BILL NUMBER: AB 1 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Dymally
DECEMBER 4, 2006
An act to amend Section 49557.2 of the Education Code, to amend
Section 123290 of the Health and Safety Code, to amend Sections
12693.43, 12693.73, 12693.98, and 12693.981 of, to add Sections
12693.22, 12693.415, 12693.445, 12693.702, 12693.983, and 12693.984
to, and to add Chapter 17 (commencing with Section 12693.99) to Part
6.2 of Division 2 of, the Insurance Code, and to amend Sections
14005.23, 14005.41, 14011.65, 14154, and 18925 of, and to add
Sections 14005.43, 14005.71, and 14013.5 to, the Welfare and
Institutions Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1, as introduced, Dymally. California Healthy Children
Insurance Program.
(1) Existing law establishes various public programs to provide
health care coverage to eligible children, including the Medi-Cal
program administered by the State Department of Health Care Services
and county welfare agencies, and the Healthy Families Program
administered by the Managed Risk Medical Insurance Board. Children
through 18 years of age are eligible for health care coverage under
these programs if they meet certain household income and other
requirements. Existing law authorizes information sharing with
respect to children eligible for free school lunches in order to
facilitate their enrollment in the health care programs.
This bill would create the California Healthy Children Insurance
Program, which would consist of the portion of the Medi-Cal program
that provides health care coverage to children and the Healthy
Families Program. The bill would require that the California Healthy
Children Insurance Program be operated as a joint partnership by the
State Department of Health Care Services and the Managed Risk Medical
Insurance Board in a streamlined manner, with eligible children to
be enrolled in one program or the other, as appropriate. The bill
would accelerate the process for making eligibility determinations
for the California Healthy Children Insurance Program by authorizing
the administering agencies to rely on income eligibility
determinations made by other public assistance programs, including
reduced price school lunch programs, the California Special
Supplemental Nutrition Program for Women, Infants, and Children
(WIC), and the Food Stamp Program. The bill would require the
administering agencies to request documentation and verify
information only to the extent necessary to determine eligibility and
as required by federal law. The bill would provide simplified annual
renewals of eligibility by self-certification by recipients. The
bill would expand eligibility for the Healthy Families Program and
the Healthy Families Program element of the California Healthy
Children Insurance Program by allowing children with family incomes
up to 300% of the federal poverty level to qualify and by otherwise
liberalizing enrollment requirements. The bill would enact certain
privacy and confidentiality provisions relative to Healthy Families
Program applicants and enrollees. The bill would create the
California Healthy Children Expert Panel to advise the administering
agencies on various matters. The bill would require the administering
agencies to award local enrollment investment grants from available
funds to local and regional children's health initiative activities
designed to increase and retain the enrollment of children in health
care coverage. The bill would require the Secretary of the California
Health and Human Services Agency to coordinate local children's
health insurance programs with certain state and federally funded
programs. The bill would require the Managed Risk Medical Insurance
Board to undertake pilot demonstration projects to test strategies
and gather data relative to increasing health care coverage for
uninsured children in families with incomes above 300% of the federal
poverty level. The bill would require the board to develop materials
for distribution by state agencies to small business employers
regarding availability of purchasing pool coverage. The bill would
require the California Health and Human Services Agency in
conjunction with the Secretary of Labor and Workforce Development and
the Secretary of Business, Transportation and Housing to establish a
task force relative to increasing employer health care coverage of
children. The bill would make various related modifications to the
Medi-Cal program and the Healthy Families Program. The bill would
enact related provisions and state the intent of the Legislature
relative to certain other provisions, and would provide for a
phase-in of its provisions over several years. Because the
modifications to the Medi-Cal program would impose certain duties on
counties relative to administration of that program, the bill would
impose a state-mandated local program.
(2) Existing law establishes the Medi-Cal-to-Healthy Families
Bridge Benefits Program, which is administered by the Managed Risk
Medical Insurance Board as part of the Healthy Families Program.
Under existing law, the Medi-Cal-to-Healthy Families Bridge Benefits
Program, until the Healthy Families Presumptive Eligibility Program
is implemented, provides a child who meets specified eligibility
requirements, including having a family income at or below 200% of
the poverty level, one calendar month of health care benefits in
order to provide the child with the opportunity to apply for the
Healthy Families Program.
This bill would instead establish the Medi-Cal-to-Healthy Families
Seamless Bridge Benefits Program, which, until the Healthy Families
Presumptive Eligibility Program is implemented, would provide a child
who meets specified eligibility requirements, including having a
family income at or below 300% of the poverty level, continuing
health care benefits until the board determines the child's
eligibility for the Healthy Families Program. This bill would require
the board to either enroll the child in the Healthy Families Program
with no interruption in coverage or terminate the child's seamless
bridge benefits in accordance with due process requirements.
(3) Existing law establishes the Healthy Families-to-Medi-Cal
Bridge Benefits Program to provide any person enrolled for coverage
under the Healthy Families Program who meets certain criteria, as
specified, with two calendar months of health care benefits in order
to provide the person with the opportunity to apply for Medi-Cal.
This bill would instead establish the Healthy Families-to-Medi-Cal
Seamless Bridge Benefits Program to provide any person enrolled for
coverage under the Healthy Families Program who meets certain
criteria, as specified, with continuing health care benefits until a
Medi-Cal eligibility determination is made, at which point either the
person would be enrolled in Medi-Cal with no interruption in
coverage or the seamless bridge benefits would terminate in
accordance with due process requirements.
(4) Existing law requires the state to administer, to the extent
allowed under federal law, and only if federal financial
participation is available, the Medi-Cal to Healthy Families
Accelerated Enrollment program, to provide a child who meets
specified eligibility requirements, including the income requirements
of the Healthy Families Program, with temporary health benefits for
the period during which the child has an application pending for
coverage under the Healthy Families Program.
This bill would revise the eligibility requirements for that
Accelerated Enrollment program, as specified.
(5) Existing law creates the Healthy Families Fund, and provides
that money in the fund is continuously appropriated for purposes of
the Healthy Families Program.
This bill would provide that the Managed Risk Medical Insurance
Board may implement the provisions of the bill only to the extent
that funds are appropriated for the purposes of the bill in the
annual Budget Act or in another statute.
(6) 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 these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Health care coverage is a critical investment in the health of
California's children, for the following reasons:
(1) Children with health care coverage are more likely to get the
care they need, especially essential preventive care that can prevent
avoidable conditions and expensive emergency room visits.
(2) Children with health care coverage are healthier and perform
better in school. California's investment in children's health care
coverage has been successful. For example, children enrolled in the
Healthy Families Program have shown a 25-percent improvement in
health and a 68-percent improvement in their ability to "pay
attention" and to "keep up with school activities."
(b) California's investment in state health care coverage for
children has significantly reduced the number of children who have no
health care coverage.
(c) With about 800,000 children in California without health care
coverage, the goal of extending coverage to all children in the state
is within reach, especially since a majority (55 percent) of them
already qualify for state health care coverage through the Medi-Cal
program or the Healthy Families Program.
(d) California can no longer afford to waste precious resources by
dropping children from coverage unnecessarily due to bureaucratic
red tape, only to reenroll them at a later date. If this phenomenon
of children losing coverage temporarily were addressed, the number of
low-income children without health care coverage nationally would be
reduced by 40 percent.
(e) Appropriate technology solutions can help improve program
administration and efficiency while reducing barriers to coverage for
children, making it easier for children to get and keep the health
care coverage they need.
(f) With existing enrollment successes like local children's
health initiatives innovations, express lane eligibility through
school lunch programs, and the deemed eligible infants and newborn
hospital gateways, any reforms designed to reach all children must
build and improve upon the Medi-Cal program and the Healthy Families
Program, local enrollment and retention innovations, and available
technologies to enroll more children.
(g) Across the state, over 27 local coalitions of local health
plans, community leaders, health providers, businesses, unions,
county agencies, First 5 Commissions, faith leaders, schools, and
others are at work to expand access to health care coverage for
children, resulting in exceptional models for what is needed
statewide.
(h) California voters overwhelmingly support a plan that would
ensure that every child in California has health care coverage. This
support is solid throughout the state and across partisan lines, even
when voters understand the financial cost required to cover all
children.
(i) The Legislature aims to ensure this simple goal on behalf of
California's children:
Every child in California can get health care coverage to grow up
healthy and strong.
SEC. 2. Section 49557.2 of the Education Code is amended to read:
49557.2. (a) (1) At the option of the school district or county
superintendent, and to the extent necessary to implement Section
14005.41 of the Welfare and Institutions Code, the following
information may be incorporated into the National School
Lunch Program application packet or notification of eligibility for
the National School Lunch Program using simple and
culturally appropriate language:
(A) A notification that if a child qualifies for free school
lunches, then the child may qualify for free or reduced-cost health
coverage.
(B) A request for the applicant's consent for the child to
participate in the Medi-Cal program, if eligible for free school
lunches, and to have the information on the school lunch application
shared with the entity designated by the State Department of Health
Care Services to make an accelerated determination and the
local agency that determines eligibility under the Medi-Cal program.
(C) A notification that the school district will not forward the
school lunch application to the entity designated by the State
Department of Health Care Services to make an accelerated
determination and the local agency that determines eligibility under
the Medi-Cal program, without the consent of the child's parent or
guardian.
(D) A notification that the school lunch application is
confidential and, with the exception of forwarding the information
for use in health program enrollment upon the consent of the child's
parent or guardian, the school district will not share the
information with any other governmental agency, including the federal
Department of Homeland Security and the Social Security
Administration.
(E) A notification that the school lunch application information
will only be used by the entity designated by the State Department of
Health Care Services to make an accelerated determination
and the state and local agencies that administer the Medi-Cal
program for purposes directly related to the administration of the
program and will not be shared with other government agencies,
including the federal Department of Homeland Security and
the Social Security Administration for any purpose other than the
administration of the Medi-Cal program.
(F) Information regarding the Medi-Cal program, including
available services, program requirements, rights and
responsibilities, and privacy and confidentiality requirements.
(2) The State Department of Education, in consultation with school
districts, county superintendents of schools, consumer advocates,
counties, the State Department of Health Care Services,
and other stakeholders, shall make recommendations regarding the
National School Lunch Program application, on or before
February 1, 2003. The recommendations shall include specific changes
to the National School Lunch Program application materials
as necessary to implement Section 14005.41 of the Welfare and
Institutions Code, information for staff as to how to implement the
changes, and a description of the process by which information on the
National School Lunch Program application will be shared
with the county, as the local agency that determines eligibility
under the Medi-Cal program.
(3) At the option of the school, the request for consent in
subparagraph (B) of paragraph (1) may be modified so that the parent
or guardian can also consent to allowing Medi-Cal to inform the
school as provided in subdivision (n) of Section 14005.41 of the
Welfare and Institutions Code when followup is needed in order to
complete the Medi-Cal application process.
(b) (1) School districts and county superintendents of schools may
implement a process to share information provided on the
National School Lunch Program application with the entity
designated by the State Department of Health Care Services
to make an accelerated determination and with the local agency that
determines eligibility under the Medi-Cal program, and shall share
this information with those entities, if the applicant consents to
that sharing of information. Schools may designate, only as necessary
to implement this section, non-food nonfood
service staff to assist in the administration of free, reduced
price, or paid school lunch applications that have applicant consent,
but only if that designation does not displace or have an adverse
effect on food service staff. This information may be shared
electronically, physically, or through whatever method is determined
appropriate.
