Amended in Senate June 14, 2013

Amended in Senate June 4, 2013

California Legislature—2013–14 First Extraordinary Session

Assembly Bill No. 1

Introduced by Assembly Member John A. Pérez

(Coauthors: Assembly Members Alejo, Blumenfield, Bocanegra, Campos, Eggman, Garcia, Gomez, begin delete Hernandez, end delete begin insert Roger  end insert begin insert Hernández, end insert Pan, V. Manuel Pérez, and Quirk-Silva)

(Coauthors: Senators Calderon, Correa, De León, Hueso, and Lara)

January 28, 2013

An act to amend Section 12698.30 of the Insurance Code, and to amend Sections begin delete 14005.36, 14005.39, 14132, end delete begin insert 14005.36 end insert and 15926 of, to amend and repeal Sections 14005.38, begin delete 14008.85, end delete 14011.16, begin delete and end delete 14011.17 begin insert , and 14012 end insert of, to amend, repeal, and add Sections begin delete 14005.18, 14005.28, 14005.30, 14005.31, 14005.32, 14005.37, 14007.1, 14007.6, and 14012 end delete begin insert 14005.30, 14005.37, 14016.5, and 14016.6 end insert of, to add Sections begin delete 14000.7, 14005.60, 14005.62,14005.63, 14005.64, 14005.65, 14007.15, 14014.5, end delete begin insert 14005.60, 14005.61, 14005.64, 14013.3, end insert 14015.7, begin insert 14015.8, end insert 14055, begin delete 14057, 14102, end delete 14102.5, and begin delete 14132.02 end delete begin insert 14103 end insert to, and to add and repeal Section 14015.5 of, the Welfare and Institutions Code, relating to health.

LEGISLATIVE COUNSEL’S DIGEST

AB 1, as amended, John A. Pérez. 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.

This bill would, commencing January 1, 2014, implement various provisions of the federal Patient Protection and Affordable Care Act (Affordable Care Act), as amended, by, among other things, modifying provisions relating to determining eligibility for certain groups. The bill would, in this regard, extend Medi-Cal eligibility to specified adults begin delete and former foster children end delete and would require that income eligibility be determined based on modified adjusted gross income (MAGI), as prescribed. The bill would prohibit the use of an asset or resources test for individuals whose financial eligibility for Medi-Cal is determined based on the application of MAGI. begin delete The bill would also add, commencing January 1, 2014, benefits, services, and coverage included in the essential health benefits package, as adopted by the state and approved by the United States Secretary of Health and Human Services, to the schedule of Medi-Cal benefits. end delete begin insert The bill would require that individuals who are enrolled in the Low Income Health Program as of December 31, 2013, under a specified waiver who are at or below 133% of the federal poverty level be transitioned directly to the Medi-Cal program, as prescribed. The bill would provide that the implementation of the optional expansion of Medi-Cal benefits to adults who meet specified eligibility requirements shall be contingent on the federal medical assistance percentage (FMAP) payable to the state under the Affordable Care Act is not being reduced below specified percentages, as specified. 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.

begin delete

This bill would require that a person who wishes to apply for an insurance affordability program, as defined, be allowed to file an application on his or her own behalf or on behalf of his or her family and would authorize a person to be accompanied, assisted, and represented in the application and renewal process by an individual or organization of his or her choice. This bill would also require the department, to the extent required by federal law, to provide assistance to any applicant or beneficiary who requests help with the application or redetermination.

end delete

The bill would require the California Health Benefit Exchange (Exchange) to implement a workflow transfer protocol, as prescribed, for persons calling the customer service center operated by the Exchange for the purpose of applying for an insurance affordability program, to ascertain which individuals are potentially eligible for Medi-Cal. This bill would also prescribe the authority the department, the Exchange, and the counties would have, until July 1, 2015, to perform Medi-Cal eligibility determinations. begin insert The bill would require the department to verify the accuracy of certain information that is provided as part of the application or redetermination process when determining end insert begin insert whet end insert begin insert her an individual is eligible for Medi-Cal benefits, as prescribed. The bill would require the department, any other government agency that is determining eligibility for, or enrollment in, the Medi-Cal program or any other program administered by the department, or collecting protected information for those purposes, and the Exchange to share specified information with each other as necessary to enable them to perform their respective statutory and regulatory duties under state and federal law. end insert

begin delete

Existing law requires the department to adopt regulations for use by the county in determining whether an applicant is a resident of the state and of the county, subject to the requirements of federal law. Existing law requires that the regulations require that state residency be established only if certain requirements are met, including the requirement that the applicant makes specified declarations under penalty of perjury.

end delete begin delete

This bill would revise those provisions to, among other things, further prescribe the circumstances under which state residency may be established and to require the department to electronically verify an individual’s state residency using certain sources and would set forth how an individual may establish state residency if the department is unable to electronically verify his or her state residency. The bill would, for purposes of establishing state residency, authorize an individual to make various declarations under penalty of perjury, and would authorize other individuals, such as parents or legal guardians, to make various declarations under penalty of perjury regarding the individual’s state residency if the individual is incapable of indicating intent. By expanding the crime of perjury, the bill would impose a state-mandated local program.

end delete begin insert

Existing law requires an applicant or beneficiary, as specified, who resides in an area served by a managed health care plan or pilot program in which beneficiaries may enroll, to personally attend a presentation at which the applicant or beneficiary is informed of managed care and fee-for-service options for receiving Medi-Cal benefits. Existing law requires the applicant or beneficiary to indicate in writing his or her choice of health care options and provides that if the applicant or beneficiary does not make a choice, he or she shall be assigned to and enrolled in an appropriate Medi-Cal managed care plan, pilot project, or fee-for-service case management provider providing service within the area in which the beneficiary resides. Existing law requires the department to develop a program, as specified, to implement these provisions.

end insert begin insert

This bill would revise these provisions to, among other things, require the department to develop a program to allow individuals or their authorized representatives to select Medi-Cal managed care plans via the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERs).

end insert

Existing law requires Medi-Cal beneficiaries, with some exceptions, to file semiannual status reports to ensure that beneficiaries make timely and accurate reports of any change in circumstance that may affect their eligibility and requires, with some exceptions, a county to promptly redetermine eligibility whenever a county receives information about changes in a beneficiary’s circumstances that may affect eligibility for Medi-Cal benefits.

This bill would, commencing January 1, 2014, revise these provisions to, among other things, delete the semiannual status report requirement and require a county to perform redeterminations every 12 months. The bill would require any forms signed by the beneficiary for purposes of redetermining eligibility to be signed under penalty of perjury. By expanding the crime of perjury, 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 with regard to certain mandates no reimbursement is required by this act for a specified reason.

With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

begin insert

This bill would become operative only if SB 1 of the 2013-14 First Extraordinary Session is enacted and takes effect.

end insert

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) The United States is the only industrialized country in the
world without a universal health insurance system.

(b) (1) In 2006, the United States Census reported that 46
million Americans did not have health insurance.

(2) In California in 2009, according to the UCLA Center for
Health Policy Research’s “The State of Health Insurance in
California: Findings from the 2009 California Health Interview
Survey,” 7.1 million Californians were uninsured in 2009,
amounting to 21.1 percent of nonelderly Californians who had no
health insurance coverage for all or some of 2009, up nearly 2
percentage points from 2007.

(c) On March 23, 2010, President Obama signed the Patient
Protection and Affordable Care Act (Public Law 111-148), which
was amended by the Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152), and together are referred to as
the Affordable Care Act of 2010 (Affordable Care Act).

(d) The Affordable Care Act is the culmination of decades of
movement toward health reform, and is the most fundamental
legislative transformation of the United States health care system
in 40 years.

(e) As a result of the enactment of the Affordable Care Act,
according to estimates by the UCLA Center for Health Policy
Research and the UC Berkeley Labor Center, using the California
Simulation of Insurance Markets, in 2019, after the Affordable
Care Act is fully implemented:

(1) Between 89 and 92 percent of Californians under 65 years
of age will have health coverage.

(2) Between 1.2 and 1.6 million individuals will be newly
enrolled in Medi-Cal.

(f) It is the intent of the Legislature to ensure full implementation
of the Affordable Care Act, including the Medi-Cal expansion for
individuals with incomes below 133 percent of the federal poverty
level, so that millions of uninsured Californians can receive health
care coverage.

SEC. 2.  

Section 12698.30 of the Insurance Code is amended
to read:

12698.30.  

(a) (1) Subject to paragraph (2), at a minimum,
coverage shall be provided to subscribers during one pregnancy,
and for 60 days thereafter, and to children less than two years of
age who were born of a pregnancy covered under this program to
a woman enrolled in the program before July 1, 2004.

(2) Commencing January 1, 2014, at a minimum, coverage shall
be provided to subscribers during one pregnancy, and until the end
of the month in which the 60th day thereafter occurs, and to
children less than two years of age who were born of a pregnancy
covered under this program to a woman enrolled in the program
before July 1, 2004.

(b) Coverage provided pursuant to this part shall include, at a
minimum, those services required to be provided by health care
service plans approved by the United States Secretary of Health
and Human Services as a federally qualified health care service
plan pursuant to Section 417.101 of Title 42 of the Code of Federal
Regulations.

(c) Coverage shall include health education services related to
tobacco use.

(d) Medically necessary prescription drugs shall be a required
benefit in the coverage provided under this part.

begin delete

SEC. 3.  

Section 14000.7 is added to the Welfare and
Institutions Code, to read:

14000.7.  

(a) The department shall provide assistance to any
applicant or beneficiary that requests help with the application or
redetermination process to the extent required by federal law.

(b) The assistance provided under subdivision (a) shall be
available to the individual in person, over the telephone, and online,
and in a manner that is accessible to individuals with disabilities
and those who have limited English proficiency.

(c) To the extent otherwise required by Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(d) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(e) This section shall become operative on January 1, 2014.

SEC. 4.  

Section 14005.18 of the Welfare and Institutions Code
is amended to read:

14005.18.  

(a) A woman is eligible, to the extent required by
federal law, as though she were pregnant, for all pregnancy-related
and postpartum services for a 60-day period beginning on the last
day of pregnancy.

For purposes of this section, “postpartum services” means those
services provided after childbirth, child delivery, or miscarriage.

(b) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

SEC. 5.  

Section 14005.18 is added to the Welfare and
Institutions Code, to read:

14005.18.  

(a) To help prevent premature delivery and low
birthweights, the leading causes of infant and maternal morbidity
and mortality, and to promote women’s overall health, well-being,
and financial security and that of their families, it is imperative
that pregnant women enrolled in Medi-Cal be provided with all
medically necessary services. Therefore, a woman is eligible, to
the extent required by federal law, as though she were pregnant,
for all pregnancy-related and postpartum services for a period
beginning on the last day of pregnancy and continuing until the
end of the month in which the 60th day of postpartum occurs.

(b) For purposes of this section, the following definitions shall
apply:

(1) “Pregnancy-related services” means, at a minimum, all
services required under the state plan.

(2) “Postpartum services” means those services provided after
child birth, child delivery, or miscarriage.

(c) This section shall become operative January 1, 2014.

SEC. 6.  

Section 14005.28 of the Welfare and Institutions Code
is amended to read:

14005.28.  

(a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall exercise its option under Section
1902(a)(10)(A)(ii)(XVII) of the federal Social Security Act (42
U.S.C. Sec. 1396a(a)(10)(A)(ii)(XVII)) to extend Medi-Cal benefits
to independent foster care adolescents, as defined in Section
1905(w)(1) of the federal Social Security Act (42 U.S.C. Sec.
1396d(w)(1)).

(b) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
and if the state plan amendment described in subdivision (a) is
approved by the federal Health Care Financing Administration,
the department may implement subdivision (a) without taking any
regulatory action and 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.

(c) The department shall implement subdivision (a) on October
1, 2000, but only if, and to the extent that, the department has
obtained all necessary federal approvals.

(d) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

SEC. 7.  

Section 14005.28 is added to the Welfare and
Institutions Code, to read:

14005.28.  

(a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall implement Section 1902(a)(10)(A)(i)(IX) of the
federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(i)(IX))
to provide Medi-Cal benefits to an individual who is in foster care
on his or her 18th birthday until his or her 26th birthday. In
addition, the department shall implement the option in paragraph
(3) of subdivision (b) of Section 435.150 of Title 42 of the Code
of Federal Regulations to provide Medi-Cal benefits to individuals
that were in foster care and enrolled in Medicaid in any state.

(1) A foster care adolescent who is in foster care on his or her
18th birthday shall be enrolled to receive benefits under this section
without any interruption in coverage and without requiring a new
application.

(2) The department shall develop procedures to identify and
enroll individuals who meet the criteria for Medi-Cal eligibility
in this subdivision, including, but not limited to, former foster care
adolescents who were in foster care on their 18th birthday and who
lost Medi-Cal coverage as a result of attaining 21 years of age.
The department shall work with counties to identify and conduct
outreach to former foster care adolescents who lost Medi-Cal
coverage during the 2013 calendar year as a result of attaining 21
years of age, to ensure they are aware of the ability to reenroll
under the coverage provided pursuant to this section.

(3) (A) The department shall develop and implement a
simplified redetermination form for this program. A beneficiary
qualifying for the benefits extended pursuant to this section shall
fill out and return this form only if information known to the
department is no longer accurate or is materially incomplete.

(B) The department shall seek federal approval to institute a
renewal process that allows a beneficiary receiving benefits under
this section to remain on Medi-Cal after a redetermination form
is returned as undeliverable and the county is otherwise unable to
establish contact. If federal approval is granted, the recipient shall
remain eligible for services under the Medi-Cal fee-for-service
program until the time contact is reestablished or ineligibility is
established, and to the extent federal financial participation is
available.

(C) The department shall terminate eligibility only after it
determines that the recipient is no longer eligible and all due
process requirements are met in accordance with state and federal
law.

(b) This section shall be implemented only if and to the extent
that federal financial participation is available.

(c) This section shall become operative January 1, 2014.

end delete

begin delete SEC. 8. end delete
begin insert SEC. 3. end insert   

Section 14005.30 of the Welfare and Institutions Code
is amended to read:

14005.30.  

(a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any
options under Section 1396u-1(b)(2)(C) made available to and
exercised by the state.

(2) The department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code to adopt
less restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).

(3) To the extent federal financial participation is available, the
department shall exercise its option under Section 1396u-1(b)(2)(C)
of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012. The department
shall implement this paragraph only if, and to the extent that the
State Child Health Insurance Program waiver described in Section
12693.755 of the Insurance Code extending Healthy Families
Program eligibility to parents and certain other adults is approved
and implemented.

(b) To the extent that federal financial participation is available,
the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to expand eligibility for Medi-Cal under subdivision (a) by
establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).

(c) To the extent federal financial participation is available, the
department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b)
of the federal Social Security Act (42 U.S.C. Sec. 1396u-1) and
the amount equal to 100 percent of the federal poverty level
applicable to the size of the family. A recipient shall be entitled
to the same disregard, but only to the extent it is more beneficial
than, and is substituted for, the earned income disregard available
to recipients.

(d) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec.
401 et seq.) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the
federal poverty level requires the department to modify the income
disregard pursuant to subdivision (c) and in which new income
limits for the program established by this section are adopted by
the department.

(e) Subdivision (b) shall be applied retroactively to January 1,
1998.

(f) 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, without taking regulatory action,
subdivisions (a) and (b) of this section by means of an all-county
letter or similar instruction. 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) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

begin delete SEC. 9. end delete
begin insert SEC. 4. end insert   

Section 14005.30 is added to the Welfare and
Institutions Code, to read:

14005.30.  

(a) (1)  begin delete To the extent that federal financial
participation is available, end delete Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code begin delete , known as the
Section 1931(b) program, including any options under Section
1396u-1(b)(2)(C) made available to and exercised by the state end delete .

begin delete

(2) The department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code to adopt
less restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).

(b) Commencing January 1, 2014, pursuant to Section
1396a(e)(14)(C) of Title 42 of the United States Code, there shall
be no assets test and no deprivation test for any individual under
this section.

end delete begin insert

(b) (1) When determining eligibility under this section, an
applicant’s or beneficiary’s income and resources shall be
determined, counted, and valued in accordance with the
requirements of Section 1396a(e)(14) of Title 42 of the United
States Code, as added by the ACA.

end insert begin insert

(2) When determining eligibility under this section, an
applicant’s or beneficiary’s assets shall not be considered and
deprivation shall not be a requirement for eligibility.

end insert

(c) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec.
401 et seq.) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the
federal poverty level requires the department to modify the income
disregard pursuant to subdivision (c) and in which new income
limits for the program established by this section are adopted by
the department.

begin insert

(d) The MAGI-based income eligibility standard applied under
this section shall conform with the maintenance of effort
requirements of Sections 1396a(e)(14) and 1396a(gg) of Title 42
of the United States Code, as added by the ACA.

end insert begin insert

(e) For purposes of this section, the following definitions shall
apply:

end insert begin insert

(1)  “ACA” means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as originally enacted and as
amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152) and any subsequent
amendments.

end insert begin insert

(2) “MAGI-based income” means income calculated using the
financial methodologies described in Section 1396a(e)(14) of Title
42 of the United States Code, as added by the federal Patient
Protection and Affordable Care Act (Public Law 111-148) and as
amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152) and any subsequent
amendments.

end insert begin insert

(f) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

end insert begin delete

(d)

end delete

begin insert (g) end insert  This section shall become operative begin insert on end insert January 1, 2014.

begin delete

SEC. 10.  

Section 14005.31 of the Welfare and Institutions Code
is amended to read:

14005.31.  

(a) (1) Subject to paragraph (2), for any person
whose eligibility for benefits under Section 14005.30 has been
determined with a concurrent determination of eligibility for cash
aid under Chapter 2 (commencing with Section 11200), loss of
eligibility or termination of cash aid under Chapter 2 (commencing
with Section 11200) shall not result in a loss of eligibility or
termination of benefits under Section 14005.30 absent the existence
of a factor that would result in loss of eligibility for benefits under
Section 14005.30 for a person whose eligibility under Section
14005.30 was determined without a concurrent determination of
eligibility for benefits under Chapter 2 (commencing with Section
11200).

(2) Notwithstanding paragraph (1), a person whose eligibility
would otherwise be terminated pursuant to that paragraph shall
not have his or her eligibility terminated until the transfer
procedures set forth in Section 14005.32 or the redetermination
procedures set forth in Section 14005.37 and all due process
requirements have been met.

(b) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice
to be used by the counties, to inform Medi-Cal beneficiaries whose
eligibility for cash aid under Chapter 2 (commencing with Section
11200) has ended, but whose eligibility for benefits under Section
14005.30 continues pursuant to subdivision (a), that their benefits
will continue. To the extent feasible, the notice shall be sent out
at the same time as the notice of discontinuation of cash aid, and
shall include all of the following:

(1) A statement that Medi-Cal benefits will continue even though
cash aid under the CalWORKs program has been terminated.

(2) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.

(3) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but shall be required to submit a semiannual status report
and annual reaffirmation forms. The notice shall remind individuals
whose cash aid ended under the CalWORKs program as a result
of not submitting a status report that he or she should review his
or her circumstances to determine if changes have occurred that
should be reported to the Medi-Cal eligibility worker.

(4) A statement describing the responsibility of the Medi-Cal
beneficiary to report to the county, within 10 days, significant
changes that may affect eligibility.

(5) A telephone number to call for more information.

(6) A statement that the Medi-Cal beneficiary’s eligibility
worker will not change, or, if the case has been reassigned, the
new worker’s name, address, and telephone number, and the hours
during which the county’s eligibility workers can be contacted.

(c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.) is available.

(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, without taking any 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. Comprehensive implementing instructions
shall be issued to the counties no later than March 1, 2001.

(e) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

SEC. 11.  

Section 14005.31 is added to the Welfare and
Institutions Code, to read:

14005.31.  

(a) (1) Subject to paragraph (2), for any person
whose eligibility for benefits under Section 14005.30 has been
determined with a concurrent determination of eligibility for cash
aid under Chapter 2 (commencing with Section 11200), loss of
eligibility or termination of cash aid under Chapter 2 (commencing
with Section 11200) shall not result in a loss of eligibility or
termination of benefits under Section 14005.30 absent the existence
of a factor that would result in loss of eligibility for benefits under
Section 14005.30 for a person whose eligibility under Section
14005.30 was determined without a concurrent determination of
eligibility for benefits under Chapter 2 (commencing with Section
11200).

(2) Notwithstanding paragraph (1), a person whose eligibility
would otherwise be terminated pursuant to that paragraph shall
not have his or her eligibility terminated until the transfer
procedures set forth in Section 14005.32 or the redetermination
procedures set forth in Section 14005.37 and all due process
requirements have been met.

(b) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice
to be used by the counties to inform Medi-Cal beneficiaries whose
eligibility for cash aid under Chapter 2 (commencing with Section
11200) has ended, but whose eligibility for benefits under Section
14005.30 continues pursuant to subdivision (a), that their benefits
will continue. To the extent feasible, the notice shall be sent out
at the same time as the notice of discontinuation of cash aid, and
shall include all of the following:

(1) A statement that Medi-Cal benefits will continue even though
cash aid under the CalWORKs program has been terminated.

(2) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.

(3) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but may be required to submit annual reaffirmation
forms. The notice shall remind individuals whose cash aid ended
under the CalWORKs program as a result of not submitting a status
report that he or she should review his or her circumstances to
determine if changes have occurred that should be reported to the
Medi-Cal eligibility worker.

(4) A statement describing the responsibility of the Medi-Cal
beneficiary to report to the county, within 10 days, significant
changes that may affect eligibility.

(5) A telephone number to call for more information.

(6) A statement that the Medi-Cal beneficiary’s eligibility
worker will not change, or, if the case has been reassigned, the
new worker’s name, address, and telephone number, and the hours
during which the county’s eligibility workers can be contacted.

