Family PACT is a limited-benefits family planning program. The eligibility process is completed through a Family PACT provider and has 4 simple eligibility criteria. If eligible, your Health Access Program (HAP) card will be activated and you will be seen the same day.
1. You must be a California resident;
2. Your income for your family size must be at or below 200% of the federal poverty guidelines;
3. The client must have no other source of health care coverage for family planning services, or meet the criteria specified for eligibility with Other Health Coverage and;
4. You must have a medical necessity for family planning services.
Federal Poverty Level Income Guidelines
are based on the "basic family unit". The “basic family unit” consists of the applicant, spouse (including common-law) and minor
children, if any, related by blood, marriage, or adoption, and residing in the same household.
If an applicant is claimed as a tax dependent by the applicant’s spouse or parents, the applicant’s basic family unit include the applicant, spouse if living together, the tax filer and the tax filer’s other tax dependents.
Your provider will ask you for any updates to your current information at the beginning of every appointment. Your provider will let you know if a change has impacted your eligibility for the program. If your income increases above the program level due to a new situation, you would no longer be eligible for Family PACT. Your Family PACT provider will be able to make any necessary changes and determine if you are still eligible for the program. New Federal Poverty Level Income Guidelines are posted every year.
How do I apply?
Only enrolled Family PACT providers may determine client eligibility and enroll Family PACT clients in the program. These providers are trained to help fill out the form correctly..
Family PACT providers use a Client Eligibility Certification (CEC) form and a Retroactive Eligibility Certification (REC) form to certify a client eligible for Family PACT benefits. Information reported by the client about health care coverage, family size and income is used by the provider to determine eligibility. The client must meet all of the eligibility criteria outlined in this section.
To find a provider near you, enter your zip code in the zip code locator at the top of the website or call 800-942-1054. This will give you providers to call in your area for an appointment.
Retroactive Eligibility Certification: This form is designed to cover family planning expenses that were paid for in the 3 months prior to enrolling in Family PACT. The entire process is handled between the Family PACT client and the Department of Health Care Services (DHCS) Beneficiary Services Center. If you submit a claim for the expenses incurred before you were enrolled in Family PACT, the claim will be denied because you were not eligible.
Your Family PACT provider will determine if you were eligible for Family PACT 3 months prior to enrolling. You will be given a number to call to the Beneficiary Services Center to request a claim packet in the mail. You will then provide an itemized list of services paid for to submit with the claim packet.
If you are 17 years of age or younger, you are considered a minor. If you are 18 years of age or older, you are considered an adult. Family planning services does not require the consent of anyone other than the person who is to receive services. In determining eligibility for minors, the State will exclude parental income. Minors may apply for family planning services on the basis of their need for these services, without parental consent.