(2) If a school is aware that a child, who has been found eligible
for free school lunches under the National School Lunch Program, and
for whom the parent or guardian has consented to share the
information provided on the application, already has an active
Medi-Cal program or Healthy Families Program
case, the application shall not be processed for an accelerated
determination but shall be forwarded to the local agency that
determines eligibility under the Medi-Cal program pursuant to Section
14005.41 of the Welfare and Institutions Code. The school shall
notify the parent or guardian of the child's ineligibility for
accelerated Medi-Cal due to the current eligibility status and that
the child's application will be forwarded to the county pursuant to
this section. The notice shall include a statement, with contact
information, advising the parent or guardian to contact the Medi-Cal
program or the Healthy Families
programs Program regarding the child's
eligibility status.
(3) Each school district or county superintendent that chooses to
share information pursuant to this subdivision shall enter into a
memorandum of understanding with the local agency that determines
eligibility under the Medi-Cal program, that sets forth the roles and
responsibilities of each agency and the process to be used in
sharing the information.
(4) The local agency that determines eligibility under the
Medi-Cal program shall only use information provided by applicants on
the school lunch application for purposes directly related to the
administration of the Medi-Cal program.
(5) After school districts share information regarding the school
lunch application with the entity designated by the State Department
of Health Care Services to make an accelerated
determination and the local agency that determines eligibility under
the Medi-Cal program, for the purpose of determining Medi-Cal program
eligibility, the local agency and the school district shall not
share information about school lunch participation or the Medi-Cal
program eligibility information with each other except as
specifically authorized under subdivision (n) of Section 14005.41 of
the Welfare and Institutions Code and other provisions of law.
(c) Effective July 1, 2005, the notifications and consent
referenced in subdivision (a) and the procedures set out in
subdivision (b) shall include the Healthy Families Program and any
relevant county- and local-sponsored health insurance programs as
necessary to implement Section 14005.41 of the Welfare and
Institutions Code.
(d) If a school district finds that the child is eligible for
reduced price or paid meals under the National School Lunch Program
and consent was provided as described in subdivision (b), the entity
designated by the State Department of Health Care Services
to make an accelerated determination shall notify the parent or
guardian of the child's ineligibility for an accelerated Medi-Cal
determination pursuant to Section 14005.41 of the Welfare and
Institutions Code. The notification shall include information on
other available health programs for which the child may be eligible.
(e) The notifications and consent referenced in subdivision (a)
and the procedures set out in this section shall be modified as
necessary by the department, in consultation with the State
Department of Health Care Services, school districts, and
stakeholders, including consumer advocates, by January 1, 2009, to
implement subdivisions (o) and (p) of Section 14005.41 of the Welfare
and Institutions Code to allow children who meet the income
eligibility requirements for participation in either the free or
reduced price meal program to be processed for both an accelerated
determination and ongoing medical assistance upon the consent and
authorization of their parent or guardian.
SEC. 3. Section 123290 of the Health and Safety Code is amended to
read:
123290. The department, under any program established pursuant to
this article, shall do all of the following:
(a) Establish guidelines to determine resource allocation giving
consideration to an area's nutritional need.
(b) Designate the counties within which a program will be
conducted, with the approval of those counties.
(c) Establish the minimum nutritional requirements for recipients.
(d) Designate specific supplemental foods to meet the minimum
nutritional requirements for recipients.
(e) Develop and maintain a system for the delivery of supplemental
foods to recipients through the distribution of supplemental foods
designated in subdivision (d) and nutrition coupons when other
methods of delivery are impractical.
(f) (1) Develop and coordinate a smoking cessation component of
program operations, with consideration of local agency plans, needs,
and available tobacco education resources.
(2) In consultation with the directors of local agencies and with
other individuals with expertise in the field of smoking cessation,
identify and promulgate a strategy for smoking cessation in the state
plan of operation and administration of the WIC program, including,
but not limited to all , both
of the following:
(A) Designating an agency staff member to coordinate smoking
cessation efforts.
(B) Providing training on smoking cessation and tobacco education
to designated staff members of local agencies who are responsible for
counseling participants in the program.
(3) Develop and implement procedures to ensure that tobacco -
use screening and education, including, but not limited to,
smoking cessation counseling and referrals where appropriate, are
offered to all participants.
(g) (1) Establish guidelines and criteria to be used by
participating local agencies, when determining recipient eligibility,
that require, in addition to a recipient being a low-income pregnant
woman, or a low-income postpartum and lactating woman, or a
low-income infant or child under five years of age, that the
recipient be at nutritional risk.
(2) A health professional on the staff of the local agency shall
determine if a person is at nutritional risk through a medical or
nutritional assessment. This determination may be based on referral
data submitted by a health professional not on the staff of the local
agency. The person's height or length and weight shall be measured,
and a hematological test for anemia, such as a hemoglobin or
hematocrit test, shall be performed. However, the tests shall not be
required for infants under six months of age. In addition, the blood
test shall not be required for children who were determined to be
within the normal range at their last program certification. However,
the blood test shall be performed on the children at least once a
year. A breastfeeding woman may be certified if the child she is
breastfeeding is determined to be at nutritional risk and the woman
meets the income eligibility criteria.
(h) Operate the program as an adjunct to existing health services
, which shall include, but shall not be limited to, all of the
following:
(1) Develop in consultation with local agencies an electronic
application system that utilizes the real-time electronic connection
to the state eligibility database developed pursuant to subdivision
(b) of Section 14011.7 of the Welfare and Institutions Code to allow
children, with consent, to request an accelerated determination for
the California Healthy Children Insurance Program and apply for
ongoing medical assistance, pursuant to Section 14005.43 of the
Welfare and Institutions Code, utilizing information provided for
application to the California WIC program.
(2) Protect and safeguard the privacy and confidentiality of
applicants and of enrollees. Information and documentation about an
applicant or enrollee shall not be used, shared, or disclosed except
to determine eligibility for the California Healthy Children
Insurance Program or for activities connected to California Healthy
Children Insurance Program administration, including outreach and
followup. Disclosure of or access to information concerning
California Healthy Children Program applicants or enrollees shall be
restricted to persons or agency representatives who are subject to
standards of privacy and confidentiality that are no less protective
than those required by Section 12693.984 of the Insurance Code.
Nothing in this paragraph shall restrict the existing authority to
access and use Medi-Cal beneficiary and claims data by the Department
of Justice's Bureau of Medi-Cal Fraud and Elder Abuse.
(3) Encourage local agencies to
participate in and utilize the electronic application system .
(i) Seek federal funds to carry out this article.
SEC. 4. Section 12693.22 is added to the Insurance Code, to read:
12693.22. Notwithstanding any other provision of law, the board
shall implement changes to the program enacted pursuant to the act
that added this section during the 2007-08 Regular Session of the
Legislature only to the extent that funds are appropriated for the
purposes of that act in the annual Budget Act or in another statute.
SEC. 5. Section 12693.415 is added to the Insurance Code, to read:
12693.415. (a) The board shall consult and coordinate with the
State Department of Health Care Services, the California Healthy
Children Expert Panel, and other stakeholders, including consumer
advocates, in implementing an electronic application system that
utilizes the real-time electronic connection to the state eligibility
database developed pursuant to subdivision (b) of Section 14011.7 of
the Welfare and Institutions Code and adopted pursuant to Section
14005.43 of the Welfare and Institutions Code. The board and the
State Department of Health Care Services shall accept the electronic
application provided for in Section 14005.43 of the Welfare and
Institutions Code as an application for the California Healthy
Children Insurance Program. The accelerated determination shall be
administered by the State Department of Health Care Services to
provide full-scope benefits pursuant to Medi-Cal program
requirements, at no cost to the applicant.
(b) If the board determines that one or more amendments to the
State Child Health Plan are necessary to ensure federal financial
participation in the provisions of this section, the board shall
prepare and submit necessary requests for the plan amendments to the
federal government.
(c) This section shall become operative on July 1, 2009.
SEC. 6. Section 12693.43 of the Insurance Code is amended to read:
12693.43. (a) Applicants applying to the purchasing pool shall
agree to pay family contributions, unless the applicant has a family
contribution sponsor. Family contribution amounts consist of the
following two components:
(1) The flat fees described in subdivision (b) or (d).
(2) Any amounts that are charged to the program by participating
health, dental, and vision plans selected by the applicant that
exceed the cost to the program of the highest cost Family
Value Package family value package in a given
geographic area.
(b) In each geographic area, the board shall designate one or more
Family Value Packages family value packages
for which the required total family contribution is:
(1) Seven dollars ($7) per child with a maximum required
contribution of fourteen dollars ($14) per month per family for
applicants with annual household incomes up to and including 150
percent of the federal poverty level.
(2) Nine dollars ($9) per child with a maximum required
contribution of twenty-seven dollars ($27) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70.
(3) On and after July 1, 2005, fifteen dollars ($15) per child
with a maximum required contribution of forty-five dollars ($45) per
month per family for applicants with annual household income to which
subparagraph (B) of paragraph (6) of subdivision (a) of Section
12693.70 is applicable. Notwithstanding any other provision of law,
if an application with an effective date prior to July 1, 2005, was
based on annual household income to which subparagraph (B) of
paragraph (6) of subdivision (a) of Section 12693.70 is applicable,
then this subparagraph paragraph shall
be applicable to the applicant on July 1, 2005, unless subparagraph
(B) of paragraph (6) of subdivision (a) of Section 12693.70 is no
longer applicable to the relevant family income. The program shall
provide prior notice to any applicant for currently enrolled
subscribers whose premium will increase on July 1, 2005, pursuant to
this subparagraph paragraph and, prior
to the date the premium increase takes effect, shall provide that
applicant with an opportunity to demonstrate that subparagraph (B) of
paragraph (6) of subdivision (a) of Section 12693.70 is no longer
applicable to the relevant family income.
(4) On and after July 1, 2008, twenty-three dollars ($23) per
child with a maximum required contribution of sixty-nine dollars
($69) per month per family for applicants with annual household
incomes greater than 250 percent and up to and including 300 percent
of the federal poverty level.
(c) Combinations of health, dental, and vision plans that are more
expensive to the program than the highest cost Family Value
Package family value package may be offered to
and selected by applicants. However, the cost to the program of those
combinations that exceeds the price to the program of the highest
cost Family Value Package family value
package shall be paid by the applicant as part of the
family contribution.
(d) The board shall provide a family contribution discount to
those applicants who select the health plan in a geographic area that
has been designated as the Community Provider Plan. The discount
shall reduce the portion of the family contribution described in
subdivision (b) to the following:
(1) A family contribution of four dollars ($4) per child with a
maximum required contribution of eight dollars ($8) per month per
family for applicants with annual household incomes up to and
including 150 percent of the federal poverty level.
(2) Six dollars ($6) per child with a maximum required
contribution of eighteen dollars ($18) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70.
