​​​​​​​​Find out if I Qualify

You may enroll with GHPP if you are:

• Diagnosed with a genetic condition that is covered by GHPP
• A Resident of California
• Financial Eligibility
• Age Criteria
• Other Insurance

Medical Eligibility

The GHPP covers genetic conditions specified in the California Code of Regulations (CCR), Title 17, Section 2932​. There is a specific list of genetic conditions that are eligible for GHPP enrollment.  View the complete list of GHPP eligible conditions.

Residential Eligibility

• 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 Muni​cipal Utility District (SMUD)

​​Financial Eligibility

The GHPP will require you to submit the following financial information:

• Copy of the 1040 taxes of the previous calendar year
• Copy of the 540 taxes of the previous calendar year
•  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
• 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​
  

Other Insurance

• Health Maintenance Organization (HMO)
Clients with HMO insurance may apply for GHPP benefits. However, the GHPP will only cover limited services such as:
• ​ Annual outpatient Special Care Center assessments, evaluations, and case conferences
• Services that are not a covered benefit by the HMO. A written denial from the HMO is required. The denial must assert that the service is a non-benefit. A claims denial for other reasons will not be accepted.
• The GHPP does not pay for your HMO co-pay and premium

Please submit a copy of your HMO benefit booklet together with your application.

• Preferred Provider Organization (PPO)
Clients with PPO insurance may apply for GHPP benefits. However, the PPO must be billed first before the GHPP.
• If you have a PPO, you must obtain prior authorization from the GHPP. The GHPP will not pay for services that are not prior authorized.
• ​GHPP does not pay for your PPO co-pay or premium.

Please submit a copy of your PPO benefit booklet together with your GHPP application.

• Medicare A and B
Clients with Medicare A and B may apply for GHPP benefits. However, the Medicare Part A or Part B must be billed first before the GHPP.
• If you have Medicare A and B, you must obtain prior authorization from the GHPP. The GHPP will not pay for services that are not prior authorized.
• GHPP does not pay for your Medicare co-pay or premium.​
• Frequently Asked Questions - Medicare Part D​
  

• Medi-Cal

Clients with Medi-Cal may apply for GHPP benefits. Medi-Cal clients, including those enrolled in a Medi-Cal Managed Care plan, will receive the same services they are receiving from Medi-Cal in addition to the services available through the GHPP. Example of an additional service is Special Care Center services. Once the Medi-Cal clients are enrolled into this program, GHPP will case manage their case.