| 1 | | - | Amended IN Senate August 18, 2022 Amended IN Senate August 11, 2022 Amended IN Senate June 27, 2022 Amended IN Assembly March 17, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2402Introduced by Assembly Member Blanca Rubio(Coauthor: Assembly Member Wood)(Coauthor: Senator Rubio)February 17, 2022 An act to amend Section 15853 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2402, as amended, Blanca Rubio. Medi-Cal: continuous eligibility.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.Under existing law, beginning no earlier than January 1, 2025, a child under 5 years of age is continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age, subject to specified circumstances. Existing law makes this provision contingent on obtaining all necessary federal approvals, an appropriation, and a determination by the department that systems have been programmed to implement certain provisions.Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.This bill would require require, beginning no earlier than January 1, 2025, that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. approvals, an appropriation, and a determination by the department, as described above. The bill would also remove the above-described reference to citizenship and immigration status requirements.Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the 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 15853 of the Welfare and Institutions Code is amended to read:15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(A) Implementation of this paragraph is contingent on all of the following conditions:(i) Any necessary federal approvals for that continuous eligibility have been obtained by the department.(ii) The Legislature has appropriated funding to implement Section 14005.255 after a determination that ongoing General Fund resources are available to support the ongoing implementation of Section 14005.255 in the 202425 fiscal year and subsequent fiscal years.(iii) The department has determined that systems have been programmed to implement Section 14005.255.(B) The department shall issue a declaration certifying the date that all conditions in subparagraph (A) have been met. The department shall post the declaration on its internet website and provide a copy of the declaration to the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel. This paragraph shall become operative on January 1, 2025, or the date certified by the department pursuant to this subparagraph, whichever is later.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board.SEC. 2. 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. |
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| 1 | + | Amended IN Senate August 11, 2022 Amended IN Senate June 27, 2022 Amended IN Assembly March 17, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2402Introduced by Assembly Member Blanca Rubio(Coauthor: Assembly Member Wood)(Coauthor: Senator Rubio)February 17, 2022 An act to amend Sections 15832, 15840, and 15853 of, and to add Section 14005.255 to, Section 15853 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2402, as amended, Blanca Rubio. Medi-Cal: continuous eligibility.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 law requires the department, to the extent federal financial participation is available, to exercise a federal option to extend continuous eligibility to children 19 years of age and younger until the earlier of either the end of a 12-month period following the eligibility determination or the date the child exceeds 19 years of age.Under this bill, a child under 5 years of age would be continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age. The bill would prohibit the redetermination of Medi-Cal eligibility before the child reaches 5 years of age, unless the department or county possesses facts indicating that the family has requested the childs voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the childs original enrollment was based on a state or county error or on fraud, abuse, or perjury, as specified. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and, except as specified, on the availability of federal financial participation.Existing law establishes the Medi-Cal Access Program, which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is above 208% but does not exceed 317% of the federal poverty level, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified. Existing law requires a subscriber to provide income information at the end of 12 months of coverage, and requires that the infant be disenrolled from the program if the annual household income exceeds 317% of the federal poverty level or if the infant is eligible for full-scope Medi-Cal with no share of cost.This bill would remove the requirement for providing income information at the end of the 12 months, and would instead require that the infant remain continuously eligible for the Medi-Cal program until they are 5 years of age, as specified, to the extent that any necessary federal approvals are obtained and federal financial participation is available.Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.This bill would require that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. The bill would also remove the above-described reference to citizenship and immigration status requirements.Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the 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 14005.255 is added to the Welfare and Institutions Code, to read:14005.255.(a)(1)Notwithstanding Section 14005.25, a child under five years of age is continuously eligible for Medi-Cal, including without regard to income, until the child reaches five years of age.(2)A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, unless the department or county possesses facts indicating that the family has requested the childs voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the childs original enrollment was based on a state or county error or on fraud, abuse, or perjury attributed to the child or the childs representative.(b)(1)The department shall seek any necessary federal approvals to implement subdivision (a).(2)(A)Subdivision (a) shall be implemented to the extent that any necessary federal approvals are obtained.(B)Subdivision (a) shall be implemented to the extent that federal financial participation is available, except as specified in subdivision (c) of Section 14007.8 regarding state funds used for purposes of children eligible for Medi-Cal pursuant to subdivision (a) of Section 14007.8.SEC. 2.Section 15832 of the Welfare and Institutions Code is amended to read:15832.