CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2146Introduced by Assembly Member Chiu(Coauthors: Assembly Members Frazier and Mayes)(Coauthor: Senator Allen)February 10, 2020 An act to add Section 14164.5 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 2146, as introduced, Chiu. Public University Dental School Intergovernmental Transfer Program.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, including certain dental services.Existing law provides that any county, political subdivision of the state, or other governmental entity in the state may elect to transfer funds in the form of cash or loans to the department in support of the Medi-Cal program, and provides the department discretion to accept or not accept any elective transfer from a county, political subdivision, or other governmental entity for obtaining federal financial participation. Pursuant to this provision, existing law authorizes the Director of Health Care Services to maximize federal financial participation to provide access to services provided by hospitals that are not reimbursed by certified public expenditure by authorizing the use of intergovernmental transfers to fund the nonfederal share of supplemental payments as permitted under federal law, and requires the department to establish various intergovernmental transfer programs, including the Nondesignated Public Hospital Intergovernmental Transfer Program.This bill would require the department to establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program, and to authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Medi-Cal beneficiaries. The bill would require each transferring entity, upon providing any intergovernmental transfer of funds, to certify that the transferred funds qualify for federal financial participation, and would provide that any intergovernmental transfer of funds made is voluntary. The bill would prohibit the department from assessing any fee to reimburse the department for specified costs, including administrative costs. The bill would require the department to obtain federal approvals and federal matching funds, and to implement those provisions by various means, including policy letters.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. (a) The Legislature hereby finds and declares all of the following: (1) People with developmental or intellectual disabilities face numerous barriers to accessing health care and achieving good health.(2) People with disabilities and special needs often have behavioral, cognitive, and physical limitations that can make completing daily health care tasks and receiving regular dental services difficult. These difficulties lead to disproportionate levels of dental disease for people with disabilities and special needs.(3) Providing dental care to people with special needs often takes more time and specialized skill than providing similar services to healthy and ambulatory patients. According to a 2018 report published by the Legislative Analysts Office, individuals with developmental disabilities are more likely than the general population to lack access to regular dental care across their lifespan.(4) University dental school clinics are important safety net sites, and these clinics are often the last resort for Californias most vulnerable patients to access dental care. These clinics also serve as the training ground for a dental workforce as these individuals prepare to care for medically needy Californians. Moreover, these clinics assume the additional costs associated with this responsibility.(5) University dental school clinics are severely impacted, which results in significant wait times for patients who seek care. Many patients with special health care needs travel for hours to these clinics because the patients cannot receive their dental care anywhere else in the state. These patients frequently face lengthy delays in receiving their treatment.(6) Fully funding university dental school clinics for the unreimbursed cost of providing specialized care to patients with special needs will increase the ability of these clinics to provide care to greater numbers of Medi-Cal beneficiaries and expand access to oral health care in California.(b) It is the intent of the Legislature to authorize public university dental schools to utilize intergovernmental transfers as a means to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.SEC. 2. Section 14164.5 is added to the Welfare and Institutions Code, immediately following Section 14164, to read:14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2146Introduced by Assembly Member Chiu(Coauthors: Assembly Members Frazier and Mayes)(Coauthor: Senator Allen)February 10, 2020 An act to add Section 14164.5 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 2146, as introduced, Chiu. Public University Dental School Intergovernmental Transfer Program.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, including certain dental services.Existing law provides that any county, political subdivision of the state, or other governmental entity in the state may elect to transfer funds in the form of cash or loans to the department in support of the Medi-Cal program, and provides the department discretion to accept or not accept any elective transfer from a county, political subdivision, or other governmental entity for obtaining federal financial participation. Pursuant to this provision, existing law authorizes the Director of Health Care Services to maximize federal financial participation to provide access to services provided by hospitals that are not reimbursed by certified public expenditure by authorizing the use of intergovernmental transfers to fund the nonfederal share of supplemental payments as permitted under federal law, and requires the department to establish various intergovernmental transfer programs, including the Nondesignated Public Hospital Intergovernmental Transfer Program.This bill would require the department to establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program, and to authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Medi-Cal beneficiaries. The bill would require each transferring entity, upon providing any intergovernmental transfer of funds, to certify that the transferred funds qualify for federal financial participation, and would provide that any intergovernmental transfer of funds made is voluntary. The bill would prohibit the department from assessing any fee to reimburse the department for specified costs, including administrative costs. The bill would require the department to obtain federal approvals and federal matching funds, and to implement those provisions by various means, including policy letters.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill
No. 2146
Introduced by Assembly Member Chiu(Coauthors: Assembly Members Frazier and Mayes)(Coauthor: Senator Allen)February 10, 2020
Introduced by Assembly Member Chiu(Coauthors: Assembly Members Frazier and Mayes)(Coauthor: Senator Allen)
February 10, 2020
An act to add Section 14164.5 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2146, as introduced, Chiu. Public University Dental School Intergovernmental Transfer Program.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, including certain dental services.Existing law provides that any county, political subdivision of the state, or other governmental entity in the state may elect to transfer funds in the form of cash or loans to the department in support of the Medi-Cal program, and provides the department discretion to accept or not accept any elective transfer from a county, political subdivision, or other governmental entity for obtaining federal financial participation. Pursuant to this provision, existing law authorizes the Director of Health Care Services to maximize federal financial participation to provide access to services provided by hospitals that are not reimbursed by certified public expenditure by authorizing the use of intergovernmental transfers to fund the nonfederal share of supplemental payments as permitted under federal law, and requires the department to establish various intergovernmental transfer programs, including the Nondesignated Public Hospital Intergovernmental Transfer Program.This bill would require the department to establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program, and to authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Medi-Cal beneficiaries. The bill would require each transferring entity, upon providing any intergovernmental transfer of funds, to certify that the transferred funds qualify for federal financial participation, and would provide that any intergovernmental transfer of funds made is voluntary. The bill would prohibit the department from assessing any fee to reimburse the department for specified costs, including administrative costs. The bill would require the department to obtain federal approvals and federal matching funds, and to implement those provisions by various means, including policy letters.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, including certain dental services.