(3) On and after July 1, 2005, twelve dollars ($12) per child with
a maximum required contribution of thirty-six dollars ($36) per
month per family for applicants with annual household income to which
subparagraph (B) of paragraph (6) of subdivision (a) of Section
12693.70 is applicable. Notwithstanding any other provision of law,
if an application with an effective date prior to July 1, 2005, was
based on annual household income to which subparagraph (B) of
paragraph (6) of subdivision (a) of Section 12693.70 is applicable,
then this subparagraph paragraph shall
be applicable to the applicant on July 1, 2005, unless subparagraph
(B) of paragraph (6) of subdivision (a) of Section 12693.70 is no
longer applicable to the relevant family income. The program shall
provide prior notice to any applicant for currently enrolled
subscribers whose premium will increase on July 1, 2005, pursuant to
this subparagraph paragraph and, prior
to the date the premium increase takes effect, shall provide that
applicant with an opportunity to demonstrate that subparagraph (B) of
paragraph (6) of subdivision (a) of Section 12693.70 is no longer
applicable to the relevant family income.
(4) On and after July 1, 2008, twenty dollars ($20) per child with
a maximum required contribution of sixty dollars ($60) per month per
family for applicants with annual household incomes greater than 250
percent and up to and including 300 percent of the federal poverty
level.
(e) Applicants, but not family contribution sponsors, who pay
three months of required family contributions in advance shall
receive the fourth consecutive month of coverage with no family
contribution required.
(f) Applicants, but not family contribution sponsors, who pay the
required family contributions by an approved means of electronic fund
transfer shall receive a 25-percent discount from the required
family contributions.
(g) It is the intent of the Legislature that the family
contribution amounts described in this section comply with the
premium cost sharing limits contained in Section 2103 of Title XXI of
the Social Security Act. If the amounts described in subdivision (a)
are not approved by the federal government, the board may adjust
these amounts to the extent required to achieve approval of the state
plan.
(h) The adoption and one readoption of regulations to implement
paragraph (3) of subdivision (b) and paragraph (3) of subdivision (d)
shall be deemed to be an emergency and necessary for the immediate
preservation of public peace, health, and safety, or general welfare
for purposes of Sections 11346.1 and 11349.6 of the Government Code,
and the board is hereby exempted from the requirement that it
describe specific facts showing the need for immediate action and
from review by the Office of Administrative Law. For purpose of
subdivision (e) of Section 11346.1 of the Government code
Code , the 120-day period, as applicable to the
effective period of an emergency regulatory action and submission of
specified materials to the Office of Administrative law
Law , is hereby extended to 180 days.
SEC. 7. Section 12693.445 is added to the Insurance Code, to read:
12693.445. (a) An eligible child may be enrolled in the program
prior to payment of the required family contribution. The board shall
send a statement for the amount due after enrollment.
(b) Families shall have the option to pay for one year of Healthy
Families Program premiums in advance in order to receive a discount
of 25 percent for the total year premium amount.
(c) The board shall expand and extend the number of premium
payment sites and shall consult with the California Healthy Children
Expert Panel and local children's health initiatives and other
stakeholders, including consumer advocates, on suggested additional
payment site locations.
SEC. 8. Section 12693.702 is added to the Insurance Code, to read:
12693.702. (a) Notwithstanding any other
provision of law and irrespective of differences in financial
eligibility standards and methodologies, upon proof of current
enrollment in any of the programs listed in paragraphs (1) to (3),
inclusive, the board and the department shall use the income
eligibility determination made by the listed programs to determine
the child's income eligibility for the California Healthy Children
Insurance Program and to establish the child's percent of the poverty
level as defined in Section 50041.5 of Title 22 of the California
Code of Regulations:
(1) The California Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) as provided for in Article 2
(commencing with Section 123275) of Chapter 1 of Part 2 of Division
106 of the Health and Safety Code.
(2) The National School Lunch Program (NSLP) as provided for
pursuant to Chapter 13 (commencing with Section 1751) of Title 42 of
the United States Code.
(3) The Food Stamp Program as provided for pursuant to Chapter 51
(commencing with Section 2011) of Title 7 of the United States Code.
(b) The board and the department shall accept the children's
program's documentation as reliable for purposes of satisfying any
documentation requirements for the California Healthy Children
Insurance Program and, if the eligibility determination pursuant to
this section does not establish eligibility for the California
Healthy Children Insurance Program, for purposes of determining
eligibility for medical assistance on all other available grounds.
(c) Nothing in this section shall be construed to authorize denial
of benefits through the California Healthy Children Insurance
Program or other program to a child who, without the application of
this section, would qualify for those benefits or to relieve the
program of the obligation to determine eligibility on other grounds.
SEC. 9. Section 12693.73 of the Insurance Code is amended to read:
12693.73. Notwithstanding any other provision of law, children
excluded from coverage under Title XXI of the Social Security Act are
not eligible for coverage under the program, except as specified in
clause (ii) of subparagraph (A) of paragraph (6) of subdivision (a)
of Section 12693.70 , Section 12693.76, and Section
12693.76 12693.9913 .
SEC. 10. Section 12693.98 of the Insurance Code is amended to
read:
12693.98. (a) (1) The Medi-Cal-to-Healthy Families Seamless
Bridge Benefits Program is hereby established to provide any
child who meets the criteria set forth in subdivision (b) with
a one calendar-month period of continuing
health care benefits in order to provide the child
with an opportunity to apply for the until the board
has made a Healthy Families Program established under
Chapter 16 (commencing with Section 12693) eligibility
determination .
(2) The Medi-Cal-to-Healthy Families Seamless Bridge
Benefits Program shall be administered by the board and the State
Department of Health Care Services.
(b) (1) Any child who meets all of the following requirements
shall be eligible for one calendar month of Healthy
health benefits under the Medi-Cal-to-Healthy
Families benefits funded by Title XXI of the Social Security
Act, known as the State Children's Health Insurance
Seamless Bridge Benefits Program:
(A) He or she has been receiving, but is no longer eligible for,
full-scope Medi-Cal benefits without a share of cost.
(B) He or she is eligible for full-scope Medi-Cal benefits with a
share of cost.
(C) He or she is under 19 years of age at the time he or she is no
longer eligible for full-scope Medi-Cal benefits without a share of
cost.
(D) He or she has family income at or below 200
300 percent of the federal poverty level.
(E) He or she is not otherwise excluded under the definition of
"targeted low-income child" under subsections (b)(1)(B)(ii), (b)(1)
(C), and (b)(2) of Section 2110 of the Social Security Act (42 U.S.C.
Secs. 1397jj(b)(1)(B)(ii), 1397jj(b)(1)(C), and 1397jj(b)(2)).
(2) The one calendar month of benefits under
this chapter shall begin on the first day of the month following the
last day of the receipt of benefits without a share of cost and
shall continue until the board has made an eligibility determination
for the Healthy Families Program, at which point the board shall
either enroll the child in the Healthy Families Program with no
interruption in coverage to the child, or the child's seamless
bridge benefits shall be terminated in accordance with due process
requirements .
(c) The income methodology for determining a child's family
income, as required by paragraph (1) of subdivision (b) shall be the
same methodology used in determining a child's eligibility for the
full scope of Medi-Cal benefits.
(d) The one calendar-month period scope
of Healthy Families Program benefits provided under
this chapter shall be identical to the scope of benefits that the
child was receiving under the Medi-Cal program without a share of
cost.
(e) The one calendar-month period of Healthy
Families Program benefits provided under this chapter
shall only be made available through a Medi-Cal provider or under a
Medi-Cal managed care arrangement or contract.
(f) Except as provided in subdivision (j), nothing in
this section shall be construed to provide Healthy Families benefits
for more than a one calendar-month period under any circumstances,
including the failure to apply for benefits under the Healthy
Families Program or the failure to be made aware of the availability
of the Healthy Families Program, unless the circumstances described
in subdivision (b) reoccur.
(g) (1) This section shall become operative on the first day of
the second month following the effective date of this section,
subject to paragraph (2).
(2) Under no circumstances shall this section become operative
until, and shall be implemented only to the extent that, all
necessary federal approvals, including approval of any amendments to
the State Child Health Plan have been sought and obtained and federal
financial participation under the federal State Children's Health
Insurance Program, as set forth in Title XXI of the Social Security
Act, has been approved.
(h) This section shall
become inoperative if an unappealable court decision or judgment
determines that any either of the
following apply applies :
(1) The provisions of this section are unconstitutional under the
United States Constitution or the California Constitution.
(2) The provisions of this section do not comply with the State
Children's Health Insurance Program, as set forth in Title XXI of the
Social Security Act.
(3) The provisions of this section require that the health care
benefits provided pursuant to this section are required to be
furnished for more than two calendar months.
(i)
(g) If the State Child Health Insurance Program waiver
described in Section 12693.755 is approved, and at the time the
waiver is implemented, the benefits described in this section shall
also be available to persons who meet the eligibility requirements of
the program and are parents of, or, as defined by the board, adults
responsible for, children enrolled to receive coverage under this
part or enrolled to receive full-scope Medi-Cal services with no
share of cost.
(j) The one month of benefits provided in this section shall be
increased to two months commencing on implementation of the waiver
referred to in Section 12693.755.
(k)
(h) Effective July 1, 2008, the department, the counties, and the
board may transfer a family's case file and other eligibility
information, solely for the purposes of transferring a child's
eligibility between the Medi-Cal program and the Healthy Families
Program, without seeking the family's consent.
(i) This section shall cease to be implemented
become inoperative on the date that the
Director of Health Care Services executes a declaration
stating that implementation of the Healthy Families Presumptive
Eligibility Program established pursuant to Section 12693.98a has
commenced , and as of that date is repealed .
SEC. 11. Section 12693.981 of the Insurance Code is amended to
read:
12693.981. (a) (1) The Healthy Families-to-Medi-Cal Seamless
Bridge Benefits Program is hereby established to provide any
person enrolled for coverage under this part who meets the criteria
set forth in subdivision (b) with a two calendar-month
period of continuing health care benefits
in order to provide the person with an opportunity to apply
for Medi-Cal until a Medi-Cal eligibility
determination has been made .
(2) The Healthy Families-to-Medi-Cal Seamless Bridge
Benefits Program shall be administered by the board.
(b) (1) Any person who meets all of the following requirements
shall be eligible for two additional calendar months of
Healthy Families
Families-to-Medi-Cal Seamless Bridge benefits:
(A) He or she has been receiving, but is no longer eligible for,
benefits under the program Healthy Families
Program .
(B) He or she appears to be income eligible for full-scope
Medi-Cal benefits without a share of cost.
(2) The two additional calendar months of
benefits under this chapter shall begin on the first day of the month
following the last day of the person's eligibility for benefits
under the program Healthy Families Program
and shall continue until an eligibility determination is made, at
which point the person shall be either enrolled in the Medi-Cal
program with no interruption in coverage or the seamless bridge
benefits shall be terminated in accordance with due process
requirements .
(c) The two-calendar-month period of Healthy Families
scope of Medi-Cal benefits provided under this
chapter shall be identical to the scope of benefits that the person
was receiving under the program Healthy
Families Program .
(d) Nothing in this section shall be construed to provide
Healthy Families benefits for more than a two calendar-month period
under any circumstances, including the failure to apply for benefits
under the Medi-Cal program or the failure to be made aware of the
availability of the Medi-Cal program unless the circumstances
described in subdivision (b) reoccur The board shall
not require the payment of premiums by persons receiving
bridge benefits under this section .
(e) This section shall become inoperative if an unappealable court
decision or judgment determines that any
either of the following apply applies
:
(1) The provisions of this section are unconstitutional under the
United States Constitution or the California Constitution.