(a)To be eligible to participate in the program, a person shall meet all of the requirements in either paragraph (1) or (2):(1)(A)Be a woman who is pregnant or in her postpartum period as specified in Section 15840 and who is a resident of the state. A person who is a member of a federally recognized California Indian tribe is a resident of the state for these purposes.(B)Have a household income that is above 208 percent of the official federal poverty level but does not exceed 317 percent of the official federal poverty level.(C)Agree to the payment of the complete subscriber contribution. A federally recognized California Indian tribal government may make the subscriber contributions on behalf of a member of the tribe only if a contribution on behalf of members of federally recognized California Indian tribes does not limit or preclude federal financial participation under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.). If a federally recognized California Indian tribal government makes a contribution on behalf of a member of the tribe, the tribal government shall ensure that the subscriber is made aware of all the health care delivery options available in the county where the member resides.(2)(A)Be a child under two years of age who is delivered by a mother enrolled in the program under this chapter. Except as stated in this section, these infants shall be automatically enrolled in the program.(B)For the applicable month, not be enrolled in employer-sponsored health care coverage, or have been enrolled in that health care coverage in the prior three months or enrolled in full-scope Medi-Cal without a share of cost. Exceptions may be identified in regulations or other guidance and shall, at minimum, include all exceptions applicable to the Healthy Families Program on and after March 23, 2010.(C)Be subject to subscriber contributions as determined by the department.(3)For infants identified in paragraph (2), all of the following shall apply:(A)Enrollment in the program shall cover the first 12 months of the infants life unless the infant is determined eligible for Medi-Cal benefits under Section 14005.26. An infant shall be screened for eligibility under Section 14005.26 immediately after the infant is born. If the infant is eligible under Section 14005.26, the infant shall be automatically enrolled in the Medi-Cal program on that basis.(B)(i)At the end of the 12 months, the infant shall remain continuously eligible for the Medi-Cal program until they are five years of age. A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, except as specified in Section 14005.255. This clause shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available. The department shall seek any necessary federal approvals to implement this clause.(ii)Effective January 1, 2014, when determining eligibility for benefits under the program, income shall be determined, counted, and valued in accordance with the requirements of Section 1397bb(b)(1)(B) of Title 42 of the United States Code as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments.(C)At the end of their first and second year in the program, infants shall be screened for eligibility for the Medi-Cal program.(4)If at any time the director determines that the eligibility criteria established under this chapter for the program may jeopardize the states ability to receive federal financial participation under the federal Patient Protection and Affordable Care Act (Public Law 111-148), or any amendment or extension of that act, the director may alter the eligibility criteria to the extent necessary for the state to receive that federal financial participation.(b)This section shall become operative on July 1, 2014.SEC. 3.Section 15840 of the Welfare and Institutions Code is amended to read:15840.(a)(1)At a minimum, coverage provided pursuant to this chapter shall be provided to subscribers during one pregnancy, and until the end of the month in which the 60th day after pregnancy occurs, and to eligible children less than two years of age, or less than five years of age pursuant to Section 15832, who were born of a pregnancy covered under this program or the Access for Infants and Mothers program under former Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code to a woman enrolled in the Access for Infants and Mothers program.(2)(A)Upon the effective date reflected in any necessary federal approvals obtained by the department pursuant to subdivision (c) of Section 14005.185, a subscriber described in paragraph (1) shall be eligible for an additional 10-month period following the 60-day postpartum period, for a total of 12 months of continuous eligibility after the end of pregnancy.(B)This paragraph shall be implemented only if, and to the extent that, any necessary federal approvals are obtained pursuant to Section 14005.185 and federal financial participation is available, and subject to an annual appropriation by the Legislature for this purpose.(b)Coverage provided pursuant to this chapter shall include, at a minimum, those services required to be provided by health care service plans approved by the Secretary of Health and Human Services as a federally qualified health care service plan pursuant to Section 417.101 of Title 42 of the Code of Federal Regulations.(c)Medically necessary prescription drugs shall be a required benefit in the coverage provided pursuant to this chapter.(d)To the extent required pursuant to Section 15818 to comply with paragraph (1) of subdivision (b) of Section 30122 of the Revenue and Taxation Code, health education services related to tobacco use shall be a benefit in the coverage provided under this chapter.SEC. 4.SECTION 1. Section 15853 of the Welfare and Institutions Code is amended to read:15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board.SEC. 5.SEC. 2. 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. |
