BILL NUMBER: SB 337	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Alquist

                        FEBRUARY 25, 2009

   An act to amend Section 14011.16 of, to amend and repeal Section
14005.25 of, and to repeal Sections 14011.17 and 14011.18 of, the
Welfare and Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 337, as introduced, Alquist. Medi-Cal: continuous eligibility:
semiannual status reports.
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is partially governed and funded under federal
Medicaid provisions.
   Existing law, until January 1, 2012, requires the department,
subject to the availability of federal financial participation, to
exercise a federal option to expand continuous eligibility to
children 19 years of age and younger for 6 months, after which date
the continuous eligibility period shall be from the date of a
determination of eligibility to the earlier of either the end of a
12-month period following the eligibility determination or the date
the child exceeds 19 years of age.
   This bill would eliminate the provisions limiting continuous
eligibility to 6 months, would make those provisions that become
operative on January 1, 2012, applicable commencing January 1, 2010,
and would make conforming changes.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14005.25 of the Welfare and Institutions Code,
as amended by Section 27 of Chapter 758 of the Statutes of 2008, is
amended to read:
   14005.25.  (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger. A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
   (1) The end of a 12-month period following the eligibility
determination.
   (2) The date the individual exceeds the age of 19 years.
   (b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code. 
   (d) In order to implement changes in the level of funding for
health care services, commencing on the first day of the month
following 90 days after the operative date of amendments to this
section that added this subdivision, the continuous eligibility time
period provided in paragraph (1) of subdivision (a) shall be reduced
to six months.  
   (e) This section shall remain in effect only until January 1,
2012, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2012, deletes or extends
that date. 
  SEC. 2.  Section 14005.25 of the Welfare and Institutions Code, as
added by Section 28 of Chapter 758 of the Statutes of 2008, is
repealed. 
   14005.25.  (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger. A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
   (1) The end of a 12-month period following the eligibility
determination.
   (2) The date the individual exceeds the age of 19 years.
   (b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
   (d) This section shall become operative on January 1, 2012.

  SEC. 3.  Section 14011.16 of the Welfare and Institutions Code is
amended to read:
   14011.16.  (a) Commencing August 1, 2003, the department shall
implement a requirement for beneficiaries to file semiannual status
reports as part of the department's procedures to ensure that
beneficiaries make timely and accurate reports of any change in
circumstance that may affect their eligibility. The department shall
develop a simplified form to be used for this purpose. The department
shall explore the feasibility of using a form that allows a
beneficiary who has not had any changes to so indicate by checking a
box and signing and returning the form.
   (b) Beneficiaries who have been granted continuous eligibility
under Section 14005.25 shall not be required to submit semiannual
status reports. To the extent federal financial participation is
available, all children under 19 years of age shall be exempt from
the requirement to submit semiannual status reports. 
   (c) For any period of time that the continuous eligibility period
described in paragraph (1) of subdivision (a) of Section 14005.25 is
reduced to six months, subdivision (b) shall become inoperative, and
all children under 19 years of age shall be required to file
semiannual status reports.  
   (d) 
    (c)  Beneficiaries whose eligibility is based on a
determination of disability or on their status as aged or blind shall
be exempt from the semiannual status report requirement described in
subdivision (a). The department may exempt other groups from the
semiannual status report requirement as necessary for simplicity of
administration. 
   (e) 
    (d)  When a beneficiary has completed, signed, and filed
a semiannual status report that indicated a change in circumstance,
eligibility shall be redetermined. 
   (f) 
    (e)  Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department shall implement this section by means of all
county letters or similar instructions without taking regulatory
action. Thereafter, the department shall adopt regulations in
accordance with the requirements of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code. 
   (g) 
    (f)  This section shall be implemented only if and to
the extent federal financial participation is available.
  SEC. 4.  Section 14011.17 of the Welfare and Institutions Code is
repealed. 
   14011.17.  The following persons shall be exempt from the
semiannual reporting requirements described in Section 14011.16:
   (a) Pregnant women whose eligibility is based on pregnancy.
   (b) Beneficiaries receiving Medi-Cal through Aid for Adoption of
Children Program.
   (c) Beneficiaries who have a public guardian.
   (d) Medically indigent children who are not living with a parent
or relative and who have a public agency assuming their financial
responsibility.
   (e) Individuals receiving minor consent services.
   (f) Beneficiaries in the Breast and Cervical Cancer Treatment
Program.
   (g) Beneficiaries who are CalWORKs recipients and custodial
parents whose children are CalWORKs recipients. 
  SEC. 5.  Section 14011.18 of the Welfare and Institutions Code is
repealed. 
   14011.18.  (a) On or before December 15, 2010, the State
Department of Health Care Services shall report to the fiscal and
health policy committees of the Legislature on the effects of
reducing the time period of continuous eligibility for children and
imposing a semiannual status reporting requirement to maintain
Medi-Cal eligibility for children. The report shall include all of
the following information:
   (1) The number of children enrolled in Medi-Cal by eligibility
category prior to the imposition of semiannual status reporting and
on a quarterly basis after the imposition of semiannual reporting.
Within each eligibility category, the report also shall identify the
number of enrolled children in Medi-Cal managed care and in
fee-for-service Medi-Cal.
   (2) The annual cost per child enrollee in managed care and by cost
category in fee-for-service prior to the imposition of semiannual
reporting and for the 2009-10 fiscal year.
   (3) An analysis of enrollment interruptions and reinstatements for
children prior to the imposition of semiannual reporting and for the
2009-10 fiscal year. The analysis shall include data on the number
of children disenrolled as a result of the semiannual reporting
requirement, the number of those children who were subsequently
reenrolled in Medi-Cal by duration of their enrollment gap, and an
analysis, to the extent feasible, of the extent to which enrollment
gaps resulted from the failure of families to file a complete
semiannual report versus a change in family circumstances that
resulted in a child no longer being eligible for no-cost Medi-Cal
coverage, and the number of children that transitioned to the Healthy
Families Program as a result of semiannual reporting.
   (4) An estimate of the additional annual county eligibility
administration costs or savings resulting from the processing of
semiannual reports for children, disenrollment processing,
reinstatement, reenrollment, and caseload reductions.
   (b) For purposes of preparing the report, the department shall
seek funding, or participation from appropriate nonprofit
organizations, including foundations and universities, or both.