Get the free Family PACT Program Retroactive Eligibility Certification (REC) - cdph ca
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This form certifies eligibility for retroactive reimbursement for family planning and reproductive health expenses under the Family PACT program in California.
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How to fill out family pact program retroactive
How to fill out Family PACT Program Retroactive Eligibility Certification (REC)
01
Obtain the Family PACT Program Retroactive Eligibility Certification (REC) form.
02
Fill out the applicant's personal information, including name, address, and contact details.
03
Provide details on the applicant's family size and income.
04
Indicate the specific services received during the retroactive period.
05
Include any necessary documentation to support the claims, such as proof of income or prior medical records.
06
Sign and date the form to certify the information provided is accurate.
07
Submit the completed REC form to the appropriate Family PACT Program office.
Who needs Family PACT Program Retroactive Eligibility Certification (REC)?
01
Individuals who have received Family PACT services but did not apply for eligibility at the time of service.
02
Eligible low-income individuals seeking reimbursement for family planning services received in the past.
03
Those who may have had a gap in coverage and need to establish retroactive eligibility for family planning services.
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Does family Pact check your income?
Your income must be at or below 200 percent of the federal poverty income guidelines. This is based on the basic family unit.
What does the family pact cover?
Family PACT services are for specific contraceptive methods and family planning-related services. Clinical and preventive services include office visits, procedures, drugs and contraceptive supplies. for abortions has been defined as 21 days for Medi-Cal. Office visits are not covered by Family PACT during this period.
Does family Pact check your income?
Your income must be at or below 200 percent of the federal poverty income guidelines. This is based on the basic family unit.
How do I get retroactive for Medi-Cal?
Request Medi-Cal “retroactive coverage” if services were provided. To request retroactive coverage, contact the county social services office within one year of the month in which the covered services were provided to you.
Who is eligible to certify a site family pact?
Site Certifier A Medical Director, MD, CNP, or CNM who is enrolled in Medi-Cal is eligible to certify the site. The designated site certifier must be identified on the application for enrollment and is responsible for overseeing the family planning services rendered at the identified service location to be enrolled.
How much does family pact cost?
Family PACT provides no-cost family planning services.
What diagnosis does the family pact cover?
Family planning counseling and education. Sexually transmitted infection (STI) testing & treatment. HIV testing. Cervical cancer screening.
Who is eligible to certify a site for family pact?
Site Certifier A Medical Director, MD, CNP, or CNM who is enrolled in Medi-Cal is eligible to certify the site. The designated site certifier must be identified on the application for enrollment and is responsible for overseeing the family planning services rendered at the identified service location to be enrolled.
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What is Family PACT Program Retroactive Eligibility Certification (REC)?
The Family PACT Program Retroactive Eligibility Certification (REC) is a process that allows eligible individuals to request coverage for family planning services received in the past before they were enrolled in the Family PACT program.
Who is required to file Family PACT Program Retroactive Eligibility Certification (REC)?
Individuals who received family planning services prior to being enrolled in the Family PACT program and wish to seek reimbursement for those services are required to file the REC.
How to fill out Family PACT Program Retroactive Eligibility Certification (REC)?
To fill out the REC, individuals must complete the designated form with accurate personal information, details of the services provided, dates of service, and any other relevant information as outlined in the instructions accompanying the form.
What is the purpose of Family PACT Program Retroactive Eligibility Certification (REC)?
The purpose of the REC is to determine eligibility for family planning services that were provided before an individual was officially enrolled in the Family PACT program, thereby allowing for the potential reimbursement of those services.
What information must be reported on Family PACT Program Retroactive Eligibility Certification (REC)?
The information that must be reported includes the individual’s personal details, dates of service, type of services received, provider information, and any other relevant documentation to support the request for retroactive eligibility.
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