| Old | New | Differences | |
|---|---|---|---|
| 1 | - | ||
| 1 | + | Amended IN Senate June 18, 2019 Amended IN Assembly May 16, 2019 Amended IN Assembly April 03, 2019 Amended IN Assembly March 28, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 526Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Boerner Horvath, Burke, Carrillo, Flora, Kalra, McCarty, Nazarian, Quirk-Silva, Waldron, and Wicks)(Coauthor: Senator Wiener)February 13, 2019 An act to repeal Section 12694 of the Insurance Code, and to add Section 14124.16 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 526, as amended, Petrie-Norris. Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program.Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk.Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify existing WIC enrollment system and Medi-Cal eligibility and enrollment systems to electronically transfer to WIC the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for WIC for the purpose of enrolling those Medi-Cal enrollees in WIC.The bill would, while the automated enrollment pathway is being developed, require the department, in coordination with the WIC Program and local WIC agencies to, among other things, conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program, and to provide specify notices about program eligibility to those persons. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition their implementation on the department obtaining all necessary federal approvals. The bill would also require the department to complete the project approval lifecycle process, as specified, for the automated enrollment gateway pathway prior to implementing these provisions.Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 12694 of the Insurance Code is repealed.SEC. 2. Section 14124.16 is added to the Welfare and Institutions Code, to read:14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program.(b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs.(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings.(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits.(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.(e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.(g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.(2) Providing express lane eligibility to children based on their receipt of WIC benefits.(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.(h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.(i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent.(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment.(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. (i)(j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.(j)(k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section.(k)(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway.(l)(m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.(m)(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section.SEC. 3. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. | |
| 2 | 2 | ||
| 3 | - | ||
| 3 | + | Amended IN Senate June 18, 2019 Amended IN Assembly May 16, 2019 Amended IN Assembly April 03, 2019 Amended IN Assembly March 28, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 526Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Boerner Horvath, Burke, Carrillo, Flora, Kalra, McCarty, Nazarian, Quirk-Silva, Waldron, and Wicks)(Coauthor: Senator Wiener)February 13, 2019 An act to repeal Section 12694 of the Insurance Code, and to add Section 14124.16 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 526, as amended, Petrie-Norris. Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program.Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk.Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify existing WIC enrollment system and Medi-Cal eligibility and enrollment systems to electronically transfer to WIC the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for WIC for the purpose of enrolling those Medi-Cal enrollees in WIC.The bill would, while the automated enrollment pathway is being developed, require the department, in coordination with the WIC Program and local WIC agencies to, among other things, conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program, and to provide specify notices about program eligibility to those persons. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition their implementation on the department obtaining all necessary federal approvals. The bill would also require the department to complete the project approval lifecycle process, as specified, for the automated enrollment gateway pathway prior to implementing these provisions.Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES | |
| 4 | 4 | ||
| 5 | - | ||
| 5 | + | Amended IN Senate June 18, 2019 Amended IN Assembly May 16, 2019 Amended IN Assembly April 03, 2019 Amended IN Assembly March 28, 2019 | |
| 6 | 6 | ||
| 7 | - | Amended IN Senate July 01, 2019 | |
| 8 | 7 | Amended IN Senate June 18, 2019 | |
| 9 | 8 | Amended IN Assembly May 16, 2019 | |
| 10 | 9 | Amended IN Assembly April 03, 2019 | |
| 11 | 10 | Amended IN Assembly March 28, 2019 | |
| 12 | 11 | ||
| 13 | 12 | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION | |
| 14 | 13 | ||
| 15 | 14 | Assembly Bill No. 526 | |
| 16 | 15 | ||
| 17 | 16 | Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Boerner Horvath, Burke, Carrillo, Flora, Kalra, McCarty, Nazarian, Quirk-Silva, Waldron, and Wicks)(Coauthor: Senator Wiener)February 13, 2019 | |
| 18 | 17 | ||
| 19 | 18 | Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Boerner Horvath, Burke, Carrillo, Flora, Kalra, McCarty, Nazarian, Quirk-Silva, Waldron, and Wicks)(Coauthor: Senator Wiener) | |
| 20 | 19 | February 13, 2019 | |
| 21 | 20 | ||
| 22 | 21 | An act to repeal Section 12694 of the Insurance Code, and to add Section 14124.16 to the Welfare and Institutions Code, relating to Medi-Cal. | |
| 23 | 22 | ||
| 24 | 23 | LEGISLATIVE COUNSEL'S DIGEST | |
| 25 | 24 | ||