(c)

 
Notwithstanding Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.

(d)

 
This section shall become operative on January 1, 2014.

SEC. 12.  

Section 14005.32 of the Welfare and Institutions
Code is amended to read:

14005.32.  

(a) (1) If the county has evidence clearly
demonstrating that a beneficiary is not eligible for benefits under
this chapter pursuant to Section 14005.30, but is eligible for
benefits under this chapter pursuant to other provisions of law, the
county shall transfer the individual to the corresponding Medi-Cal
program. Eligibility under Section 14005.30 shall continue until
the transfer is complete.

(2) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice
to be used by the counties, to inform beneficiaries that their
Medi-Cal benefits have been transferred pursuant to paragraph (1)
and to inform them about the program to which they have been
transferred. To the extent feasible, the notice shall be issued with
the notice of discontinuance from cash aid, and shall include all
of the following:

(A) A statement that Medi-Cal benefits will continue under
another program, even though aid under Chapter 2 (commencing
with Section 11200) has been terminated.

(B) The name of the program under which benefits will continue,
and an explanation of that program.

(C) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.

(D) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but shall be required to submit a semiannual status report
and annual reaffirmation forms. In addition, if the person or persons
to whom the notice is directed has been found eligible for
transitional Medi-Cal as described in Section 14005.8 or 14005.85,
the statement shall explain the reporting requirements and duration
of benefits under those programs, and shall further explain that,
at the end of the duration of these benefits, a redetermination, as
provided for in Section 14005.37 shall be conducted to determine
whether benefits are available under any other provision of law.

(E) A statement describing the beneficiary’s responsibility to
report to the county, within 10 days, significant changes that may
affect eligibility or share of cost.

(F) A telephone number to call for more information.

(G) A statement that the beneficiary’s eligibility worker will
not change, or, if the case has been reassigned, the new worker’s
name, address, and telephone number, and the hours during which
the county’s Medi-Cal eligibility workers can be contacted.

(b) No later than September 1, 2001, the department shall submit
a federal waiver application seeking authority to eliminate the
reporting requirements imposed by transitional medicaid under
Section 1925 of the federal Social Security Act (Title 42 U.S.C.
Sec. 1396r-6).

(c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.) is available.

(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, without taking any 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. Comprehensive implementing instructions
shall be issued to the counties no later than March 1, 2001.

(e) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

SEC. 13.  

Section 14005.32 is added to the Welfare and Institutions
Code, to read:

14005.32.  

(a) (1) If the county has evidence clearly
demonstrating that a beneficiary is not eligible for benefits under
this chapter pursuant to Section 14005.30, but is eligible for
benefits under this chapter pursuant to other provisions of law, the
county shall transfer the individual to the corresponding Medi-Cal
program in conformity with and subject to the requirements of
Section 14005.37. Eligibility under Section 14005.30 shall continue
until the transfer is complete.

(2) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice
to be used by the counties to inform beneficiaries that their
Medi-Cal benefits have been transferred pursuant to paragraph (1)
and to inform them about the program to which they have been
transferred. To the extent feasible, the notice shall be issued with
the notice of discontinuance from cash aid, and shall include all
of the following:

(A) A statement that Medi-Cal benefits will continue under
another program, even though aid under Chapter 2 (commencing
with Section 11200) has been terminated.

(B) The name of the program under which benefits will continue
and an explanation of that program.

(C) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.

(D) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but may be required to submit annual reaffirmation
forms. In addition, if the person or persons to whom the notice is
directed has been found eligible for transitional Medi-Cal as
described in Section 14005.8 or 14005.85, the statement shall
explain the reporting requirements and duration of benefits under
those programs and shall further explain that, at the end of the
duration of these benefits, a redetermination, as provided in Section
14005.37, shall be conducted to determine whether benefits are
available under any other law.

(E) A statement describing the beneficiary’s responsibility to
report to the county, within 10 days, significant changes that may
affect eligibility or share of cost.

(F) A telephone number to call for more information.

(G) A statement that the beneficiary’s eligibility worker will
not change, or, if the case has been reassigned, the new worker’s
name, address, and telephone number, and the hours during which
the county’s Medi-Cal eligibility workers can be contacted.

(b)

 
Notwithstanding Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.

(c)

 
This section shall become operative on January 1, 2014.

end delete

begin delete SEC. 14. end delete
begin insert SEC. 5. end insert   

Section 14005.36 of the Welfare and Institutions Code
is amended to read:

14005.36.  

(a) The county shall undertake outreach efforts to
beneficiaries receiving benefits under this chapter, in order to
maintain the most up-to-date home addresses, telephone numbers,
and other necessary contact information, and to encourage and
assist with timely submission of the annual reaffirmation form,
and, when applicable, transitional Medi-Cal program reporting
forms and to facilitate the Medi-Cal redetermination process when
one is required as provided in Section 14005.37. In implementing
this subdivision, a county may collaborate with community-based
organizations, provided that confidentiality is protected.

(b) The department shall encourage and facilitate efforts by
managed care plans to report updated beneficiary contact
information to counties.

(c)  begin insert (1) end insert begin insert   end insert The department and each county shall incorporate, in
a timely manner, updated contact information received from
managed care plans pursuant to subdivision (b) into the
beneficiary’s Medi-Cal case file and into all systems used to inform
plans of their beneficiaries’ enrollee status. Updated Medi-Cal
beneficiary contact information shall be limited to the beneficiary’s
telephone number, change of address information, and change of
name. begin delete The county shall attempt to verify that the information it
receives from the plan is accurate, which may include, but is not
limited to, making contact with the beneficiary, before updating
the beneficiary’s case file. end delete

begin insert

(2) When a managed care plan obtains a beneficiary’s updated
contact information, the managed care plan shall ask the
beneficiary for approval to provide the beneficiary’s updated
contact information to the appropriate county. If the managed care
plan does not obtain approval from the beneficiary to provide the
appropriate county with the updated contact information, the
county shall attempt to verify the plan is accurate, which may
include, but is not limited to, making contact with the beneficiary,
before updating the beneficiary’s case file. The contact shall first
be attempted using the method of contact identified by the
beneficiary as the preferred method of contact, if a method has
been identified.

end insert

(d) This section shall be implemented only to the extent that
federal financial participation under Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) is available.

(e) To the extent otherwise required by Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

begin delete SEC. 15. end delete
begin insert SEC. 6. end insert   

Section 14005.37 of the Welfare and Institutions Code
is amended to read:

14005.37.  

(a) Except as provided in Section 14005.39,
whenever a county receives information about changes in a
beneficiary’s circumstances that may affect eligibility for Medi-Cal
benefits, the county shall promptly redetermine eligibility. The
procedures for redetermining Medi-Cal eligibility described in this
section shall apply to all Medi-Cal beneficiaries.

(b)  Loss of eligibility for cash aid under that program shall not
result in a redetermination under this section unless the reason for
the loss of eligibility is one that would result in the need for a
redetermination for a person whose eligibility for Medi-Cal under
Section 14005.30 was determined without a concurrent
determination of eligibility for cash aid under the CalWORKs
program.

(c) A loss of contact, as evidenced by the return of mail marked
in such a way as to indicate that it could not be delivered to the
intended recipient or that there was no forwarding address, shall
require a prompt redetermination according to the procedures set
forth in this section.

(d) Except as otherwise provided in this section, Medi-Cal
eligibility shall continue during the redetermination process
described in this section. A Medi-Cal beneficiary’s eligibility shall
not be terminated under this section until the county makes a
specific determination based on facts clearly demonstrating that
the beneficiary is no longer eligible for Medi-Cal under any basis
and due process rights guaranteed under this division have been
met.

(e) For purposes of acquiring information necessary to conduct
the eligibility determinations described in subdivisions (a) to (d),
inclusive, a county shall make every reasonable effort to gather
information available to the county that is relevant to the
beneficiary’s Medi-Cal eligibility prior to contacting the
beneficiary. Sources for these efforts shall include, but are not
limited to, Medi-Cal, CalWORKs, and CalFresh case files of the
beneficiary or of any of his or her immediate family members,
which are open or were closed within the last 45 days, and
wherever feasible, other sources of relevant information reasonably
available to the counties.

(f) If a county cannot obtain information necessary to
redetermine eligibility pursuant to subdivision (e), the county shall
attempt to reach the beneficiary by telephone in order to obtain
this information, either directly or in collaboration with
community-based organizations so long as confidentiality is
protected.

(g) If a county’s efforts pursuant to subdivisions (e) and (f) to
obtain the information necessary to redetermine eligibility have
failed, the county shall send to the beneficiary a form, which shall
highlight the information needed to complete the eligibility
determination. The county shall not request information or
documentation that has been previously provided by the
beneficiary, that is not absolutely necessary to complete the
eligibility determination, or that is not subject to change. The form
shall be accompanied by a simple, clear, consumer-friendly cover
letter, which shall explain why the form is necessary, the fact that
it is not necessary to be receiving CalWORKs benefits to be
receiving Medi-Cal benefits, the fact that receipt of Medi-Cal
benefits does not count toward any time limits imposed by the
CalWORKs program, the various bases for Medi-Cal eligibility,
including disability, and the fact that even persons who are
employed can receive Medi-Cal benefits. The cover letter shall
include a telephone number to call in order to obtain more
information. The form and the cover letter shall be developed by
the department in consultation with the counties and representatives
of consumers, managed care plans, and Medi-Cal providers. A
Medi-Cal beneficiary shall have no less than 20 days from the date
the form is mailed pursuant to this subdivision to respond. Except
as provided in subdivision (h), failure to respond prior to the end
of this 20-day period shall not impact his or her Medi-Cal
eligibility.

(h) If the purpose for a redetermination under this section is a
loss of contact with the Medi-Cal beneficiary, as evidenced by the
return of mail marked in such a way as to indicate that it could not
be delivered to the intended recipient or that there was no
forwarding address, a return of the form described in subdivision
(g) marked as undeliverable shall result in an immediate notice of
action terminating Medi-Cal eligibility.

(i) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), a beneficiary
does not submit the completed form to the county, the county shall
send the beneficiary a written notice of action stating that his or
her eligibility shall be terminated 10 days from the date of the
notice and the reasons for that determination, unless the beneficiary
submits a completed form prior to the end of the 10-day period.

(j) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), the beneficiary
submits an incomplete form, the county shall attempt to contact
the beneficiary by telephone and in writing to request the necessary
information. If the beneficiary does not supply the necessary
information to the county within 10 days from the date the county
contacts the beneficiary in regard to the incomplete form, a 10-day
notice of termination of Medi-Cal eligibility shall be sent.

(k) If, within 30 days of termination of a Medi-Cal beneficiary’s
eligibility pursuant to subdivision (h), (i), or (j), the beneficiary
submits to the county a completed form, eligibility shall be
determined as though the form was submitted in a timely manner
and if a beneficiary is found eligible, the termination under
subdivision (h), (i), or (j) shall be rescinded.

(l) If the information reasonably available to the county pursuant
to the redetermination procedures of subdivisions (d), (e), (g), and
(m) does not indicate a basis of eligibility, Medi-Cal benefits may
be terminated so long as due process requirements have otherwise
been met.

(m) The department shall, with the counties and representatives
of consumers, including those with disabilities, and Medi-Cal
providers, develop a timeframe for redetermination of Medi-Cal
eligibility based upon disability, including ex parte review, the
redetermination form described in subdivision (g), timeframes for
responding to county or state requests for additional information,
and the forms and procedures to be used. The forms and procedures
shall be as consumer-friendly as possible for people with
disabilities. The timeframe shall provide a reasonable and adequate
opportunity for the Medi-Cal beneficiary to obtain and submit
medical records and other information needed to establish
eligibility for Medi-Cal based upon disability.

(n) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.) is available.

(o) 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 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. Comprehensive implementing instructions
shall be issued to the counties no later than March 1, 2001.

(p) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

begin delete SEC. 16. end delete
begin insert SEC. 7. end insert   

Section 14005.37 is added to the Welfare and
Institutions Code, to read:

14005.37.  

(a) Except as provided in Section 14005.39, a county
shall perform redeterminations of eligibility for Medi-Cal
beneficiaries every 12 months and shall promptly redetermine
eligibility whenever the county receives information about changes
in a beneficiary’s circumstances that may affect eligibility for
Medi-Cal benefits. The procedures for redetermining Medi-Cal
eligibility described in this section shall apply to all Medi-Cal
beneficiaries.

(b)  Loss of eligibility for cash aid under that program shall not
result in a redetermination under this section unless the reason for
the loss of eligibility is one that would result in the need for a
redetermination for a person whose eligibility for Medi-Cal under
Section 14005.30 was determined without a concurrent
determination of eligibility for cash aid under the CalWORKs
program.

(c) A loss of contact, as evidenced by the return of mail marked
in such a way as to indicate that it could not be delivered to the
intended recipient or that there was no forwarding address, shall
require a prompt redetermination according to the procedures set
forth in this section.

(d) Except as otherwise provided in this section, Medi-Cal
eligibility shall continue during the redetermination process
described in this section and a beneficiary’s Medi-Cal eligibility
shall not be terminated under this section until the county makes
a specific determination based on facts clearly demonstrating that
the beneficiary is no longer eligible for Medi-Cal benefits under
any basis and due process rights guaranteed under this division
have been met. begin insert For the purposes of this subdivision, for a
beneficiary who is subject to the use of MAGI-based financial
methods, the determination of whether the beneficiary is eligible
for Medi-Cal benefits under any basis shall include, but is not
limited to, a determination of eligibility for Medi-Cal benefits on
a basis that is exempt from the use of MAGI-based financial
methods only if either of the following occurs: end insert

begin insert

(A) The county assesses the beneficiary as being potentially
eligible under a program that is exempt from the use of
MAGI-based financial methods, including, but not limited to, on
the basis of age, blindness, disability, or the need for long-term
care services and supports.

end insert begin insert

(B) The beneficiary requests that the county determine whether
he or she is eligible for Medi-Cal benefits on a basis that is exempt
from the use of MAGI-based financial methods.

end insert

(e) (1) For purposes of acquiring information necessary to
conduct the eligibility redeterminations described in this section,
a county shall gather information available to the county that is
relevant to the beneficiary’s Medi-Cal eligibility prior to contacting
the beneficiary. Sources for these efforts shall include information
contained in the beneficiary’s file or other information, including
more recent information available to the county, including, but not
limited to, Medi-Cal, CalWORKs, and CalFresh case files of the
beneficiary or of any of his or her immediate family members,
which are open begin insert , end insert or were closed within the last begin delete 45 end delete begin insert 90 end insert days,
information accessed through any databases accessed under
Sections 435.948, 435.949, and 435.956 of Title 42 of the Code
of Federal Regulations, and wherever feasible, other sources of
relevant information reasonably available to the county begin insert or to the
county via the department end insert .

(2) In the case of an annual redetermination, if, based upon
information obtained pursuant to paragraph (1), the county is able
to make a determination of continued eligibility, the county shall
notify the beneficiary of both of the following:

(A) The eligibility determination and the information it is based
on.

(B) That the beneficiary is required to inform the county via the
Internet, by telephone, by mail, in person, or through other
commonly available electronic means, in counties where such
electronic communication is available, if any information contained
in the notice is inaccurate but that the beneficiary is not required
to sign and return the notice if all information provided on the
notice is accurate.

(3) The county shall make all reasonable efforts not to send
multiple notices during the same time period about eligibility. The
notice of eligibility renewal shall contain other related information
such as if the beneficiary is in a new Medi-Cal program.

(4) In the case of a redetermination due to a change in
circumstances, if a county determines that the change in
circumstances does not affect the beneficiary’s eligibility status,
the county shall not send the beneficiary a notice unless required
to do so by federal law.

(f) (1) In the case of an annual eligibility redetermination, if
the county is unable to determine continued eligibility based on
the information obtained pursuant to paragraph (1) of subdivision
(e), the beneficiary shall be so informed and shall be provided with
an annual renewal form begin insert , at least 60 days before the beneficiary’s
annual redetermination date, end insert that is prepopulated with information
that the county has obtained and that identifies any additional
information needed by the county to determine eligibility. The
form shall begin delete be accompanied by a cover letter advising the
beneficiary of end delete begin insert include end insert all of the following:

(A) The requirement that he or she provide any necessary
information to the county within 60 days of the date that the form
is sent to the beneficiary.

(B) That the beneficiary may respond to the county via the
Internet, by mail, by telephone, in person, or through other
commonly available electronic means if those means are available
in that county.

(C) That if the beneficiary chooses to return the form to the
county in person or via mail, the beneficiary shall sign the form
in order for it to be considered complete.

(D) The begin delete phone end delete begin insert telephone end insert number to call in order to obtain more
information.

(2) The county shall attempt to contact the beneficiary via the
Internet, by telephone, or through other commonly available
electronic means, if those means are available in that county, during
the 60-day period begin insert after the prepopulated form is mailed to the
beneficiary end insert to collect the necessary information begin insert if the beneficiary
has not responded to the request for additional information or has
provided an incomplete response end insert .

(3) If the beneficiary has not provided any response to the
written request for information sent pursuant to paragraph (1)
within 60 days from the date the form is sent, the county shall
terminate his or her eligibility for Medi-Cal benefits following the
provision of timely notice.

(4) If the beneficiary responds to the written request for
information during the 60-day period pursuant to paragraph (1)
but the information provided is not complete, the county shall
follow the procedures set forth in begin insert paragraph (3) of end insert subdivision (g)
to work with the beneficiary to complete the information.

(5) (A) The form begin delete and cover letter end delete required by this subdivision
shall be developed by the department in consultation with the
counties and representatives of eligibility workers and consumers.

(B) For beneficiaries whose eligibility is not determined using
MAGI-based financial methods, the county may use existing
renewal forms until the state develops prepopulated renewal forms
to provide to beneficiaries. The department shall develop
prepopulated renewal forms for use with beneficiaries whose
eligibility is not determined using MAGI-based financial methods
by January 1, 2015.

(g) (1) In the case of a redetermination due to change in
circumstances, if a county cannot obtain sufficient information to
redetermine eligibility pursuant to subdivision (e), begin delete the county shall
attempt to reach the beneficiary by telephone and other commonly
available electronic means, in counties where such electronic
communication is available, in order to obtain this information,
either directly or in collaboration with community-based
organizations so long as confidentiality is protected. end delete

begin delete (2) If a county’s efforts pursuant to subdivision (e) and
paragraph (1) of this subdivision to obtain the information
necessary to redetermine eligibility have failed, end delete the county shall
send to the beneficiary a form begin delete stating end delete begin insert that is prepopulated with
the information that the county has obtained and that states end insert the
information needed to renew eligibility. The county shall only
request information related to the change in circumstances. The
county shall not request information or documentation that has
been previously provided by the beneficiary, that is not absolutely
necessary to complete the eligibility determination, or that is not
subject to change. The county shall only request information for
nonapplicants necessary to make an eligibility determination or
for a purpose directly related to the administration of the state
Medicaid plan. The form shall advise the individual to provide
any necessary information to the county via the Internet, by
telephone, by mail, in person, or through other commonly available
electronic means and, if the individual will provide the form by
mail or in person, to sign the form. The form shall include a
telephone number to call in order to obtain more information. The
form shall be developed by the department in consultation with
the counties, representatives of consumers, and eligibility workers.
A Medi-Cal beneficiary shall have begin delete no less than 20 end delete begin insert 30 end insert days from
the date the form is mailed pursuant to this subdivision to respond.
Except as provided in paragraph begin delete (3) end delete begin insert (2) end insert , failure to respond prior
to the end of this begin delete 20-day end delete begin insert 30-day end insert period shall not impact his or her
Medi-Cal eligibility.

begin delete

(3)

end delete

begin insert ( end insert begin insert 2) end insert  If the purpose for a redetermination under this section is a
loss of contact with the Medi-Cal beneficiary, as evidenced by the
return of mail marked in such a way as to indicate that it could not
be delivered to the intended recipient or that there was no
forwarding address, a return of the form described in this
subdivision marked as undeliverable shall result in an immediate
notice of action terminating Medi-Cal eligibility.

begin delete

(4) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to this subdivision, a beneficiary
does not submit the completed form to the county or otherwise
provide the needed information to the county, the county shall
send the beneficiary a written notice of action stating that his or
her eligibility shall be terminated 10 days from the date of the
notice and the reasons for that determination, unless the beneficiary
submits a completed form or otherwise provides the needed
information to the county prior to the end of the 10-day period.

end delete begin delete

(5) If, within 20 days of

end delete

begin insert ( end insert begin insert 3) end insert begin insert   end insert begin insert During the 30-day period after end insert the date of mailing of a form
to the Medi-Cal beneficiary pursuant to this subdivision, begin delete the
beneficiary submits an incomplete form, end delete the county shall attempt
to contact the beneficiary by telephone, in writing, or other
commonly available electronic means, in counties where such
electronic communication is available, to request the necessary
information begin insert if the beneficiary has not responded to the request for
additional information or has provided an incomplete response end insert .
If the beneficiary does not supply the necessary information to the
county within begin delete 10 days from the date the county contacts the
beneficiary in regard to the incomplete form end delete begin insert the 30-day limit end insert , a
10-day notice of termination of Medi-Cal eligibility shall be sent.

begin insert

(h) Beneficiaries shall be required to report any change in
circumstances that may affect their eligibility within 10 calendar
days following the date the change occurred.

end insert begin delete

(h)

end delete

begin insert ( end insert begin insert i) end insert  If within 90 days of

termination of a Medi-Cal beneficiary’s eligibility or a change
in eligibility status pursuant to this section, the beneficiary submits
to the county a signed and completed form or otherwise provides
the needed information to the county, eligibility shall be
redetermined by the county and if the beneficiary is found eligible,
begin insert or the beneficiary end insert begin insert ’s status has not changed, whichever applies, end insert
the termination shall be rescinded begin insert as though the form were
submitted in a timely manner end insert .