(2) The provisions of this section do not comply with the State
Children's Health Insurance Program, as set forth in Title XXI of the
federal Social Security Act.
(3) The provisions of this section require that the health care
benefits provided pursuant to this section are required to be
furnished for more than two calendar months.
(f) Effective July 1, 2008, the department, the counties, and the
board may transfer a family's case file and other eligibility
information solely for the purposes of transferring a child's
eligibility between the Medi-Cal program and the Healthy Families
Program, without seeking the family's consent.
SEC. 12. Section 12693.983 is added to the Insurance Code, to
read:
12693.983. The board shall adopt regulations to implement the
Medi-Cal to Healthy Families Accelerated Enrollment program
established under Section 14011.65 of the Welfare and Institutions
Code. If the board determines that one or more amendments to the
State Child Health Plan are necessary to ensure full federal
financial participation in the provisions of the program, the board
shall prepare and submit requests for the plan amendments to the
federal government.
SEC. 13. Section 12693.984 is added to the Insurance Code, to
read:
12693.984. (a) The board shall strictly protect and safeguard
the privacy and confidentiality of applicants and enrollees of the
Healthy Families Program.
(b) Information and documentation about an applicant or enrollee
shall not be used, shared, or disclosed except for the following
purposes:
(1) Determining eligibility for the Healthy Families Program.
(2) Making referrals to the Medi-Cal program.
(3) Activities strictly connected to Healthy Families Program
administration.
(c) Disclosure of or access to information concerning Healthy
Families Program applicants or enrollees shall be restricted as
provided in this section to persons or agency representatives who are
subject to standards of privacy and confidentiality that are no less
protective than those required by this section.
(d) This section shall apply to all requests to the Healthy
Families Program for information from outside sources, including, but
not limited to, governmental agencies, the courts, or law
enforcement officials.
SEC. 14. Chapter 17 (commencing with Section 12693.99) is added to
Part 6.2 of Division 2 of the Insurance Code, to read:
CHAPTER 17. CALIFORNIA HEALTHY CHILDREN INSURANCE PROGRAM
12693.99. (a) The California Healthy Children Insurance Program
is hereby created. The Managed Risk Medical Insurance Board and the
State Department of Health Care Services shall continue to administer
the Healthy Families Program and the Medi-Cal program, respectively,
in accordance with all existing requirements. The board and
department shall coordinate their respective administration of each
program under a joint partnership entitled the California Healthy
Children Insurance Program that provides health care coverage for all
eligible children, and which shall consist of and incorporate by
this reference all of the provisions of the Healthy Families Program
(Part 6.2 (commencing with Section 12693) of Division 2) and of the
Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3
of Division 9 of the Welfare and Institutions Code) unless otherwise
provided by this chapter. The Healthy Families Program and the
Medi-Cal program shall provide health care coverage to children who
qualify for the California Healthy Children Insurance Program under
this chapter. The provisions of the Medi-Cal program, including, but
not limited to, the confidentiality and privacy protections set forth
in Section 14100.2 of the Welfare and Institutions Code, apply to
all children applying for and enrolled in the California Healthy
Children Insurance Program.
(b) The administering agencies shall operate the California
Healthy Children Insurance Program in a coordinated and seamless
manner with respect to the persons intended to be covered. Both
administering agencies shall coordinate enrollment, renewal,
eligibility, and outreach, and shall assign clear lines of
responsibility for all associated agency activities with enforceable
accountability. A child enrolled in either the Healthy Families
Program or the Medi-Cal program shall be deemed to be enrolled in the
California Healthy Children Insurance Program. It is the intent of
the Legislature that from the child's perspective there shall only be
a single program, even if the details are handled by two programs,
agencies, and funding sources.
(c) As used in this chapter, "California Healthy Children
Insurance Program" shall be deemed to refer jointly to the Healthy
Families Program for children under 19 years of age and the portions
of the Medi-Cal program that provide health care coverage to persons
under 19 years of age, and "administering agencies" shall be deemed
to refer to the board or department, as applicable. Implementation of
duties and responsibilities of the California Healthy Children
Insurance Program shall be the responsibility of the board, to the
extent that the duties and responsibilities relate to the Healthy
Families Program, or the State Department of Health Care Services, to
the extent that the duties and responsibilities relate to the
Medi-Cal program. Implementation of duties and responsibilities that
require the participation of both agencies shall be done jointly, as
coordinated between them by agreement.
12693.9901. (a) The California Healthy Children Expert Panel is
hereby established to guide the board and the State Department of
Health Care Services in the design and implementation of the
California Healthy Children Insurance Program and to identify issues
and solutions to ensure efficient and effective ongoing operations,
particularly relating to the coordination among Medi-Cal and Healthy
Families and local outreach and enrollment partners.
(b) The California Healthy Children Expert Panel shall advise the
board and the State Department of Health Care Services on the
California Healthy Children Insurance Program. The panel shall
consist of 15 members with expertise in children's health and health
care coverage, and shall include representatives from health care
providers, including physicians and public hospitals, health plans,
consumer advocates, including those representing specific
populations, local children's health initiatives, school and business
communities, county agencies, and other stakeholders. The Senate
Committee on Rules, the Speaker of the Assembly, and the Governor
shall each appoint five members to the panel. The panel shall meet at
least quarterly, and shall reside in the State Department of Health
Care Services.
(c) The Managed Risk Medical Insurance Board shall be increased by
one member, who shall be a member of the California Healthy Children
Expert Panel, selected by members of the panel.
12693.9902. The California Healthy Children Expert Panel shall
regularly evaluate and make recommendations to ensure smooth and
effective enrollment processes in the California Healthy Children
Insurance Program, including, but not limited to, the single point of
entry, Healthy Families Program and county Medi-Cal eligibility
determinations, and local enrollment activities. Recommendations
shall emphasize improvements and standards to ensure that children
can easily enroll in a timely manner, enrollment determinations are
accurate with a clear and timely appeals process, enrollment
processes are well-coordinated between local, county, and centralized
systems, and children are able to retain their coverage. The
administering agencies shall review, respond to, and consider
implementation of the panel's recommendations. If either or both
administering agencies reject any of the panel's recommendations, the
rejecting agency shall submit a report to the panel and to the
Legislature outlining the reasons it will not implement the panel's
recommendations.
12693.9906. In determining eligibility for the California Healthy
Children Insurance Program, the department and the board shall
request documentation and shall verify information only to the extent
necessary to determine eligibility and only to the extent required
by federal law. Every child enrolled in the California Healthy
Children Insurance Program shall continue to receive benefits until
proven ineligible or unless there is a failure to pay premiums where
applicable.
12693.9908. (a) From funds available for that purpose, the board,
in consultation with the State Department of Health Care Services,
shall award local enrollment investment grants for local strategies
involving California Healthy Children Insurance Program enrollment,
retention, and utilization of health care. Grants shall be made
available to existing and new countywide or regional children's
health initiative coalitions that include an array of local
organizations and agencies. For purposes of applying for and
receiving these grants, the children's health initiative coalitions
shall designate a fiscal agent. Local and regional community-based
organizations shall also be eligible for these grants, particularly
in regions where comprehensive coalitions are not established.
Supplemental grant amounts shall be available for countywide
coalitions or regions that contribute local funding for enrollment,
retention, and access strategies through the coalition.
(b) The California Healthy Children Expert Panel shall develop
recommendations to the California Healthy Children Insurance Program
for the specific objectives, criteria, and structure of the local
enrollment investment grants, with the principal goals of promoting
local innovations and strategies for increasing children's health
insurance enrollment and retention and health care access. The
administering agencies of the California Healthy Children Insurance
Program shall review, respond to, and consider implementation of the
panel's recommendations.
(c) Each local children's health initiative coalition or
organization awarded a grant shall submit a plan every other year to
the board of its proposed strategies to promote outreach, enrollment,
retention in health insurance, and access to health care. These
activities may include, but are not limited to, the following: one
application technology, application assistance training and
certification, a system for administering enrollment fees to
application assistants, grants to community-based organizations for
enrollment and retention assistance, application assistance at
schools, implementing "express lane" strategies through school lunch,
food stamps, WIC, and other programs, health care access education,
coordinated retention strategies, "no wrong door" strategies, and
improvement to data collection and reporting systems.
(d) Local children's health initiative coalitions shall submit a
plan for an interim evaluation after one year and conduct a full
evaluation after two years. The evaluation shall include outcome
measures such as the number of children enrolled in health insurance,
the percentage of children retained after one year, if available,
the number of children receiving enrollment assistance who were
denied coverage and the reasons why, and documented performance
improvements in the number of children accessing and remaining in
health care coverage. The evaluation should document problems
children face in enrolling, staying enrolled, or accessing care, with
recommendations for improving the California Healthy Children
Insurance Program.
12693.9909. (a) The California Healthy Children Insurance Program
shall enable local children's health initiatives to create their own
premium hardship funds or sponsorship programs to help children in
their region to pay required premiums for enrollment in the
California Healthy Children Insurance Program. The administering
agencies shall develop a mechanism for communicating with local
children's health initiative coalitions, with the families' consent,
about children's premium payments.
(b) The California Healthy Children Insurance Program shall enable
counties and regions of multiple counties to have the option to buy
or partially subsidize Healthy Families Program coverage for children
with family incomes above 300 percent of the federal poverty level
and to seek federal financial participation, to the extent available.
12693.9910. The California Healthy Children Insurance Program
shall accept, review, and approve, within broad standards, local
children's health initiative demonstration projects to test new
innovations in enrollment technology, integrated insurance programs,
enrollment and retention processes and strategies, and voluntary
employer coverage participation strategies.
12693.9911. The California Healthy Children Insurance Program, in
conjunction with local children's health initiatives, shall develop
strategies for partnerships between the program and the local
children's health initiatives to help children retain their
California Healthy Children Insurance Program health care coverage,
including processes for sharing address updates and for notifying
local children's health initiatives when children in their area are
at risk of losing coverage.
12693.9912. (a) The California Healthy Children Insurance Program
shall establish, in consultation with the California Healthy
Children Expert Panel and other stakeholders, including consumer
advocates, simplified annual renewal forms for children enrolled in
the Healthy Families Program and for individuals enrolled in the
Medi-Cal program, including forms prepopulated with the eligibility
information and a simple checkoff list for individuals to identify
whether each eligibility information item remains correct. The
renewal form shall request children and families to provide and
certify with their signature any changes to the prepopulated
eligibility information form. The California Healthy Children
Insurance Program shall establish a process to allow families to
renew their coverage by telephone.
(b) The California Healthy Children Insurance Program shall, in
consultation with the California Healthy Children Expert Panel,
develop strategies to notify families of their child's renewal date
including notifications on regular communications such as premium
payment statements or on insurance cards.
