application (English).pdf 06-26-2018