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| 3 | | - | Amended IN Senate August 18, 2022 Amended IN Senate August 11, 2022 Amended IN Senate June 27, 2022 Amended IN Assembly March 17, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2402Introduced by Assembly Member Blanca Rubio(Coauthor: Assembly Member Wood)(Coauthor: Senator Rubio)February 17, 2022 An act to amend Section 15853 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2402, as amended, Blanca Rubio. Medi-Cal: continuous eligibility.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.Under existing law, beginning no earlier than January 1, 2025, a child under 5 years of age is continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age, subject to specified circumstances. Existing law makes this provision contingent on obtaining all necessary federal approvals, an appropriation, and a determination by the department that systems have been programmed to implement certain provisions.Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.This bill would require require, beginning no earlier than January 1, 2025, that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. approvals, an appropriation, and a determination by the department, as described above. The bill would also remove the above-described reference to citizenship and immigration status requirements.Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the 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 |
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| 3 | + | Amended IN Senate August 11, 2022 Amended IN Senate June 27, 2022 Amended IN Assembly March 17, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2402Introduced by Assembly Member Blanca Rubio(Coauthor: Assembly Member Wood)(Coauthor: Senator Rubio)February 17, 2022 An act to amend Sections 15832, 15840, and 15853 of, and to add Section 14005.255 to, Section 15853 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2402, as amended, Blanca Rubio. Medi-Cal: continuous eligibility.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 law requires the department, to the extent federal financial participation is available, to exercise a federal option to extend continuous eligibility to children 19 years of age and younger until the earlier of either the end of a 12-month period following the eligibility determination or the date the child exceeds 19 years of age.Under this bill, a child under 5 years of age would be continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age. The bill would prohibit the redetermination of Medi-Cal eligibility before the child reaches 5 years of age, unless the department or county possesses facts indicating that the family has requested the childs voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the childs original enrollment was based on a state or county error or on fraud, abuse, or perjury, as specified. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and, except as specified, on the availability of federal financial participation.Existing law establishes the Medi-Cal Access Program, which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is above 208% but does not exceed 317% of the federal poverty level, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified. Existing law requires a subscriber to provide income information at the end of 12 months of coverage, and requires that the infant be disenrolled from the program if the annual household income exceeds 317% of the federal poverty level or if the infant is eligible for full-scope Medi-Cal with no share of cost.This bill would remove the requirement for providing income information at the end of the 12 months, and would instead require that the infant remain continuously eligible for the Medi-Cal program until they are 5 years of age, as specified, to the extent that any necessary federal approvals are obtained and federal financial participation is available.Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.This bill would require that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. The bill would also remove the above-described reference to citizenship and immigration status requirements.Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the 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 |
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| 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.Under existing law, beginning no earlier than January 1, 2025, a child under 5 years of age is continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age, subject to specified circumstances. Existing law makes this provision contingent on obtaining all necessary federal approvals, an appropriation, and a determination by the department that systems have been programmed to implement certain provisions.Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.This bill would require require, beginning no earlier than January 1, 2025, that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. approvals, an appropriation, and a determination by the department, as described above. The bill would also remove the above-described reference to citizenship and immigration status requirements.Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the 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. |
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| 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 law requires the department, to the extent federal financial participation is available, to exercise a federal option to extend continuous eligibility to children 19 years of age and younger until the earlier of either the end of a 12-month period following the eligibility determination or the date the child exceeds 19 years of age.Under this bill, a child under 5 years of age would be continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age. The bill would prohibit the redetermination of Medi-Cal eligibility before the child reaches 5 years of age, unless the department or county possesses facts indicating that the family has requested the childs voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the childs original enrollment was based on a state or county error or on fraud, abuse, or perjury, as specified. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and, except as specified, on the availability of federal financial participation.Existing law establishes the Medi-Cal Access Program, which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is above 208% but does not exceed 317% of the federal poverty level, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified. Existing law requires a subscriber to provide income information at the end of 12 months of coverage, and requires that the infant be disenrolled from the program if the annual household income exceeds 317% of the federal poverty level or if the infant is eligible for full-scope Medi-Cal with no share of cost.This bill would remove the requirement for providing income information at the end of the 12 months, and would instead require that the infant remain continuously eligible for the Medi-Cal program until they are 5 years of age, as specified, to the extent that any necessary federal approvals are obtained and federal financial participation is available.Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.This bill would require that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. The bill would also remove the above-described reference to citizenship and immigration status requirements.Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the 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. |
