BILL NUMBER: SB 438 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 6, 2009
AMENDED IN SENATE APRIL 23, 2009
INTRODUCED BY Senator Yee
FEBRUARY 26, 2009
An act to add Section 12693.766 to the Insurance Code and
to add Section 14011.61 to the Welfare and Institutions
Code, relating to health care coverage
Med-Cal .
LEGISLATIVE COUNSEL'S DIGEST
SB 438, as amended, Yee. Health care coverage.
Medi-Cal.
Existing law provides for creation of various programs to
provide health care services to persons with limited incomes and
meeting various eligibility requirements. These programs include the
Healthy Families Program administered by the Managed Risk Medical
Insurance Board and establishes the Medi-Cal
program administered by the State Department of Health Care Services
and county welfare departments under which qualified low-come
persons are provided with health care services .
This bill would require the board, in consultation with the
department, to begin the transfer of initial eligibility
determinations for the Healthy Families Program to the county welfare
department, and would require the counties to assume full
responsibility for eligibility determinations, annual
redeterminations, and ongoing case maintenance by January 1, 2011. By
imposing new duties on those county departments, the bill would
impose a state-mandated local program.
Under existing law, the State Department of Health Care Services
is required, to the extent federal financial participation is
available and subject to federal approval of any necessary state plan
amendments, to exercise an option under federal law to implement a
program for accelerated enrollment of children in the Medi-Cal
program.
This bill would also require the department, to the extent federal
financial participation is available and subject to approval of any
necessary state plan amendments, to exercise an option under federal
law to implement a program for accelerated enrollment of children and
pregnant women in the Medi-Cal program and would make each county
welfare department a qualified entity for determining eligibility for
Medi-Cal benefits for those children and pregnant women. I
f the county determines that the child is eligible for the
Medi-Cal program with a share of cost, the county would be required
to enroll the child in the Medi-Cal program and forward the
application to the Managed Risk Medical Insurance Board for an
evaluation of the child's eligibility for the Healthy Families
Program. Because the bill would increase
impose additional duties on those county departments, the
bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to 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. Section 12693.766 is added to the
Insurance Code, to read:
12693.766. (a) Notwithstanding any other provision of this part,
the board, in consultation with the State Department of Health Care
Services, shall begin the transfer of initial and eligibility
determinations for the program to the county departments. The
counties shall assume full responsibility for the eligibility
determinations for the program by January 1, 2011.
(b) The board and the department shall consult with stakeholders,
including counties and advocates for program clients, in the
development of procedures for transferring the responsibility for
determinations, annual redeterminations, and ongoing case maintenance
to the county level.
(c) Upon transfer of program eligibility determinations to the
county level, the collection of family contributions and
participating health plan selection may continue to be contracted to
a private entity. In order to maximize efficiency, it is the intent
of the Legislature that plan selection and collection of
contributions be incorporated, to the extent possible, into the
Medi-Cal managed care enrollment broker contract administered by the
State Department of Health Care Services.
SEC. 2. SECTION 1. Section 14011.61
is added to the Welfare and Institutions Code, to read:
14011.61. (a) To the extent federal financial participation is
available, the department shall exercise the option provided in
Section 1920a of the federal Social Security Act (42 U.S.C. Sec.
1396r-1a) to implement a program for accelerated enrollment of
children and pregnant women.
(b) The department shall designate each county welfare department
as a qualified entity for determining eligibility under this section.
(c) The department shall implement this section only if, and to
the extent that, federal financial participation is available.
(d) The department shall seek federal approval of any state plan
amendments necessary to implement this section. When federal approval
of the state plan amendment or amendments is received, the
department shall commence implementation of this section on the first
day of the second month following the month in which federal
approval of the state plan amendment or amendments is received, or on
July 1, 2010, whichever is later.
(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, without taking any regulatory action, implement
this section by means of all-county letters. 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.
(f) Upon the receipt of an application for a child directly from
the pregnant woman parent or another
source on behalf of the child, or an application
for a pregnant woman directly from the parent
pregnant woman or another source on behalf of the pregnant
woman, the county shall determine whether the child or pregnant woman
appears eligible for Medi-Cal benefits and, if so, grant accelerated
enrollment to the child or pregnant woman. Upon the granting of
accelerated enrollment for a child or pregnant woman, the county
shall determine whether the child or pregnant woman is eligible for
Medi-Cal benefits. If the county determines that the child or
pregnant woman does not meet the eligibility requirements for
participation in the Medi-Cal program, the county shall report this
finding to the Medical Eligibility Data System so that accelerated
enrollment coverage benefits are discontinued. If the county
determines that the child is eligible for the Medi-Cal program with a
share of cost, the county shall enroll the child in the Medi-Cal
program and forward the application to the Managed Risk Medical
Insurance Board for an evaluation of the child's eligibility for the
Healthy Families Program.
SEC. 3. If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.