(c) The California Healthy Children Insurance Program shall
educate families about the legal right to transfer to lower premium
levels in the Healthy Families Program or to no-cost Medi-Cal if the
child's family income decreases and shall also implement provisions
providing that a child shall be enrolled in the most beneficial
program for which the child is eligible. The California Healthy
Children Insurance Program shall use the Medi-Cal-to-Healthy Families
Seamless Bridge Benefits Program in Section 12693.98 or, when
Section 12693.98 becomes inoperative under subdivision (i) of that
section, the Healthy Families Presumptive Eligibility Program in
Section 12693.98a and the Healthy Families-to-Medi-Cal Seamless
Bridge Benefits Program in Section 12693.981 to transfer children who
are eligible for a lower premium tier under the Healthy Families
Program or no-cost Medi-Cal into the appropriate program. Lower
premiums or no-cost coverage shall begin at the time the child
requests the determination. No child
shall be terminated from the California Healthy Children
Insurance Program, once that child is enrolled, until the board or
the department reviews the child's eligibility for the Medi-Cal
program and the Healthy Families Program under all possible grounds
and completes an eligibility redetermination for the Medi-Cal program
and the Healthy Families Program, following the procedures in
Section 14005.37 of the Welfare and Institutions Code.
(d) To assist families in learning about available choices and to
coordinate plans and providers among all family members with
different sources of health insurance coverage, the California
Healthy Children Insurance Program shall, in coordination with the
California Healthy Children Expert Panel and interested counties,
consumer advocates, and stakeholders, provide information about the
Medi-Cal program and Healthy Families Program plan and provider
options. The program shall develop and make available online a
coordinated listing of health plans and providers for the Healthy
Families Program and all Medi-Cal managed care models and Medi-Cal
fee-for-service providers for children. This coordinated listing
shall include provider networks and a provider locator system to
identify for families under each program which plans include their
current or preferred providers. The coordinated listing shall be
updated regularly and shall be available through the California
Healthy Children Insurance Program Internet Web site and the Healthy
Families Program online provider locator.
12693.9913. (a) Notwithstanding any other provision of law, all
children under 19 years of age who meet the state residency
requirements of the Medi-Cal program or the Healthy Families Program
shall be eligible for the California Healthy Children Insurance
Program if they meet either of the following criteria:
(1) Live in families with countable household income at or below
300 percent of the federal poverty level.
(2) Meet the income and resource requirements of Section 14005.7
or 14005.30 of the Welfare and Institutions Code, including those
children for whom federal financial participation is not available
under Title XIX of the federal Social Security Act (42 U.S.C. Sec.
1396 et seq.), or under Title XXI of the federal Social Security Act
(42 U.S.C. Sec. 1397aa et seq.) for full-scope coverage.
(b) Children in families whose household income would render them
ineligible for no-cost Medi-Cal or Medicare, and who are in
compliance with Sections 12693.71 and 12693.72, shall be enrolled in
the Healthy Families Program and shall also be eligible for Medi-Cal
with a share of cost in accordance with Section 14005.7 of the
Welfare and Institutions Code. Other children described in this
section shall be enrolled in no-cost Medi-Cal.
12693.9914. Nothing in this chapter shall be construed to
authorize denial of medical assistance under the Medi-Cal program to
a child who, without the application of this chapter would qualify
for that assistance or to relieve the California Healthy Children
Insurance Program of the obligation to determine eligibility on all
available other grounds.
12693.9915. (a) (1) During the planning and development phase
before the statewide California Healthy Children Insurance Program is
implemented, the local children's health insurance programs and
local children's health initiative coalitions shall continue to
highlight best practices that will guide the development and
implementation of the statewide California Healthy Children Insurance
Program. During this planning and development phase, the
administering agencies and the Secretary of California Health and
Human Services shall coordinate local children's health insurance
programs and local children's health initiative coalitions with state
and federally funded programs such as the emergency Medi-Cal program
and the Child Health and Disability Prevention (CHDP) program and
CHDP Gateway program so that local funds do not replace but augment
existing state and federally funded programs and services. That
coordination shall begin upon enactment of this chapter.
(2) The local children's health insurance programs shall pilot
financing options that seek to leverage state and federal funding and
help shape the statewide California Healthy Children Insurance
Program financing strategy. If funds are available during this
planning and development phase, the state may provide local children'
s health insurance programs that meet eligibility, benefit, cost
sharing, and quality assurance standards, established by the board in
consultation with the department and the California Healthy Children
Expert Panel, with funds to match local funding to cover premiums
based on a percentage of the Healthy Families Program's community
provider plan rate.
(b) (1) During the transition phase, which is the period after
implementation of the California Healthy Children Insurance Program
has begun but before the program is fully implemented, the board, in
consultation with the State Department of Health Care Services and
the California Healthy Children Expert Panel, shall approve local
pilot programs proposed and created by local children's health
insurance programs and local children's health initiative coalitions
on or after January 1, 2001, that have local financing to either
support a local children's coverage expansion program or a children's
coverage expansion through the Healthy Families Program or the
Medi-Cal program. These local pilot programs would qualify for phased
in state funds, subject to availability, and for federal funds, if
applicable, to match local funding. The pilot programs that are based
on local children's coverage expansion programs shall meet standards
established by the board in consultation with the department and the
California Healthy Children Expert Panel, including eligibility,
comprehensive benefits, affordable cost sharing, and quality
assurance.
(2) Local pilot programs shall model features such as simplified,
automated, and coordinated enrollment and retention processes,
integrated safety net or local providers, employer participation
opportunities, and leveraged funding for children's coverage
programs.
(3) Local programs with local funding may pilot broader coverage
expansions, such as young adults and higher income children and
adults.
(c) The pilot programs shall be tracked and independently
evaluated with private funding to identify best practices for
implementation in both urban and rural areas. The administering
agencies in consultation with the California Healthy Children Expert
Panel shall consider the pilot project findings in making
recommendations on implementation features of the California Healthy
Children Insurance Program.
(d) Once the California Healthy Children Insurance Program is
operational statewide, there shall be a period of time during which
local pilot programs, subject to specified criteria, will receive
state-matching funds while transitioning to the statewide program.
Children enrolled in or eligible for local children's health programs
shall be eligible for either the Medi-Cal program or the Healthy
Families Program, as authorized in this chapter.
(e) (1) The transition shall provide an automatic rollover for
children enrolled in the local children's health insurance programs
into their existing health plan under the Medi-Cal program or the
Healthy Families Program, if the health plan is a participating plan
in the program under which the child qualifies.
(2) For good cause, or upon the child's next annual renewal, a
child may switch plans or otherwise remain in his or her existing
plan.
(f) After the transition period and once the California Healthy
Children Insurance Program is fully operational statewide, counties
shall have the option to support coverage under the California
Healthy Children Insurance Program, but county funding shall not be
required to support children's coverage under the California Healthy
Children Insurance Program.
12693.9916. (a) The board, in consultation with the California
Healthy Children Expert Panel, shall establish a pilot research
demonstration project to test effective strategies and gather data
about the impact of specific efforts to increase coverage for
uninsured children in families with incomes above 300 percent of the
federal poverty level. The pilot research demonstrations shall be
designed to provide opportunities for families with family incomes
above 300 percent of the federal poverty level to purchase affordable
health insurance through private purchasing pools or public health
insurance programs for their uninsured children. The pilot
demonstration projects shall operate in up to four local areas for a
period of two to three years.
(b) The pilot demonstration projects shall be designed in the
following manner:
(1) The pilots shall identify and test strategies that minimize
the potential risks of adverse selection and crowd-out. Those
strategies may include, but shall not be limited to, preenrollment
and reenrollment waiting periods and differentiated premium
schedules.
(2) Coverage extension shall be offered at full cost to children
enrolled in the Healthy Families Program who would otherwise lose
coverage due to increased family income.
(3) The pilots may also have enrollment caps or enrollment cap
triggers and analysis shall assess the characteristics of children on
the waiting lists.
(4) To offset the risk of adverse selection, the pilots shall
include a carve-out of CCS-eligible conditions.
(5) The pilots shall consider administrative efficiency and
maximize the use of existing infrastructures. The pilots may build on
existing local child health insurance programs or existing
commercial insurance options or purchasing pools.
(6) In choosing pilot sites, the demonstration projects shall
consider the diverse local environments in the state. The design
shall consider rural-urban differences, the local managed care and
provider networks, the proportion of uninsured children in the
county, the stability of premiums and health care costs, the
availability of group coverage, and previous experiences with child
health insurance expansion programs.
(7) Each pilot shall collect and produce data and be evaluated to
determine its success in increasing coverage for uninsured higher
income children, crowd-out, adverse selection, and affordability.
(c) Local children's health insurance programs proposing coverage
expansion projects under paragraph (3) of subdivision (b) of Section
12693.9915 may also be included in the pilot demonstration projects
under this section.
(d) The board shall seek private funding to support all or part of
the design, implementation, and evaluation of the pilot
demonstration projects under this section.
(e) The board, in consultation with the California Healthy
Children Expert Panel, shall report the findings of the pilot
demonstrations and make recommendations to the Legislature on
effective strategies for statewide implementation.
12693.9917. Notwithstanding any other provision of law, the board
may implement this chapter only to the extent that funds are
appropriated, for the purposes of the act enacting this chapter
during the 2007-08 Regular Session of the Legislature, in the annual
Budget Act or in another statute.
12693.9918. (a) In consultation with the California Healthy
Children Expert Panel, the board shall develop materials to inform
small businesses in California with 2 to 50 employees of
opportunities to purchase insurance from existing purchasing pools,
such as Pac Advantage. The board shall provide these outreach
materials to the Department of General Services, which shall
disseminate these materials as appropriate through existing
communications with employers, including, but not limited to,
department Internet Web sites, department small business outreach
events, and communications from the department's procurement division
and the department's Office of Small Business and Disabled Veteran
Business Enterprise Services. Nothing in this section shall require
the dissemination of outreach materials in every communication by the
department. The board shall also provide these outreach materials to
the Employment Development Department, which shall disseminate these
materials through existing communications with employers, including,
but not limited to, the Internet Web site of that department,
seminars sponsored by that department for employers, communications
with employers advisory councils, and newsletters sent to employers.
(b) The California Health and Human Services Agency shall
establish and convene, in conjunction with the Secretary of Labor and
Workforce Development and the Secretary of Business, Transportation
and Housing, a task force to explore and identify viable policy
options for increasing employer health care coverage of dependent
children in California, consistent with the goals of the California
Healthy Children Insurance Program. Task force members shall include,
but not be limited to, employers, business organization
representatives, labor union representatives, consumer advocates,
health care providers, health plans, county representatives, and
legislative staff. The Senate Committee on Rules, the Speaker of the
Assembly, and the Governor shall each appoint five members to the
task force.
(c) The employer participation options considered and recommended
by the task force shall take into account the following criteria:
(1) Promote voluntary employer and employee participation in
children's health care coverage.
(2) Leverage employer dollars for covering insured children.
(3) Maintain tax incentives for employer-sponsored insurance.
(4) Maximize federal dollars.
(5) Offer affordable and efficient coverage for families,
employers, and the state.
(6) Ensure that employer participation strategies offer
comprehensive health benefits for children.
(7) Coordinate with existing public programs to promote efficiency
in operation.
(8) Do not undermine existing employer-paid dependent coverage.
(9) Balance the goal of involving employers currently not insuring
children with the goal of treating employers who already cover
dependents equitably.
(d) The task force shall develop policy recommendations to
increase employer-sponsored coverage for dependent children. The
report shall be delivered to the California Healthy Children Expert
Panel and to the Legislature no later than January 2009.