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| 51 | | - | The people of the State of California do enact as follows:SECTION 1. Section 15853 of the Welfare and Institutions Code is amended to read:15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(A) Implementation of this paragraph is contingent on all of the following conditions:(i) Any necessary federal approvals for that continuous eligibility have been obtained by the department.(ii) The Legislature has appropriated funding to implement Section 14005.255 after a determination that ongoing General Fund resources are available to support the ongoing implementation of Section 14005.255 in the 202425 fiscal year and subsequent fiscal years.(iii) The department has determined that systems have been programmed to implement Section 14005.255.(B) The department shall issue a declaration certifying the date that all conditions in subparagraph (A) have been met. The department shall post the declaration on its internet website and provide a copy of the declaration to the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel. This paragraph shall become operative on January 1, 2025, or the date certified by the department pursuant to this subparagraph, whichever is later.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board.SEC. 2. 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. |
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| 64 | + | The people of the State of California do enact as follows:SECTION 1.Section 14005.255 is added to the Welfare and Institutions Code, to read:14005.255.(a)(1)Notwithstanding Section 14005.25, a child under five years of age is continuously eligible for Medi-Cal, including without regard to income, until the child reaches five years of age.(2)A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, unless the department or county possesses facts indicating that the family has requested the childs voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the childs original enrollment was based on a state or county error or on fraud, abuse, or perjury attributed to the child or the childs representative.(b)(1)The department shall seek any necessary federal approvals to implement subdivision (a).(2)(A)Subdivision (a) shall be implemented to the extent that any necessary federal approvals are obtained.(B)Subdivision (a) shall be implemented to the extent that federal financial participation is available, except as specified in subdivision (c) of Section 14007.8 regarding state funds used for purposes of children eligible for Medi-Cal pursuant to subdivision (a) of Section 14007.8.SEC. 2.Section 15832 of the Welfare and Institutions Code is amended to read:15832.(a)To be eligible to participate in the program, a person shall meet all of the requirements in either paragraph (1) or (2):(1)(A)Be a woman who is pregnant or in her postpartum period as specified in Section 15840 and who is a resident of the state. A person who is a member of a federally recognized California Indian tribe is a resident of the state for these purposes.(B)Have a household income that is above 208 percent of the official federal poverty level but does not exceed 317 percent of the official federal poverty level.(C)Agree to the payment of the complete subscriber contribution. A federally recognized California Indian tribal government may make the subscriber contributions on behalf of a member of the tribe only if a contribution on behalf of members of federally recognized California Indian tribes does not limit or preclude federal financial participation under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.). If a federally recognized California Indian tribal government makes a contribution on behalf of a member of the tribe, the tribal government shall ensure that the subscriber is made aware of all the health care delivery options available in the county where the member resides.(2)(A)Be a child under two years of age who is delivered by a mother enrolled in the program under this chapter. Except as stated in this section, these infants shall be automatically enrolled in the program.(B)For the applicable month, not be enrolled in employer-sponsored health care coverage, or have been enrolled in that health care coverage in the prior three months or enrolled in full-scope Medi-Cal without a share of cost. Exceptions may be identified in regulations or other guidance and shall, at minimum, include all exceptions applicable to the Healthy Families Program on and after March 23, 2010.(C)Be subject to subscriber contributions as determined by the department.(3)For infants identified in paragraph (2), all of the following shall apply:(A)Enrollment in the program shall cover the first 12 months of the infants life unless the infant is determined eligible for Medi-Cal benefits under Section 14005.26. An infant shall be screened for eligibility under Section 14005.26 immediately after the infant is born. If the infant is eligible under Section 14005.26, the infant shall be automatically enrolled in the Medi-Cal program on that basis.(B)(i)At the end of the 12 months, the infant shall remain continuously eligible for the Medi-Cal program until they are five years of age. A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, except as specified in Section 14005.255. This clause shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available. The department shall seek any necessary federal approvals to implement this clause.(ii)Effective January 1, 2014, when determining eligibility for benefits under the program, income shall be determined, counted, and valued in accordance with the requirements of Section 1397bb(b)(1)(B) of Title 42 of the United States Code as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments.