BILL NUMBER: AB 43	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 27, 2011
	AMENDED IN ASSEMBLY  APRIL 25, 2011

INTRODUCED BY   Assembly Member Monning
    (   Coauthor:   Assembly Member  
Fuentes   ) 

                        DECEMBER 6, 2010

   An act to add Section 14005.60 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 43, as amended, Monning. Medi-Cal: eligibility.
   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, in part, governed and funded by federal Medicaid
provisions.
   Existing federal law requires states, beginning January 1, 2014,
as a condition of receiving federal Medicaid funds, to provide health
care services to persons who are under 65 years of age, not
pregnant, not entitled to, or enrolled for, benefits under Medicare
Part A, or enrolled for benefits under Medicare Part B, or as
otherwise specified, and whose income does not exceed 133% of the
poverty line, as defined.
   This bill would require the department to establish, by January 1,
2014, eligibility for Medi-Cal benefits for any person who meets
these eligibility requirements. This bill would permit the
department, to the extent permitted by federal law, to phase in
coverage for those individuals.
   This bill would require the department to prepare and submit for
approval to the federal Centers for Medicare and Medicaid Services an
initial transition plan, as specified. This bill would also require
the department to submit the initial transition plan to the
appropriate policy and fiscal committees of the Legislature.
   Because counties are required to make Medi-Cal eligibility
determinations and this bill would expand Medi-Cal eligibility, the
bill would impose a state-mandated local program.
    The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to 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 14005.60 is added to the Welfare and
Institutions Code, to read:
   14005.60.  (a) By January 1, 2014, the department shall establish
eligibility for Medi-Cal benefits for any person who meets the
eligibility requirements of subclause (VIII) of Section 1902(a)(10)
(A)(i) and Section 1902(k)(2) of Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.).
   (b) To the extent permitted by federal law, the department may
phase in coverage for persons described in subdivision (a).
   (c) (1) The department shall, in accordance with the Special Terms
and Conditions  for   of  California's
Bridge to Reform Section 1115(a) Medicaid Demonstration
(11-W-00193/9), prepare and submit for approval to the federal
Centers for Medicare and Medicaid Services an initial transition plan
that contains all of the following:
   (A) An outline of the process for determining eligibility for
persons described in subdivision (a), including, but not limited to,
the transition of enrollees in the demonstration project pursuant to
Part 3.6 (commencing with Section 15909) that does not require the
enrollees to submit a new application.
   (B) A plan to manage the transition to new eligibility levels in
2014 by considering, reviewing, and preliminarily determining new
applications beginning as early as July 1, 2013, including in a
county that has not established a demonstration project pursuant to
Part 3.6 (commencing with Section 15909) or that has limited
enrollment in the demonstration project.
   (C) Criteria for provider participation and the means of securing
provider agreements for the transition.
   (D) The schedule of implementation activities for the state to
make the transition plan operational.
   (E) The process the state will use to ensure adequate primary care
and specialty provider networks.
   (2) The department shall also submit the initial transition plan
to the appropriate policy and fiscal committees of the Legislature.
   (d) Nothing in this section shall be construed to limit
eligibility for Medi-Cal benefits as authorized by any other
provision of law.
  SEC. 2.   If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.