begin delete

(i)

end delete

begin insert ( end insert begin insert j) end insert  If the information available to the county pursuant to the
redetermination procedures of this section does not indicate a basis
of eligibility, Medi-Cal benefits may be terminated so long as due
process requirements have otherwise been met.

begin delete

(j)

end delete

begin insert ( end insert begin insert k) end insert  The department shall, with the counties and representatives
of consumers, including those with disabilities, and Medi-Cal
eligibility workers, develop a timeframe for redetermination of
Medi-Cal eligibility based upon disability, including ex parte
review, the redetermination forms described in subdivisions (f)
and (g), timeframes for responding to county or state requests for
additional information, and the forms and procedures to be used.
The forms and procedures shall be as consumer-friendly as possible
for people with disabilities. The timeframe shall provide a
reasonable and adequate opportunity for the Medi-Cal beneficiary
to obtain and submit medical records and other information needed
to establish eligibility for Medi-Cal based upon disability.

begin delete

(k)

end delete

begin insert ( end insert begin insert l) end insert  The county shall consider blindness as continuing until the
reviewing physician determines that a beneficiary’s vision has
improved beyond the applicable definition of blindness contained
in the plan.

begin delete

(l)

end delete

begin insert ( end insert begin insert m) end insert  The county shall consider disability as continuing until the
review team determines that a beneficiary’s disability no longer
meets the applicable definition of disability contained in the plan.

begin delete

(m) If a county has enough information available to it to renew
eligibility with respect to all eligibility criteria, the county shall
begin a new 12-month eligibility period.

end delete begin insert

(n) In the case of a redetermination due to a change in
circumstances, if a county determines that the beneficiary remains
eligible for Medi-Cal benefits, the county shall begin a new
12-month eligibility period.

end insert begin delete

(n)

end delete

begin insert ( end insert begin insert o) end insert   For individuals determined ineligible for Medi-Cal by a
county following the redetermination procedures set forth in this
section, the county shall determine eligibility for other insurance
affordability programs and if the individual is found to be eligible,
the county shall, as appropriate, transfer the individual’s electronic
account to other insurance affordability programs via a secure
electronic interface.

begin delete

(o)

end delete

begin insert ( end insert begin insert p) end insert  Any renewal form or notice shall be accessible to persons
who are limited-English proficient and persons with disabilities
consistent with all federal and state requirements.

begin delete

(p)

end delete

begin insert ( end insert begin insert q) end insert  The requirements to provide information in begin delete subdivision (b) end delete
begin insert subdivisions (e) and (g), end insert and to report changes in circumstances
in subdivision begin delete (c) end delete begin insert (h), end insert may be provided through any of the modes
of submission allowed in Section 435.907(a) of Title 42 of the
Code of Federal Regulations, including an Internet Web site
identified by the department, telephone, mail, in person, and other
commonly available electronic means as authorized by the
department.

begin delete

(q)

end delete

begin insert ( end insert begin insert r) end insert  Forms required to be signed by a beneficiary pursuant to this
section shall be signed under penalty of perjury. Electronic
signatures, telephonic signatures, and handwritten signatures
transmitted by electronic transmission shall be accepted.

begin delete

(r)

end delete

begin insert ( end insert begin insert s) end insert  For purposes of this section, “MAGI-based financial
methods” means income calculated using the financial
methodologies described in Section 1396a(e)(14) of Title 42 of
the United States Code, and as added by the federal Patient
Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152), and any subsequent
amendments.

begin insert

(t) When contacting a beneficiary under paragraphs (2) and
(4) of subdivision (f), and paragraph (3) of subdivision (g), a
county shall first attempt to use the method of contact identified
by the beneficiary as the preferred method of contact, if a method
has been identified.

end insert begin insert

(u) The department shall seek federal approval to extend the
annual redetermination date under this section for a three-month
period for those Medi-Cal beneficiaries whose annual
redeterminations are scheduled to occur between January 1, 2014,
and March 31, 2014.

end insert begin insert

(v) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, and
notwithstanding Section 10231.5 of the Government Code, the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

end insert begin delete

(s)

end delete

begin insert ( end insert begin insert w) end insert  This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

begin delete

(t)

end delete

begin insert ( end insert begin insert x) end insert  This section shall become operative begin insert on end insert January 1, 2014.

begin delete SEC. 17. end delete
begin insert SEC. 8. end insert   

Section 14005.38 of the Welfare and Institutions Code
is amended to read:

14005.38.  

(a) To the extent feasible, the department shall use
the redetermination form required by subdivision (g) of Section
14005.37 as the annual reaffirmation form.

(b) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

begin delete

SEC. 18.  

Section 14005.39 of the Welfare and Institutions
Code is amended to read:

14005.39.  

(a) If a county has facts clearly demonstrating that
a Medi-Cal beneficiary cannot be eligible for Medi-Cal due to an
event, such as death or change of state residency, Medi-Cal benefits
shall be terminated without a redetermination under Section
14005.37.

(b) Whenever Medi-Cal eligibility is terminated without a
redetermination, as provided in subdivision (a), the Medi-Cal
eligibility worker shall record that fact or event causing the
eligibility termination in the beneficiary’s file, along with a
certification that a full redetermination could not result in a finding
of Medi-Cal eligibility. Following this certification, a notice of
action specifying the basis for termination of Medi-Cal eligibility
shall be sent to the beneficiary.

(c) This section shall be implemented only if and to the extent
that federal financial participation under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et. seq.) is available and
necessary federal approvals have been obtained.

(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, without taking any 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.

SEC. 19.  

Section 14005.60 is added to the Welfare and
Institutions Code, to read:

14005.60.  

(a) Commencing January 1, 2014, the department
shall provide eligibility for Medi-Cal benefits for any person who
meets the eligibility requirements of Section
1902(a)(10)(A)(i)(VIII) of Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII)).

(b) Persons who qualify under subdivision (a) and are currently
enrolled in a Low Income Health Program (LIHP) under
California’s Bridge to Reform Section 1115(a) Medicaid
Demonstration shall be transitioned to the Medi-Cal program under
this section in accordance with the transition plan as approved by
the federal Centers for Medicare and Medicaid Services. With
respect to plan enrollment, a LIHP enrollee shall be simultaneously
notified by the department at least 60 days prior to January 1, 2014,
of all of the following:

(1) Which Medi-Cal health plan or plans contain his or her
existing medical home provider.

(2) That the LIHP enrollee, subject to his or her ability to choose
or change plans as described in paragraph (3), will be assigned to
a health plan that includes his or her medical home and will be
enrolled effective January 1, 2014. If the enrollee wants to keep
his or her medical home, no additional action will be required.

(3) The opportunity to choose a different health plan prior to
January 1, 2014, if there is more than one plan available in the
county where he or she resides. Instructions on how to choose or
change plans shall be included in the notice, along with a packet
of information about the available plans in the LIHP enrollee’s
county.

(4) If his or her existing medical home provider is not contracted
with any Medi-Cal managed care health plan, he or she will receive
all provider and health plan information required to be sent to new
enrollees. If he or she does not affirmatively select one of the
available Medi-Cal managed care plans within 30 days of receipt
of the notice, he or she will automatically be assigned a plan
through the department prescribed auto-assignment process.

(c) In counties where no Medi-Cal managed care health plans
are available, LIHP enrollees shall be (1) notified that they will
be transitioned to fee-for-service Medi-Cal as of January 1, 2014,
(2) informed if their LIHP medical home provider is a Medi-Cal
fee-for-service provider, (3) provided instructions on how to access
services, (4) given a list of Medi-Cal fee-for-service providers by
area of practice with contact information for each provider, and
(5) provided any other information that is required to be sent to
new enrollees.

(d) The department shall consult with stakeholders in developing
the notice required by this section, including representatives of
Medi-Cal beneficiaries, representatives of public hospitals, and
representatives of county social service departments.

(e) In order to ensure that no persons lose health care coverage
in the course of the transition, the department shall require that
notices of the January 1, 2014, change be sent to LIHP enrollees
upon their LIHP redetermination in 2013 and again at least 90 days
prior to the transition. Pursuant to Section 1902(k)(1) and Section
1937(b)(1)(D) of the federal Social Security Act (42 U.S.C. Sec.
1396a(k)(1); 42 U.S.C. Sec. 1396u-7(b)(1)(D)), the department
shall seek approval from the United States Secretary of Health and
Human Services to establish a benchmark benefit package that
includes the same benefits, services, and coverage that are provided
to all other full-scope Medi-Cal enrollees, supplemented by any
benefits, services, and coverage included in the essential health
benefits package adopted by the state pursuant to Section 1367.005
of the Health and Safety Code and Section 10112.27 of the
Insurance Code and approved by the United States Secretary of
Health and Human Services under Section 18022 of Title 42 of
the United States Code, and any successor essential health benefit
package adopted by the state.

SEC. 20.  

Section 14005.62 is added to the Welfare and
Institutions Code, to read:

14005.62.  

Commencing January 1, 2014, the department shall
accept an individual’s attestation of information and verify
information pursuant to Section 15926.2.

end delete

begin insert

begin insert SEC. 9. end insert   

end insert

begin insert Section 14005.60 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14005.60. end insert   

(a) Commencing January 1, 2014, the department
shall provide Medi-Cal benefits for individuals who meet eligibility
requirements of Section 1902(a)(10)(A)(i)(VIII) of Title XIX of the
federal Social Security Act (42 U.S.C. Sec.
1396a(a)(10)(A)(i)(VIII)).

(b) An individual eligible under this section shall not have
income that exceeds 133 percent of the federal poverty level as
determined, counted, and valued in accordance with the
requirements of Section 1396a(e)(14) of Title 42 of the United
States Code, as added by the federal Patient Protection and
Affordable Care Act (Public Law 111-148), and as amended by
the federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152) and any subsequent amendments.

(c) (1) Individuals who are eligible under this section shall be
required to mandatorily enroll into a Medi-Cal managed care
health plan in those counties where a Medi-Cal managed care
health plan is available.

(2) (A) Individuals residing in a county where no Medi-Cal
managed care health plan is available shall be provided services
under the Medi-Cal fee-for-service delivery system subject to
subparagraph (B).

(B) If a Medi-Cal managed care health plan becomes available
to individuals referenced in subparagraph (A), those individuals
shall be enrolled in a Medi-Cal managed care health plan.

(d) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, and
notwithstanding Section 10231.5 of the Government Code, the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

(e) This section shall be implemented only if and to the extent
that federal financial participation under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available.

end insert

begin insert

begin insert SEC. 10. end insert   

end insert

begin insert Section 14005.61 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14005.61. end insert   

(a) Except as provided in subdivision (e), individuals
who are enrolled in a Low Income Health Program (LIHP) as of
December 31, 2013, under California’s Bridge to Reform Section
1115(a) Medicaid Demonstration who are at or below 133 percent
of the federal poverty level shall be transitioned directly to the
Medi-Cal program in accordance with the requirements of this
section and pursuant to federal approval.

(b) Except as provided in paragraph (8) of subdivision (c),
individuals who are eligible under subdivision (a) shall be required
to enroll into Medi-Cal managed care health plans.

(c) Except as provided in subdivision (d), with respect to
managed care health plan enrollment, a LIHP enrollee shall be
notified by the department at least 60 days prior to January 1,
2014, in accordance with the department’s LIHP transition plan
of all of the following:

(1) Which Medi-Cal managed care health plan or plans contain
his or her existing primary care provider, if the department has
this information and the primary care provider is contracted with
a Medi-Cal managed care health plan.

(2) That the LIHP enrollee, subject to his or her ability to
change as described in paragraph (3), will be assigned to a health
plan that includes his or her primary care provider and enrolled
effective January 1, 2014. If the enrollee wants to keep his or her
primary care provider, no additional action will be required if the
primary care provider is contracted with a Medi-Cal managed
care health plan.

(3) That the LIHP enrollee may choose any available Medi-Cal
managed care health plan and primary care provider in his or her
county of residence prior to January 1, 2014, if more than one
such plan is available in the county where he or she resides, and
he or she will receive all provider and health plan information
required to be sent to new enrollees and instructions on how to
choose or change his or her health plan and primary care provider.

(4) That in counties with more than one Medi-Cal managed
care health plan, if the LIHP enrollee does not affirmatively choose
a plan within 30 days of receipt of the notice, he or she shall be
enrolled into the Medi-Cal managed care health plan that contains
his or her LIHP primary care provider as part of the Medi-Cal
managed care contracted primary care network, if the department
has this information about the primary care provider, and the
primary care provider is contracted with a Medi-Cal managed
care health plan. If the primary care provider is contracted with
more than one Medi-Cal managed care health plan, then the LIHP
enrollee will be assigned to one of the health plans containing his
or her primary care provider in accordance with an assignment
process established to ensure the linkage.

(5) That if the LIHP enrollee’s existing primary care provider
is not contracted with any Medi-Cal managed care health plan,
then he or she will receive all provider and health plan information
required to be sent to new enrollees. If the LIHP enrollee does not
affirmatively select one of the available Medi-Cal managed care
plans within 30 days of receipt of the notice, he or she will
automatically be assigned a plan through the
department-prescribed auto-assignment process.

(6) That the LIHP enrollee does not need to take any action to
be transitioned to the Medi-Cal program or to retain his or her
primary care provider, if the primary care provider is available
pursuant to paragraph (2).

(7) That the LIHP enrollee may choose not to transition to the
Medi-Cal program, and what this choice will mean for his or her
health care coverage and access to health care services.

(8) That in counties where no Medi-Cal managed care health
plans are available, the LIHP enrollee will be transitioned into
fee-for-service Medi-Cal, and provided with all information that
is required to be sent to new Medi-Cal enrollees including the
assistance telephone number for fee-for-service beneficiaries, and
that, if a Medi-Cal managed care health plan becomes available
in the residence county, he or she will be enrolled in a Medi-Cal
managed care health plan according to the enrollment procedures
in place at that time.

(d) Individuals who qualify under subdivision (a) who apply
and are determined eligible for LIHP after the date identified by
the department that is not later than October 1, 2013, will be
considered late enrollees. Late enrollees shall be notified in
accordance with subdivision (c), except according to a different
timeframe, but will transition to Medi-Cal coverage on January
1, 2014. Late enrollees after the date identified in this subdivision
shall be transitioned pursuant to the department’s LIHP transition
plan process.

(e) Individuals who qualify under subdivision (a) and are not
denoted as active LIHP enrollees according to the Medi-Cal
Eligibility Data System at any point within the date range identified
by the department that will start not sooner than December 20,
2013, and continue through December 31, 2013, will not be
included in the LIHP transition to the Medi-Cal program. These
individuals may apply for Medi-Cal eligibility separately from the
LIHP transition process.

(f) In conformity with the department’s transition plan,
individuals who are enrolled in a LIHP at any point from
September 2013 through December 2013, under California’s
Bridge to Reform Section 1115(a) Medicaid Demonstration and
are above 133 percent of the federal poverty level will be provided
information regarding how to apply for an insurance affordability
program, including submission of an application by telephone, by
mail, online, or in person.

(g) A Medi-Cal managed care health plan that receives a LIHP
enrollee during this transition shall assign the LIHP primary care
provider of the enrollee as the Medi-Cal managed care health plan
primary care provider of the enrollee, to the extent possible, if the
Medi-Cal managed care health plan contracts with that primary
care provider, unless the beneficiary has chosen another primary
care provider on his or her choice form. A LIHP enrollee who is
enrolled into a Medi-Cal managed care plan may work through
the Medi-Cal managed care plan to change his or her assigned
primary care provider or other provider, after enrollment and
subject to provider availability, according to the standard
processes that are currently available in Medi-Cal managed care
for selecting providers.

(h) The director may, with federal approval, suspend, delay, or
otherwise modify the requirement for LIHP program eligibility
redeterminations in 2013 to facilitate the process of transitioning
LIHP enrollees to other health coverage in 2014.

(i) The county LIHPs and their designees shall work with the
department and its designees during the 2013 and 2014 calendar
years to facilitate continuity of care and data sharing for the
purposes of delivering Medi-Cal services in the 2014 calendar
year.

(j) This section shall be implemented only if and to the extent
that federal financial participation under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and
all necessary federal approvals have been obtained.

end insert

begin delete

SEC. 21.  

Section 14005.63 is added to the Welfare and
Institutions Code, to read:

14005.63.  

(a) A person who wishes to apply for an insurance
affordability program shall be allowed to file an application on his
or her own behalf or on behalf of his or her family. Subject to the
requirements of Section 14014.5, an individual also may be
accompanied, assisted, and represented in the application and
renewal process by an individual or organization of his or her own
choice. If the individual, for any reason, is unable to apply or renew
on his or her own behalf, any of the following persons may assist
in the application process or during a renewal of eligibility:

(1) The individual’s guardian, conservator, a person authorized
to make health care decisions on behalf of the individual pursuant
to an advance health care directive, or executor or administrator
of the individual’s estate.

(2) A public agency representative.

(3) The individual’s legal counsel, relative, friend, or other
spokesperson of his or her choice.

(b) A person who wishes to challenge a decision concerning his
or her eligibility for or receipt of benefits from an insurance
affordability program has the right to represent himself or herself
or use legal counsel, a relative, a friend, or other spokesperson of
his or her choice subject to the requirements of Section 14014.5.

(c) To the extent otherwise required by Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(d) This section shall be implemented on October 1, 2013, or
when all necessary federal approvals have been obtained,
whichever is later, and only if and to the extent that federal
financial participation is available.

SEC. 22.  

Section 14005.64 is added to the Welfare and
Institutions Code, to read:

14005.64.  

(a) This section implements Section 1902(e)(14)(C)
of the federal Social Security Act (42 U.S.C. Sec. 1396a(e)(14)(C))
and Section 435.603(g) of Title 42 of the Code of Federal
Regulations, which prohibits the use of an assets test for individuals
whose income eligibility is determined based on modified adjusted
gross income (MAGI), and Section 2002 of the federal Patient
Protection and Affordable Care Act (Affordable Care Act) (42
U.S.C. Sec. 1396a(e)(14)(I)) and Section 435.603(d) of Title 42
of the Code of Federal Regulations, which requires a 5-percent
income disregard for individuals whose income eligibility is
determined based on MAGI.

(b) In the case of individuals whose financial eligibility for
Medi-Cal is determined based on the application of MAGI pursuant
to Section 435.603 of Title 42 of the Code of Federal Regulations,
the eligibility determination shall not include any assets or
resources test.

(c) The department shall implement the 5-percent income
disregard for individuals whose income eligibility is determined
based on MAGI in Section 2002 of the Affordable Care Act (42
U.S.C. Sec. 1396a(e)(14)(I)) and Section 435.603(d) of Title 42
of the Code of Federal Regulations.

(d) The department shall adopt an equivalent income level for
each eligibility group whose income level will be converted to
MAGI. The equivalent income level shall not be less than the dollar
amount of all income exemptions, exclusions, deductions, and
disregards in effect on March 23, 2010, plus the existing income
level expressed as a percent of the federal poverty level for each
eligibility group so as to ensure that the use of MAGI income
methodology does not result in populations who would have been
eligible under this chapter and Part 6.3 (commencing with Section
12695) of Division 2 of the Insurance Code losing coverage.

(e)

 
The department shall include individuals under 19 years of age,
or in the case of full-time students, under 21 years of age, in the
household for purposes of determining eligibility under Section
1396a(e)(14) of Title 42 of the United States Code, as added by
the federal Patient Protection and Affordable Care Act (Public
Law 111-148), and as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152) and
any subsequent amendments, as provided in Section 435.603(f)(3)
of Title 42 of the Code of Federal Regulations.

(f) This section shall become operative on January 1, 2014.

  

SEC. 23.  

Section 14005.65 is added to the Welfare and
Institutions Code, to read:

14005.65.  

In accordance with the state’s options under Section
435.603(h) of Title 42 of the Code of Federal Regulations, the
department shall adopt procedures to take into account projected
future changes in income and family size, for individuals whose
Medi-Cal income eligibility is determined using MAGI-based
methods, in order to grant or maintain eligibility for those
individuals who may be ineligible or become ineligible if only the
current monthly income and family size are considered.

(a) For current beneficiaries whose eligibility has already been
approved, the department shall base financial eligibility on
projected annual household income for the remainder of the current
calendar year if the current monthly income would render the
beneficiary ineligible due to fluctuating income.

(b) For applicants, the department shall, in determining the
current monthly household income and family size, base an initial
determination of eligibility on the projected annual household
income and family size for the upcoming year if considering the
current monthly income and family size in isolation would render
an applicant ineligible.

(c) In the procedures adopted pursuant to this section, the
department shall implement a reasonable method to account for a
reasonably predictable decrease in income and increase in family
size, as evidenced by a history of predictable fluctuations in income
or other clear indicia of a future decrease in income and increase
in family size. The department shall not assume potential future
increases in income or decreases in family size to make an applicant
or beneficiary ineligible in the current month.

(d) This section shall become operative on January 1, 2014.

end delete

begin insert

begin insert SEC. 11. end insert   

end insert

begin insert Section 14005.64 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14005.64. end insert   

(a) Effective January 1, 2014, and notwithstanding
any other provision of law, when determining eligibility for
Medi-Cal benefits, an applicant’s or beneficiary’s income and
resources shall be determined, counted, and valued in accordance
with the requirements of Section 1902(e)(14) of the federal Social
Security Act (42 U.S.C. 1396a(e)(14)), as added by the ACA, which
prohibits the use of an assets or resources test for individuals
whose income eligibility is determined based on modified adjusted
gross income.

(b) When determining the eligibility of applicants and
beneficiaries using the MAGI-based financial methods, the
5-percent income disregard required under Section
1902(e)(14)(B)(I) of the federal Social Security Act (42 U.S.C.
Sec. 1396a(e)(14)(B)(I)) shall be applied.