12693.9919. The phase-in schedule for the California Healthy
Children Insurance Program shall be as follows:
(a) The first year of implementation, called "Year 1 of
Transition," shall begin January 1, 2008. All of the following shall
occur in Year 1 of Transition:
(1) The state shall establish and convene the California Healthy
Children Expert Panel. The California Healthy Children Expert Panel
shall, in coordination with the Secretary of California Health and
Human Services, examine and report to the Legislature, on or before
September 1, 2008, findings on current practices in an
"accountability first" report. To ensure that taxpayer dollars are
maximized, the "accountability first" report shall examine the
current state children's health insurance enrollment system to
identify specific bureaucratic barriers and inefficiencies including
"churning" whereby eligible children are dropped from coverage only
to be reenrolled. The report shall recommend areas for improvement
regarding enrollment and retention in children's health insurance
programs, address opportunities for modernizing the enrollment
system, examine the appropriate use of electronic technology, and
develop proposals to avoid wasteful and duplicative administrative
processes such as churning.
(2) The California Healthy Children Expert Panel shall develop
recommendations for the board and the State Department of Health Care
Services to implement the local pilot programs as specified in
Section 12693.9915.
(3) The California Healthy Children Expert Panel shall develop
recommendations for the pilot research demonstration projects for
higher income uninsured children as specified in Section 12693.9916.
(4) The administering agencies shall design and prepare to
implement the California Healthy Children Insurance Program.
(A) The Secretary of California Health and Human Services shall
establish and convene the task force specified in subdivision (b) of
Section 12693.9918 to explore opportunities for employer
participation strategies in covering dependent children.
(B) The administering agencies shall develop plans to implement
the local pilot programs pursuant to Section 12693.9915 and
coordinate existing county buy-in efforts with the California Healthy
Children Insurance Program transition.
(C) The administering agencies and the Secretary of California
Health and Human Services shall coordinate with, and implement
financing relief for, local insurance programs and county buy-in
programs pursuant to Section 12693.9915.
(D) The administering agencies shall design the pilot research
demonstration project for higher income uninsured children pursuant
to Section 12693.9916.
(E) The administering agencies shall develop the local enrollment
investment grants and shall plan for streamlined enrollment and
renewal.
(b) The second year of inplementation, called "Year 2 of
Transition," shall begin January 1, 2009. All of the following shall
occur in Year 2 of Transition:
(1) The administering agencies shall implement the local pilot
programs as specified in Section 12693.9915, the local enrollment
investment grants as specified in Section 12693.9908, and the
following streamlined enrollment and renewal strategies:
(A) Express lane enrollment for reduced-price school lunch
children.
(B) Express lane enrollment improvements for food stamps.
(C) Healthy Families Program accelerated enrollment from counties.
(D) Seamless bridge program and the Healthy Families Presumptive
Eligibility Program, as applicable.
(E) Self-certification for eligibility information.
(F) Medi-Cal eligibility at 133 percent of the federal poverty
level.
(G) Modifications to the upfront Healthy Families Program premium
prior to enrollment.
(2) The board shall do both of the following:
(A) Provide state financial support for local pilot programs
pursuant to subdivision (b) of Section 12693.9915.
(B) Provide financial review and award local enrollment investment
grants pursuant to Section 12693.9908.
(c) On or before January 1, 2010, the California Healthy Children
Insurance Program enrollment shall be open to newly eligible children
and all of the following shall occur:
(1) All enrollment innovations and improvements shall be
operational.
(2) The board shall continue to provide state financial support
for local pilot programs as children begin to transition to the
statewide California Healthy Children Insurance Program pursuant to
subdivision (d) of Section 12693.9915.
(3) The board and the State Department of Health Care Services
shall fund all children newly eligible for the California Healthy
Children Insurance Program.
(4) The administering agencies shall implement the following
enrollment and renewal strategies:
(A) Simplified renewal forms.
(B) Phone-in renewals.
(C) Express lane enrollment at WIC sites.
(D) Electronic gateway systems for express lane enrollment.
(d) If funds are available to begin enrollment of newly eligible
children before January 1, 2010, the board and the State Department
of Health Care Services shall implement those eligibility and
enrollment provisions when those funds are available or as soon
thereafter as possible.
SEC. 15. (a) It is the intent of the Legislature to authorize the
California Healthy Children Insurance Program to develop health care
coverage options for persons of the ages of 19 and 20 years who are
ineligible for the Healthy Families Program or the Medi-Cal program.
These coverage options may include statewide or local demonstration
programs, and may consist of an option for the person, or a parent on
the person's behalf, to purchase California Healthy Children
Insurance Program coverage at full premium cost, or an option for the
person to maintain coverage through continuation coverage when
coverage would otherwise terminate due to the person's age.
(b) It is the intent of the Legislature to expand children's
health care coverage by building on the shared financial
responsibility of individuals, employers, and the government to
support that coverage.
(c) It is the intent of the Legislature to develop strategies to
promote and support voluntary employer participation in children's
health care coverage, relative to children of employees. These
employer participation options shall be designed to offer health care
coverage to dependent children through arrangements that are
affordable and efficient for employers and families. Particular
attention shall be paid to how new opportunities for employer
participation would interact with current practices and patterns in
employer-sponsored dependent coverage.
(d) It is the intent of the Legislature to implement the
California Healthy Children Insurance Program over several years to
provide adequate time to develop the statewide policies and
infrastructure, to transition effectively from local children's
health insurance efforts to a statewide program, and to phase-in
implementation consistent with available resources.
(e) It is the intent of the Legislature that in the third year of
implementation, all enrollment innovations and changes should be
operational and California Healthy Children Insurance Program
enrollment will be open for newly eligible children. Newly eligible
children may be phased in according to age consistent with available
resources.
(f) The state already provides some coverage and pays for services
for children without health care coverage through programs such as,
but not limited to, the California Children's Services (CCS) program,
the Family Planning, Access, Care, and Treatment (Family PACT)
Waiver Program, Medi-Cal minor consent for pregnancy-related care,
substance abuse and alcohol and drug treatment, the Child Health and
Disability Prevention (CHDP) Program, the CHDP Gateway Program,
emergency Medi-Cal coverage, and share-of-cost Medi-Cal coverage. It
is the intent of the Legislature that these programs be maintained
under the California Healthy Children Insurance Program as well as
safety net financing. For the purposes of financing the California
Healthy Children Insurance Program, the costs attributable to the
California Healthy Children Insurance Program coverage are those
additional costs beyond the funding for these existing programs.
SEC. 16. Section 14005.23 of the Welfare and Institutions Code is
amended to read:
14005.23. (a) To the extent federal
financial participation is available, the department shall, when
determining eligibility for children under Section 1396a()(1)(D) of
Title 42 of the United States Code, designate a birth date by which
all children who have not attained the age of 19 years will meet the
age requirement of Section 1396a()(1)(D) of Title 42 of the United
States Code.
(b) Commencing January 1, 2009, to the extent federal financial
participation is available, the department shall apply the less
restrictive income deduction described in Section 1396a(r) of Title
42 of the United States Code when determining eligibility for the
children identified in subdivision (a). The amount of this deduction
shall be the difference between 133 percent and 100 percent of the
federal poverty level applicable to the size of the family.
SEC. 17. Section 14005.41 of the Welfare and Institutions Code is
amended to read:
14005.41. (a) Notwithstanding any other provision of law, the
department shall deem to have met the income documentation
requirements for participation in the Medi-Cal program, without a
share of cost, for any child who is less than six years of
age and who has been determined to be eligible for free meals
through a federally funded program using the National School Lunch
Program application provided for pursuant to Chapter 13 (commencing
with Section 1751) of Title 42 of the United States Code.
(b) Notwithstanding any other provision of law, with regard to any
child who is enrolled in and attending public school in the State of
California, the department shall accept documentation of enrollment
for free meals under the National School Lunch Program as sufficient
documentation of California residency for that child for the purposes
of the Medi-Cal program.
(c) (1) (A) Notwithstanding any other provision of law, each
county shall participate in a statewide pilot project to determine
Medi-Cal program eligibility for any child under six years of age and
currently enrolled in school in the State of California who is
eligible for free meals under the National School Lunch Program upon
receipt of proof of participation in the National School Lunch
Program and a signed Medi-Cal application, which may be the
supplemented application, described in subdivision (i). Counties
shall notify the parent or guardian of the results of the eligibility
determination.
(B) Notwithstanding any other provision of law, each county shall
participate in a statewide pilot project to use the procedure
described in this subdivision to determine Medi-Cal eligibility
without a share of cost, and, if eligible, shall enroll in the
Medi-Cal program, any child six years of age or older currently
enrolled in school in the State of California who is eligible for
free meals under the National School Lunch Program, upon receipt of
proof of participation in the National School Lunch Program and a
signed Medi-Cal application, which may be the supplemented
application, described in subdivision (i). If the county determines
from the supplemented application described in subdivision (i) that
the child meets the eligibility requirements for participation in the
Medi-Cal program, the county shall notify the parent or guardian
that the child has been found eligible for the Medi-Cal program. If
the county is unable to determine from the information on the
application as described in subdivision (i) whether the child is
eligible, the county shall contact the family to seek any additional
information regarding income, household composition, or deductions
that the department, in consultation with the county welfare
departments, may determine to be necessary to complete the Medi-Cal
application. If the county determines that the child does not meet
the income eligibility
requirements for participation in the full-scope no-cost Medi-Cal
program, the county shall notify the parent or guardian of the
determination and shall forward the school lunch application and any
supplemental forms as described in subdivision (i) to the Healthy
Families Program. If an applicant is determined to be ineligible for
the full-scope no-cost Medi-Cal program and for the Healthy Families
Program, the school lunch application and any supplemental forms as
described in subdivision (i) shall be forwarded to a county- or
local-sponsored health insurance program, as applicable, if the
parent or guardian has provided consent. For purposes of this
section, a county- or local-sponsored health insurance program
includes a county agency, a local initiative, a county-organized
health system, or other local entity that provides health care
coverage to children who do not qualify for the full-scope no-cost
Medi-Cal program or for the Healthy Families Program.
(2) Each county shall ask the parent or guardian of each child
identified in subparagraph (A) of paragraph (1) and the parent or
guardian of each child whom the county determines to meet the income
eligibility requirements for participation in the Medi-Cal program
under subparagraph (B) of paragraph (1) to provide additional
documentation as required by current law necessary for retention of
eligibility in the Medi-Cal program. If a parent or guardian does not
provide the documentation required for retention of full-scope
Medi-Cal program eligibility, the county shall continue the child's
enrollment in the Medi-Cal program, but only for the limited scope of
Medi-Cal program benefits as described in Section 14007.5. If
applicable, the county shall also forward the school lunch
application and any supplemental forms as described in subdivision
(i), for applicants who are determined to be ineligible for the
full-scope no-cost Medi-Cal program and for the Healthy Families
Program, to a county- or local-sponsored health insurance program if
the parent or guardian has provided consent.
(d) Nothing in this section shall be construed as preventing the
department from verifying eligibility through the Income Eligibility
Verification System match mandated by Section 1137 of the federal
Social Security Act (42 U.S.C. Sec. 1320b-7) or from requesting
additional information or documentation required by federal law.
(e) Each county shall include its cost of implementing this
section in its annual Medi-Cal administrative budget requests
submitted to the department.
(f) For purposes of this section, the Medi-Cal program application
date shall be the date on which the school lunch application
information is received by the local agency determining eligibility
under the Medi-Cal program.
