How do I qualify for Path to Health?
To qualify for benefits, applicants must meet the following:
- Be an undocumented adult between the ages of 26-49 years old.
- Live in one of the following counties: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Modoc, Mono, Napa, Nevada, Plumas, San Benito, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Tuolumne, Yolo and Yuba.
- Either be already enrolled in restricted scope, emergency services only Medi-Cal (aid codes 1U, 3T, 55, 58, 5F, 5T, C1, C2, C3, C4, C5, C6, C7, C8, D2, D3, D4, D5, D6, D7, J3, J4, J6, J8, K3, K5, K7, K9, M2, or M4) or can supply sufficient verification of income at or below 138% of the Federal Poverty Level, are not pregnant, and do not have any other health coverage. Learn more about the Federal Poverty Level here.
How do I sign up for Path to Health?
- Find a Participating Provider
- Complete the application at a participating health center
- After your application has been completed & accepted, you will receive an ID card and guide in the mail within 10 days.
How will my doctor or the pharmacy know that I’m enrolled in Path to Health?
You’ll receive a Path to Health ID Card (which will include the start and end dates of your coverage); a Path to Health Member Guide; and Notice of Privacy Practices in the mail within 10 days of enrollment. If you need to fill a prescription before you receive your card, the pharmacy can look up your Path to Health coverage with MedImpact by using your Path to Health ID number or by calling (800) 788-2949. If you need to see a health center provider before you receive your card, the health center can lookup your coverage in the Path to Health enrollment portal or by calling (877) 283-7284.
How do I get primary care services?
You can receive Path to Health covered services at the health center where you completed your application, as well as other providers participating in the CMSP Provider Network. Covered benefits include:
- Screening for depression, alcohol misuse, obesity counseling (performed by a physician)
- Screenings for HIV, HPV, Hepatitis B & C, STI Screenings
- Various in-office minor medical procedures
- Outpatient mental health (mild to moderate) services
- Outpatient substance use disorder treatment services
- Physical Therapy
- Tobacco-use counseling and intervention (performed by a physician)
- Primary care or specialist office visits
- Preventative health screenings
- Routine screening laboratory testing
- Adult immunizations
- Specified X-rays of head, neck, chest, trunk, upper and lower extremities
- Specified ultrasound of head, neck, trunk, upper and lower extremities
- Colorectal cancer screening
- EKG, Osteoporosis, DEXA Scan
- Prescription medications with a $5 copay per prescription ($1500 maximum benefit limit)
The following services are not covered by Path to Health:
- Emergency services (use your Medi-Cal ID card if you’re enrolled in restricted scope, emergency services only Medi-Cal or contact your County Social Services department to apply for Medi-Cal)
- Inpatient hospital services (use your Medi-Cal ID card if you’re enrolled in restricted scope, emergency services only Medi-Cal or contact your County Social Services department to apply for Medi-Cal)
- Pregnancy-related care (use your Medi-Cal ID card if you’re enrolled in restricted scope, emergency services only Medi-Cal or contact your County Social Services department if you become pregnancy and need health care coverage)
- Dental care (use your Medi-Cal ID card if you’re enrolled in restricted scope, emergency services only Medi-Cal for emergency dental services or contact your County Social Services department to apply for Medi-Cal)
- Chiropractic or acupuncture care
- Out-of-network care
- Any procedure or service not included on the list of covered benefits
Path to Health is the “payer of last resort” and is the secondary payer to state and federal health coverage programs. If you have HIV or AIDS, need family planning or infertility services, have Hepatitis C, or have breast or cervical cancer, you are required to seek eligibility with the following programs:
- California AIDS Drug Assistance Program (ADAP) for HIV and AIDS medications (call 1-888-311-7632)
- Family Planning, Access, Care and Treatment (Family PACT) for family planning and infertility treatment (call 1-800-942-1054)
- Assistance Program for Hepatitis C medications (www.pparx.org or call 1-888-477-2669)
- Breast and Cervical Cancer Treatment Program (BCCTP) (call 1-800-824-0088)
How do I fill my prescriptions at the pharmacy?
You need to go to a pharmacy contracted for Path to Health/CMSP and show them your Path to Health ID card. For a listing of included pharmacies, click here. Certain medications are covered by Path to Health for a $5 per prescription co-payment. Path to Health will pay for a maximum of $500 per prescription and up to $1500 for each enrollment period (6-months). For a listing of which medications are covered by Path to Health, click here.
How long does my Path to Health coverage last?
After you complete your enrollment, your Path to Health coverage will last until December 31, 2023. Your Path to Health ID Card will include the start and end dates of your coverage.
How do I re-apply for Path to Health?
The reapplication process is the same as the application process. Please visit a participating health center to start an application for a new enrollment period.
How do I apply for Medi-Cal?
If you aren’t enrolled in Medi-Cal, you will need to apply through the county social services department in your county Your health center may also have staff to assist you with the Medi-Cal application process.