(C)At the end of their first and second year in the program, infants shall be screened for eligibility for the Medi-Cal program.(4)If at any time the director determines that the eligibility criteria established under this chapter for the program may jeopardize the states ability to receive federal financial participation under the federal Patient Protection and Affordable Care Act (Public Law 111-148), or any amendment or extension of that act, the director may alter the eligibility criteria to the extent necessary for the state to receive that federal financial participation.(b)This section shall become operative on July 1, 2014.SEC. 3.Section 15840 of the Welfare and Institutions Code is amended to read:15840.(a)(1)At a minimum, coverage provided pursuant to this chapter shall be provided to subscribers during one pregnancy, and until the end of the month in which the 60th day after pregnancy occurs, and to eligible children less than two years of age, or less than five years of age pursuant to Section 15832, who were born of a pregnancy covered under this program or the Access for Infants and Mothers program under former Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code to a woman enrolled in the Access for Infants and Mothers program.(2)(A)Upon the effective date reflected in any necessary federal approvals obtained by the department pursuant to subdivision (c) of Section 14005.185, a subscriber described in paragraph (1) shall be eligible for an additional 10-month period following the 60-day postpartum period, for a total of 12 months of continuous eligibility after the end of pregnancy.(B)This paragraph shall be implemented only if, and to the extent that, any necessary federal approvals are obtained pursuant to Section 14005.185 and federal financial participation is available, and subject to an annual appropriation by the Legislature for this purpose.(b)Coverage provided pursuant to this chapter shall include, at a minimum, those services required to be provided by health care service plans approved by the Secretary of Health and Human Services as a federally qualified health care service plan pursuant to Section 417.101 of Title 42 of the Code of Federal Regulations.(c)Medically necessary prescription drugs shall be a required benefit in the coverage provided pursuant to this chapter.(d)To the extent required pursuant to Section 15818 to comply with paragraph (1) of subdivision (b) of Section 30122 of the Revenue and Taxation Code, health education services related to tobacco use shall be a benefit in the coverage provided under this chapter.SEC. 4.SECTION 1. Section 15853 of the Welfare and Institutions Code is amended to read:15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board.SEC. 5.SEC. 2. 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. |
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| 67 | | - | 15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(A) Implementation of this paragraph is contingent on all of the following conditions:(i) Any necessary federal approvals for that continuous eligibility have been obtained by the department.(ii) The Legislature has appropriated funding to implement Section 14005.255 after a determination that ongoing General Fund resources are available to support the ongoing implementation of Section 14005.255 in the 202425 fiscal year and subsequent fiscal years.(iii) The department has determined that systems have been programmed to implement Section 14005.255.(B) The department shall issue a declaration certifying the date that all conditions in subparagraph (A) have been met. The department shall post the declaration on its internet website and provide a copy of the declaration to the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel. This paragraph shall become operative on January 1, 2025, or the date certified by the department pursuant to this subparagraph, whichever is later.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board. |
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| 76 | + | |
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| 77 | + | |
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| 78 | + | (2)A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, unless the department or county possesses facts indicating that the family has requested the childs voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the childs original enrollment was based on a state or county error or on fraud, abuse, or perjury attributed to the child or the childs representative. |
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| 79 | + | |
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| 80 | + | |
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| 81 | + | |
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| 82 | + | (b)(1)The department shall seek any necessary federal approvals to implement subdivision (a). |
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| 83 | + | |
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| 84 | + | |
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| 85 | + | |
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| 86 | + | (2)(A)Subdivision (a) shall be implemented to the extent that any necessary federal approvals are obtained. |
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| 87 | + | |
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| 88 | + | |
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| 89 | + | |
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| 90 | + | (B)Subdivision (a) shall be implemented to the extent that federal financial participation is available, except as specified in subdivision (c) of Section 14007.8 regarding state funds used for purposes of children eligible for Medi-Cal pursuant to subdivision (a) of Section 14007.8. |
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| 91 | + | |
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| 92 | + | |
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| 93 | + | |
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| 94 | + | |
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| 95 | + | |
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| 96 | + | |
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| 97 | + | |
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| 98 | + | (a)To be eligible to participate in the program, a person shall meet all of the requirements in either paragraph (1) or (2): |
