AB 50, as amended, Pan. Health care coverage: Medi-Cal: eligibility.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.begin delete Chapters 3 and 4 of the First Extraordinary Session of 2013-14, to be effective on the 91st day after adjournment of that session, implement various provisions of the federal Patient Protection and Affordable Care Act (PPACA) relating to determining eligibility for the Medi-Cal program.end delete
This billbegin delete would authorize the department to implement some of those provisions by, among other things, all-county letters, until the time any necessary regulations are adopted. The bill would require the department to adopt regulations implementing those provisions by July 1, 2015. This
billend delete would, effective January 1, 2014, and under specified federal provisions applicable to qualified pregnant women and children, provide that a woman shall be eligible for full-scope Medi-Cal benefits if her income is less than 100% of the federal poverty level as determined, counted, and valued in accordance with federal law.begin insert The bill would require the department to adopt regulations implementing that provision by January 1, 2017, and to provide semiannual status reports to the Legislature until that time.end insert
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.
Existing law, to be effective on the 91st day after adjournment of the First Extraordinary Session of 2013-14, would, commencing January 1, 2014, require the department to develop a program to implement provisions that would authorize individuals or their authorized representatives to select Medi-Cal managed care plans via the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), as specified. In this regard, the program is required to include training of specialized county employees to carry out the program.
end deleteThis bill would, instead, require the program to include training of individuals, including county human services staff, to carry out the program.
end deleteExisting law requires the department to establish and maintain a County Administrative Cost Control Plan under which costs for county administration for the determination of eligibility for benefits are controlled, as specified. Existing law requires the department to develop and implement a new budgeting methodology for Medi-Cal county administrative costs to be used to reimburse counties for eligibility determinations for applicants and beneficiaries, and requires that the budgeting methodology include identification of the costs of eligibility determinations for applicants, and the costs of eligibility redeterminations and case maintenance activities for recipients, for different groupings of cases.
end deleteThis bill would instead provide that the budgeting methodology may include identification of the costs of eligibility determinations for applicants, and the costs of eligibility redeterminations and case maintenance activities for recipients, for different groupings of cases. The bill would authorize the development of the new budgeting methodology to include, among other things, county survey of costs, time and motion studies, and in-person observations by department staff. The bill would require that the new budgeting methodology be implemented no sooner than the 2015-16 fiscal year and that it reflect the impact of PPACA implementation on county administrative work.
end deleteExisting law requires the California Health and Human Services Agency, in consultation with specified entities, to establish a standardized single, accessible application form and related renewal procedures for state health subsidy programs, as defined, in accordance with specified requirements. Existing law authorizes the form to include questions that are voluntary for applicants to answer regarding demographic data categories, including race, ethnicity, primary language, disability status, and other categories recognized by the federal Secretary of Health and Human Services pursuant to federal law.
end deleteThis bill would authorize the form to also include questions that are voluntary for applicants to answer regarding sexual orientation and gender identity or expression. The bill would, effective January 1, 2015, require the form to include questions that are voluntary for applicants to answer regarding the demographic data categories specified. This bill would make other technical changes.
end deleteThe 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.
This bill would declare that it is to take effect immediately as an urgency statute.
end deleteVote: begin delete2⁄3 end deletebegin insertmajorityend insert.
Appropriation: no.
Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 14005.22 is added to the Welfare and
2Institutions Code, to read:
(a) Effective January 1, 2014, a woman shall be
4eligible for full-scope Medi-Cal benefits under Section
P4 11396a(a)(10)(A)(i)(III) of Title 42 of the United States Code if her
2income is less than 100 percent of the federal poverty level as
3determined, counted, and valued in accordance with the
4requirements of Section 1396a(e)(14) of Title 42 of the United
5States Code, as added by the federal Patient Protection and
6Affordable Care Act (Public Law 111-148) and as amended by
7the federal Health Care and Education Reconciliation Act of 2010
8(Public Law 111-152) and any subsequent amendments, and she
9meets all other eligibility requirements.
10(b) Notwithstanding Chapter 3.5 (commencing with Section
1111340) of Part 1 of Division 3 of Title 2 of the
Government Code,
12the department, without taking any further regulatory action, shall
13implement, interpret, or make specific this section by means of
14all-county letters, plan letters, plan or provider bulletins, or similar
15instructions until the time regulations are adopted. The department
16shall adopt regulations by January 1, 2017, in accordance with the
17requirements of Chapter 3.5 (commencing with Section 11340) of
18Part 1 of Division 3 of Title 2 of the Government Code. Beginning
19six months after the effective date of this section, notwithstanding
20Section 10321.5 of the Government Code, the department shall
21provide a status report to the Legislature on a semiannual basis,
22in compliance with Section 9795 of the Government Code, until
23regulations have been adopted.
24(c) This section shall be implemented only if and to the extent
25that federal financial participation is available and any necessary
26federal approvals have been
obtained.
If the Commission on State Mandates determines that
28this act contains costs mandated by the state, reimbursement to
29local agencies and school districts for those costs shall be made
30pursuant to Part 7 (commencing with Section 17500) of Division
314 of Title 2 of the Government Code.
All matter omitted in this version of the bill appears in the bill as amended in the Senate, September 3, 2013. (JR11)
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