(c) (1) The department shall establish income eligibility
thresholds for those Medi-Cal eligibility groups whose eligibility
will be determined using MAGI-based financial methods. The
income eligibility thresholds shall be developed using the financial
methodologies described in Section 1396a(e)(14) of Title 42 of the
United States Code and in conformity with Section 1396a(gg) of
Title 42 of the United States Code as added by the ACA.

(2) In utilizing state data or the national standard methodology
with Survey of Income and Program Participation data to develop
the converted modified adjusted gross income standard for
Medi-Cal applicants and beneficiaries, the department shall ensure
that the financial methodology used for identifying the equivalent
income eligibility threshold preserves Medi-Cal eligibility for
applicants and beneficiaries to the extent required by federal law.
The department shall report to the Legislature on the expected
changes in income eligibility thresholds using the chosen
methodology for individuals whose income is determined on the
basis of a converted dollar amount or federal poverty level
percentage. The department shall convene stakeholders, including
the Legislature, counties, and consumer advocates regarding the
results of the converted standards and shall review with them the
information used for the specific calculations before adopting its
final methodology for the equivalent income eligibility threshold
level.

(d) The department shall include individuals under 19 years of
age, or in the case of full-time students, under 21 years of age, in
the household for purposes of determining eligibility under Section
1396a(e)(14) of Title 42 of the United States Code, as added by
the ACA.

(e) For purposes of this section, the following definitions shall
apply:

(1) “ACA” means the federal Patient Protection and Affordable
Care Act (Public Law 111-148) as originally enacted and as
amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152) and any subsequent
amendments.

(2) “MAGI-based financial methods” means income calculated
using the financial methodologies described in Section
1396a(e)(14) of Title 42 of the United States Code, and as added
by the ACA.

(f) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, and
notwithstanding Section 10231.5 of the Government Code, the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

(g) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

end insert

begin delete

SEC. 24.  

Section 14007.1 of the Welfare and Institutions Code
is amended to read:

14007.1.  

(a) The department shall adopt regulations for use
by the county welfare department in determining whether an
applicant is a resident of this state and of the county subject to the
requirements of federal law. The regulations shall require that state
residency is not established unless the applicant does both of the
following:

(1) The applicant produces one of the following:

(A) A recent California rent or mortgage receipt or utility bill
in the applicant’s name.

(B) A current California motor vehicle driver’s license or
California Identification Card issued by the Department of Motor
Vehicles in the applicant’s name.

(C) A current California motor vehicle registration in the
applicant’s name.

(D) A document showing that the applicant is employed in this
state.

(E) A document showing that the applicant has registered with
a public or private employment service in this state.

(F) Evidence that the applicant has enrolled his or her children
in a school in this state.

(G) Evidence that the applicant is receiving public assistance
in this state.

(H) Evidence of registration to vote in this state.

(2) The applicant declares, under penalty of perjury, that all of
the following apply:

(A) The applicant does not own or lease a principal residence
outside this state.

(B) The applicant is not receiving public assistance outside this
state. As used in this subdivision, “public assistance” does not
include unemployment insurance benefits.

(b) A denial of a determination of residency may be appealed
in the same manner as any other denial of eligibility. The
Administrative Law Judge shall receive any proof of residency
offered by the applicant and may inquire into any facts relevant
to the question of residency. A determination of residency shall
not be granted unless a preponderance of the credible evidence
supports the applicant’s intent to remain indefinitely in this state.

(c) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

SEC. 25.  

Section 14007.1 is added to the Welfare and
Institutions Code, to read:

14007.1.  

(a) The department shall electronically verify an
individual’s state residency using information from the federal
Supplemental Nutrition Assistance Program, the CalWORKS
program, the California Health Benefit Exchange, the Franchise
Tax Board, the Department of Motor Vehicles, the state agency
administering the state’s unemployment compensation laws, and
the electronic service established in accordance with Section
435.949 of Title 42 of the Code of Federal Regulations, and other
available sources. If the department is unable to electronically
verify an individual’s state residency using these electronic data
sources, an individual may establish state residency as set forth in
this section.

(b) If the individual is 21 years of age or older, is capable of
indicating intent, and is not residing in an institution, state
residency is established when the individual does both of the
following.

(1) The individual provides one of the following:

(A)

 
A recent California rent or mortgage receipt or utility bill in
the individual’s name.

(B)

 
A current California motor vehicle driver’s license or California
Identification Card issued by the Department of Motor Vehicles
in the individual’s name.

(C)

 
A current California motor vehicle registration in the
individual’s name.

(D)

 
A document showing that the individual is employed in this
state or is seeking employment in the state.

(E)

 
A document showing that the individual has registered with a
public or private employment service in this state.

(F)

 
Evidence that the individual has enrolled his or her children in
a school in this state.

(G)

 
Evidence that the individual is receiving public assistance in
this state.

(H)

 
Evidence of registration to vote in this state.

(I)

 
A declaration by the individual under penalty of perjury that
he or she intends to reside in this state and does not have a fixed
address and cannot provide any of the documents identified in
subparagraphs (A) to (H), inclusive.

(J)

 
A declaration by the individual under penalty of perjury that
he or she has entered the state with a job commitment or is seeking
employment in the state and cannot provide any of the documents
identified in subparagraphs (A) to (H), inclusive.

(2) The individual declares, under penalty of perjury, that both
of the following apply:

(A) The individual does not own or lease a principal residence
outside this state.

(B) The individual is not receiving public assistance outside
this state. For purposes of this subdivision, “public assistance”
shall not include unemployment insurance benefits.

(c) If the individual is 21 years or age or older, is incapable of
indicating intent, and is not residing in an institution, state
residency is established when the parent, legal guardian of the
individual, or any other person with knowledge declares, under
penalty of perjury, that the individual is residing in this state.

(d) If the individual is 21 years of age or older, is residing in an
institution, and became incapable of indicating intent before
reaching 21 years of age, state residency is established by any of
the following:

(1) When the parent applying for Medi-Cal on the individual’s
behalf (A) declares under penalty of perjury that the individual’s
parents reside in separate states and (B) establishes that he or she
(the parent) is a resident of this state in accordance with the
requirements of this section.

(2) When the legal guardian applying for Medi-Cal on the
individual’s behalf (A) declares under penalty of perjury that
parental rights have been terminated and (B) establishes that he
or she (the legal guardian) is a resident of this state in accordance
with the requirements of this section.

(3) When the parent or parents applying for Medi-Cal on the
individual’s behalf establishes in accordance with the requirements
of this section that he, she, or they (the parent or parents), were a
resident of this state at the time the individual was placed in the
institution.

(4) When the legal guardian applying for Medi-Cal on the
individual’s behalf (A) declares under penalty of perjury that
parental rights have been terminated and (B) establishes in
accordance with the requirements of this section that he or she (the
legal guardian) was a resident of this state at the time the individual
was placed in the institution.

(5) When the parent, or parents, applying for Medi-Cal on the
individual’s behalf (A) provides a document from the institution
that demonstrates that the individual is institutionalized in this
state and (B) establishes in accordance with the requirements of
this section that he, she, or they (the parent or parents), are a
resident of this state.

(6) When the legal guardian applying for Medi-Cal on the
individual’s behalf (A) provides a document from the institution
that demonstrates that the individual is institutionalized in this
state, (B) declares under penalty of perjury that parental rights
have been terminated, and (C) establishes in accordance with the
requirements of this section that he or she (the legal guardian) is
a resident of this state.

(7) When the individual or party applying for Medi-Cal on the
individual’s behalf (A) provides a document from the institution
that demonstrates that the individual is institutionalized in this
state, (B) declares under penalty of perjury that the individual has
been abandoned by his or her parents and does not have a legal
guardian, and (C) establishes that he or she (the individual or party
applying for Medi-Cal on the individual’s behalf) is a resident of
this state in accordance with the requirements of this section.

(e) Except when another state has placed the individual in the
institution, if the individual is 21 years of age or older, is residing
in an institution, and became incapable of indicating intent on or
after reaching 21 years of age, state residency is established when
the person filing the application on the individual’s behalf provides
a document from the institution that demonstrates that the
individual is institutionalized in this state.

(f) If the individual is 21 years of age or older, is capable of
indicating intent, and is residing in an institution, state residency
is established when the individual (1) provides a document from
the institution that demonstrates that the individual is
institutionalized in this state, and (2) declares under penalty of
perjury that he or she intends to reside in this state.

(g) If the individual is under 21 years of age, is married or
emancipated from his or her parents, is capable of indicating intent,
and is not residing in an institution, state residency is established
in accordance with subdivision (b).

(h) If the individual is under 21 years of age, is not living in an
institution, and is not described in subdivision (g), state residency
is established by any of the following:

(1) When the individual resides with his or her parent or parents
and the parent or parents establish that he, she, or they (the parent
or parents), as the case may be, are a resident of this state in
accordance with the requirements of subdivision (b).

(2) When the individual resides with a caretaker relative and
the caretaker relative establishes that he, she, or they (the caretaker
relative or caretaker relatives), are a resident of this state in
accordance with the requirements of subdivision (b).

(3) When the person with whom the individual is residing is
not the individual’s parent or caretaker relative and he or she (A)
declares under penalty of perjury that the individual is residing
with him or her, and (B) establishes that he or she (the person with
whom the individual is residing) is a resident of this state in
accordance with the requirements of subdivision (b).

(4) When the individual does not reside with his or her parents
or with a caretaker relative and he or she declares under penalty
of perjury that he or she is living in this state.

(i) If the individual is under 21 years of age, is institutionalized,
and is not married or emancipated, state residency is established
in accordance with paragraphs (3), (4), (5), (6) and (7) of
subdivision (d).

(j) A denial of a determination of residency may be appealed
in the same manner as any other denial of eligibility. The
administrative law judge shall receive any proof of residency
offered by the individual and may inquire into any facts relevant
to the question of residency. A determination of residency shall
not be granted unless a preponderance of the credible evidence
supports that the individual is a resident of this state under Section
14007.15.

(k) To the extent otherwise required by Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(l) For purposes of this section, the definitions in subdivision
(i) of Section 14007.15 shall apply.

(m) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(n) This section shall become operative on January 1, 2014.

SEC. 26.  

Section 14007.15 is added to the Welfare and
Institutions Code, immediately following Section 14007.1, to read:

14007.15.  

(a) Except as provided in subdivision (f), an
individual is a resident of this state if he or she is 21 years of age
or older, is not residing in an institution, is living in the state, and
any of the following apply:

(1) The individual intends to reside in this state, including
individuals who do not have a fixed address.

(2) The individual has entered this state with a job commitment
or is seeking employment in this state, regardless of whether he
or she is currently employed.

(3) The individual is incapable of indicating intent.

(b) Except as provided in subdivision (f), an individual that is
21 years of age or older, is residing in an institution, and became
incapable of indicating intent before reaching 21 years of age is a
resident of this state if any of the following apply:

(1) The individual’s parents reside in separate states and the
parent applying for Medi-Cal on the individual’s behalf is a resident
of this state under this section.

(2) The parental rights have been terminated and a legal guardian
has been appointed for the individual and the legal guardian
applying for Medi-Cal on the individual’s behalf is a resident of
this state under this section.

(3) The individual’s parent or parents, or legal guardian if
parental rights have been terminated, was a resident of this state
under this section at the time the individual was placed in the
institution.

(4) The individual is institutionalized in this state and the parent
or parents, or legal guardian if parental rights have been terminated,
applying for Med-Cal on the individual’s behalf is a resident of
this state under this section.

(5) The individual is institutionalized in this state, has been
abandoned by his or her parent or parents, does not have a legal
guardian, and the individual or party that filed the Medi-Cal
application on the individual’s behalf is a resident of this state
under this section.

(c) Except as provided in subdivision (f) and except where
another state has placed the individual in the institution, an
individual is a resident of this state if he or she is 21 years of age
or older, is institutionalized in this state, and became incapable of
indicating intent on or after reaching 21 years of age.

(d) Except as provided in subdivision (f), an individual is a
resident of this state if he or she is 21 years of age or older, is
institutionalized in this state, and intends to reside in this state.

(e) Except as provided in subdivision (f), an individual that is
under 21 years of age is a resident of this state if one of the
following apply:

(1) The individual is not residing in an institution, is capable of
indicating intent, is married or is emancipated from his or her
parents, is living in this state, and one of the following apply:

(A) The individual intends to reside in this state, which includes
an individual who does not have a fixed address.

(B) The individual has entered this state with a job commitment
or is seeking employment in this state, regardless of whether he
or she is currently employed.

(2) The individual is not described in paragraph (1) and is not
living in an institution, and any of the following apply:

(A) The individual resides in this state, including without a fixed
address.

(B) The individual resides with his or her parent or parents or
a caretaker relative who is a resident of this state under this section.

(3) The individual is institutionalized, is not married or
emancipated, and any of the following apply:

(A) The individual’s parent or parents, or legal guardian if
parental rights have been terminated, was a resident of this state
under this section at the time of placement in the institution.

(B) The individual is institutionalized in this state and his or
her parent or parents, or legal guardian if parental rights have been
terminated, who files the application on the individual’s behalf is
a resident of this state under this section.

(C) The individual is institutionalized in this state, has been
abandoned by his or her parents, does not have a legal guardian,
and the individual or party that files the application on the
individual’s behalf is a resident of this state under this section.

(f) An individual who is receiving a state supplementary
payment (SSP) is a resident of the state paying the SSP.

(g) An individual who lives in this state and is receiving foster
care or adoption assistance under Title IV-E of the federal Social
Security Act is a resident of this state.

(h) (1) If this state or an agent of this state arranges for an
individual to be placed in an institution located in another state,
the individual is a resident of this state.

(2) The following actions do not constitute a placement by this
state:

(A) Providing basic information to the individual about another
state’s Medicaid program and information about the availability
of health care services and facilities in another state.

(B) Assisting an individual to locate an institution in another
state when the individual is capable of indicating intent and
independently decides to move to the other state.

(3) When a competent individual leaves the facility in which
he or she was placed by this state, that individual’s state of
residence is the state where the individual is physically located.

(4) If this state initiates a placement in another state because it
lacks an appropriate facility to provide services to the individual,
the individual is a resident of this state.

(i) For the purposes of this section and Section 14007.1, the
following definitions apply:

(1) “Incapable of indicating intent” means when an individual
is considered to be any of the following:

(A) Determined to have an I.Q. of 49 or less or to have a mental
age of 7 years or younger based upon tests administered by a
properly licensed mental health or developmental disabilities
professional.

(B) Found to be incapable of indicating intent based on medical
documentation provided by a physician, psychologist, or other
person licensed by the state in the field of mental health or
developmental disabilities.

(C) Been judicially determined to be legally incompetent.

(2) “Institution” shall have the same meaning as that term is
defined in Section 435.1010 of Title 42 of the Code of Federal
Regulations. For the purposes of determining residency under
subdivision (h), the term also includes licensed foster care homes
providing food, shelter, and supportive services to one or more
persons unrelated to the proprietor.

(j) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(k) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(l) This section shall become operative on January 1, 2014.

SEC. 27.  

Section 14007.6 of the Welfare and Institutions Code
is amended to read:

14007.6.  

(a) A recipient who maintains a residence outside of
this state for a period of at least two months shall not be eligible
for services under this chapter where the county has made inquiry
of the recipient pursuant to Section 11100, and where the recipient
has not responded to this inquiry by clearly showing that he or she
has (1) not established residence elsewhere; and (2) been prevented
by illness or other good cause from returning to this state.

(b) If a recipient whose services are terminated pursuant to
subdivision (a) reapplies for services, services shall be restored
provided all other eligibility criteria are met if this individual can
prove both of the following:

(1) His or her permanent residence is in this state.

(2) That residence has not been established in any other state
which can be considered to be of a permanent nature.

(c) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

SEC. 28.  

Section 14007.6 is added to the Welfare and
Institutions Code, to read:

14007.6.  

(a) A recipient who maintains a residence outside of
this state for a period of at least two months shall not be eligible
for services under this chapter where the county has made inquiry
of the recipient pursuant to Section 11100, and where the recipient
has not responded to this inquiry by clearly showing that he or she
has (1) not established residence elsewhere; or (2) been prevented
by illness or other good cause from returning to this state.

(b) If a recipient whose services are terminated pursuant to
subdivision (a) reapplies for services, services shall be restored
provided all other eligibility criteria are met and the individual is
considered a resident pursuant to Section 14007.15.

(c) To the extent otherwise required by Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(d) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(e) This section shall become operative on January 1, 2014.

SEC. 29.  

Section 14008.85 of the Welfare and Institutions
Code is amended to read:

14008.85.  

(a) To the extent federal financial participation is
available, a parent who is the principal wage earner shall be
considered an unemployed parent for purposes of establishing
eligibility based upon deprivation of a child where any of the
following applies:

(1) The parent works less than 100 hours per month as
determined pursuant to the rules of the Aid to Families with
Dependent Children program as it existed on July 16, 1996,
including the rule allowing a temporary excess of hours due to
intermittent work.

(2) The total net nonexempt earned income for the family is not
more than 100 percent of the federal poverty level as most recently
calculated by the federal government. The department may adopt
additional deductions to be taken from a family’s income.

(3) The parent is considered unemployed under the terms of an
existing federal waiver of the 100-hour rule for recipients under
the program established by Section 1931(b) of the federal Social
Security Act (42 U.S.C. Sec. 1396u-1).

(b) 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 an
all-county letter or similar instruction 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.

(c) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

end delete

begin delete SEC. 30. end delete
begin insert SEC. 12. end insert   

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) 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) When a beneficiary has completed, signed, and filed a
semiannual status report that indicated a change in circumstance,
eligibility shall be redetermined.

(f) 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) This section shall be implemented only if and to the extent
federal financial participation is available.

(h) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

begin delete SEC. 31. end delete
begin insert SEC. 13. end insert   

Section 14011.17 of the Welfare and Institutions
Code is amended to read:

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.

(h) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

begin delete SEC. 32. end delete
begin insert SEC. 14. end insert   

Section 14012 of the Welfare and Institutions Code
is amended to read:

14012.  

(a) Reaffirmation shall be filed annually and may be
required at other times in accordance with general standards
established by the department.

(b) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

begin delete

SEC. 33.  

Section 14012 is added to the Welfare and Institutions
Code, to read:

14012.  

(a) This section implements Section 435.916(a)(1) of
Title 42 of the Code of Federal Regulations, which applies to the
eligibility of Medi-Cal beneficiaries whose financial eligibility is
determined using modified adjusted gross income (MAGI) based
income.

(b) To the extent required by federal law or regulations, the
eligibility of Medi-Cal beneficiaries whose financial eligibility is
determined using a MAGI-based income shall be renewed once
every 12 months, and no more frequently than every 12 months.

(c) This section shall become operative on January 1, 2014.

SEC. 34.  

Section 14014.5 is added to the Welfare and
Institutions Code, to read:

14014.5.  

(a) It is the intent of the Legislature to protect
individual privacy and the integrity of Medi-Cal and other
insurance affordability programs by restricting the disclosure of
personal identifying information to prevent identity theft, abuse,
or fraud in situations where an insurance affordability program
applicant or beneficiary appoints an authorized representative to
assist him or her in obtaining health care benefits.

(b) The department, in consultation with the California Health
Benefit Exchange, shall implement policies and prescribe forms,
notices, and other safeguards to ensure the privacy and protection
of the rights of applicants who appoint an authorized representative
consistent with the provisions of Section 1902 of the federal Social
Security Act (42 U.S.C. Sec. 1396a) and Section 435.908 of Title
42 of the Code of Federal Regulations.

(c) All insurance affordability programs shall obtain completed
authorization forms pursuant to subdivision (b) prior to making
the final determination concerning the eligibility or renewal to
which the authorization applies.

(d) An authorization pursuant to this section shall do both of
the following:

(1) Specify what authority the applicant or beneficiary is
granting to the authorized representative and what notices, if any,
should be sent to the authorized representative in addition to the
applicant or beneficiary.

(2) Be effective until the applicant or beneficiary cancels or
modifies the authorization or appoints a new authorized
representative, or the authorized representative informs the agency
that he or she is no longer acting in that capacity or there is a
change in the legal authority on which the authority was based.
The notice shall conform to all federal requirements.

(e) An authorization pursuant to this section may be canceled
or modified at any time for any reason by the insurance
affordability program applicant or beneficiary by submitting notice
of cancellation or modification to the appropriate insurance
affordability program in accordance with policies and forms
developed pursuant to subdivision (b).

(f) The agency shall accept electronic, including telephonically
recorded, signatures, and handwritten signatures transmitted by
facsimile or other electronic transmission.

(g) For purposes of this section all of the following definitions
shall apply:

(1) “Authorized representative” means:

(A) (i) Any individual appointed in writing, on a form
designated by the department, by a competent person that is an
applicant for or beneficiary of any insurance affordability program,
to act in place or on behalf of the applicant or beneficiary for
purposes related to the insurance affordability program, including,
but not limited to, accompanying, assisting, or representing the
applicant in the application process or the beneficiary in the
redetermination of eligibility process, as specified by the applicant
or beneficiary.

(ii) Legal documentation of authority to act on behalf of the
applicant or beneficiary under state law, including, but not limited
to, a court order establishing legal guardianship or a valid power
of attorney to make health care decisions, shall service in place of
a written appointment by the applicant or beneficiary.

(2) “Competent” means being able to act on one’s own behalf
in business and personal matters.

(h) An authorized representative of an applicant or beneficiary
of an insurance affordability program who also is employed by or
is a contractor for any type of health care provider or facility shall
fully disclose in writing to the applicant or beneficiary that the
authorized representative is employed by or contracting with such
a provider or facility and of any potential conflicts of interest.