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| 99 | + | |
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| 100 | + | |
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| 101 | + | |
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| 102 | + | (1)(A)Be a woman who is pregnant or in her postpartum period as specified in Section 15840 and who is a resident of the state. A person who is a member of a federally recognized California Indian tribe is a resident of the state for these purposes. |
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| 103 | + | |
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| 104 | + | |
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| 105 | + | |
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| 106 | + | (B)Have a household income that is above 208 percent of the official federal poverty level but does not exceed 317 percent of the official federal poverty level. |
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| 107 | + | |
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| 108 | + | |
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| 109 | + | |
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| 110 | + | (C)Agree to the payment of the complete subscriber contribution. A federally recognized California Indian tribal government may make the subscriber contributions on behalf of a member of the tribe only if a contribution on behalf of members of federally recognized California Indian tribes does not limit or preclude federal financial participation under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.). If a federally recognized California Indian tribal government makes a contribution on behalf of a member of the tribe, the tribal government shall ensure that the subscriber is made aware of all the health care delivery options available in the county where the member resides. |
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| 111 | + | |
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| 112 | + | |
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| 113 | + | |
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| 114 | + | (2)(A)Be a child under two years of age who is delivered by a mother enrolled in the program under this chapter. Except as stated in this section, these infants shall be automatically enrolled in the program. |
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| 115 | + | |
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| 116 | + | |
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| 117 | + | |
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| 118 | + | (B)For the applicable month, not be enrolled in employer-sponsored health care coverage, or have been enrolled in that health care coverage in the prior three months or enrolled in full-scope Medi-Cal without a share of cost. Exceptions may be identified in regulations or other guidance and shall, at minimum, include all exceptions applicable to the Healthy Families Program on and after March 23, 2010. |
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| 119 | + | |
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| 120 | + | |
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| 121 | + | |
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| 122 | + | (C)Be subject to subscriber contributions as determined by the department. |
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| 123 | + | |
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| 124 | + | |
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| 125 | + | |
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| 126 | + | (3)For infants identified in paragraph (2), all of the following shall apply: |
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| 127 | + | |
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| 128 | + | |
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| 129 | + | |
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| 130 | + | (A)Enrollment in the program shall cover the first 12 months of the infants life unless the infant is determined eligible for Medi-Cal benefits under Section 14005.26. An infant shall be screened for eligibility under Section 14005.26 immediately after the infant is born. If the infant is eligible under Section 14005.26, the infant shall be automatically enrolled in the Medi-Cal program on that basis. |
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| 131 | + | |
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| 132 | + | |
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| 133 | + | |
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| 134 | + | (B)(i)At the end of the 12 months, the infant shall remain continuously eligible for the Medi-Cal program until they are five years of age. A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, except as specified in Section 14005.255. This clause shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available. The department shall seek any necessary federal approvals to implement this clause. |
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| 135 | + | |
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| 136 | + | |
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| 137 | + | |
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| 138 | + | (ii)Effective January 1, 2014, when determining eligibility for benefits under the program, income shall be determined, counted, and valued in accordance with the requirements of Section 1397bb(b)(1)(B) of Title 42 of the United States Code as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments. |
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| 139 | + | |
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| 140 | + | |
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| 141 | + | |
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| 142 | + | (C)At the end of their first and second year in the program, infants shall be screened for eligibility for the Medi-Cal program. |
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| 143 | + | |
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| 144 | + | |
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| 145 | + | |
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| 146 | + | (4)If at any time the director determines that the eligibility criteria established under this chapter for the program may jeopardize the states ability to receive federal financial participation under the federal Patient Protection and Affordable Care Act (Public Law 111-148), or any amendment or extension of that act, the director may alter the eligibility criteria to the extent necessary for the state to receive that federal financial participation. |