| 26 | 25 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 27 | 26 | ||
| 28 | 27 | AB 526, as amended, Petrie-Norris. Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children. | |
| 29 | 28 | ||
| 30 | - | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program.Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk.Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify | |
| 29 | + | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program.Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk.Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify existing WIC enrollment system and Medi-Cal eligibility and enrollment systems to electronically transfer to WIC the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for WIC for the purpose of enrolling those Medi-Cal enrollees in WIC.The bill would, while the automated enrollment pathway is being developed, require the department, in coordination with the WIC Program and local WIC agencies to, among other things, conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program, and to provide specify notices about program eligibility to those persons. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition their implementation on the department obtaining all necessary federal approvals. The bill would also require the department to complete the project approval lifecycle process, as specified, for the automated enrollment gateway pathway prior to implementing these provisions.Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. | |
| 31 | 30 | ||
| 32 | 31 | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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. | |
| 33 | 32 | ||
| 34 | 33 | Existing federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program. | |
| 35 | 34 | ||
| 36 | 35 | Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk. | |
| 37 | 36 | ||
| 38 | 37 | Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified. | |
| 39 | 38 | ||
| 40 | - | This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify | |
| 39 | + | This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify existing WIC enrollment system and Medi-Cal eligibility and enrollment systems to electronically transfer to WIC the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for WIC for the purpose of enrolling those Medi-Cal enrollees in WIC. | |
| 41 | 40 | ||
| 42 | - | The bill would, while the automated enrollment pathway is being developed, require the department, in coordination with the WIC Program and local WIC agencies to, among other things, conduct regular data matches to identify which WIC recipients are not enrolled in | |
| 41 | + | The bill would, while the automated enrollment pathway is being developed, require the department, in coordination with the WIC Program and local WIC agencies to, among other things, conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program, and to provide specify notices about program eligibility to those persons. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition their implementation on the department obtaining all necessary federal approvals. The bill would also require the department to complete the project approval lifecycle process, as specified, for the automated enrollment gateway pathway prior to implementing these provisions. | |
| 43 | 42 | ||
| 44 | 43 | Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, this bill would impose a state-mandated local program. | |
| 45 | 44 | ||
| 46 | 45 | The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. | |
| 47 | 46 | ||
| 48 | 47 | This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. | |
| 49 | 48 | ||
| 50 | 49 | ## Digest Key | |
| 51 | 50 | ||
| 52 | 51 | ## Bill Text | |
| 53 | 52 | ||
| 54 | - | The people of the State of California do enact as follows:SECTION 1. Section 12694 of the Insurance Code is repealed.SEC. 2. Section 14124.16 is added to the Welfare and Institutions Code, to read:14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health | |
| 53 | + | The people of the State of California do enact as follows:SECTION 1. Section 12694 of the Insurance Code is repealed.SEC. 2. Section 14124.16 is added to the Welfare and Institutions Code, to read:14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program.(b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs.(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings.(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits.(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.(e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.(g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.(2) Providing express lane eligibility to children based on their receipt of WIC benefits.(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.(h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.(i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent.(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment.(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. (i)(j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.(j)(k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section.(k)(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway.(l)(m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.(m)(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section.SEC. 3. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. | |
| 55 | 54 | ||
| 56 | 55 | The people of the State of California do enact as follows: | |
| 57 | 56 | ||
| 58 | 57 | ## The people of the State of California do enact as follows: | |
| 59 | 58 | ||
| 60 | 59 | SECTION 1. Section 12694 of the Insurance Code is repealed. | |
| 61 | 60 | ||
| 62 | 61 | SECTION 1. Section 12694 of the Insurance Code is repealed. | |
| 63 | 62 | ||
| 64 | 63 | ### SECTION 1. | |
| 65 | 64 | ||
| 66 | 65 | ||
| 67 | 66 | ||
| 68 | - | SEC. 2. Section 14124.16 is added to the Welfare and Institutions Code, to read:14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health | |
