BILL NUMBER: SBX3 26AMENDED BILL TEXT AMENDED IN SENATE APRIL 16, 2009 INTRODUCED BY Senator Alquist MARCH 3, 2009An 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.An act to add Section 12693.265 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 26, as amended, Alquist.Medi-Cal: continuous eligibility: semiannual status reports.Healthy Families Program: dental-only coverage.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.Existing law, the federal Children's Health Insurance Program Reauthorization Act of 2009, authorizes states with a separate Children's Health Insurance Program to provide dental-only supplemental coverage to children who are enrolled in group health care coverage or health insurance coverage offered through an employer and who would otherwise satisfy the requirements for being a targeted low-income child, as specified. Existing law creates the Healthy Families Program, administered by the Managed Risk Medical Insurance Board, to arrange for the provision of health, dental, and vision benefits to eligible children pursuant to the federal Children's Health Insurance Program. This bill would, contingent on the receipt and appropriation of funds, require the board to provide dental-only coverage consistent with the federal Children's Health Insurance Program Reauthorization Act of 2009, as specified, and would authorize the board to adopt regulations to implement that requirement. The bill would also state the intent of the Legislature to enact legislation that would implement other provisions of the federal Children's Health Insurance Program Reauthorization Act of 2009. 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. The Legislature hereby finds and declares all of the following: (a) Congress and the President have reauthorized the federal Children's Health Insurance Program, which provides funding for the state's Healthy Families Program. (b) The reauthorization legislation has provided additional funding for children's health insurance and additional flexibility to states to improve and expand health care coverage for children. (c) Although more than nine of every 10 children in California have health care coverage, about 683,000 children in the state are without health care coverage according to 2007 data from the Center for Health Policy Research at the University of California at Los Angeles. (d) It is imperative that the state act to take advantage of the increased federal funding and enhanced flexibility in administering the federal Children's Health Insurance Program. (e) It is the intent of the Legislature to enact legislation that would implement the key elements of the federal Children's Health Insurance Program Reauthorization Act of 2009, including receiving federal matching funds for enrolling eligible immigrant children, implementing changes to citizen documentation requirements, ensuring parity in state coverage, establishing new payment methods for clinics participating in the Healthy Families Program, measuring quality of care within public programs, and taking advantage of the increased federal funding that is available to California, including bonuses and targeted grant programs, such as performance bonuses and outreach funding. SEC. 2. Section 12693.265 is added to the Insurance Code , to read: 12693.265. (a) Subject to subdivisions (b) and (c), the board shall provide dental-only coverage as authorized by Section 501 of the Children's Health Insurance Program Reauthorization Act of 2009 (Public Law 111-3). To be eligible to receive this coverage, a child shall be an eligible child, as described in subdivision (a) of Section 12693.70, except that the child shall be enrolled in employer-sponsored coverage that does not provide dental benefits or cost sharing that meets the requirements of Section 12693.63 and its implementing regulations. (b) The board may adopt, and may only one time readopt, regulations to implement subdivision (a). The adoption and one-time readoption of a regulation authorized by this subdivision is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the board is hereby exempted for this purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code. (c) This section shall be implemented only if and to the extent that federal financial participation is obtained and only if and to the extent that funds are appropriated by the Legislature for purposes of this section in the annual Budget Act or in another statute.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.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.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) 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. (d) When a beneficiary has completed, signed, and filed a semiannual status report that indicated a change in circumstance, eligibility shall be redetermined. (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. (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.SEC. 5.Section 14011.18 of the Welfare and Institutions Code is repealed.SEC. 6.SEC. 3. 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.