(i) All notices regarding the insurance affordability program,
including, but not limited to, those related to the application,
redetermination, or actions taken by the agency, shall be sent to
the applicant or beneficiary, and to the authorized representative
if authorized by the applicant or beneficiary.

(j) (1) If an applicant or beneficiary is not competent and has
not appointed an appropriately authorized representative pursuant
to this section or that appointment is no longer effective, any of
the individuals identified in subparagraphs (A) to (C), inclusive,
may be recognized by the hearing officer as the authorized
representative to represent the applicant or beneficiary at the state
hearing regarding a notice of action if, at the hearing, he or she
demonstrates that the applicant or beneficiary is not competent
and that lack of competency is the reason that he or she has not
been authorized by the applicant or beneficiary to act as the
applicant’s or beneficiary’s authorized representative. The
individuals that may be recognized are:

(A) A relative of the applicant or beneficiary or a person
appointed by the relative.

(B) A person with knowledge of the applicant’s or beneficiary’s
circumstances that completed and signed the Statement of Facts
on the applicant’s or beneficiary’s behalf.

(C) An applicant’s or beneficiary’s legal counsel or advocate
working under the supervision of an attorney.

(2) If an applicant or beneficiary is not competent and has not
appointed an appropriately authorized representative pursuant to
this section or that appointment is no longer effective, the hearing
officer may allow an individual with knowledge about the
applicant’s or beneficiary’s circumstances to represent the applicant
or beneficiary at the hearing if (A) the hearing officer determines
that the representation is in the applicant or beneficiary’s best
interests and (B) there is not a person who qualifies under
paragraph (1) that is available to represent the applicant or
beneficiary.

(k) (1) Pursuant to Section 435.923(e) of Title 42 of the Code
of Federal Regulations, a provider or staff member or volunteer
of an organization who intends to serve as an authorized
representative shall provide a signed written agreement that he or
she will adhere to requirements set forth in the Code of Federal
Regulations for authorized representatives, including Section
447.10 of Title 42, subpart F of Part 431 of Title 45, and Section
155.260(f) of Title 45. The department shall work with counties
and consumer advocates to develop a standard agreement form
that may be used for this purpose.

(2) Pursuant to 435.923(e) of Title 45 of the Code of Federal
Regulations, the regulations developed pursuant to this section
shall require authorized representatives to comply with all
applicable state and federal laws regarding conflicts of interest
and confidentiality of information.

(3)

 
The standard agreement form developed pursuant to paragraph
(1) shall include a notification regarding the requirements of this
subdivision and a statement that by signing the agreement, the
individual named as an authorized representative agrees to abide
by those requirements.

(l) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(m) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(n) This section shall be implemented on October 1, 2013, or
when all necessary federal approvals have been obtained,
whichever is later.

end delete

begin insert

begin insert SEC. 15. end insert   

end insert

begin insert Section 14013.3 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14013.3. end insert   

(a) When determining whether an individual is
eligible for Medi-Cal benefits, the department shall verify the
accuracy of the information identified in this section that is
provided as a part of the application or redetermination process
in conformity with this section.

(b) Prior to requesting additional verification from an applicant
or beneficiary for information he or she provides as part of the
application or redetermination process, the department shall obtain
information about an individual that is available electronically
from other state and federal agencies and programs in determining
an individual’s eligibility for Medi-Cal benefits or for potential
eligibility for an insurance affordability program offered through
the California Health Benefit Exchange established pursuant to
Title 22 (commencing with Section 100500) of the Government
Code. Needed information shall be obtained from the following
sources, as well as any other source the department determines is
useful:

(1) Information related to wages, net earnings from
self-employment, unearned income, and resources from any of the
following:

(A) The State Wage Information Collection Agency.

(B) The federal Internal Revenue Service.

(C) The federal Social Security Administration.

(D) The Employment Development Department.

(E) The state administered supplementary payment program
under Section 1382e of Title 42 of the United States Code.

(F) Any state program administered under a plan approved
under Titles I, X, XIV, or XVI of the federal Social Security Act.

(2) Information related to eligibility or enrollment from any of
the following:

(A) The CalFresh program pursuant to Chapter 10 (commencing
with Section 18900) of Part 6.

(B) The CalWORKS program.

(C) The state’s children’s health insurance program under Title
XXI of the federal Social Security Act (42 U.S.C. 1397aa et seq.).

(D) The California Health Benefit Exchange established
pursuant Title 22 (commencing with Section 100500) of the
Government Code.

(E) The electronic service established in accordance with
Section 435.949 of Title 42 of the Code of Federal Regulations.

(c) (1) If the income information obtained by the department
pursuant to subdivision (b) is reasonably compatible with the
information provided by or on behalf of the individual, the
department shall accept the information provided by or on behalf
of the individual as being accurate.

(2) If the income information obtained by the department is not
reasonably compatible with the information provided by or on
behalf of the individual, the department shall require that the
individual provide additional information that reasonably explains
the discrepancy.

(3) For the purposes of this subdivision, income information
obtained by the department is reasonably compatible with
information provided by or on behalf of an individual if any of the
following conditions are met:

(A) Both state that the individual’s income is above the
applicable income standard or other relevant income threshold
for eligibility.

(B) Both state that the individual’s income is at or below the
applicable income standard or other relevant income threshold
for eligibility.

(C) The information provided by or on behalf of the individual
states that the individual’s income is above, and the information
obtained by the department states that the individual’s income is
at or below, the applicable income standard or other relevant
income threshold for eligibility.

(4) If subparagraph (C) of paragraph (3) applies, the individual
shall be informed that the income information provided by him or
her was higher than the information that was electronically verified
and that he or she may request a reconciliation of the difference.
This paragraph shall be implemented no later than January 1,
2015.

(d) (1) The department shall accept the attestation of the
individual regarding whether she is pregnant unless the department
has information that is not reasonably compatible with the
attestation.

(2) If the information obtained by the department is not
reasonably compatible with the information provided by or on
behalf of the individual under paragraph (1), the department shall
require that the individual provide additional information that
reasonably explains the discrepancy.

(e) If any information not described in subdivision (c) or (d)
that is needed for an eligibility determination or redetermination
and is obtained by the department is not reasonably compatible
with the information provided by or on behalf of the individual,
the department shall require that the individual provide additional
information that reasonably explains the discrepancy.

(f) The department shall develop, and update as it is modified,
a verification plan describing the verification policies and
procedures adopted by the department to verify eligibility
information. If the department determines that any state or federal
agencies or programs not previously identified in the verification
plan are useful in determining an individual’s eligibility for
Medi-Cal benefits or for potential eligibility, for an insurance
affordability program offered through the California Health Benefit
Exchange, the department shall update the verification plan to
identify those additional agencies or programs. The development
and modification of the verification plan shall be undertaken in
consultation with representatives from county human services
departments, legal aid advocates, and the Legislature. This
verification plan shall conform to all federal requirements and
shall be posted on the department’s Internet Web site.

(g) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, and
notwithstanding Section 10231.5 of the Government Code, the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

(h) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(i) This section shall become operative on January 1, 2014.

end insert

begin delete SEC. 35. end delete
begin insert SEC. 16. end insert   

Section 14015.5 is added to the Welfare and
Institutions Code, to read:

14015.5.  

(a) Notwithstanding any other provision of state law,
the department shall retain or delegate the authority to perform
Medi-Cal eligibility determinations as set forth in this section.

(b) If after an assessment and verification for potential eligibility
for Medi-Cal benefits using the applicable MAGI-based income
standard of all persons that apply through an electronic or a paper
application processed by CalHEERS, which is jointly managed
by the department and the Exchange, and to the extent required
by federal law and regulation is completed, the Exchange and the
department begin delete may end delete begin insert is able to end insert electronically determine the applicant’s
eligibility for Medi-Cal benefits using only the information initially
provided online, or through the written application submitted by,
or on behalf of, the applicant, and without further staff review to
verify the accuracy of the submitted information, the Exchange
and the department shall determine that applicant’s eligibility for
the Medi-Cal program using the applicable MAGI-based income
standard.

(c) Except as provided in subdivision (b) and Section 14015.7,
the county of residence shall be responsible for eligibility
determinations and ongoing case management for the Medi-Cal
program.

(d) (1) Notwithstanding any other provision of state law, the
Exchange shall be authorized to provide information regarding
available Medi-Cal managed health care plan selection options to
applicants determined to be eligible for Medi-Cal benefits using
the MAGI-based income standard and allow those applicants to
choose an available managed health care plan.

(2) The Exchange is authorized to record an applicant’s health
plan selection into CalHEERS for reporting to the department.
CalHEERS shall have the ability to report to the department the
results of an applicant’s health plan selection.

(e) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, begin insert and
notwithstanding Section 10231.5 of the Government Code, end insert the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

(f) For the purposes of this section, the following definitions
shall apply:

(1) “ACA” means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health
Care and Education Reconciliation Act of 2010 (Public Law
111-152).

(2) “CalHEERS” means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.

(3) “Exchange” means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.

(4) “MAGI-based income” means income calculated using the
financial methodologies described in Section 1396a(e)(14) of Title
42 of the United States Code as added by ACA and any subsequent
amendments.

(g) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

(h) This section shall become operative on October 1, 2013.

begin delete

(i) This section shall become inoperative on July 1, 2015, and,
as of January 1, 2016, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2016, deletes or
extends the dates on which it becomes inoperative and is repealed.

end delete begin insert

(i) This section shall remain in effect only until July 1, 2015,
and as of that date is repealed, unless a later enacted statute, that
is enacted before July 1, 2015, deletes or extends that date.

end insert

begin delete SEC. 36. end delete
begin insert SEC. 17. end insert   

Section 14015.7 is added to the Welfare and
Institutions Code, to read:

14015.7.  

(a) (1) Notwithstanding any other begin insert provision of end insert law,
for persons who call the customer service center operated by the
Exchange for the purpose of applying for an insurance affordability
program, the Exchange shall implement a workflow transfer
protocol that consists of only those questions that are essential to
reliably ascertain whether the caller’s household appears to include
any individuals who are potentially eligible for Medi-Cal benefits
and to determine an appropriate point of begin delete referral end delete begin insert transferral end insert . The
workflow transfer protocol and begin delete referral end delete begin insert transferral end insert procedures
used by the Exchange shall be developed and implemented in
conjunction with and subject to review and approval by the
department.

(2) (A) Except as provided in paragraph (3), if, after applying
the transfer protocol specified in paragraph (1), the Exchange
determines that the caller’s household appears to include one or
more individuals who are potentially eligible for Medi-Cal benefits
using the applicable MAGI-based income standard, the Exchange
shall begin delete refer end delete begin insert transfer end insert the caller to his or her county of residence or
other appropriate county resource for completion of the federally
required assessment. The county shall proceed with the assessment
and also perform any required eligibility determination.

(B) Subject to any income limitations that may be imposed by
the Exchange, and subject to review and approval from the
department, if after applying the transfer protocol specified in
paragraph (1) the Exchange determines that the caller’s household
appears to include an individual who is pregnant, or who is
potentially eligible for Medi-Cal benefits on a basis other than
using a MAGI-based income standard because an applicant is
potentially disabled, 65 years of age or older, or potentially in need
of long-term care services, the Exchange shall begin delete refer end delete begin insert transfer end insert the
caller to his or her county of residence or other appropriate county
resource for completion of the federally required assessment. The
county shall proceed with the assessment and also perform any
required eligibility determination.

(3) Notwithstanding any other begin insert provision of end insert law, only during the
initial open enrollment period established by the Exchange, and
in no case after June 30, 2014, if after applying the transfer protocol
specified in paragraph (1) the Exchange determines that the caller’s
household appears to include both individuals who are potentially
eligible for Medi-Cal benefits using the applicable MAGI-based
income standard and individuals who are not potentially eligible
for Medi-Cal benefits, the Exchange shall proceed with its
assessment and if it is subsequently determined that an applicant
or applicants are potentially eligible for Medi-Cal benefits using
the applicable MAGI-based income standard, the Exchange shall
initially determine the begin delete applicant or applicants end delete begin insert applicant’s or
applicants end insert begin insert ’ end insert eligibility for Medi-Cal benefits. If determined eligible,
the applicant’s or applicants’ coverage shall start on January 1,
2014, or on the date of the determination, whichever is later. The
county of residence shall be responsible for final confirmation of
eligibility determinations relying on data provided by and
verifications done by the Exchange and the county shall perform
only that additional work that is necessary for the county to prepare
and send out the required notice to the applicant regarding the
result of the eligibility determination and shall not impose any
additional burdens upon the applicant. The county of residence
shall be responsible for sending out the required notices of all
Medi-Cal eligibility determinations.

(4) Notwithstanding any other begin insert provision of end insert law, if after applying
the transfer protocol specified in paragraph (1) the Exchange
determines that the caller’s household appears to only include
individuals who are not potentially eligible for Medi-Cal benefits,
the Exchange shall proceed with its assessment of eligibility. If it
is subsequently determined that an applicant or applicants are
potentially eligible for Medi-Cal benefits using the applicable
MAGI-based income standard, the Exchange shall initially
determine the applicant or applicants eligibility for Medi-Cal
benefits. If determined eligible, the applicant’s or applicants’
coverage shall start on January 1, 2014, or on the date of the
determination, whichever is later. The county of residence shall
be responsible for final confirmation of eligibility determinations
relying on data provided by and verifications done by the Exchange
and the county shall perform only that additional work that is
necessary for the county to prepare and send out the required notice
to the applicant regarding the result of the eligibility determination
and shall not impose any additional burdens upon the applicant.
The county of residence shall be responsible for sending out the
required notices of all Medi-Cal eligibility determinations.

(5) Subject to any income limitations that may be imposed by
the Exchange, and subject to review and approval from the
department, if after assessing the potential eligibility of an
applicant, which shall include enrolling the individual in
Exchange-based coverage if eligible and, if the determination is
being made pursuant to begin delete subdivision end delete begin insert paragraph end insert (3), begin insert initially end insert
determining begin delete initial end delete eligibility for MAGI-based Medi-Cal, the
Exchange determines that the applicant is pregnant, or is potentially
eligible for Medi-Cal benefits on a basis other than using a
MAGI-based income standard because the applicant is potentially
disabled, 65 years of age or older, or potentially in need of
long-term care services, or if the applicant requests a full Medi-Cal
eligibility determination, the Exchange shall, consistent with
federal law and regulations, transmit all information provided by
or on behalf of the applicant, and any information obtained or
verified by the Exchange, to the applicant’s county of residence
or other appropriate county resource via secure electronic interface,
promptly and without undue delay, for a full Medi-Cal eligibility
determination.

(6) Except as otherwise provided in this section and subdivision
(b) of Section 14015.5, the county of residence shall be responsible
for eligibility determinations and ongoing case management for
the Medi-Cal program.

(7) Implementation of the protocols and begin delete referral end delete begin insert transferral end insert
procedures in this subdivision shall be subject to the terms specified
in the agreements established under subdivision (b).

(b) The department, Exchange, and each county consortia shall
jointly enter into an interagency agreement that specifies the
operational parameters and performance standards pertaining to
the transfer protocol. After consulting with counties, consumer
advocates, and labor organizations that represent employees of the
customer service center operated by the Exchange and employees
of county customer service centers, the Exchange and the
department shall determine and implement the performance
standards that shall be incorporated into these agreements.

(c) Prior to October 1, 2014, the Exchange and the department,
in consultation with counties, consumer advocates, and labor
organizations that represent employees of the customer service
center operated by the Exchange and employees of county customer
service centers, shall review and determine the efficacy of the
enrollment procedures established in 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, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, begin insert and
notwithstanding Section 10231.5 of the Government Code, end insert the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

(e) For the purposes of this section, the following definitions
shall apply:

(1) “ACA” means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health
Care and Education Reconciliation Act of 2010 (Public Law
111-152).

(2) “CalHEERS” means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.

(3) “Exchange” means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.

(4) “MAGI-based income” means income calculated using the
financial methodologies described in Section 1396a(e)(14) of Title
42 of the United States Code as added by ACA and any subsequent
amendments.

(f) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.

begin insert

(g) The state shall be responsible for providing the
administrative funding to the counties for work associated with
this section. Funding shall be subject to the annual state budget
process.

end insert begin delete

(g)

end delete

begin insert ( end insert begin insert h) end insert  This section shall become operative on October 1, 2013.

begin insert

begin insert SEC. 18. end insert   

end insert

begin insert Section 14015.8 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14015.8. end insert   

The department, any other government agency that
is determining eligibility for, or enrollment in, the Medi-Cal
program or any other program administered by the department,
or collecting protected health information for those purposes, and
the California Health Benefit Exchange established pursuant to
Title 22 (commencing with Section 100500) of the Government
Code, shall share information with each other as necessary to
enable them to perform their respective statutory and regulatory
duties under state and federal law. This information shall include,
but not be limited to, personal information, as defined in
subdivision (a) of Section 1798.3 of the Civil Code, and protected
health information, as defined in Parts 160 and 164 of Title 45 of
the Code of Federal Regulations, regarding individual beneficiaries
and applicants.

end insert

begin insert

begin insert SEC. 19. end insert   

end insert

begin insert Section 14016.5 of the end insert begin insert Welfare and Institutions Code end insert
begin insert is amended to read: end insert

14016.5.  

(a) At the time of determining or redetermining the
eligibility of a Medi-Cal program or Aid to Families with
Dependent Children (AFDC) program applicant or beneficiary
who resides in an area served by a managed health care plan or
pilot program in which beneficiaries may enroll, each applicant
or beneficiary shall personally attend a presentation at which the
applicant or beneficiary is informed of the managed care and
fee-for-service options available regarding methods of receiving
Medi-Cal benefits. The county shall ensure that each beneficiary
or applicant attends this presentation.

(b) The health care options presentation described in subdivision
(a) shall include all of the following elements:

(1) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship in the fee-for-service sector.

(2) Each beneficiary or eligible applicant shall be provided with
the name, address, telephone number, and specialty, if any, of each
primary care provider, and each clinic participating in each prepaid
managed health care plan, pilot project, or fee-for-service case
management provider option. This information shall be provided
under geographic area designations, in alphabetical order by the
name of the primary care provider and clinic. The name, address,
and telephone number of each specialist participating in each
prepaid managed health care plan, pilot project, or fee-for-service
case management provider option shall be made available by
contacting either the health care options contractor or the prepaid
managed health care plan, pilot project, or fee-for-service case
management provider.

(3) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship in a managed care option, if his or her treating provider
is a primary care provider or clinic contracting with any of the
prepaid managed health care plans, pilot projects, or fee-for-service
case management provider options available, has available capacity,
and agrees to continue to treat that beneficiary or applicant.

(4) In areas specified by the director, each beneficiary or eligible
applicant shall be informed that if he or she fails to make a choice,
or does not certify that he or she has an established relationship
with a primary care provider or clinic, he or she shall be assigned
to, and enrolled in, a prepaid managed health care plan, pilot
project, or fee-for-service case management provider.

(c) No later than 30 days following the date a Medi-Cal or
AFDC beneficiary or applicant is determined eligible, the
beneficiary or applicant shall indicate his or her choice in writing,
as a condition of coverage for Medi-Cal benefits, of either of the
following health care options:

(1) To obtain benefits by receiving a Medi-Cal card, which may
be used to obtain services from individual providers, that the
beneficiary would locate, who choose to provide services to
Medi-Cal beneficiaries.

The department may require each beneficiary or eligible
applicant, as a condition for electing this option, to sign a statement
certifying that he or she has an established patient-provider
relationship, or in the case of a dependent, the parent or guardian
shall make that certification. This certification shall not require
the acknowledgment or guarantee of acceptance, by any indicated
Medi-Cal provider or health facility, of any beneficiary making a
certification under this section.

(2) (A) To obtain benefits by enrolling in a prepaid managed
health care plan, pilot program, or fee-for-service case management
provider that has agreed to make Medi-Cal services readily
available to enrolled Medi-Cal beneficiaries.

(B) At the time the beneficiary or eligible applicant selects a
prepaid managed health care plan, pilot project, or fee-for-service
case management provider, the department shall, when applicable,
encourage the beneficiary or eligible applicant to also indicate, in
writing, his or her choice of primary care provider or clinic
contracting with the selected prepaid managed health care plan,
pilot project, or fee-for-service case management provider.

(d) (1) In areas specified by the director, a Medi-Cal or AFDC
beneficiary or eligible applicant who does not make a choice, or
who does not certify that he or she has an established relationship
with a primary care provider or clinic, shall be assigned to and
enrolled in an appropriate Medi-Cal managed care plan, pilot
project, or fee-for-service case management provider providing
service within the area in which the beneficiary resides.

(2) If it is not possible to enroll the beneficiary under a Medi-Cal
managed care plan, pilot project, or a fee-for-service case
management provider because of a lack of capacity or availability
of participating contractors, the beneficiary shall be provided with
a Medi-Cal card and informed about fee-for-service primary care
providers who do all of the following:

(A) The providers agree to accept Medi-Cal patients.

(B) The providers provide information about the provider’s
willingness to accept Medi-Cal patients as described in Section
14016.6.

(C) The providers provide services within the area in which the
beneficiary resides.

(e) If a beneficiary or eligible applicant does not choose a
primary care provider or clinic, or does not select any primary care
provider who is available, the managed health care plan, pilot
project, or fee-for-service case management provider that was
selected by or assigned to the beneficiary shall ensure that the
beneficiary selects a primary care provider or clinic within 30 days
after enrollment or is assigned to a primary care provider within
40 days after enrollment.

(f) (1) The managed care plan shall have a valid Medi-Cal
contract, adequate capacity, and appropriate staffing to provide
health care services to the beneficiary.

(2) The department shall establish standards for all of the
following:

(A) The maximum distances a beneficiary is required to travel
to obtain primary care services from the managed care plan,
fee-for-service case management provider, or pilot project in which
the beneficiary is enrolled.

(B) The conditions under which a primary care service site shall
be accessible by public transportation.