(g) (1) This section shall be implemented only if, and to the
extent that, federal financial participation is available for the
services provided and only for the period of time the free National
School Lunch Program utilizes a gross income standard at or below 133
percent of the federal poverty level. This section shall be
implemented in a manner consistent with any federal approval.
(2) Notwithstanding paragraph (1), if the department determines
that one or more state plan amendments are necessary to ensure full
federal financial participation in the provisions of this section,
the department shall prepare and submit requests for the state plan
amendments to the federal government, after which this section shall
not be implemented until the department receives approval of all
necessary state plan amendments.
(h) (1) Notwithstanding subdivision (g), not later than March 1,
2003, the department, in consultation with the State Department of
Education and representatives of the school districts, county
superintendents of schools, local agencies that administer the
Medi-Cal program, consumer advocates, and other stakeholders, shall
develop and distribute the policies and procedures, including any
all-county letters, necessary to implement Section 49557.2 of the
Education Code and this section.
(2) The policies and procedures required to be developed and
distributed pursuant to subdivision (a) shall include, at a minimum,
both of the following:
(A) Processes for the school districts, county superintendents of
schools, and local agencies that administer the Medi-Cal program to
use in forwarding and processing free school lunch application
information pursuant to Section 49557.2 of the Education Code, and in
following up with the applicants to obtain any necessary
documentation required by federal law.
(B) Instructions for implementing the eligibility provisions of
this chapter.
(3) The policies and procedures required to be developed pursuant
to subdivision (a) shall specify all of the following:
(A) The information on the school lunch application may be used to
initiate a Medi-Cal program application only when the applicant has
provided his or her consent pursuant to Section 49557.2 of the
Education Code.
(B) The date of the Medi-Cal program application shall be the date
on which the school lunch application was received by the local
agency that determines eligibility under the Medi-Cal program.
(C) The county, in determining eligibility for the Medi-Cal
program, shall request additional documentation only as required by
federal law, and shall enroll any child whose parent or guardian does
not provide the necessary documentation for full-scope benefits
under the Medi-Cal program in the Medi-Cal program with limited scope
benefits, as described in Section 14007.5.
(i) To the extent federal financial participation is available,
and to the extent administratively feasible, the department shall
utilize the free National School Lunch Program application developed
under Section 49557.2 of the Education Code, if supplemented as
needed by simplified forms and disclosures, including Medi-Cal rights
and responsibility notices and privacy notices, as a Medi-Cal
application for children described in this section.
(j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of all-county
letters or similar instructions without taking regulatory action.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
(k) The department shall review the effectiveness of the statewide
pilot project and make recommendations regarding appropriate ways to
expand the use of the approaches contained in this section.
() In order to expedite health care coverage for
children who have been determined eligible for free meals under the
National School Lunch Program, the department, at its discretion, may
choose to implement this section in whole or in part by exercising
the option described in Section 1396r-1a of Title 42 of the United
States Code to allow information provided on the National School
Lunch Program application referred to, and supplemented as described,
in paragraph (1) of subdivision (a) of Section 49557.2 of the
Education Code to serve as a basis for a preliminary eligibility
determination by a qualified entity designated by the department.
(m) County- and local-sponsored health program agencies are
authorized to use the supplemental application described in
subdivision (i) and received pursuant to subdivision (c) to make an
eligibility determination for those respective programs, and shall
request additional information only as needed to complete the
eligibility process.
(n) A county may, at its option, and with the consent of the
parent or guardian as provided in paragraph (3) of subdivision (a) of
Section 49557.2 of the Education Code, notify the school of the
names and contact information of children who are in jeopardy of
losing accelerated Medi-Cal coverage because a child's parent or
guardian has not provided required followup information to the
county. This notice shall be limited to the names and contact
information, and shall not specify what information is missing. This
shall be done for the sole purpose of enabling the school, at its
option, to conduct outreach activities to encourage or assist those
parents or guardians to complete and submit the required followup
information.
(o) Effective January 1, 2009, any child currently enrolled in
school who is eligible for reduced price meals under the National
School Lunch Program shall be eligible for an accelerated
determination for the California Healthy Children Insurance Program
and the child's school lunch application, along with any supplemental
forms and disclosures as described in subdivision (i), will be
evaluated by the appropriate entity for ongoing medical assistance,
upon the authorization of the child's parent or guardian, pursuant to
this section and Section 49557.2 of the Education Code and as
otherwise provided by law.
(p) The procedures set out in this section shall be revised to
allow an electronic application system that utilizes the real-time
electronic connection to the state eligibility database developed
pursuant to subdivision (b) of Section 14011.7 to allow children,
with the consent of their parent or guardian, to request an
accelerated determination for the California Healthy Children
Insurance Program and apply for ongoing medical assistance pursuant
to Section 14005.43 utilizing information provided for application to
the National School Lunch Program. As part of this revision, the
department, in consultation with the Managed Risk Medical Insurance
Board, the California Healthy Children Expert Panel, and other
stakeholders, including consumer advocates, shall develop a means for
using the electronic application to allow students at provisional
schools to apply for medical assistance.
(q) Notwithstanding any other provision of law, to the degree
federal financial participation is available, individuals who are
eligible for the National School Lunch Program on the basis of
categorical eligibility shall not be required to submit any
additional income information to establish income eligibility for an
accelerated determination and ongoing medical assistance pursuant to
this section. Ex parte and other procedures in Section 14005.37 shall
be used to make an eligibility determination, if necessary.
SEC. 18. Section 14005.43 is added to the Welfare and Institutions
Code, to read:
14005.43. (a) The department, working in coordination with the
Managed Risk Medical Insurance Board pursuant to Section 12693.415 of
the Insurance Code, the California Healthy Children Expert Panel,
the governing agencies designated by Section 123290 of the Health and
Safety Code and Section 14005.41, and other stakeholders including
consumer advocates, shall develop an electronic application system
that utilizes the real-time electronic connection to the state
eligibility database developed pursuant to subdivision (b) of Section
14011.7 to be used by children applying for the California Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC)
as provided for in Article 2 (commencing with Section 123275) of
Chapter 1 of Part 2 of Division 106 of the Health and Safety Code and
the National School Lunch Program (NSLP) as provided pursuant to
Chapter 13 (commencing with Section 1751) of Title 42 of the United
States Code.
(1) Pursuant to this section, the electronic application shall be
designed to allow children to request an accelerated determination
for the California Healthy Children Insurance Program and apply for
ongoing medical assistance utilizing information provided for
application to the WIC Program or the NSLP or any other children's
programs that may be added in the future, as appropriate, at the
recommendation of the governing agencies of the California Healthy
Children Insurance Program, the California Healthy Children Expert
Panel, and other stakeholders, including consumer advocates. All
information and documentation provided for in application to these
programs shall be deemed reliable for purposes of determining
eligibility for the California Healthy Children Insurance Program.
(2) Eligibility personnel at participating WIC and NSLP sites or
another entity designated by the department shall be authorized to
make an accelerated determination and shall utilize the electronic
application for medical assistance purposes only with the consent and
authorization of the applicant's parent or guardian and shall
safeguard the information shared pursuant to this section.
(3) The department shall utilize the electronic application
developed pursuant to this section for an accelerated eligibility
determination and shall provide ongoing eligibility for medical
assistance pending a final determination.
(4) The electronic application and the process for conducting the
eligibility review and communicating with families shall be designed
such that the initial submission of the electronic application using
the information provided for application to WIC or NSLP is sufficient
to authorize accelerated enrollment and to constitute a Medi-Cal
application.
(5) All efforts shall be made to coordinate and streamline the
enrollment process, pursuant to this section, with the express
enrollment process set out in Section 14005.41 and in Section 49557.2
of the Education Code.
(6) The electronic application and any followup procedures that
may be required for a final determination of eligibility shall
request information and documentation only to the extent required by
federal law and shall be periodically reevaluated by the California
Healthy Children Expert Panel to enhance simplicity as changes to
federal law may allow.
(b) Notwithstanding any other provision of law and irrespective of
differences in financial eligibility standards and methodologies,
upon proof of current enrollment in any of the programs listed in
paragraphs (1) to (3), inclusive, the board and the department shall
use the income eligibility determination made by the programs listed
in those paragraphs to determine the child's income eligibility for
the California Healthy Children Insurance Program and to establish
the child's percent of the poverty level as defined in Section
50041.5 of Title 22 of the California Code of Regulations:
(1) The California Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) as provided for in Article 2
(commencing with Section 123275) of Chapter 1 of Part 2 of Division
106 of the Health and Safety Code.
(2) The National School Lunch Program (NSLP) as provided for
pursuant to Chapter 13 (commencing with Section 1751) of Title 42 of
the United States Code.
(3) The Food Stamp Program as provided for pursuant to Chapter 51
(commencing with Section 2011) of Title 7 of the United States Code.
The board and the department shall accept the children's program's
documentation as reliable for purposes of satisfying any
documentation requirements for the California Healthy Children
Insurance Program and, if the eligibility determination pursuant to
this section does not establish eligibility for the California
Healthy Children Insurance Program, for purposes of determining
eligibility for medical assistance on all other available grounds.
(c) Nothing in this section shall be construed to authorize denial
of benefits through the California Healthy Children Insurance
Program or other program to a child who, without the application of
this section, would qualify for those benefits or to relieve the
program of the obligation to determine eligibility on other grounds.
SEC. 19. Section 14005.71 is added to the Welfare and Institutions
Code, to read:
14005.71. In determining eligibility, including redeterminations
of eligibility, for coverage under the Medi-Cal program for a child,
the department shall request documentation and verify information
provided only to the extent required under federal law.
SEC. 20. Section 14011.65 of the Welfare and Institutions Code is
amended to read:
14011.65. (a) To the extent allowed under federal law and only if
federal financial participation is available under Title XXI of the
Social Security Act (42 U.S.C. Sec. 1397aa et seq.), the state shall
administer the Medi-Cal to Healthy Families Accelerated Enrollment
program, to provide any child who meets the criteria set forth in
subdivision (b) with temporary health benefits for the period
described in paragraph (2) of subdivision (b) , as
established under Part 6.2 (commencing with Section 12693) of
Division 2 of the Insurance Code .
(b) (1) Any child who meets all of the following requirements
, shall be eligible for temporary health benefits
under this section:
(A) The child meets either of the following requirements:
(i) The child, or his or her parent or
guardian, submits an application for the Medi-Cal program directly to
the county , or has submitted an application for the Medi-Cal
program to a single point of entry as defined in subdivision (e) of
Section 14011.6 and has been granted accelerated enrollment into the
Medi-Cal program by the single point of entry pursuant to Section
14011.6.
(ii) The child is not receiving
Medi-Cal benefits at the time that the application is submitted, with
the exception of accelerated enrollment provided pursuant to Section
14011.6 .
(B) The child's income, as determined on the basis of the
application described in clause (i) of subparagraph (A),
is within the income limits established by the Healthy Families
Program.
(C) The child is under 19 years of age at the time of the
application.
(D) The county determines, on the basis of the application
described in clause (i) of subparagraph (A), that the
child is eligible for full scope Medi-Cal with a share of cost.
(E) The child is not receiving Medi-Cal benefits at the time that
the application is submitted.
(F)
(E) The child, or his or her parent or
guardian, gives , or has given consent for the
application to be shared with the Healthy Families Program for
purposes of determining the child's Healthy Families Program
eligibility.