Existing law provides that any county, political subdivision of the state, or other governmental entity in the state may elect to transfer funds in the form of cash or loans to the department in support of the Medi-Cal program, and provides the department discretion to accept or not accept any elective transfer from a county, political subdivision, or other governmental entity for obtaining federal financial participation. Pursuant to this provision, existing law authorizes the Director of Health Care Services to maximize federal financial participation to provide access to services provided by hospitals that are not reimbursed by certified public expenditure by authorizing the use of intergovernmental transfers to fund the nonfederal share of supplemental payments as permitted under federal law, and requires the department to establish various intergovernmental transfer programs, including the Nondesignated Public Hospital Intergovernmental Transfer Program.
This bill would require the department to establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program, and to authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Medi-Cal beneficiaries. The bill would require each transferring entity, upon providing any intergovernmental transfer of funds, to certify that the transferred funds qualify for federal financial participation, and would provide that any intergovernmental transfer of funds made is voluntary. The bill would prohibit the department from assessing any fee to reimburse the department for specified costs, including administrative costs. The bill would require the department to obtain federal approvals and federal matching funds, and to implement those provisions by various means, including policy letters.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. (a) The Legislature hereby finds and declares all of the following: (1) People with developmental or intellectual disabilities face numerous barriers to accessing health care and achieving good health.(2) People with disabilities and special needs often have behavioral, cognitive, and physical limitations that can make completing daily health care tasks and receiving regular dental services difficult. These difficulties lead to disproportionate levels of dental disease for people with disabilities and special needs.(3) Providing dental care to people with special needs often takes more time and specialized skill than providing similar services to healthy and ambulatory patients. According to a 2018 report published by the Legislative Analysts Office, individuals with developmental disabilities are more likely than the general population to lack access to regular dental care across their lifespan.(4) University dental school clinics are important safety net sites, and these clinics are often the last resort for Californias most vulnerable patients to access dental care. These clinics also serve as the training ground for a dental workforce as these individuals prepare to care for medically needy Californians. Moreover, these clinics assume the additional costs associated with this responsibility.(5) University dental school clinics are severely impacted, which results in significant wait times for patients who seek care. Many patients with special health care needs travel for hours to these clinics because the patients cannot receive their dental care anywhere else in the state. These patients frequently face lengthy delays in receiving their treatment.(6) Fully funding university dental school clinics for the unreimbursed cost of providing specialized care to patients with special needs will increase the ability of these clinics to provide care to greater numbers of Medi-Cal beneficiaries and expand access to oral health care in California.(b) It is the intent of the Legislature to authorize public university dental schools to utilize intergovernmental transfers as a means to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.SEC. 2. Section 14164.5 is added to the Welfare and Institutions Code, immediately following Section 14164, to read:14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. (a) The Legislature hereby finds and declares all of the following: (1) People with developmental or intellectual disabilities face numerous barriers to accessing health care and achieving good health.(2) People with disabilities and special needs often have behavioral, cognitive, and physical limitations that can make completing daily health care tasks and receiving regular dental services difficult. These difficulties lead to disproportionate levels of dental disease for people with disabilities and special needs.(3) Providing dental care to people with special needs often takes more time and specialized skill than providing similar services to healthy and ambulatory patients. According to a 2018 report published by the Legislative Analysts Office, individuals with developmental disabilities are more likely than the general population to lack access to regular dental care across their lifespan.(4) University dental school clinics are important safety net sites, and these clinics are often the last resort for Californias most vulnerable patients to access dental care. These clinics also serve as the training ground for a dental workforce as these individuals prepare to care for medically needy Californians. Moreover, these clinics assume the additional costs associated with this responsibility.(5) University dental school clinics are severely impacted, which results in significant wait times for patients who seek care. Many patients with special health care needs travel for hours to these clinics because the patients cannot receive their dental care anywhere else in the state. These patients frequently face lengthy delays in receiving their treatment.(6) Fully funding university dental school clinics for the unreimbursed cost of providing specialized care to patients with special needs will increase the ability of these clinics to provide care to greater numbers of Medi-Cal beneficiaries and expand access to oral health care in California.(b) It is the intent of the Legislature to authorize public university dental schools to utilize intergovernmental transfers as a means to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.