(C) The conditions under which a managed care plan,
fee-for-service case management provider, or pilot project shall
provide nonmedical transportation to a primary care service site.

(3) In developing the standards required by paragraph (2), the
department shall take into account, on a geographic basis, the
means of transportation used and distances typically traveled by
Medi-Cal beneficiaries to obtain fee-for-service primary care
services and the experience of managed care plans in delivering
services to Medi-Cal enrollees. The department shall also consider
the provider’s ability to render culturally and linguistically
appropriate services.

(g) To the extent possible, the arrangements for carrying out
subdivision (d) shall provide for the equitable distribution of
Medi-Cal beneficiaries among participating managed care plans,
fee-for-service case management providers, and pilot projects.

(h) If, under the provisions of subdivision (d), a Medi-Cal
beneficiary or applicant does not make a choice or does not certify
that he or she has an established relationship with a primary care
provider or clinic, the person may, at the option of the department,
be provided with a Medi-Cal card or be assigned to and enrolled
in a managed care plan providing service within the area in which
the beneficiary resides.

(i) Any Medi-Cal or AFDC beneficiary who is dissatisfied with
the provider or managed care plan, pilot project, or fee-for-service
case management provider shall be allowed to select or be assigned
to another provider or managed care plan, pilot project, or
fee-for-service case management provider.

(j) The department or its contractor shall notify a managed care
plan, pilot project, or fee-for-service case management provider
when it has been selected by or assigned to a beneficiary. The
managed care plan, pilot project, or fee-for-service case
management provider that has been selected by, or assigned to, a
beneficiary, shall notify the primary care provider or clinic that it
has been selected or assigned. The managed care plan, pilot project,
or fee-for-service case management provider shall also notify the
beneficiary of the managed care plan, pilot project, or
fee-for-service case management provider or clinic selected or
assigned.

(k) (1) The department shall ensure that Medi-Cal beneficiaries
eligible under Title XVI of the Social Security Act are provided
with information about options available regarding methods of
receiving Medi-Cal benefits as described in subdivision (c).

(2) (A) The director may waive the requirements of subdivisions
(c) and (d) until a means is established to directly provide the
presentation described in subdivision (a) to beneficiaries who are
eligible for the federal Supplemental Security Income for the Aged,
Blind, and Disabled Program (Subchapter 16 (commencing with
Section 1381) of Chapter 7 of Title 42 of the United States Code).

(B) The director may elect not to apply the requirements of
subdivisions (c) and (d) to beneficiaries whose eligibility under
the Supplemental Security Income program is established before
January 1, 1994.

(l) In areas where there is no prepaid managed health care plan
or pilot program that has contracted with the department to provide
services to Medi-Cal beneficiaries, and where no other enrollment
requirements have been established by the department, no explicit
choice need be made, and the beneficiary or eligible applicant shall
receive a Medi-Cal card.

(m) The following definitions contained in this subdivision shall
control the construction of this section, unless the context requires
otherwise:

(1) “Applicant,” “beneficiary,” and “eligible applicant,” in the
case of a family group, mean any person with legal authority to
make a choice on behalf of dependent family members.

(2) “Fee-for-service case management provider” means a
provider enrolled and certified to participate in the Medi-Cal
fee-for-service case management program the department may
elect to develop in selected areas of the state with the assistance
of and in cooperation with California physician providers and other
interested provider groups.

(3) “Managed health care plan” and “managed care plan” mean
a person or entity operating under a Medi-Cal contract with the
department under this chapter or Chapter 8 (commencing with
Section 14200) to provide, or arrange for, health care services for
Medi-Cal beneficiaries as an alternative to the Medi-Cal
fee-for-service program that has a contractual responsibility to
manage health care provided to Medi-Cal beneficiaries covered
by the contract.

(n) (1) Whenever a county welfare department notifies a public
assistance recipient or Medi-Cal beneficiary that the recipient or
beneficiary is losing Medi-Cal eligibility, the county shall include,
in the notice to the recipient or beneficiary, notification that the
loss of eligibility shall also result in the recipient’s or beneficiary’s
disenrollment from Medi-Cal managed health care or dental plans,
if enrolled.

(2) (A) Whenever the department or the county welfare
department processes a change in a public assistance recipient’s
or Medi-Cal beneficiary’s residence or aid code that will result in
the recipient’s or beneficiary’s disenrollment from the managed
health care or dental plan in which he or she is currently enrolled,
a written notice shall be given to the recipient or beneficiary.

(B) This paragraph shall become operative and the department
shall commence sending the notices required under this paragraph
on or before the expiration of 12 months after the effective date
of this section.

(o) This section shall be implemented in a manner consistent
with any federal waiver required to be obtained by the department
in order to implement this section.

begin insert

(p) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

end insert

begin insert

begin insert SEC. 20. end insert   

end insert

begin insert Section 14016.5 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14016.5. end insert   

(a) At the time of determining or redetermining the
eligibility of a Medi-Cal program or Aid to Families with
Dependent Children (AFDC) program applicant or beneficiary
who resides in an area served by a managed health care plan or
pilot program in which beneficiaries may enroll, each applicant
or beneficiary shall be informed of the managed care and
fee-for-service options available regarding methods of receiving
Medi-Cal benefits.

(b) The information described in subdivision (a) shall include
all of the following elements:

(1) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship in the fee-for-service sector.

(2) Each beneficiary or eligible applicant shall be provided
with the name, address, telephone number, and specialty, if any,
of each primary care provider, and each clinic participating in
each prepaid managed health care plan, pilot project, or
fee-for-service case management provider option. This information
shall be provided under geographic area designations, in
alphabetical order by the name of the primary care provider and
clinic. The name, address, and telephone number of each specialist
participating in each prepaid managed health care plan, pilot
project, or fee-for-service case management provider option shall
be made available by contacting either the health care options
contractor or the prepaid managed health care plan, pilot project,
or fee-for-service case management provider.

(3) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship in a managed care option, if his or her treating
provider is a primary care provider or clinic contracting with any
of the prepaid managed health care plans, pilot projects, or
fee-for-service case management provider options available, has
available capacity, and agrees to continue to treat that beneficiary
or applicant.

(4) In areas specified by the director, each beneficiary or
eligible applicant shall be informed that if he or she fails to make
a choice, or does not certify that he or she has an established
relationship with a primary care provider or clinic, he or she shall
be assigned to, and enrolled in, a prepaid managed health care
plan, pilot project, or fee-for-service case management provider.

(c) No later than 30 days following the date a Medi-Cal or
AFDC beneficiary or applicant is determined eligible, the
beneficiary or applicant shall indicate his or her choice in writing,
as a condition of coverage for Medi-Cal benefits, of either of the
following health care options:

(1) To obtain benefits by receiving a Medi-Cal card, which may
be used to obtain services from individual providers, that the
beneficiary would locate, that choose to provide services to
Medi-Cal beneficiaries.

The department may require each beneficiary or eligible
applicant, as a condition for electing this option, to sign a
statement certifying that he or she has an established
patient-provider relationship, or in the case of a dependent, the
parent or guardian shall make that certification. This certification
shall not require the acknowledgment or guarantee of acceptance,
by any indicated Medi-Cal provider or health facility, of any
beneficiary making a certification under this section.

(2) (A) To obtain benefits by enrolling in a prepaid managed
health care plan, pilot program, or fee-for-service case
management provider that has agreed to make Medi-Cal services
readily available to enrolled Medi-Cal beneficiaries.

(B) At the time the beneficiary or eligible applicant selects a
prepaid managed health care plan, pilot project, or fee-for-service
case management provider, the department shall, when applicable,
encourage the beneficiary or eligible applicant to also indicate,
in writing, his or her choice of primary care provider or clinic
contracting with the selected prepaid managed health care plan,
pilot project, or fee-for-service case management provider.

(d) (1) In areas specified by the director, a Medi-Cal or AFDC
beneficiary or eligible applicant who does not make a choice, or
who does not certify that he or she has an established relationship
with a primary care provider or clinic, shall be assigned to and
enrolled in an appropriate Medi-Cal managed care plan, pilot
project, or fee-for-service case management provider providing
service within the area in which the beneficiary resides.

(2) If it is not possible to enroll the beneficiary under a Medi-Cal
managed care plan, pilot project, or a fee-for-service case
management provider because of a lack of capacity or availability
of participating contractors, the beneficiary shall be provided with
a Medi-Cal card and informed about fee-for-service primary care
providers who do all of the following:

(A) The providers agree to accept Medi-Cal patients.

(B) The providers provide information about the provider’s
willingness to accept Medi-Cal patients as described in Section
14016.6.

(C) The providers provide services within the area in which the
beneficiary resides.

(e) If a beneficiary or eligible applicant does not choose a
primary care provider or clinic, or does not select any primary
care provider who is available, the managed health care plan,
pilot project, or fee-for-service case management provider that
was selected by or assigned to the beneficiary shall ensure that
the beneficiary selects a primary care provider or clinic within 30
days after enrollment or is assigned to a primary care provider
within 40 days after enrollment.

(f) (1) The managed care plan shall have a valid Medi-Cal
contract, adequate capacity, and appropriate staffing to provide
health care services to the beneficiary.

(2) The department shall establish standards for all of the
following:

(A) The maximum distances a beneficiary is required to travel
to obtain primary care services from the managed care plan,
fee-for-service case management provider, or pilot project in which
the beneficiary is enrolled.

(B) The conditions under which a primary care service site shall
be accessible by public transportation.

(C) The conditions under which a managed care plan,
fee-for-service case management provider, or pilot project shall
provide nonmedical transportation to a primary care service site.

(3) In developing the standards required by paragraph (2), the
department shall take into account, on a geographic basis, the
means of transportation used and distances typically traveled by
Medi-Cal beneficiaries to obtain fee-for-service primary care
services and the experience of managed care plans in delivering
services to Medi-Cal enrollees. The department shall also consider
the provider’s ability to render culturally and linguistically
appropriate services.

(g) To the extent possible, the arrangements for carrying out
subdivision (d) shall provide for the equitable distribution of
Medi-Cal beneficiaries among participating managed care plans,
fee-for-service case management providers, and pilot projects.

(h) If, under the provisions of subdivision (d), a Medi-Cal
beneficiary or applicant does not make a choice or does not certify
that he or she has an established relationship with a primary care
provider or clinic, the person may, at the option of the department,
be provided with a Medi-Cal card or be assigned to and enrolled
in a managed care plan providing service within the area in which
the beneficiary resides.

(i) Any Medi-Cal or AFDC beneficiary who is dissatisfied with
the provider or managed care plan, pilot project, or fee-for-service
case management provider shall be allowed to select or be assigned
to another provider or managed care plan, pilot project, or
fee-for-service case management provider.

(j) The department or its contractor shall notify a managed care
plan, pilot project, or fee-for-service case management provider
when it has been selected by or assigned to a beneficiary. The
managed care plan, pilot project, or fee-for-service case
management provider that has been selected by, or assigned to, a
beneficiary, shall notify the primary care provider or clinic that
it has been selected or assigned. The managed care plan, pilot
project, or fee-for-service case management provider shall also
notify the beneficiary of the managed care plan, pilot project, or
fee-for-service case management provider or clinic selected or
assigned.

(k) (1) The department shall ensure that Medi-Cal beneficiaries
eligible under Title XVI of the federal Social Security Act are
provided with information about options available regarding
methods of receiving Medi-Cal benefits as described in subdivision
(c).

(2) (A) The director may waive the requirements of subdivisions
(c) and (d) until a means is established to directly provide the
information described in subdivision (a) to beneficiaries who are
eligible for the federal Supplemental Security Income for the Aged,
Blind, and Disabled Program (Subchapter 16 (commencing with
Section 1381) of Chapter 7 of Title 42 of the United States Code).

(B) The director may elect not to apply the requirements of
subdivisions (c) and (d) to beneficiaries whose eligibility under
the Supplemental Security Income program is established before
January 1, 1994.

(l) In areas where there is no prepaid managed health care plan
or pilot program that has contracted with the department to provide
services to Medi-Cal beneficiaries, and where no other enrollment
requirements have been established by the department, no explicit
choice need be made, and the beneficiary or eligible applicant
shall receive a Medi-Cal card.

(m) The following definitions contained in this subdivision shall
control the construction of this section, unless the context requires
otherwise:

(1) “Applicant,” “beneficiary,” and “eligible applicant,” in
the case of a family group, mean any person with legal authority
to make a choice on behalf of dependent family members.

(2) “Fee-for-service case management provider” means a
provider enrolled and certified to participate in the Medi-Cal
fee-for-service case management program the department may
elect to develop in selected areas of the state with the assistance
of and in cooperation with California physician providers and
other interested provider groups.

(3) “Managed health care plan” and “managed care plan”
mean a person or entity operating under a Medi-Cal contract with
the department under this chapter or Chapter 8 (commencing with
Section 14200) to provide, or arrange for, health care services for
Medi-Cal beneficiaries as an alternative to the Medi-Cal
fee-for-service program that has a contractual responsibility to
manage health care provided to Medi-Cal beneficiaries covered
by the contract.

(n) (1) Whenever a county welfare department notifies a public
assistance recipient or Medi-Cal beneficiary that the recipient or
beneficiary is losing Medi-Cal eligibility, the county shall include,
in the notice to the recipient or beneficiary, notification that the
loss of eligibility shall also result in the recipient’s or beneficiary’s
disenrollment from Medi-Cal managed health care or dental plans,
if enrolled.

(2) Whenever the department or the county welfare department
processes a change in a public assistance recipient’s or Medi-Cal
beneficiary’s residence or aid code that will result in the recipient’s
or beneficiary’s disenrollment from the managed health care or
dental plan in which he or she is currently enrolled, a written
notice shall be given to the recipient or beneficiary.

(o) This section shall be implemented in a manner consistent
with any federal waiver required to be obtained by the department
in order to implement this section.

(p) (1)  If the functionality is available in the California
Healthcare Eligibility, Enrollment, and Retention System
(CalHEERS), individuals or their authorized representatives may
select Medi-Cal managed care plans via CalHEERS.

(A) Any person that assists a Medi-Cal beneficiary who is
eligible for the program based on modified adjusted gross income
(MAGI) to select a Medi-Cal managed care plan via CalHEERS
shall complete a training program that includes all of the
following:

(i) The right to select a plan, to designate a plan at a later date,
to have plan choice materials sent by mail, and that if the person
does not select a plan, one will be selected for them.

(ii) All plan enrollment options and requirements with regard
to MAGI Medi-Cal eligibility.

(iii) Any applicable timeframes in which the plan choice must
be designated and the mechanism for designating plan choice.

(iv) How to use provider directories, how to identify which
providers are in a particular plan network, and the applicable
characteristics of primary care and specialty care providers and
providers of other services, such as languages spoken, whether
they are accepting new patients, and office locations.

(v) To the extent applicable, how to access Medi-Cal services
prior to plan enrollment, including the right to retroactive
Medi-Cal benefits.

(B) Any person that assists a Medi-Cal beneficiary who is not
eligible for Medi-Cal on the basis of MAGI to select a Medi-Cal
managed care plan shall complete a training program that includes
all of the following:

(i) All of the information included in the training program
described in subparagraph (A).

(ii) The enrollment options and requirements with regard to
each Medi-Cal eligibility category, including whether enrollment
is mandatory, how to obtain medical exemptions and continuity
of care, waiver programs, carved-out services, and the California
Children’s Services Program, as applicable.

(2) The department shall consult with a group of stakeholders
through either a group currently in existence or convened for this
purpose that includes representatives of plans, providers, consumer
advocates, counties, eligibility workers, CalHEERS, the California
Health Benefit Exchange (Exchange), and the Legislature to review
process, timelines, scripts, training curricula, monitoring and
oversight plans, and plan marketing and informational materials.

(3) In developing materials, scripts, and processes, the
department and the Exchange shall consult with or test the
materials, scripts, and processes with stakeholders that have
expertise in health plan selection, and in assisting populations of
diverse demographic characteristics such as race, ethnicity,
language spoken, geographic region, sexual orientation, and
gender identity or preference.

(4) The department, CalHEERS, the Exchange, and counties
may adopt the recommendations of the advisory body convened
in paragraph (2) and specify the reasons if the recommendations
are not adopted.

(q) This section shall become operative on January 1, 2014.

end insert

begin insert

begin insert SEC. 21. end insert   

end insert

begin insert Section 14016.6 of the end insert begin insert Welfare and Institutions Code end insert
begin insert is amended to read: end insert

14016.6.  

The State Department of Health begin insert Care end insert Services shall
develop a program to implement Section 14016.5 and to provide
information and assistance to enable Medi-Cal beneficiaries to
understand and successfully use the services of the Medi-Cal
managed care plans in which they enroll. The program shall
include, but not be limited to, the following components:

(a) (1) Development of a method to inform beneficiaries and
applicants of all of the following:

(A) Their choices for receiving Medi-Cal benefits including the
use of fee-for-service sector managed health care plans, or pilot
programs.

(B) The availability of staff and information resources to
Medi-Cal managed health care plan enrollees described in
subdivision (f).

(2) (A) Marketing and informational materials including printed
materials, films, and exhibits, to be provided to Medi-Cal
beneficiaries and applicants when choosing methods of receiving
health care benefits.

(B) The department shall not be responsible for the costs of
developing material required by subparagraph (A).

(C) (i) The department may prescribe the format and edit the
informational materials for factual accuracy, objectivity and
comprehensibility .

(ii) The department shall use the edited materials in informing
beneficiaries and applicants of their choices for receiving Medi-Cal
benefits.

(b) Provision of information that is necessary to implement this
program in a manner that fairly and objectively explains to
beneficiaries and applicants their choices for methods of receiving
Medi-Cal benefits, including information prepared by the
department emphasizing the benefits and limitations to
beneficiaries of enrolling in managed health care plans and pilot
projects as opposed to the fee-for-service system.

(c) Provision of information about providers who will provide
services to Medi-Cal beneficiaries. This may be information about
provider referral services of a local provider professional
organization. The information shall be made available to Medi-Cal
beneficiaries and applicants at the same time the beneficiary or
applicant is being informed of the options available for receiving
care.

(d) Training of specialized county employees to carry out the
program.

(e) Monitoring the implementation of the program in those
county welfare offices where choices are made available in order
to assure that beneficiaries and applicants may make a
well-informed choice, without duress.

(f) Staff and information resources dedicated to directly assist
Medi-Cal managed health care plan enrollees to understand how
to effectively use the services of, and resolve problems or
complaints involving, their managed health care plans.

(g) The responsibilities outlined in this section shall, at the
option of the department, be carried out by a specially trained
county or state employee or by an independent contractor paid by
the department. If a county sponsored prepaid health plan or pilot
program is offered, the responsibilities outlined in this section shall
be carried out either by a specially trained state employee or by
an independent contractor paid by the department.

(h) The department shall adopt any regulations as are necessary
to ensure that the informing of beneficiaries of their health care
options is a part of the eligibility determination process.

begin insert

(i) This section shall remain in effect only until January 1, 2014,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2014, deletes or extends that date.

end insert

begin insert

begin insert SEC. 22. end insert   

end insert

begin insert Section 14016.6 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14016.6. end insert   

The State Department of Health Care Services shall
develop a program to implement subdivision (p) of Section 14016.5
and to provide information and assistance to enable Medi-Cal
beneficiaries to understand and successfully use the services of
the Medi-Cal managed care plans in which they enroll. The
program shall include, but not be limited to, the following
components:

(a) (1) Development of a method to inform beneficiaries and
applicants of all of the following:

(A) Their choices for receiving Medi-Cal benefits including the
use of fee-for-service sector managed health care plans, or pilot
programs.

(B) The availability of staff and information resources to
Medi-Cal managed health care plan enrollees described in
subdivision (f).

(2) (A) Marketing and informational materials, including
printed materials, films, and exhibits, to be provided to Medi-Cal
beneficiaries and applicants when choosing methods of receiving
health care benefits.

(B) The department shall not be responsible for the costs of
developing material required by subparagraph (A).

(C) (i) The department may prescribe the format and edit the
informational materials for factual accuracy, objectivity, and
comprehensibility .

(ii) The department, the California Health Benefit Exchange
(Exchange), the California Healthcare Eligibility, Enrollment, and
Retention System (CalHEERS), and entities or persons designated
pursuant to subdivision (g) shall use the edited materials in
informing beneficiaries and applicants of their choices for
receiving Medi-Cal benefits.

(b) Provision of information that is necessary to implement this
program in a manner that fairly and objectively explains to
beneficiaries and applicants their choices for methods of receiving
Medi-Cal benefits, including information prepared by the
department.

(c) Provision of information about providers who will provide
services to Medi-Cal beneficiaries. This may be information about
provider referral services of a local provider professional
organization. The information shall be made available to Medi-Cal
beneficiaries and applicants at the same time the beneficiary or
applicant is being informed of the options available for receiving
care.

(d) Training of specialized county employees to carry out the
program.

(e) Monitoring the implementation of the program at any
location, including online at the Exchange or at counties, where
choices are made available in order to assure that beneficiaries
and applicants may make a well-informed choice, without duress.

(f) Staff and information resources dedicated to directly assist
Medi-Cal managed health care plan enrollees to understand how
to effectively use the services of, and resolve problems or
complaints involving, their managed health care plans.

(g) Notwithstanding any other provision of state law, the
department, in consultation with the Exchange, may authorize
specific persons or entities, including counties, to provide
information to beneficiaries concerning their health care options
for receiving Medi-Cal benefits and assistance with enrollment.
This subdivision shall apply in all geographic areas designated
by the director. This subdivision shall be implemented in a manner
consistent with federal law.

