MediCAL Unwinding/Re-Enrollment
Don’t risk a gap in your MediCAL or CHIP coverage. All states are now restarting eligibility reviews after suspending them for the COVID-19 emergency. Make sure your contact information is
30 Van Ness, Suite 210,
San Francisco CA 94102
T: 415-575-5700 F: 415-575-5790
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
0-21 | N/A (eligibility based on financial or other need) | English Korean | 60 days (A+T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Provider mails or faxes CCS Referral Form [pdf], or parent mails or faxes CCS Application Form [pdf] | Detailed medical reports |
| General consent form |
1625 Van Ness, 3rd Floor
San Francisco, CA 94107
T: 415-600-6200 F: 415-749-1433
Website
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
0-18 | FSM Uninsured | English | 60 days (A) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Parent calls to start intake process |
| General consent form |
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
0-18 | FSM Uninsured | All Languages | 10 days (A+T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Parent calls central access number or walks in to any civil service clinic to start intake process | Detailed medical reports |
|
SF General Hospital, UCSF Department of Pediatrics
1001 Potrero Ave, MS 6E (mailing address)
Main Hospital Building, 6B (physical location)
San Francisco, CA 94110
T:415-206-6129 F: 415-206-6302
[email protected]
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
Developmental or behavioral concerns, including:
| 0-5 6-18 | FSM | English | 60 days (A) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Primary Care Provider emails or faxes MDAC Referral Form [pdf] to start intake process | Copies of previous assessments if available |
| General consent form |
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
Development delay in 1 or more areas; or an established risk condition | 0-3 | FSM | English | 45 days (A+T) |
Developmental disability defined as:
| 3+ | FSM
SFHP
BC
HK
Uninsured | English
Spanish
Cantonese
Mandarin | 120 days (A+T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Provider emails or faxes Early Start Referral Form [pdf], or parent emails or faxes Early Start Intake Form [doc] to start intake process | Medical/ |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Parent calls intake line to start intake process (If you are a provider, call intake line with parents to initiate the process ) | Relevant Medical Reports |
Early Childhood Special Education Services (Early Start) *
1520 Oakdale Ave, Ground Floor
San Francisco, CA 94124
T: 415-401-2525 F: 415-920-5075
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
Solely low incidence disability:
| 0-3 | N/A | English | 45 days (A + T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Typically referred by GGRC or child’s doctor. Child may also be referred by parent. | Medical Report indicating solely low incidence disability | Proof of residency | SFUSD Authorization to Release Information |
Special Education
Attn: Prekindergarten Intake Unit
1520 Oakdale Ave, Ground Floor
San Francisco, CA 94124
T: 415-401-2525 F: 415-920-5075
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
| 3-5 | N/A | English | 15 days to respond to referral (A+T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
PreK SpEd Referral Packet Family/parent sends docs directly to Pre-K Unit (SFCD can help parents fill out) | Any pertinent medical reports are requested, but not required unless child has a vision impairment. | Parents must send in a completed intake packet with supporting documents (Proof of Residency, Birth Certificate, hearing/vision screening results if available) | Included in PreK SpEd Referral Packet |
Enrolled in TK/K through 12 with SFUSD
Depends on School Site of Attendance
T: 415-759-2206 F: 415-242-2528
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
| 5-22 | N/A | English | 15 days to respond to referral (A+T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Parent or provider submits detailed letter with request for assessment to the child’s SFUSD school site. Sample Request for Assessment Letter English [doc] | Any pertinent medical reports are requested, but not required. | N/A |
Screening and Assessment Center (Central Office) *
3045 Santiago St
San Francisco, CA 94116
T: 415-759-2206 F: 415-242-2528
| Category | Ages | Insurance | Language | Timeline |
|---|---|---|---|---|
| 5-22 | N/A | English | 15 days to respond to referral (A+T) |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Any pertinent medical reports are requested, but not required. | Parents must send in a completed referral packet with supporting documents (e.g. proof of Residency and Birth Certificate) | Included in Private/Parochial Referral Packet |
| Referral | Medical Info Needed | Family/Parent Docs | Consent Forms |
|---|---|---|---|
Delete this table and referral heading if no need for a second referral section | Content | Content | Content |
Don’t risk a gap in your MediCAL or CHIP coverage. All states are now restarting eligibility reviews after suspending them for the COVID-19 emergency. Make sure your contact information is
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