SECTION 1. (a) The Legislature hereby finds and declares all of the following: (1) People with developmental or intellectual disabilities face numerous barriers to accessing health care and achieving good health.(2) People with disabilities and special needs often have behavioral, cognitive, and physical limitations that can make completing daily health care tasks and receiving regular dental services difficult. These difficulties lead to disproportionate levels of dental disease for people with disabilities and special needs.(3) Providing dental care to people with special needs often takes more time and specialized skill than providing similar services to healthy and ambulatory patients. According to a 2018 report published by the Legislative Analysts Office, individuals with developmental disabilities are more likely than the general population to lack access to regular dental care across their lifespan.(4) University dental school clinics are important safety net sites, and these clinics are often the last resort for Californias most vulnerable patients to access dental care. These clinics also serve as the training ground for a dental workforce as these individuals prepare to care for medically needy Californians. Moreover, these clinics assume the additional costs associated with this responsibility.(5) University dental school clinics are severely impacted, which results in significant wait times for patients who seek care. Many patients with special health care needs travel for hours to these clinics because the patients cannot receive their dental care anywhere else in the state. These patients frequently face lengthy delays in receiving their treatment.(6) Fully funding university dental school clinics for the unreimbursed cost of providing specialized care to patients with special needs will increase the ability of these clinics to provide care to greater numbers of Medi-Cal beneficiaries and expand access to oral health care in California.(b) It is the intent of the Legislature to authorize public university dental schools to utilize intergovernmental transfers as a means to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.
SECTION 1. (a) The Legislature hereby finds and declares all of the following:
### SECTION 1.
(1) People with developmental or intellectual disabilities face numerous barriers to accessing health care and achieving good health.
(2) People with disabilities and special needs often have behavioral, cognitive, and physical limitations that can make completing daily health care tasks and receiving regular dental services difficult. These difficulties lead to disproportionate levels of dental disease for people with disabilities and special needs.
(3) Providing dental care to people with special needs often takes more time and specialized skill than providing similar services to healthy and ambulatory patients. According to a 2018 report published by the Legislative Analysts Office, individuals with developmental disabilities are more likely than the general population to lack access to regular dental care across their lifespan.
(4) University dental school clinics are important safety net sites, and these clinics are often the last resort for Californias most vulnerable patients to access dental care. These clinics also serve as the training ground for a dental workforce as these individuals prepare to care for medically needy Californians. Moreover, these clinics assume the additional costs associated with this responsibility.
(5) University dental school clinics are severely impacted, which results in significant wait times for patients who seek care. Many patients with special health care needs travel for hours to these clinics because the patients cannot receive their dental care anywhere else in the state. These patients frequently face lengthy delays in receiving their treatment.
(6) Fully funding university dental school clinics for the unreimbursed cost of providing specialized care to patients with special needs will increase the ability of these clinics to provide care to greater numbers of Medi-Cal beneficiaries and expand access to oral health care in California.
(b) It is the intent of the Legislature to authorize public university dental schools to utilize intergovernmental transfers as a means to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.
SEC. 2. Section 14164.5 is added to the Welfare and Institutions Code, immediately following Section 14164, to read:14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.
SEC. 2. Section 14164.5 is added to the Welfare and Institutions Code, immediately following Section 14164, to read:
### SEC. 2.
14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.
14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.
14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.
14164.5. (a) The department shall establish, implement, and maintain the Public University Dental School Intergovernmental Transfer Program. Under this program, the department shall authorize public university dental schools to utilize intergovernmental transfers to support the training and dental care that these schools provide to Californias most vulnerable residents who are served by the Medi-Cal Dental Program.
(b) (1) The nonfederal share of the funding may be provided through voluntary, intergovernmental transfers from affected public entities pursuant to Section 14164. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify, in the form and manner specified by the department, that the transferred funds qualify for federal financial participation pursuant to applicable Medicaid program laws. Any intergovernmental transfer of funds made shall be voluntary for purposes of federal law.
(2) Notwithstanding any law, the department shall not assess any fee to reimburse the department for the administrative costs of operating the program and for the support of the Medi-Cal program.
(c) The department shall obtain federal approvals or waivers as necessary to implement this section and to obtain federal matching funds to the maximum extent permitted by federal law. This section shall be implemented only if, and to the extent that, federal financial participation is available and not jeopardized.
(d) 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 policy letters, all-county letters, or similar instructions, without taking further regulatory action. This section does not preclude the department from adopting regulations.