Access for Infants and Mothers Program Banner

Frequently Asked Questions

What do I do if my income is less than the AIM guidelines?

If your income is less than the AIM guidelines you may be eligible for no cost Medi-Cal. Look in your local telephone White Pages for the Department of Social Services office near you to receive more information about Medi-Cal.

What makes an application complete?

A complete application includes copies of all required documentation and the application filled out completely including signatures.

Can I send in a personal check with my application?

No, personal checks are not accepted with the application. You must submit either a money order or cashier's check made payable to the AIM program.

Can I fax my application?

Yes you can fax your application to 1-888-889-9238 this fax line is free. However, your application is not complete until proof of your valid income documentation is received.

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Can I send copies of the application?

Yes, you can use a copy of the application. Also, send valid copies of your income documents and pregnancy certification instead of originals with your money order or cashiers check.

Can I apply in person? If not, where do I mail my AIM application?

No, you can not apply in person. All applications are processed via mail. Applications can be sent in via regular or priority mail to:

California Access for Infants and Mothers Program
P.O. Box 15559
Sacramento, CA 95852-0559

Applications can be sent via overnight mail to:

California Access for Infants and Mothers Program
625 Coolidge Drive Ste 100
Folsom, CA 95630

Where can I get help filling out the application?

You can call AIM at 1-800-433-2611. All help is free.

Do I count my husband's income if he works away from home in another city, state, or country several months of the year?

Yes, if he is claiming that he lives in the home with you, the pregnant woman.

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Do I count the father of the baby and his income?

No, unless you already have a child in common, and live together.

How soon will I know when I'm enrolled?

Normal processing time for a complete application is 10 days. You will receive a letter from the AIM Program once enrolled. If the application is incomplete, you will receive a letter requesting the additional information needed and the processing time will be longer. You will receive an evidence of coverage booklet and an insurance card from the health plan you selected once enrolled in AIM. The effective date of coverage is 10 days after enrollment.

Can I send copies of my income documentation?

Yes, do not send originals.

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How soon can I see a doctor through AIM?

As of the effective date of coverage. However, keep in mind that you must call the doctor to make an appointment.

What are the benefits of having AIM as opposed to pregnancy-related restrictive Medi-Cal only?

AIM offers comprehensive benefits, including pregnancy and non-pregnancy related service. For more information, you can request a copy of the evidence of coverage from the health plan of your choice.

Do I still have a co-payment when I go to the doctor?

No, AIM does not have co-payments or deductibles.

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Will AIM pay for birth control after my baby is born?

Refer to your health plan’s benefits chart and evidence of coverage.

Can I see a doctor in a county neighboring the one in which I live?

You should contact your health plan to see if they will allow you to see a specific provider.

Will I receive a refund check from AIM if I am not eligible?

A refund check from the AIM Program will be mailed to you.

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Will AIM cover high risk pregnancies?

Yes.

Can I continue to see my current doctor?

Please call your health plan to find out if the doctor is an AIM participating provider.

Are vision and dental covered with AIM?

Refer to your health plan's benefits chart.

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Can I change doctors if it doesn't work out with my new AIM doctor?

Any requests to transfer doctors must be made through the Health Plan.

Is the work deduction taken if I'm not working now, but I worked last year and I'm using that income to qualify me for the program?

A work deduction is used for the period in which income documentation is received.

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Do I list my children if they live with me only half of the time?

Yes, if they are claimed as dependents on your federal or state tax return.

Does my husband and I have to use income from the same year?

No. Either spouse can use previous year's income or current income.

What is gross income after deductions?

The first step in determining eligibility is to look at gross income (before taxes). The Program then subtracts any applicable deduction (see a list of allowable deductions). These deductions are mandatory.

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Who selects my provider and the hospital at which I will deliver my baby?

The pregnant woman can select her provider through the health plan. Depending on the health plan contract, the provider will inform you of the hospital where you will deliver your baby.

How is self-employed income calculated?

The AIM Program uses net profit income to determine eligibility (gross income minus business expenses). There are two options to show income for self-employed individuals. They may submit last year's Federal Income Tax Form 1040 with the Schedule C. Or they may submit the most recent 3 month Profit and Loss Statement. Any deductions for meals/entertainment and/or depreciation are added back into the net profit income. Any losses (negative dollar amounts) are counted as zero ($0).

How do I obtain a non-obstetrical specialist while in the AIM Program?

Call your health plan's customer or member services. If you are in an EPO, you can do a self referral. If you are in an HMO, you need to obtain a referral from your primary care provider.

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How can I find out if my obstetrician and delivering hospital are part of the AIM Program?

Call your health plan's customer or member services, or refer to your health plan's provider directory.

Can I transfer to a different health plan if my doctor or delivering hospital is no longer recognized as an AIM provider by my original health plan?