(h) To the extent otherwise required by Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, the department shall adopt emergency
regulations implementing this section no later than July 1, 2015.
The department may thereafter readopt the emergency regulations
pursuant to that chapter. The adoption and readoption, by the
department, of regulations implementing this section shall be
deemed to be an emergency and necessary to avoid serious harm
to the public peace, health, safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and
the department is hereby exempted from the requirement that it
describe facts showing the need for immediate action and from
review by the Office of Administrative Law.

(i) This section shall become operative on January 1, 2014.

end insert

begin delete SEC. 37. end delete
begin insert SEC. 23. end insert   

Section 14055 is added to the Welfare and Institutions
Code, to read:

14055.  

(a) For the purposes of this chapter, “caretaker relative”
means a relative of a dependent child by blood, adoption, or
marriage with whom the child is living, who assumes primary
responsibility for the child’s care, and who is one of the following:

(1) The child’s father, mother, grandfather, grandmother,
brother, sister, stepfather, stepmother, stepbrother, stepsister, great
grandparent, uncle, aunt, nephew, niece, great-great grandparent,
great uncle or aunt, first cousin, great-great-great grandparent,
great-great uncle or aunt, or first cousin once removed.

(2) The spouse or registered domestic partner of one of the
relatives identified in paragraph (1), even after the marriage is
terminated by death or divorce or the domestic partnership has
been legally terminated.

(b) This section shall become operative on January 1, 2014.

begin delete

SEC. 38.  

Section 14057 is added to the Welfare and Institutions
Code, to read:

14057.  

(a) For the purposes of this chapter, “insurance
affordability program” means a program that is one of the
following:

(1) The state’s Medi-Cal program under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et seq.).

(2) The state’s children’s health insurance program (CHIP)
under Title XXI of the federal Social Security Act (42 U.S.C. Sec.
1397aa et seq.).

(3) A program that makes available to qualified applicants
coverage in a qualified health plan through the California Health
Benefit Exchange, established pursuant to Title 22 (commencing
with Section 100500) of the Government Code, with advance
payment of the premium tax credit established under Section 36B
of the Internal Revenue Code.

(4) A program that makes available coverage in a qualified
health plan through the California Health Benefit Exchange,
established pursuant to Title 22 (commencing with Section 100500)
of the Government Code, with cost-sharing reductions established
under Section 1402 of the federal Patient Protection and Affordable
Care Act (Public Law 111-148), and any subsequent amendments
to that act.

(b) This section shall become operative on January 1, 2014.

SEC. 39.  

Section 14102 is added to the Welfare and Institutions
Code, to read:

14102.  

(a) (1) Notwithstanding any other law and except as
otherwise provided in this section, any individual who is 21 years
of age or older, who does not have minor children eligible for
Medi-Cal, and would be eligible for full-scope Medi-Cal benefits
pursuant to Section 1902(a)(10)(A)(i)(VIII) of Title XIX of the
federal Social Security Act (42 U.S.C. Sec.
1396a(a)(10)(A)(i)(VIII)) but for the five-year eligibility limitation
under Section 1613 of Title 8 of the United States Code and who
is otherwise eligible for state-only funded full-scope benefits shall
be ineligible for those state-only funded benefits if he or she is
eligible for, and is not barred from enrolling in because he or she
is outside of an available enrollment period for coverage with an
advanced premium tax credit offered through the Exchange.

(2) On or after January 1, 2015, if an individual is eligible for
and does not enroll in coverage offered through the Exchange with
an advanced premium tax credit during his or her first available
enrollment period, that individual shall be ineligible for the
state-only funded benefits referenced in paragraph (1), except as
provided in paragraph (3).

(3) An individual shall be ineligible for Medi-Cal pursuant to
this section only if and when he or she is able to receive the
premium assistance, cost sharing, and benefits described in
subdivision (c). Disenrollment from state-only Medi-Cal shall only
occur during an available enrollment period in the Exchange.

(4) The department shall inform and assist such individuals on
enrolling in coverage through the Exchange with the premium
assistance, cost sharing, and benefits described in subdivision (c)
and the process for disenrollment from Medi-Cal, if applicable, in
a way that ensures seamless transition between coverage, including,
but not limited to, developing processes to coordinate with the
county entities that administer eligibility for coverage in Medi-Cal
and the Exchange.

(b) (1) An individual who is a state-only Medi-Cal person as
defined in Section 14052 shall not be subject to subdivision (a) or
(c).

(c) An individual subject to subdivision (a) who is enrolled in
coverage through the Exchange with an advanced premium tax
credit shall be eligible for the following:

(1) Those Medi-Cal benefits for which he or she would have
been eligible but for the five-year eligibility limitation only to the
extent that they are not available through his or her individual
health plan.

(2) The department shall pay on behalf of the beneficiary:

(A) The beneficiary’s insurance premium costs for an individual
health plan, minus the beneficiary’s premium tax credit authorized
by Section 36B of Title 26 of the United States Code and its
implementing regulations.

(B) The beneficiary’s cost-sharing charges so that the individual
has the same cost-sharing charges as he or she would have in the
Medi-Cal program.

(d) For purposes of this section, the following definitions shall
apply:

(1) “Cost-sharing charges” means any expenditure required by
or on behalf of an enrollee by his or her individual health plan with
respect to essential health benefits and includes deductibles,
coinsurance, copayments, or similar charges, but excludes
premiums, and spending for noncovered services.

(2) “Exchange” means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.

(e) Benefits for services under this section shall be provided
with state-only funds only if federal financial participation is not
available for those services. The department shall maximize federal
financial participation in implementing this section to the extent
allowable.

(f) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.

(g) This section shall become operative on January 1, 2014.

end delete

begin delete SEC. 40. end delete
begin insert SEC. 24. end insert   

Section 14102.5 is added to the Welfare and
Institutions Code, to read:

14102.5.  

(a) The department shall, in collaboration with the
Exchange, the counties, consumer advocates, and the Statewide
Automated Welfare System consortia, develop and prepare one or
more reports that shall be issued on at least a quarterly basis and
shall be made publicly available within 30 days following the end
of each quarter, for the purpose of informing the California Health
and Human Services Agency, the Exchange, the Legislature, and
the public about the enrollment process for all insurance
affordability programs. The reports shall comply with federal
reporting requirements and shall, at a minimum, include the
following information, to be derived from, as appropriate
depending on the data element, CalHEERS, MEDS, or the
Statewide Automated Welfare System:

(1) For applications received for insurance affordability
programs through any venue, all of the following:

(A) The number of applications received through each venue.

(B) The number of applicants included on those applications.

(C) Applicant demographics, including, but not limited to,
gender, age, race, ethnicity, and primary language.

(D) The disposition of applications, including all of the
following:

(i) The number of eligibility determinations that resulted in an
approval for coverage.

(ii) The program or programs for which the individuals in clause
(i) were determined eligible.

(iii) The number of applications that were denied for any
coverage and the reason or reasons for the denials.

(E) The number of days for eligibility determinations begin insert to be
completed end insert .

(2) With regard to health plan selection, all of the following:

(A) The health plans that are selected by applicants enrolled in
an insurance affordability program, reported by the program.

(B) The number of Medi-Cal enrollees who do not select a health
plan but are defaulted into a plan.

(3) For annual redeterminations conducted for beneficiaries, all
of the following:

(A) The number of redeterminations processed.

(B) The number of redeterminations that resulted in continued
eligibility for the same begin insert insurance affordability end insert program.

(C) The number of redeterminations that resulted in a change
in eligibility to a different begin insert insurance affordability end insert program.

(D) The number of redeterminations that resulted in a finding
of ineligibility for any program and the reason or reasons for the
findings of ineligibility.

(E) The number of days for redeterminations to be completed.

(4) With regard to disenrollments not related to a
redetermination of eligibility, all of the following:

(A) The number of beneficiary disenrollments.

(B) The reasons for the disenrollments.

(C) The number of disenrollments that are caused by an
individual disenrolling from one insurance affordability program
and enrolling into another.

(5) The number of applications for insurance affordability
programs that were filed with the help of an assister or navigator.

(6) The total number of grievances and appeals filed by
applicants and enrollees regarding eligibility for insurance
affordability programs, the basis for the grievance, and the
outcomes of the appeals.

(b) The department shall collect the information necessary for
these reports and develop these reports using data obtained from
the Statewide Automated Welfare System, CalHEERS, MEDS,
and any other appropriate state information management systems.

(c) For purposes of this section, the following definitions shall
apply:

(1) “CalHEERS” means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.

(2) “Exchange” means the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500)
of the Government Code.

(3) “Statewide Automated Welfare System” means the system
developed pursuant to Section 10823.

(4) “MEDS” means the Medi-Cal Eligibility Data System begin insert that
is maintained by the department end insert .

(d) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. 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. Beginning
six months after the effective date of this section, begin insert and
notwithstanding Section 10231.5 of the Government Code, end insert the
department shall provide a status report to the Legislature on a
semiannual basis until regulations have been adopted.

(e) This section shall become operative on January 1, 2014.

begin delete

SEC. 41.  

Section 14132 of the Welfare and Institutions Code is
amended to read:

14132.  

The following is the schedule of benefits under this
chapter:

(a) Outpatient services are covered as follows:

Physician, hospital or clinic outpatient, surgical center,
respiratory care, optometric, chiropractic, psychology, podiatric,
occupational therapy, physical therapy, speech therapy, audiology,
acupuncture to the extent federal matching funds are provided for
acupuncture, and services of persons rendering treatment by prayer
or healing by spiritual means in the practice of any church or
religious denomination insofar as these can be encompassed by
federal participation under an approved plan, subject to utilization
controls.

(b) (1) Inpatient hospital services, including, but not limited
to, physician and podiatric services, physical therapy and
occupational therapy, are covered subject to utilization controls.

(2) For Medi-Cal fee-for-service beneficiaries, emergency
services and care that are necessary for the treatment of an
emergency medical condition and medical care directly related to
the emergency medical condition. This paragraph shall not be
construed to change the obligation of Medi-Cal managed care
plans to provide emergency services and care. For the purposes of
this paragraph, “emergency services and care” and “emergency
medical condition” shall have the same meanings as those terms
are defined in Section 1317.1 of the Health and Safety Code.

(c) Nursing facility services, subacute care services, and services
provided by any category of intermediate care facility for the
developmentally disabled, including podiatry, physician, nurse
practitioner services, and prescribed drugs, as described in
subdivision (d), are covered subject to utilization controls.
Respiratory care, physical therapy, occupational therapy, speech
therapy, and audiology services for patients in nursing facilities
and any category of intermediate care facility for the
developmentally disabled are covered subject to utilization controls.

(d) (1) Purchase of prescribed drugs is covered subject to the
Medi-Cal List of Contract Drugs and utilization controls.

(2) Purchase of drugs used to treat erectile dysfunction or any
off-label uses of those drugs are covered only to the extent that
federal financial participation is available.

(3) (A) To the extent required by federal law, the purchase of
outpatient prescribed drugs, for which the prescription is executed
by a prescriber in written, nonelectronic form on or after April 1,
2008, is covered only when executed on a tamper resistant
prescription form. The implementation of this paragraph shall
conform to the guidance issued by the federal Centers for Medicare
and Medicaid Services but shall not conflict with state statutes on
the characteristics of tamper resistant prescriptions for controlled
substances, including Section 11162.1 of the Health and Safety
Code. The department shall provide providers and beneficiaries
with as much flexibility in implementing these rules as allowed
by the federal government. The department shall notify and consult
with appropriate stakeholders in implementing, interpreting, or
making specific this paragraph.

(B) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may take the actions specified in subparagraph (A)
by means of a provider bulletin or notice, policy letter, or other
similar instructions without taking regulatory action.

(4) (A) (i) For the purposes of this paragraph, nonlegend has
the same meaning as defined in subdivision (a) of Section
14105.45.

(ii) Nonlegend acetaminophen-containing products, with the
exception of children’s acetaminophen-containing products,
selected by the department are not covered benefits.

(iii) Nonlegend cough and cold products selected by the
department are not covered benefits. This clause shall be
implemented on the first day of the first calendar month following
90 days after the effective date of the act that added this clause,
or on the first day of the first calendar month following 60 days
after the date the department secures all necessary federal approvals
to implement this section, whichever is later.

(iv) Beneficiaries under the Early and Periodic Screening,
Diagnosis, and Treatment Program shall be exempt from clauses
(ii) and (iii).

(B) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may take the actions specified in subparagraph (A)
by means of a provider bulletin or notice, policy letter, or other
similar instruction without taking regulatory action.

(e) Outpatient dialysis services and home hemodialysis services,
including physician services, medical supplies, drugs and
equipment required for dialysis, are covered, subject to utilization
controls.

(f) Anesthesiologist services when provided as part of an
outpatient medical procedure, nurse anesthetist services when
rendered in an inpatient or outpatient setting under conditions set
forth by the director, outpatient laboratory services, and X-ray
services are covered, subject to utilization controls. Nothing in
this subdivision shall be construed to require prior authorization
for anesthesiologist services provided as part of an outpatient
medical procedure or for portable X-ray services in a nursing
facility or any category of intermediate care facility for the
developmentally disabled.

(g) Blood and blood derivatives are covered.

(h) (1) Emergency and essential diagnostic and restorative
dental services, except for orthodontic, fixed bridgework, and
partial dentures that are not necessary for balance of a complete
artificial denture, are covered, subject to utilization controls. The
utilization controls shall allow emergency and essential diagnostic
and restorative dental services and prostheses that are necessary
to prevent a significant disability or to replace previously furnished
prostheses which are lost or destroyed due to circumstances beyond
the beneficiary’s control. Notwithstanding the foregoing, the
director may by regulation provide for certain fixed artificial
dentures necessary for obtaining employment or for medical
conditions that preclude the use of removable dental prostheses,
and for orthodontic services in cleft palate deformities administered
by the department’s California Children Services Program.

(2) For persons 21 years of age or older, the services specified
in paragraph (1) shall be provided subject to the following
conditions:

(A) Periodontal treatment is not a benefit.

(B) Endodontic therapy is not a benefit except for vital
pulpotomy.

(C) Laboratory processed crowns are not a benefit.

(D) Removable prosthetics shall be a benefit only for patients
as a requirement for employment.

(E) The director may, by regulation, provide for the provision
of fixed artificial dentures that are necessary for medical conditions
that preclude the use of removable dental prostheses.

(F) Notwithstanding the conditions specified in subparagraphs
(A) to (E), inclusive, the department may approve services for
persons with special medical disorders subject to utilization review.

(3) Paragraph (2) shall become inoperative July 1, 1995.

(i) Medical transportation is covered, subject to utilization
controls.

(j) Home health care services are covered, subject to utilization
controls.

(k) Prosthetic and orthotic devices and eyeglasses are covered,
subject to utilization controls. Utilization controls shall allow
replacement of prosthetic and orthotic devices and eyeglasses
necessary because of loss or destruction due to circumstances
beyond the beneficiary’s control. Frame styles for eyeglasses
replaced pursuant to this subdivision shall not change more than
once every two years, unless the department so directs.

Orthopedic and conventional shoes are covered when provided
by a prosthetic and orthotic supplier on the prescription of a
physician and when at least one of the shoes will be attached to a
prosthesis or brace, subject to utilization controls. Modification
of stock conventional or orthopedic shoes when medically
indicated, is covered subject to utilization controls. When there is
a clearly established medical need that cannot be satisfied by the
modification of stock conventional or orthopedic shoes,
custom-made orthopedic shoes are covered, subject to utilization
controls.

Therapeutic shoes and inserts are covered when provided to
beneficiaries with a diagnosis of diabetes, subject to utilization
controls, to the extent that federal financial participation is
available.

(l) Hearing aids are covered, subject to utilization controls.
Utilization controls shall allow replacement of hearing aids
necessary because of loss or destruction due to circumstances
beyond the beneficiary’s control.

(m) Durable medical equipment and medical supplies are
covered, subject to utilization controls. The utilization controls
shall allow the replacement of durable medical equipment and
medical supplies when necessary because of loss or destruction
due to circumstances beyond the beneficiary’s control. The
utilization controls shall allow authorization of durable medical
equipment needed to assist a disabled beneficiary in caring for a
child for whom the disabled beneficiary is a parent, stepparent,
foster parent, or legal guardian, subject to the availability of federal
financial participation. The department shall adopt emergency
regulations to define and establish criteria for assistive durable
medical equipment in accordance with the rulemaking provisions
of the Administrative Procedure Act (Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code).

(n) Family planning services are covered, subject to utilization
controls.

(o) Inpatient intensive rehabilitation hospital services, including
respiratory rehabilitation services, in a general acute care hospital
are covered, subject to utilization controls, when either of the
following criteria are met:

(1) A patient with a permanent disability or severe impairment
requires an inpatient intensive rehabilitation hospital program as
described in Section 14064 to develop function beyond the limited
amount that would occur in the normal course of recovery.

(2) A patient with a chronic or progressive disease requires an
inpatient intensive rehabilitation hospital program as described in
Section 14064 to maintain the patient’s present functional level as
long as possible.

(p) (1) Adult day health care is covered in accordance with
Chapter 8.7 (commencing with Section 14520).

(2) Commencing 30 days after the effective date of the act that
added this paragraph, and notwithstanding the number of days
previously approved through a treatment authorization request,
adult day health care is covered for a maximum of three days per
week.

(3) As provided in accordance with paragraph (4), adult day
health care is covered for a maximum of five days per week.

(4) As of the date that the director makes the declaration
described in subdivision (g) of Section 14525.1, paragraph (2)
shall become inoperative and paragraph (3) shall become operative.

(q) (1) Application of fluoride, or other appropriate fluoride
treatment as defined by the department, other prophylaxis treatment
for children 17 years of age and under, are covered.

(2) All dental hygiene services provided by a registered dental
hygienist in alternative practice pursuant to Sections 1768 and
1770 of the Business and Professions Code may be covered as
long as they are within the scope of Denti-Cal benefits and they
are necessary services provided by a registered dental hygienist
in alternative practice.

(r) (1) Paramedic services performed by a city, county, or
special district, or pursuant to a contract with a city, county, or
special district, and pursuant to a program established under Article
3 (commencing with Section 1480) of Chapter 2.5 of Division 2
of the Health and Safety Code by a paramedic certified pursuant
to that article, and consisting of defibrillation and those services
specified in subdivision (3) of Section 1482 of the article.

(2) All providers enrolled under this subdivision shall satisfy
all applicable statutory and regulatory requirements for becoming
a Medi-Cal provider.

(3) This subdivision shall be implemented only to the extent
funding is available under Section 14106.6.

(s) In-home medical care services are covered when medically
appropriate and subject to utilization controls, for beneficiaries
who would otherwise require care for an extended period of time
in an acute care hospital at a cost higher than in-home medical
care services. The director shall have the authority under this
section to contract with organizations qualified to provide in-home
medical care services to those persons. These services may be
provided to patients placed in shared or congregate living
arrangements, if a home setting is not medically appropriate or
available to the beneficiary. As used in this section, “in-home
medical care service” includes utility bills directly attributable to
continuous, 24-hour operation of life-sustaining medical equipment,
to the extent that federal financial participation is available.

As used in this subdivision, in-home medical care services,
include, but are not limited to:

(1) Level of care and cost of care evaluations.

(2) Expenses, directly attributable to home care activities, for
materials.

(3) Physician fees for home visits.

(4) Expenses directly attributable to home care activities for
shelter and modification to shelter.

(5) Expenses directly attributable to additional costs of special
diets, including tube feeding.

(6) Medically related personal services.

(7) Home nursing education.

(8) Emergency maintenance repair.

(9) Home health agency personnel benefits which permit
coverage of care during periods when regular personnel are on
vacation or using sick leave.

(10) All services needed to maintain antiseptic conditions at
stoma or shunt sites on the body.

(11) Emergency and nonemergency medical transportation.

(12) Medical supplies.

(13) Medical equipment, including, but not limited to, scales,
gurneys, and equipment racks suitable for paralyzed patients.

(14) Utility use directly attributable to the requirements of home
care activities which are in addition to normal utility use.

(15) Special drugs and medications.

(16) Home health agency supervision of visiting staff which is
medically necessary, but not included in the home health agency
rate.

(17) Therapy services.

(18) Household appliances and household utensil costs directly
attributable to home care activities.

(19) Modification of medical equipment for home use.

(20) Training and orientation for use of life-support systems,
including, but not limited to, support of respiratory functions.

(21) Respiratory care practitioner services as defined in Sections
3702 and 3703 of the Business and Professions Code, subject to
prescription by a physician and surgeon.

Beneficiaries receiving in-home medical care services are entitled
to the full range of services within the Medi-Cal scope of benefits
as defined by this section, subject to medical necessity and
applicable utilization control. Services provided pursuant to this
subdivision, which are not otherwise included in the Medi-Cal
schedule of benefits, shall be available only to the extent that
federal financial participation for these services is available in
accordance with a home- and community-based services waiver.

(t) Home- and community-based services approved by the
United States Department of Health and Human Services may be
covered to the extent that federal financial participation is available
for those services under waivers granted in accordance with Section
1396n of Title 42 of the United States Code. The director may
seek waivers for any or all home- and community-based services
approvable under Section 1396n of Title 42 of the United States
Code. Coverage for those services shall be limited by the terms,
conditions, and duration of the federal waivers.

(u) Comprehensive perinatal services, as provided through an
agreement with a health care provider designated in Section
14134.5 and meeting the standards developed by the department
pursuant to Section 14134.5, subject to utilization controls.

The department shall seek any federal waivers necessary to
implement the provisions of this subdivision. The provisions for
which appropriate federal waivers cannot be obtained shall not be
implemented. Provisions for which waivers are obtained or for
which waivers are not required shall be implemented
notwithstanding any inability to obtain federal waivers for the
other provisions. No provision of this subdivision shall be
implemented unless matching funds from Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the
United States Code are available.

(v) Early and periodic screening, diagnosis, and treatment for
any individual under 21 years of age is covered, consistent with
the requirements of Subchapter XIX (commencing with Section
1396) of Chapter 7 of Title 42 of the United States Code.