(2) The period of accelerated eligibility provided for under this
section begins on the first day of the month
date that the county finds that the child meets all of the
criteria described in paragraph (1) and concludes on the
last day of the month that the child either is fully enrolled in, or
has been determined ineligible for, the Healthy Families Program
date that the child is discontinued from the state
Medical Eligibility Data System due to his or her full enrollment in
the Healthy Families Program or ineligibility for the Healthy
Families Program .
(3) For any child who meets the requirements for temporary health
benefits under this section, the county shall forward to the Healthy
Families Program sufficient information from the child's application
to determine eligibility for the Healthy Families Program. To the
extent possible, submission of that information to the Healthy
Families Program shall be accomplished using an electronic process
developed for use in the Medi-Cal-to-Healthy Families Seamless
Bridge Benefits Program or the Healthy Families
Presumptive Eligibility Program . The department shall give the
Healthy Families Program a daily electronic file of all children
provided temporary health benefits pursuant to this section.
(4) The temporary health benefits provided under this section
shall be identical to the benefits provided to children who receive
full-scope Medi-Cal benefits without a share of cost and shall only
be made available through a Medi-Cal provider.
(c) The department, in consultation with the Managed Risk Medical
Insurance Board , as the governing agencies for the California
Healthy Children Insurance Program, the California Healthy Children
Expert Panel, and representatives of the local agencies that
administer the Medi-Cal program, consumer advocates, and other
stakeholders, shall develop and distribute the policies and
procedures, including any all-county letters, necessary to implement
this section.
(d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of all-county
letters or similar instructions, without taking any further
regulatory action. Thereafter, the department may adopt regulations,
as necessary, to implement this section in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
(e) The department shall seek approval of any amendments to the
state plan necessary to implement this section, in accordance with
Title XIX (42 U.S.C. Sec. 1396 et seq.) of the Social Security Act.
Notwithstanding any other provision of law, only when all necessary
federal approvals have been obtained shall this section be
implemented.
(f) Under no circumstances shall this section be implemented
unless the state has sought and obtained approval of any amendments
to its state plan, as described in Section 12693.50 of the Insurance
Code, necessary to implement this section and obtain funding under
Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.)
for the provision of benefits provided under this section.
Notwithstanding any other provision of law, and only when all
necessary federal approvals have been obtained by the state, this
section shall be implemented only to the extent federal financial
participation under Title XXI of the Social Security Act (42 U.S.C.
Sec. 1397aa et seq.) is available to fund benefits provided under
this section.
(g) Each county shall include its cost of implementing this
section in its annual Medi-Cal administrative budget request
submitted to the department.
(h) The department shall commence implementation of
this section on the first day of the third month following the month
in which federal approval of the state plan amendment or amendments
described in subdivision (f), and subdivision (b) of Section 12693.50
of the Insurance Code is received, or on August 1, 2006, whichever
is later.
(h)
(i) This section shall cease to be implemented on the
date that the director executes a declaration, pursuant to
subdivision (h) of Section 14011.65 14011.65a
, stating that implementation of Section 14011.65a has
commenced. Implementation of this section shall resume on the date
that Section 14011.65a becomes inoperative, pursuant to subdivision
(h) of that section.
SEC. 21. Section 14013.5 is added to the Welfare and Institutions
Code, to read:
14013.5. (a) Effective July 1, 2009, the department shall
implement the simplified, prepopulated annual renewal form described
in subdivision (a) of Section 12693.9912 of the Insurance Code for
all individuals and families enrolled in the Medi-Cal program.
(b) All children enrolled in the Medi-Cal program, as well as all
adults who are enrolled in Medi-Cal pursuant to Section 14005.30, may
certify with their signature any changes to the prepopulated
eligibility information form.
SEC. 22. Section 14154 of the Welfare and Institutions Code is
amended to read:
14154. (a) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office. The plan shall be part of a
single state plan, jointly developed by the department and the State
Department of Social Services, in conjunction with the counties, for
administrative cost control for the California Work Opportunity and
Responsibility to Kids (CalWORKs), Food Stamp, and Medical Assistance
(Medi-Cal) programs. Allocations shall be made to each county and
shall be limited by and determined based upon the County
Administrative Cost Control Plan. In administering the plan to
control county administrative costs, the department shall not
allocate state funds to cover county cost overruns that result from
county failure to meet requirements of the plan. The department and
the State Department of Social Services shall budget, administer, and
allocate state funds for county administration in a uniform and
consistent manner.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) The Legislature finds and declares that in order for counties
to do the work that is expected of them, it is necessary that they
receive adequate funding, including adjustments for reasonable annual
cost-of-doing-business increases. The Legislature further finds and
declares that linking appropriate funding for county Medi-Cal
administrative operations, including annual cost-of-doing-business
adjustments, with performance standards will give counties the
incentive to meet the performance standards and enable them to
continue to do the work they do on behalf of the state. It is
therefore the Legislature's intent to provide appropriate funding to
the counties for the effective administration of the Medi-Cal program
at the local level to ensure that counties can reasonably meet the
purposes of the performance
measures as contained in this section.
(d) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a process
for expediting enrollment for all newborns, including those born to
mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(C) Notwithstanding the rulemaking procedures of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the department may implement this section by
means of all-county letters or similar instructions, without further
regulatory action.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(D) When a child is determined by the county to change from no
share of cost to a share of cost and the child meets the eligibility
criteria for the Healthy Families Program
program established under Section 12693.98 of the Insurance
Code or the program established under Section
12698.98a of the Insurance Code , the child shall be placed in
the Medi-Cal-to-Healthy Families Seamless Bridge Benefits
Program or the Healthy Families Presumptive Eligibility Program,
respectively , and these cases shall be processed as follows:
(i) Ninety percent of the families of these children shall be sent
a notice informing them of the Healthy Families Program within five
working days from the determination of a share of cost.
(ii) Ninety percent of all annual redetermination forms for these
children shall be sent to the Healthy Families Program within five
working days from the determination of a share of cost if
the parent has given consent to send this information to the Healthy
Families Program .
(iii) Ninety percent of the families of these children placed in
the Medi-Cal-to-Healthy Families Seamless Bridge Benefits
Program who have not consented to sending the child's annual
redetermination form to the Healthy Families Program shall be sent a
request or the Healthy Families Presumptive
Eligibility Program , within five working days of the
determination of a share of cost, to consent to send the
shall be sent an informing notice that the Medi-Cal
program has sent the child's Medi-Cal case information to the
Healthy Families Program.
(E) Subparagraph (D) shall not be implemented until 60 days after
the Medi-Cal and Joint Medi-Cal and Healthy Families applications and
the Medi-Cal redetermination forms are revised to allow the parent
of a child to consent to forward the child's information to the
Healthy Families Program.
(e) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(f) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(g) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard of standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(h) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department, sufficient
improvement has been made by the county in meeting the performance
standards during the year for which the funds were reduced. If the
county continues not to meet the performance standards, the
department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been
made to meet the performance standards.
(i) The department shall develop procedures, in collaboration with
the counties and stakeholders, for developing instructions for the
performance standards established under subparagraph (D) of paragraph
(3) of subdivision (c) (d) , no later
than September 1, 2005.
(j) No later than September 1, 2005, the department shall issue a
revised annual redetermination form to allow a parent to indicate
parental consent to forward the annual redetermination form to the
Healthy Families Program if the child is determined to have a share
of cost.
(k) The department, in coordination with the Managed Risk Medical
Insurance Board, shall streamline the method of providing the Healthy
Families Program with information necessary to determine Healthy
Families Program eligibility for a child who is receiving
services under the Medi-Cal-to-Healthy Families Seamless
Bridge Benefits Program or the Healthy Families Presumptive
Eligibility Program .
SEC. 23. Section 18925 of the Welfare and Institutions Code is
amended to read:
18925. (a) The State Department of Health Care
Services, in conjunction with the State Department of Social
Services, shall implement a simplified eligibility process as part of
the Food Stamp Program to expedite Medi-Cal program and Healthy
Families Program enrollment for Food Stamp Program recipients,
including children and their eligible parents or caretaker relatives
who are not enrolled in those programs.
(b) Each county welfare department The
State Department of Health Care Services shall
develop a data list of family members
children and their parents residing in eligible food stamp
households who are not enrolled in the Medi-Cal program or the
Healthy Families Program.
(c) The county welfare department State
Department of Health Care Services shall develop a notice
informing individuals identified pursuant to subdivision (b) that
they may be entitled to receive benefits under the Medi-Cal program
or the Healthy Families Program.
(d) At the time of the food stamp household's annual
recertification, the county welfare department
State Department of Health Care Services shall send the
notice specified in subdivision (c) to the individuals identified in
subdivision (b) with a return envelope addressed to the
applicable county welfare department . The notice shall include
a request for permission to use the information in the food stamp
recipient's case file to make a determination of eligibility for the
Medi-Cal program and the Healthy Families Program.
(e) The notice shall be written in culturally and linguistically
appropriate language and at an appropriate literacy level. The notice
shall include information on the Medi-Cal program and the Healthy
Families Program, and a telephone number that food stamp recipients
may call for additional information.
(f) To apply for medical assistance under the Medi-Cal program,
the parent or guardian of the food stamp recipient shall
sign, date, and return the notice requesting that an eligibility
determination be made. Upon receipt of the notice, the county welfare
department shall make an eligibility determination by utilizing the
information in the food stamp recipient's case file or paper
application. The Medi-Cal application date shall be the date the
notice is received by the county welfare department. If the food
stamp case file does not include sufficient information to establish
Medi-Cal program eligibility, the county welfare department shall
request, either orally or in writing, additional information from the
food stamp recipient.
(g) If the food stamp recipient is determined to be eligible to
participate in the Medi-Cal program with a share of cost, or is
determined to be ineligible for Medi-Cal, information pertinent to
the food stamp recipient's eligibility for the Healthy Families
Program shall be forwarded by the county welfare department to the
Healthy Families Program statewide administrator for immediate
processing. If there is insufficient information to establish Healthy
Families Program eligibility, the administrator shall request,
either orally or in writing, additional information from the food
stamp recipient.
(h) Counties shall include the cost of implementing this section
in their annual administrative budget requests to the State
Department of Health Care Services.
(i) This section shall be implemented on or after July 1, 2003,
but only to the extent federal financial participation is available.
(j) The State Department of Health Care Services and the State
Department of Social Services shall develop guidelines to identify
the scope and allocation of responsibilities of state agencies and
counties under this section. Counties shall be required to adopt
procedures and make appropriate programming changes to their
automated welfare systems to accommodate simplification and
streamlining pursuant to this section. Counties shall further be
required to place a high-priority on designing and implementing the
programming to their automated welfare systems necessary to perform
an ex parte, automated Medi-Cal renewal using food stamp data, at
recertification, and to align Medi-Cal and food stamp renewal dates
to the most favorable date to the extent the later date is consistent
with current law. Designing and implementing these changes,
including programming automated welfare systems, shall be a high
priority for the department and counties and shall be operative by
July 1, 2008.
SEC. 24. Notwithstanding any other provision of law, the Managed
Risk Medical Insurance Board may implement this act only to the
extent that funds are appropriated for the purposes of the act in the
annual Budget Act or in another statute.
SEC. 25. 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.