No. If your obstetrician or delivering hospital is no longer contracting with your current health plan, call your plan's customer or member services for assistance. The plan will either assist you in choosing a new provider or hospital, or allow you to continue seeing your current obstetrician and delivery hospital to provide continuity of care.

Can I obtain brand name drugs when a generic substitution is available for my prescriptions?

Only if the provider indicates that the brand name drug cannot be substituted with a generic drug.

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Will the AIM Program cover treatment for complications beyond the last day of the month in which the 60th day following the end of my pregnancy occurs?

No. Pregnancy related treatment is covered until the last day of the month in which the 60th day following the end of the pregnancy occurs.

How do I obtain urgent or emergency care during non-business hours?

Call your primary care provider or your medical group. The answering service will connect you with the advice nurse or the doctor on call to give you further directions.

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What if my pregnancy is unsuccessful?

If your pregnancy ends on or after the date your coverage starts, you’re still responsible for paying the 1.5% contribution amount. However, you’ll be covered until the last day of the month in which the 60th day following the end of the pregnancy occurs. If you are no longer pregnant before your start date of coverage, your coverage will not begin. If notification to the program is received after start date of coverage, documentation by a licensed or certified health care professionalmust be sudmitted indicating the date your pregnancy ended.

What if my pregnancy ends in the first trimester?

If your pregnancy ends within your first trimester on or after your coverage starts, you may be eligible for a reduced contribution. The AIM Program will need documentation by a licensed or certified health care professional indicating the end date of your pregnancy. AIM will determine if you are eligible to only pay 1/3 of your 1.5% contribution amount.

What if I don’t notify AIM that my pregnancy ended within 30 days?

You must notify the AIM Program that your pregnancy ended. If you do not notify AIM that your pregnancy ended within 30 days after the end of your pregnancy, you will not receive timely notification of your disenrollment. Your coverage will still end the last day of the month in which the 60th day following the end of the pregnancy occurs.

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What if I don’t notify AIM that my pregnancy ended?

You must notify the AIM Program that your pregnancy ended. If you do not notify AIM that your pregnancy ended , the AIM Program will retro-actively disenroll you. Your coverage will still end the last day of the month in which the 60th day following the end of the pregnancy occurs. The AIM Program cannot cover medical services received after your coverage has ended.

What if I have medical bills after the end of my pregnancy?

If you receive medical services after the last day of the month in which the 60th day following the end of the pregnancy occurs, AIM will not pay for these services. If you have other health coverage, you will need to contact them to see if they will help with those medical bills. You will be responsible for any medical services you receive after the last day of the month in which the 60th day following the end of the pregnancy occurs.

What if I need medical services after the end of my pregnancy?

AIM cannot pay for any services received after the last day of the month in which the 60th day following the end of the pregnancy occurs. If you need other health coverage, you may qualify for Medi-Cal or the Major Risk Medical Insurance Program. Look in your local telephone White Pages for the Department of Social Services office near you to obtain information about Medi-Cal. You may also call the Major Risk Medical Insurance Program at 1-800-289-6574.

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I have to pay a deductible or copayment of more than $500 for maternity-only services under my private health insurance plan. Can I still apply for AIM?

Yes, applicants may have other health coverage with a maternity-only deductible or copayment greater than $500 to be eligible for the AIM Program.

What if my private health insurance plan has deductible or copayment more than $500 for all benefit services, not just maternity-only services? Can I still be eligible for the AIM Program?

You will not be eligible for the AIM Program. The deductible or copayment must be for maternity-only services.

Do I have to use my private health insurance plan instead of the AIM health plan if I am eligible for the AIM Program?

Pregnancy and non-pregnancy related services will be covered by both your private health insurance plan and your AIM coverage. However, you must use the AIM health plan network providers in order for the AIM health plan to pay for services. See the Coordination of Benefits section in your plan’s Evidence of Coverage booklet or call your AIM plan for more information.

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What if my health coverage changes?

If your health coverage changes you must call AIM or write to the AIM Program at the address shown below.

AIM Program
P.O. Box 15559
Sacramento, CA 95852-0559
FAX: 1-888-889-9238

What if I have questions about my AIM plan?

If you have any questions about your AIM plan, contact your AIM plan.

What if I have more questions about my private coverage?

If you have any questions about your private coverage, contact your private health plan.

Are maternity benefits for a paid surrogate mother covered by the AIM Program?

Maternity benefits are not covered by the AIM Program for paid surrogate mother. A paid surrogate mother is a subscriber who in advance of her pregnancy entered into agreement to become pregnant and deliver a child for another person as intended parent, in exchange for monetary compensation other than actual medical or living expenses. This benefit becomes effective for new AIM subscribers enrolled with an effective date on or after February 1, 2012.

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