Client Eligibility/Enrollment
2011 Federal Poverty Level Income Guidelines (PDF) | Effective April 1, 2011
1-2-3s of Identifying, Scheduling, and Enrolling Family PACT Clients (7-11) (PDF)
Family PACT Retroactive Eligibility Certification and Claim Processes
Effective April 1, 2011, the Family PACT program will implement a retroactive eligibility certification procedure and claim process for newly-enrolled qualified Family PACT clients.
Once a new client has been certified as eligible for Family PACT, the Family PACT provider shall ask the newly-enrolled client if he or she received a Family PACT-covered family planning and/or reproductive health service during the three-month period prior to the month that the client was enrolled in the Family PACT program. If the client responds affirmatively, the Family PACT provider will give the client retroactive eligibility information and a Retroactive Eligibility Certification (REC) form (CDPH 4001) for completion. The Family PACT provider accepts responsibility for appropriate on-site determination of retroactive eligibility according to program guidelines and administrative practices.
The Family PACT provider will then give the client a copy of the retroactive eligibility information and the completed CDPH 4001 form for client claim processing.
Sample CEC Forms
**The Sample CEC forms have moved to the Provider Resource page under
Forms.**
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This document was updated last at Thursday, December 22, 2011