| 67 | + | SEC. 2. Section 14124.16 is added to the Welfare and Institutions Code, to read:14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program.(b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs.(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings.(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits.(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.(e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.(g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.(2) Providing express lane eligibility to children based on their receipt of WIC benefits.(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.(h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.(i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent.(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment.(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. (i)(j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.(j)(k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section.(k)(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway.(l)(m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.(m)(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section. | |
| 69 | 68 | ||
| 70 | 69 | SEC. 2. Section 14124.16 is added to the Welfare and Institutions Code, to read: | |
| 71 | 70 | ||
| 72 | 71 | ### SEC. 2. | |
| 73 | 72 | ||
| 74 | - | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health | |
| 73 | + | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program.(b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs.(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings.(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits.(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.(e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.(g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.(2) Providing express lane eligibility to children based on their receipt of WIC benefits.(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.(h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.(i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent.(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment.(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. (i)(j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.(j)(k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section.(k)(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway.(l)(m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.(m)(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section. | |
| 75 | 74 | ||
| 76 | - | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health | |
| 75 | + | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program.(b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs.(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings.(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits.(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.(e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.(g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.(2) Providing express lane eligibility to children based on their receipt of WIC benefits.(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.(h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.(i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent.(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment.(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. (i)(j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.(j)(k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section.(k)(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway.(l)(m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.(m)(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section. | |
| 77 | 76 | ||
| 78 | - | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health | |
| 77 | + | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program.(B) Using the WIC application signature as an application signature for the Medi-Cal program.(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program.(b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs.(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings.(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits.(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.(e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.(g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.(2) Providing express lane eligibility to children based on their receipt of WIC benefits.(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.(h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.(i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent.(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment.(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. (i)(j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.(j)(k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section.(k)(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway.(l)(m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.(m)(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section. | |
| 79 | 78 | ||
| 80 | 79 | ||
| 81 | 80 | ||
| 82 | - | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment pathway developed by the department that performs, but is not limited to performing, all of the following functions: | |
| 81 | + | 14124.16. (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway pathway developed by the department that performs, but is not limited to performing, all of the following functions: | |
| 83 | 82 | ||
| 84 | 83 | (1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act. | |
| 85 | 84 | ||
| 86 | - | (2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards. | |
| 85 | + | (2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility records findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals receipt of Medi-Cal health care coverage, coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards. | |
| 87 | 86 | ||
| 88 | 87 | (3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following: | |