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| 147 | + | |
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| 148 | + | |
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| 149 | + | |
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| 150 | + | (b)This section shall become operative on July 1, 2014. |
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| 151 | + | |
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| 152 | + | |
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| 153 | + | |
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| 154 | + | |
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| 155 | + | |
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| 156 | + | |
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| 157 | + | |
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| 158 | + | (a)(1)At a minimum, coverage provided pursuant to this chapter shall be provided to subscribers during one pregnancy, and until the end of the month in which the 60th day after pregnancy occurs, and to eligible children less than two years of age, or less than five years of age pursuant to Section 15832, who were born of a pregnancy covered under this program or the Access for Infants and Mothers program under former Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code to a woman enrolled in the Access for Infants and Mothers program. |
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| 159 | + | |
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| 160 | + | |
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| 161 | + | |
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| 162 | + | (2)(A)Upon the effective date reflected in any necessary federal approvals obtained by the department pursuant to subdivision (c) of Section 14005.185, a subscriber described in paragraph (1) shall be eligible for an additional 10-month period following the 60-day postpartum period, for a total of 12 months of continuous eligibility after the end of pregnancy. |
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| 163 | + | |
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| 164 | + | |
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| 165 | + | |
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| 166 | + | (B)This paragraph shall be implemented only if, and to the extent that, any necessary federal approvals are obtained pursuant to Section 14005.185 and federal financial participation is available, and subject to an annual appropriation by the Legislature for this purpose. |
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| 167 | + | |
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| 168 | + | |
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| 169 | + | |
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| 170 | + | (b)Coverage provided pursuant to this chapter shall include, at a minimum, those services required to be provided by health care service plans approved by the Secretary of Health and Human Services as a federally qualified health care service plan pursuant to Section 417.101 of Title 42 of the Code of Federal Regulations. |
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| 171 | + | |
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| 172 | + | |
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| 173 | + | |
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| 174 | + | (c)Medically necessary prescription drugs shall be a required benefit in the coverage provided pursuant to this chapter. |
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| 175 | + | |
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| 176 | + | |
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| 177 | + | |
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| 178 | + | (d)To the extent required pursuant to Section 15818 to comply with paragraph (1) of subdivision (b) of Section 30122 of the Revenue and Taxation Code, health education services related to tobacco use shall be a benefit in the coverage provided under this chapter. |
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| 179 | + | |
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| 180 | + | |
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| 181 | + | |
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| 182 | + | SEC. 4.SECTION 1. Section 15853 of the Welfare and Institutions Code is amended to read:15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board. |
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| 183 | + | |
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| 184 | + | SEC. 4.SECTION 1. Section 15853 of the Welfare and Institutions Code is amended to read: |
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| 185 | + | |
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| 186 | + | ### SEC. 4.SECTION 1. |
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| 187 | + | |
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| 188 | + | 15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board. |
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| 189 | + | |
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| 190 | + | 15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board. |
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| 191 | + | |
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| 192 | + | 15853. (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the departments requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.(d) If a child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Childrens Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Childrens Services Program is referred to that program. The California Childrens Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Childrens Services Program. Diagnosis and treatment services that are authorized by the California Childrens Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Childrens Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Childrens Services Program.(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.(2) Provide for the administration of childrens coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board. |
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