Enrolled Members of the Local Consortium Tribes Who Live Out-of-County
- Lab work for blood draws provided in house.
- Orthodontics (braces) – $7,024 maximum.
- Eyeglasses and/or contacts ($1000 max) and eye exams fully covered every 2 years.
- Rx’s written by LCTHC provider found on our formulary list at LCTHC pharmacy or NL Pharm.
- All alternate resources must be exhausted; patient must have valid insurance/Medi-Cal, or if denied Medi-Cal for being over income or resources, must submit a valid denial letter from their county.
- Private Ins/HMO Co-pay/Deductible Assistance Program – Up to $3,000 total per fiscal year to assist with payment of Private Ins/HMO plan co-pays/deductibles for enrolled consortium members that meet PRC guidelines excluding the residency guideline.
- 3rd Party Program Access for Out-of-PRCDA Members – Enrolled consortium members living outside of Lake County may access the following programs (limited slots available, guidelines in policy must be met): Acupuncture, Alternative Medicine, Bariatric Surgery, Chiropractor, Dental Implants, Medical & Diabetic Shoes, DME, Electric Wheelchair/Scooter, Facial Spa Treatment, Gym Reimbursement, Holistic/OTC program, LASIK, Massage Therapy, Medicare Plan Reimbursement, Skilled Nursing Facility Payment Program.
Enrolled Members of the Local Consortium Tribes Who Live in Lake County
- Medical & Diabetic Shoes – $500 max – once every six months (must be Rx’d by LCTHC PCP or Podiatrist (w/valid referral from LCTHC) and have a diabetes diagnosis or foot pain/issue diagnosis.
- Out-of-county transportation for medical appointments that patient has been referred to by LCTHC.
- Orthodontics (braces) – 100% of cost, not to exceed $7,024.
- Dental Implants – 100% of cost, not to exceed $45,000.
- LASIK eye surgery – 100% not to exceed $7,500.
- Acupuncture, Chiropractor & Massage therapy – not to exceed 2x/wk. Must have evaluation and order from PCP with number of sessions, and must have new evaluation by PCP if patient requires new order for additional sessions.
- Holistic Medicine/OTC Supplies – not to exceed $5,000.
- Bariatric Surgery – not to exceed $30,000
- Durable Medical Equipment – medically necessary DME items under our DME policy. Must be prescribed by an in-house physician or by a physician that the patient was referred to by an LCTHC physician.
- Medicare Plan Premium Assistance – $500 max per month for any Medicare Plan (Part A-F).
- Gym Membership Reimbursement – $150 max per month on a reimbursement basis only. Patient must bring in their valid receipt for reimbursement.
- Electric Wheelchair/Scooter – Must meet all policy requirements including medical need that must be identified and met, documented by an LCTHC physician/provider. PRC Department to coordinate purchase with established supplier after eligibility is determined.
- Vision Benefits – $1,000 for eyeglasses and/or contacts, every other year that may be utilized during the “off-year” of PRC Vision benefits.
- Dermatologic Facial Spa Treatment – $250 max once per month up to 6 times per year for facials performed at local businesses.
- Alternative Medicine Program – Up to $50,000 for Alternative Medicine treatment referred by LCTHC provider.
- Behavioral Health/SUD Treatment – Only in the case where a specific case exceeds $15,000 per month over the course of three months (total $45,000).
- Injury Prevention Support program – up to $7,500 for home improvements, ramps, transportation safety supports for elders and patients w/long term (12 month) disability
- Skilled Nursing Facility payment program – up to $5,000 per month paid directly to Skilled Nursing Facilities where patient is admitted.
- Skin Removal Surgery (Pilot Program) – up to $35,000 for the removal of excess skin when referred by an LCTHC provider.
- Escort Funds (gas cards/lodging) for medical appointments that patient has been referred to by LCTHC, also for immediate family members wishing to visit patient that is hospitalized (eligibility will be based on the hospitalized patient, not the family member that is visiting).
- $70 for gas + a $60 meal per diem amount per day for up to 2 people, not to exceed one per diem (each for 2 people) for round trips less than 75 miles (not to exceed 10 days when request is to visit family member in hospital).
- $130 for gas + a $80 meal per diem amount per day for up to 2 people, not to exceed one per diem (each for 2 people) for round trips over 75 miles (not to exceed 10 days when request is to visit family member in hospital).
- $160 for gas + a $80 meal per diem amount per day for up to 2 people, not to exceed one per diem (each for 2 people) for round trips to Oakland and San Francisco (not to exceed 10 days when request is to visit family member in hospital)
- $300/night for overnight lodging (issued on a visa gift card) for out of county appointments – when used to visit hospitalized immediate family member, max is 10 nights. Lodging is only offered if the hospitalized patient is located at a facility over 75 miles round trip. When used for patient’s own appointment, lodging funds are only offered if the appointment is before 12 noon or after 8pm when the appointment is over 75 miles round trip, not to exceed 2 nights.
When traveling with the Lake County Tribal Health Transportation Dept or an LCTHC CHR:
- $80 meal per diem amount per day for up to 2 people (if patient is a minor and traveling with parent, or other patient who requires to be accompanied by a caretaker) for round trips over 75 miles, not to exceed one per diem (each for 2 people) per appointment day.
- $60 meal per diem amount per day for up to 2 people (if patient is a minor and traveling with parent, or other patient who requires to be accompanied by a caretaker) for round trips less than 75 miles, not to exceed one per diem (each for 2 people) per appointment day.
Consortium Tribes Allocations
LCTHC annually allocates $45,000 in funds directly to each consortium tribe for services and guidelines identified below.
- Tribal Youth Funds – Youth funds should be used for activities or education pertaining to health, wellness, and safety of tribal youth. Examples may include school-based health education; youth exercise programs, costs for attending wellness events, drug and alcohol prevention materials, or nutritional education.
- Tribal Elders Funds – Elders funds should be used for health and wellness activities focusing on tribal elders. Examples include diabetes prevention education, elder counseling or group activities, or providing items to increase safety or accessibility of homes.
- Tribal Sanitation Funds – Sanitation funds may be used for purposes related to sanitation, such as providing bathroom facilities during tribal and cultural events.
- Tribal Fitness Funds – Fitness funds may be used by the Tribe for purposes aimed at increasing tribal member physical fitness. Examples may include purchase of exercise equipment for generally accessible gyms or fitness rooms, fees for exercise instruction or training, costs for certifying tribal members as personal trainers, to pay for individual gym membership fees, or costs of operating a fitness facility or gym.