Regional Center will assist with copays for services that are required to meet the goals in an Individualized Program Plan — including therapies — for families with income under 400% of the federal poverty level (FPL). Limited exceptions may apply in cases of extenuating circumstances or significant unreimbursed medical expenses for the child (read more on this below).
To see whether you may be eligible, multiply the figure in this chart by 4 based on your household size.
Do not include income from In-Home Supportive Services (IHSS) in your calculation if you are a parent provider for your child.
There are some cases where families whose income is over 400% of the federal poverty level can still be eligible for help with copays or deductibles through their Regional Center. These include:
extraordinary events that impact a caregiver’s ability to meet the care and supervision needs of the child, or the caregiver’s ability to pay the copay or deductible;
a catastrophic loss that limits the ability of a caregiver to pay, and creates a direct economic impact on the family (for example, natural disasters or accidents involving major injuries of an immediate family member); or
significant, unreimbursed medical costs related to the care of the child or another dependent child who is also a Regional Center consumer.
In these circumstances, the primary health plan member must provide Regional Center with proof of income. The same caregiver must also inform Regional Center of any changes in income if those changes push the family’s income above or below the income requirement. Regional Center may agree to consider your extenuating circumstances before issuing a decision, or you may need to file a request for hearing if you have already received a denial based on excess income.
Families who have secondary or “straight” Medi-Cal coverage may need to demonstrate to Regional Center that the provider does not accept Medi-Cal, as Medi-Cal can also assist with copayments when the provider is a contracted Medi-Cal provider under the recipient’s specific plan or program type.