| 89 | 88 | ||
| 90 | - | (A) Using the WIC Programs final findings of household income to verify financial eligibility for the Medi-Cal program. | |
| 89 | + | (A) Using the WIC Programs final findings of household income to verify adults financial eligibility for the Medi-Cal program. | |
| 91 | 90 | ||
| 92 | 91 | (B) Using the WIC application signature as an application signature for the Medi-Cal program. | |
| 93 | 92 | ||
| 94 | - | (4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health | |
| 93 | + | (4) Modifying the existing WIC enrollment system and the single streamlined application of the California Health Eligibility, Enrollment, and Renewal System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled. | |
| 95 | 94 | ||
| 96 | 95 | (5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law. | |
| 97 | 96 | ||
| 98 | - | (6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program. | |
| 97 | + | (6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of enrolling those individuals in the WIC Program. | |
| 99 | 98 | ||
| 100 | - | (b) The automated enrollment pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi- | |
| 99 | + | (b) The automated enrollment gateway pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Calprogram. and WIC programs. | |
| 101 | 100 | ||
| 102 | 101 | (c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following: | |
| 103 | 102 | ||
| 104 | - | (1) Using simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings. | |
| 103 | + | (1) Using opt-out simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings. | |
| 105 | 104 | ||
| 106 | 105 | (2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals: | |
| 107 | 106 | ||
| 108 | 107 | (A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying womens Medi-Cal eligibility based on WIC findings. | |
| 109 | 108 | ||
| 110 | - | (B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits. | |
| 109 | + | (B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits immediately. benefits. | |
| 111 | 110 | ||
| 112 | - | (d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8. | |
| 111 | + | (d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment gateway pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8. | |
| 113 | 112 | ||
| 114 | - | (e) Operation of the automated enrollment pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation. | |
| 113 | + | (e) Operation of the automated enrollment gateway pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment gateway pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation. | |
| 115 | 114 | ||
| 116 | 115 | (f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination. | |
| 117 | 116 | ||
| 118 | - | (g) To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following: | |
| 117 | + | (g) When implementing the WIC to Medi-Cal automated enrollment gateway pathway, WIC agencies shall, after receiving consent from WIC recipients, electronically transmit to the Medi-Cal program all potentially relevant eligibility information from WIC records about individuals who receive WIC benefits but not Medi-Cal benefits based on a targeted data match, through which eligibility for the Medi-Cal program shall be determined for those WIC recipients. To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following: | |
| 119 | 118 | ||
| 120 | 119 | (1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation. | |
| 121 | 120 | ||
| 122 | 121 | (2) Providing express lane eligibility to children based on their receipt of WIC benefits. | |
| 123 | 122 | ||
| 124 | 123 | (3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women. | |
| 125 | 124 | ||
| 126 | - | (h) The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility. | |
| 125 | + | (h) Counties The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment gateway pathway for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility. | |
| 127 | 126 | ||
| 128 | 127 | (i) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following: | |
| 129 | 128 | ||
| 130 | 129 | (1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program. | |
| 131 | 130 | ||
| 132 | 131 | (2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipients consent. | |
| 133 | 132 | ||
| 134 | - | (B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up | |
| 133 | + | (B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the follow-up process necessary to complete WIC enrollment. | |
| 135 | 134 | ||
| 136 | 135 | (3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination. | |
| 137 | 136 | ||
| 137 | + | (i) | |
| 138 | + | ||
| 139 | + | ||
| 140 | + | ||
| 138 | 141 | (j) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider. | |
| 139 | 142 | ||
| 140 | - | ( | |
| 143 | + | (j) | |
| 141 | 144 | ||
| 142 | - | (l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment pathway. | |
| 145 | + | ||
| 146 | + | ||
| 147 | + | (k) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway pathway as described in this section. | |
| 148 | + | ||
| 149 | + | (k) | |
| 150 | + | ||
| 151 | + | ||
| 152 | + | ||
| 153 | + | (l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment gateway pathway. | |
| 154 | + | ||
| 155 | + | (l) | |
| 156 | + | ||
| 157 | + | ||
| 143 | 158 | ||
| 144 | 159 | (m) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained. | |
| 145 | 160 | ||
| 146 | - | (n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment pathway prior to implementing this section. | |
| 161 | + | (m) | |
| 162 | + | ||
| 163 | + | ||
| 164 | + | ||
| 165 | + | (n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment gateway pathway prior to implementing this section. | |
| 147 | 166 | ||
| 148 | 167 | SEC. 3. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. | |
| 149 | 168 | ||
| 150 | 169 | SEC. 3. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. | |
| 151 | 170 | ||
| 152 | 171 | SEC. 3. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. | |
| 153 | 172 | ||
| 154 | 173 | ### SEC. 3. |