BILL NUMBER: SBX3 26INTRODUCED BILL TEXT INTRODUCED BY Senator Alquist MARCH 3, 2009 An act to amend Section 14011.16 of, to amend and repeal Section 14005.25 of, and to repeal Sections 14011.17 and 14011.18 of, the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST SB 26, as introduced, Alquist. Medi-Cal: continuous eligibility: semiannual status reports. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is partially governed and funded under federal Medicaid provisions. Existing law, until January 1, 2012, requires the department, subject to the availability of federal financial participation, to exercise a federal option to expand continuous eligibility to children 19 years of age and younger for 6 months, after which date the continuous eligibility period shall be from the date of a determination of eligibility to the earlier of either the end of a 12-month period following the eligibility determination or the date the child exceeds 19 years of age. This bill would eliminate the provisions limiting continuous eligibility to 6 months, would make those provisions that become operative on January 1, 2012, applicable commencing January 1, 2010, and would make conforming changes. The California Constitution authorizes the Governor to declare a fiscal emergency and to call the Legislature into special session for that purpose. The Governor issued a proclamation declaring a fiscal emergency, and calling a special session for this purpose, on December 19, 2008. This bill would state that it addresses the fiscal emergency declared by the Governor by proclamation issued on December 19, 2008, pursuant to the California Constitution. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 14005.25 of the Welfare and Institutions Code, as amended by Section 27 of Chapter 758 of the Statutes of 2008, is amended to read: 14005.25. (a) To the extent federal financial participation is available, the department shall exercise the option under Section 1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a (e)(12)) to extend continuous eligibility to children 19 years of age and younger. A child shall remain eligible pursuant to this subdivision from the date of a determination of eligibility for Medi-Cal benefits until the earlier of either: (1) The end of a 12-month period following the eligibility determination. (2) The date the individual exceeds the age of 19 years. (b) This section shall be implemented only if, and to the extent that, federal financial participation is available. (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall, without taking regulatory action, implement this section by means of all county letters or similar instructions. Thereafter, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.(d) In order to implement changes in the level of funding for health care services, commencing on the first day of the month following 90 days after the operative date of amendments to this section that added this subdivision, the continuous eligibility time period provided in paragraph (1) of subdivision (a) shall be reduced to six months.(e) This section shall remain in effect only until January 1, 2012, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2012, deletes or extends that date.SEC. 2. Section 14005.25 of the Welfare and Institutions Code, as added by Section 28 of Chapter 758 of the Statutes of 2008, is repealed.14005.25. (a) To the extent federal financial participation is available, the department shall exercise the option under Section 1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a (e)(12)) to extend continuous eligibility to children 19 years of age and younger. A child shall remain eligible pursuant to this subdivision from the date of a determination of eligibility for Medi-Cal benefits until the earlier of either: (1) The end of a 12-month period following the eligibility determination. (2) The date the individual exceeds the age of 19 years. (b) This section shall be implemented only if, and to the extent that, federal financial participation is available. (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall, without taking regulatory action, implement this section by means of all county letters or similar instructions. Thereafter, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (d) This section shall become operative on January 1, 2012.SEC. 3. Section 14011.16 of the Welfare and Institutions Code is amended to read: 14011.16. (a) Commencing August 1, 2003, the department shall implement a requirement for beneficiaries to file semiannual status reports as part of the department's procedures to ensure that beneficiaries make timely and accurate reports of any change in circumstance that may affect their eligibility. The department shall develop a simplified form to be used for this purpose. The department shall explore the feasibility of using a form that allows a beneficiary who has not had any changes to so indicate by checking a box and signing and returning the form. (b) Beneficiaries who have been granted continuous eligibility under Section 14005.25 shall not be required to submit semiannual status reports. To the extent federal financial participation is available, all children under 19 years of age shall be exempt from the requirement to submit semiannual status reports.(c) For any period of time that the continuous eligibility period described in paragraph (1) of subdivision (a) of Section 14005.25 is reduced to six months, subdivision (b) shall become inoperative, and all children under 19 years of age shall be required to file semiannual status reports.(d)(c) Beneficiaries whose eligibility is based on a determination of disability or on their status as aged or blind shall be exempt from the semiannual status report requirement described in subdivision (a). The department may exempt other groups from the semiannual status report requirement as necessary for simplicity of administration.(e)(d) When a beneficiary has completed, signed, and filed a semiannual status report that indicated a change in circumstance, eligibility shall be redetermined.(f)(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of all county letters or similar instructions without taking regulatory action. Thereafter, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.(g)(f) This section shall be implemented only if and to the extent federal financial participation is available. SEC. 4. Section 14011.17 of the Welfare and Institutions Code is repealed.14011.17. The following persons shall be exempt from the semiannual reporting requirements described in Section 14011.16: (a) Pregnant women whose eligibility is based on pregnancy. (b) Beneficiaries receiving Medi-Cal through Aid for Adoption of Children Program. (c) Beneficiaries who have a public guardian. (d) Medically indigent children who are not living with a parent or relative and who have a public agency assuming their financial responsibility. (e) Individuals receiving minor consent services. (f) Beneficiaries in the Breast and Cervical Cancer Treatment Program. (g) Beneficiaries who are CalWORKs recipients and custodial parents whose children are CalWORKs recipients.SEC. 5. Section 14011.18 of the Welfare and Institutions Code is repealed.14011.18. (a) On or before December 15, 2010, the State Department of Health Care Services shall report to the fiscal and health policy committees of the Legislature on the effects of reducing the time period of continuous eligibility for children and imposing a semiannual status reporting requirement to maintain Medi-Cal eligibility for children. The report shall include all of the following information: (1) The number of children enrolled in Medi-Cal by eligibility category prior to the imposition of semiannual status reporting and on a quarterly basis after the imposition of semiannual reporting. Within each eligibility category, the report also shall identify the number of enrolled children in Medi-Cal managed care and in fee-for-service Medi-Cal. (2) The annual cost per child enrollee in managed care and by cost category in fee-for-service prior to the imposition of semiannual reporting and for the 2009-10 fiscal year. (3) An analysis of enrollment interruptions and reinstatements for children prior to the imposition of semiannual reporting and for the 2009-10 fiscal year. The analysis shall include data on the number of children disenrolled as a result of the semiannual reporting requirement, the number of those children who were subsequently reenrolled in Medi-Cal by duration of their enrollment gap, and an analysis, to the extent feasible, of the extent to which enrollment gaps resulted from the failure of families to file a complete semiannual report versus a change in family circumstances that resulted in a child no longer being eligible for no-cost Medi-Cal coverage, and the number of children that transitioned to the Healthy Families Program as a result of semiannual reporting. (4) An estimate of the additional annual county eligibility administration costs or savings resulting from the processing of semiannual reports for children, disenrollment processing, reinstatement, reenrollment, and caseload reductions. (b) For purposes of preparing the report, the department shall seek funding, or participation from appropriate nonprofit organizations, including foundations and universities, or both.SEC. 6. This act addresses the fiscal emergency declared by the Governor by proclamation on December 19, 2008, pursuant to subdivision (f) of Section 10 of Article IV of the California Constitution.