(w) Hospice service which is Medicare-certified hospice service
is covered, subject to utilization controls. Coverage shall be
available only to the extent that no additional net program costs
are incurred.

(x) When a claim for treatment provided to a beneficiary
includes both services which are authorized and reimbursable
under this chapter, and services which are not reimbursable under
this chapter, that portion of the claim for the treatment and services
authorized and reimbursable under this chapter shall be payable.

(y) Home- and community-based services approved by the
United States Department of Health and Human Services for
beneficiaries with a diagnosis of AIDS or ARC, who require
intermediate care or a higher level of care.

Services provided pursuant to a waiver obtained from the
Secretary of the United States Department of Health and Human
Services pursuant to this subdivision, and which are not otherwise
included in the Medi-Cal schedule of benefits, shall be available
only to the extent that federal financial participation for these
services is available in accordance with the waiver, and subject to
the terms, conditions, and duration of the waiver. These services
shall be provided to individual beneficiaries in accordance with
the client’s needs as identified in the plan of care, and subject to
medical necessity and applicable utilization control.

The director may under this section contract with organizations
qualified to provide, directly or by subcontract, services provided
for in this subdivision to eligible beneficiaries. Contracts or
agreements entered into pursuant to this division shall not be
subject to the Public Contract Code.

(z) Respiratory care when provided in organized health care
systems as defined in Section 3701 of the Business and Professions
Code, and as an in-home medical service as outlined in subdivision
(s).

(aa) (1) There is hereby established in the department, a
program to provide comprehensive clinical family planning
services to any person who has a family income at or below 200
percent of the federal poverty level, as revised annually, and who
is eligible to receive these services pursuant to the waiver identified
in paragraph (2). This program shall be known as the Family
Planning, Access, Care, and Treatment (Family PACT) Program.

(2) The department shall seek a waiver in accordance with
Section 1315 of Title 42 of the United States Code, or a state plan
amendment adopted in accordance with Section
1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code,
which was added to Section 1396a of Title 42 of the United States
Code by Section 2303(a)(2) of the federal Patient Protection and
Affordable Care Act (PPACA) (Public Law 111-148), for a
program to provide comprehensive clinical family planning
services as described in paragraph (8). Under the waiver, the
program shall be operated only in accordance with the waiver and
the statutes and regulations in paragraph (4) and subject to the
terms, conditions, and duration of the waiver. Under the state plan
amendment, which shall replace the waiver and shall be known as
the Family PACT successor state plan amendment, the program
shall be operated only in accordance with this subdivision and the
statutes and regulations in paragraph (4). The state shall use the
standards and processes imposed by the state on January 1, 2007,
including the application of an eligibility discount factor to the
extent required by the federal Centers for Medicare and Medicaid
Services, for purposes of determining eligibility as permitted under
Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States
Code. To the extent that federal financial participation is available,
the program shall continue to conduct education, outreach,
enrollment, service delivery, and evaluation services as specified
under the waiver. The services shall be provided under the program
only if the waiver and, when applicable, the successor state plan
amendment are approved by the federal Centers for Medicare and
Medicaid Services and only to the extent that federal financial
participation is available for the services. Nothing in this section
shall prohibit the department from seeking the Family PACT
successor state plan amendment during the operation of the waiver.

(3) Solely for the purposes of the waiver or Family PACT
successor state plan amendment and notwithstanding any other
provision of law, the collection and use of an individual’s social
security number shall be necessary only to the extent required by
federal law.

(4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005,
and 24013, and any regulations adopted under these statutes shall
apply to the program provided for under this subdivision. No other
provision of law under the Medi-Cal program or the State-Only
Family Planning Program shall apply to the program provided for
under this subdivision.

(5) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement, without taking regulatory action,
the provisions of the waiver after its approval by the federal Health
Care Financing Administration and the provisions of this section
by means of an all-county letter or similar instruction to providers.
Thereafter, the department shall adopt regulations to implement
this section and the approved waiver 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. Beginning
six months after the effective date of the act adding this
subdivision, the department shall provide a status report to the
Legislature on a semiannual basis until regulations have been
adopted.

(6) In the event that the Department of Finance determines that
the program operated under the authority of the waiver described
in paragraph (2) or the Family PACT successor state plan
amendment is no longer cost effective, this subdivision shall
become inoperative on the first day of the first month following
the issuance of a 30-day notification of that determination in
writing by the Department of Finance to the chairperson in each
house that considers appropriations, the chairpersons of the
committees, and the appropriate subcommittees in each house that
considers the State Budget, and the Chairperson of the Joint
Legislative Budget Committee.

(7) If this subdivision ceases to be operative, all persons who
have received or are eligible to receive comprehensive clinical
family planning services pursuant to the waiver described in
paragraph (2) shall receive family planning services under the
Medi-Cal program pursuant to subdivision (n) if they are otherwise
eligible for Medi-Cal with no share of cost, or shall receive
comprehensive clinical family planning services under the program
established in Division 24 (commencing with Section 24000) either
if they are eligible for Medi-Cal with a share of cost or if they are
otherwise eligible under Section 24003.

(8) For purposes of this subdivision, “comprehensive clinical
family planning services” means the process of establishing
objectives for the number and spacing of children, and selecting
the means by which those objectives may be achieved. These
means include a broad range of acceptable and effective methods
and services to limit or enhance fertility, including contraceptive
methods, federal Food and Drug Administration approved
contraceptive drugs, devices, and supplies, natural family planning,
abstinence methods, and basic, limited fertility management.
Comprehensive clinical family planning services include, but are
not limited to, preconception counseling, maternal and fetal health
counseling, general reproductive health care, including diagnosis
and treatment of infections and conditions, including cancer, that
threaten reproductive capability, medical family planning treatment
and procedures, including supplies and followup, and
informational, counseling, and educational services.
Comprehensive clinical family planning services shall not include
abortion, pregnancy testing solely for the purposes of referral for
abortion or services ancillary to abortions, or pregnancy care that
is not incident to the diagnosis of pregnancy. Comprehensive
clinical family planning services shall be subject to utilization
control and include all of the following:

(A) Family planning related services and male and female
sterilization. Family planning services for men and women shall
include emergency services and services for complications directly
related to the contraceptive method, federal Food and Drug
Administration approved contraceptive drugs, devices, and
supplies, and followup, consultation, and referral services, as
indicated, which may require treatment authorization requests.

(B) All United States Department of Agriculture, federal Food
and Drug Administration approved contraceptive drugs, devices,
and supplies that are in keeping with current standards of practice
and from which the individual may choose.

(C) Culturally and linguistically appropriate health education
and counseling services, including informed consent, that include
all of the following:

(i) Psychosocial and medical aspects of contraception.

(ii) Sexuality.

(iii) Fertility.

(iv) Pregnancy.

(v) Parenthood.

(vi) Infertility.

(vii) Reproductive health care.

(viii) Preconception and nutrition counseling.

(ix) Prevention and treatment of sexually transmitted infection.

(x) Use of contraceptive methods, federal Food and Drug
Administration approved contraceptive drugs, devices, and
supplies.

(xi) Possible contraceptive consequences and followup.

(xii) Interpersonal communication and negotiation of
relationships to assist individuals and couples in effective
contraceptive method use and planning families.

(D) A comprehensive health history, updated at the next periodic
visit (between 11 and 24 months after initial examination) that
includes a complete obstetrical history, gynecological history,
contraceptive history, personal medical history, health risk factors,
and family health history, including genetic or hereditary
conditions.

(E) A complete physical examination on initial and subsequent
periodic visits.

(F) Services, drugs, devices, and supplies deemed by the federal
Centers for Medicare and Medicaid Services to be appropriate for
inclusion in the program.

(9) In order to maximize the availability of federal financial
participation under this subdivision, the director shall have the
discretion to implement the Family PACT successor state plan
amendment retroactively to July 1, 2010.

(ab) (1) Purchase of prescribed enteral nutrition products is
covered, subject to the Medi-Cal list of enteral nutrition products
and utilization controls.

(2) Purchase of enteral nutrition products is limited to those
products to be administered through a feeding tube, including, but
not limited to, a gastric, nasogastric, or jejunostomy tube.
Beneficiaries under the Early and Periodic Screening, Diagnosis,
and Treatment Program shall be exempt from this paragraph.

(3) Notwithstanding paragraph (2), the department may deem
an enteral nutrition product, not administered through a feeding
tube, including, but not limited to, a gastric, nasogastric, or
jejunostomy tube, a benefit for patients with diagnoses, including,
but not limited to, malabsorption and inborn errors of metabolism,
if the product has been shown to be neither investigational nor
experimental when used as part of a therapeutic regimen to prevent
serious disability or death.

(4) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement the amendments to this subdivision
made by the act that added this paragraph by means of all-county
letters, provider bulletins, or similar instructions, without taking
regulatory action.

(5) The amendments made to this subdivision by the act that
added this paragraph shall be implemented June 1, 2011, or on the
first day of the first calendar month following 60 days after the
date the department secures all necessary federal approvals to
implement this section, whichever is later.

(ac) Diabetic testing supplies are covered when provided by a
pharmacy, subject to utilization controls.

(ad) Commencing January 1, 2014, any benefits, services, and
coverage not otherwise described in this chapter that are included
in the essential health benefits package adopted by the state
pursuant to Section 1367.005 of the Health and Safety Code and
Section 10112.27 of the Insurance Code and approved by the
United States Secretary of Health and Human Services under
Section 18022 of Title 42 of the United States Code, and any
successor essential health benefit package adopted by the state.

SEC. 42.  

Section 14132.02 is added to the Welfare and
Institutions Code, to read:

14132.02.  

(a) Pursuant to Sections 1902(k)(1) and
1937(b)(1)(D) of the federal Social Security Act (42 U.S.C. Sec.
1396a(k)(1); 42 U.S.C. Sec. 1396u-7(b)(1)(D)), the department
shall seek approval from the United States Secretary of Health and
Human Services to establish a benchmark benefit package that
includes the same benefits, services, and coverage as is provided
to all other full-scope Medi-Cal enrollees, supplemented by any
benefits, services, and coverage included in the essential health
benefits package adopted by the state pursuant to Section 1367.005
of the Health and Safety Code and Section 10112.27 of the
Insurance Code and approved by the secretary under Section 18022
of Title 42 of the United States Code, and any successor essential
health benefit package adopted by the state.

(b) This section shall become operative January 1, 2014.

end delete

begin insert

begin insert SEC. 25. end insert   

end insert

begin insert Section 14103 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

begin insert

begin insert 14103. end insert   

(a) The implementation of the optional expansion of
Medi-Cal benefits to adults who meet the eligibility requirements
of Section 1902(a)(10)(A)(i)(VIII) of Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII)), shall be
contingent upon the following:

(1) If the federal medical assistance percentage payable to the
state under the ACA for the optional expansion of Medi-Cal
benefits to adults is reduced below 90 percent, that reduction shall
be addressed in a timely manner through the annual state budget
or legislative process. Upon receiving notification of any reduction
in federal assistance pursuant to this paragraph, the Director of
Finance shall immediately notify the Chairpersons of the Senate
and Assembly Health Committees and the Chairperson of the Joint
Legislative Budget Committee.

(2) If, prior to January 1, 2018, the federal medical assistance
percentage payable to the state under the ACA for the optional
expansion of Medi-Cal benefits to adults is reduced to 70 percent
or less, the implementation of any provision in this chapter
authorizing the optional expansion of Medi-Cal benefits to adults
shall cease 12 months after the effective date of the federal law or
other action reducing the federal medical assistance percentage.

(b) For purposes of this section, “ACA” means the federal
Patient Protection and Affordable Care Act (Public Law 111-148)
as originally enacted and as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152)
and any subsequent amendments.

end insert

begin delete SEC. 43. end delete
begin insert SEC. 26. end insert   

Section 15926 of the Welfare and Institutions Code
is amended to read:

15926.  

(a) The following definitions apply for purposes of
this part:

(1) “Accessible” means in compliance with Section 11135 of
the Government Code, Section 1557 of the PPACA, and regulations
or guidance adopted pursuant to these statutes.

(2) “Limited-English-proficient” means not speaking English
as one’s primary language and having a limited ability to read,
speak, write, or understand English.

(3) “Insurance affordability program” means a program that is
one of the following:

(A) The Medi-Cal program under Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.).

(B) The begin delete Healthy Families Program end delete begin insert state’s children’s health
insurance program (CHIP) end insert under Title XXI of the federal Social
Security Act (42 U.S.C. Sec. 1397aa et seq.).

(C) A program that makes available to qualified individuals
coverage in a qualified health plan through the California Health
Benefit Exchange established pursuant to Title 22 (commencing
with Section 100500) of the Government Code with advance
payment of the premium tax credit established under Section 36B
of the Internal Revenue Code.

(4) A program that makes available coverage in a qualified
health plan through the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500)
of the Government Code with cost-sharing reductions established
under Section 1402 of PPACA and any subsequent amendments
to that act.

(b) An individual shall have the option to apply for insurance
affordability programs in person, by mail, online, by telephone,
or by other commonly available electronic means.

(c) (1) A single, accessible, standardized paper, electronic, and
telephone application for insurance affordability programs shall
be developed by the department in consultation with MRMIB and
the board governing the Exchange as part of the stakeholder process
described in subdivision (b) of Section 15925. The application
shall be used by all entities authorized to make an eligibility
determination for any of the insurance affordability programs and
by their agents.

begin insert

(2) The department may develop and require the use of
supplemental forms to collect additional information needed to
determine eligibility on a basis other than the financial
methodologies described in Section 1396a(e)(14) of Title 42 of the
United States Code, as added by the federal Patient Protection
and Affordable Care Act (Public Law 111-148), and as amended
by the federal Health Care and Education Reconciliation Act of
2010 (Public Law 111-152) and any subsequent amendments, as
provided under Section 435.907(c) of Title 42 of the Code of
Federal Regulations.

end insert begin delete

(2)

end delete

begin insert ( end insert begin insert 3) end insert  The application shall be tested and operational by the date
as required by the federal Secretary of Health and Human Services.

begin delete

(3)

end delete

begin insert ( end insert begin insert 4) end insert  The application form shall, to the extent not inconsistent
with federal statutes, regulations, and guidance, satisfy all of the
following criteria:

(A) The form shall include simple, user-friendly language and
instructions.

(B) The form may not ask for information related to a
nonapplicant that is not necessary to determine eligibility in the
applicant’s particular circumstances.

(C) The form may require only information necessary to support
the eligibility and enrollment processes for insurance affordability
programs.

(D) The form may be used for, but shall not be limited to,
screening.

(E) The form may ask, or be used otherwise to identify, if the
mother of an infant applicant under one year of age had coverage
through an insurance affordability program for the infant’s birth,
for the purpose of automatically enrolling the infant into the
applicable program without the family having to complete the
application process for the infant.

(F) The form may 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 under Section 4302 of the PPACA.

(G) Until January 1, 2016, the department shall instruct counties
to not reject an application that was in existence prior to January
1, 2014, but to accept the application and request any additional
information needed from the applicant in order to complete the
eligibility determination process. The department shall work with
counties and consumer advocates to develop the supplemental
questions.

(d) Nothing in this section shall preclude the use of a
provider-based application form or enrollment procedures for
insurance affordability programs or other health programs that
differs from the application form described in subdivision (c), and
related enrollment procedures. Nothing in this section shall
preclude the use of a joint application, developed by the department
and the State Department of Social Services, that allows for an
application to be made for multiple programs, including, but not
limited to, CalWORKs, CalFresh, and insurance affordability
programs.

(e) The entity making the eligibility determination shall grant
eligibility immediately whenever possible and with the consent of
the applicant in accordance with the state and federal rules
governing insurance affordability programs.

(f) (1) If the eligibility, enrollment, and retention system has
the ability to prepopulate an application form for insurance
affordability programs with personal information from available
electronic databases, an applicant shall be given the option, with
his or her informed consent, to have the application form
prepopulated. Before a prepopulated application is submitted to
the entity authorized to make eligibility determinations, the
individual shall be given the opportunity to provide additional
eligibility information and to correct any information retrieved
from a database.

(2) All insurance affordability programs begin delete shall end delete begin insert may end insert accept
self-attestation, instead of requiring an individual to produce a
document, for age, date of birth, family size, household income,
state residence, pregnancy, and any other applicable criteria needed
to determine the eligibility of an applicant or recipient, to the extent
permitted by state and federal law.

(3) An applicant or recipient shall have his or her information
electronically verified in the manner required by the PPACA and
implementing federal regulations and guidance begin insert and state law end insert .

(4) Before an eligibility determination is made, the individual
shall be given the opportunity to provide additional eligibility
information and to correct information.

(5) The eligibility of an applicant shall not be delayed begin insert beyond
the timeliness standards as provided in Section 435.912 of Title
42 of the Code of Federal Regulations end insert or denied for any insurance
affordability program unless the applicant is given a reasonable
opportunity, of at least the kind provided for under the Medi-Cal
program pursuant to Section 14007.5 and paragraph (7) of
subdivision (e) of Section 14011.2, to resolve discrepancies
concerning any information provided by a verifying entity.

(6) To the extent federal financial participation is available, an
applicant shall be provided benefits in accordance with the rules
of the insurance affordability program, as implemented in federal
regulations and guidance, for which he or she otherwise qualifies
until a determination is made that he or she is not eligible and all
applicable notices have been provided. Nothing in this section
shall be interpreted to grant presumptive eligibility if it is not
otherwise required by state law, and, if so required, then only to
the extent permitted by federal law.

(g) The eligibility, enrollment, and retention system shall offer
an applicant and recipient assistance with his or her application or
renewal for an insurance affordability program in person, over the
telephone, by mail, online, or through other commonly available
electronic means and in a manner that is accessible to individuals
with disabilities and those who are limited-English proficient.

(h) (1) During the processing of an application, renewal, or a
transition due to a change in circumstances, an entity making
eligibility determinations for an insurance affordability program
shall ensure that an eligible applicant and recipient of insurance
affordability programs that meets all program eligibility
requirements and complies with all necessary requests for
information moves between programs without any breaks in
coverage and without being required to provide any forms,
documents, or other information or undergo verification that is
duplicative or otherwise unnecessary. The individual shall be
informed about how to obtain information about the status of his
or her application, renewal, or transfer to another program at any
time, and the information shall be promptly provided when
requested.

(2) The application or case of an individual screened as not
eligible for Medi-Cal on the basis of Modified Adjusted Gross
Income (MAGI) household income but who may be eligible on
the basis of being 65 years of age or older, or on the basis of
blindness or disability, shall be forwarded to the Medi-Cal program
for an eligibility determination. During the period this application
or case is processed for a non-MAGI Medi-Cal eligibility
determination, if the applicant or recipient is otherwise eligible
for an insurance affordability program, he or she shall be
determined eligible for that program.

(3) Renewal procedures shall include all available methods for
reporting renewal information, including, but not limited to,
face-to-face, telephone, mail, and online renewal or renewal
through other commonly available electronic means.

(4) An applicant who is not eligible for an insurance affordability
program for a reason other than income eligibility, or for any reason
in the case of applicants and recipients residing in a county that
offers a health coverage program for individuals with income above
the maximum allowed for the Exchange premium tax credits, shall
be referred to the county health coverage program in his or her
county of residence.

(i) Notwithstanding subdivisions (e), (f), and (j), before an online
applicant who appears to be eligible for the Exchange with a
premium tax credit or reduction in cost sharing, or both, may be
enrolled in the Exchange, both of the following shall occur:

(1) The applicant shall be informed of the overpayment penalties
under the federal Comprehensive 1099 Taxpayer Protection and
Repayment of Exchange Subsidy Overpayments Act of 2011
(Public Law 112-9), if the individual’s annual family income
increases by a specified amount or more, calculated on the basis
of the individual’s current family size and current income, and that
penalties are avoided by prompt reporting of income increases
throughout the year.

(2) The applicant shall be informed of the penalty for failure to
have minimum essential health coverage.

(j) The department shall, in coordination with MRMIB and the
Exchange board, streamline and coordinate all eligibility rules and
requirements among insurance affordability programs using the
least restrictive rules and requirements permitted by federal and
state law. This process shall include the consideration of
methodologies for determining income levels, assets, rules for
household size, citizenship and immigration status, and
self-attestation and verification requirements.

(k) (1) Forms and notices developed pursuant to this section
shall be accessible and standardized, as appropriate, and shall
comply with federal and state laws, regulations, and guidance
prohibiting discrimination.

(2) Forms and notices developed pursuant to this section shall
be developed using plain language and shall be provided in a
manner that affords meaningful access to limited-English-proficient
individuals, in accordance with applicable state and federal law,
and at a minimum, provided in the same threshold languages as
required for Medi-Cal managed care plans.

(l) The department, the California Health and Human Services
Agency, MRMIB, and the Exchange board shall establish a process
for receiving and acting on stakeholder suggestions regarding the
functionality of the eligibility systems supporting the Exchange,
including the activities of all entities providing eligibility screening
to ensure the correct eligibility rules and requirements are being
used. This process shall include consumers and their advocates,
be conducted no less than quarterly, and include the recording,
review, and analysis of potential defects or enhancements of the
eligibility systems. The process shall also include regular updates
on the work to analyze, prioritize, and implement corrections to
confirmed defects and proposed enhancements, and to monitor
screening.

(m) In designing and implementing the eligibility, enrollment,
and retention system, the department, MRMIB, and the Exchange
board shall ensure that all privacy and confidentiality rights under
the PPACA and other federal and state laws are incorporated and
followed, including responses to security breaches.

(n) Except as otherwise specified, this section shall be operative
on January 1, 2014.

begin delete SEC. 44. end delete
begin insert SEC. 27. end insert   

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for certain
costs that may be incurred by a local agency or school district
because, in that regard, this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.

However, if the Commission on State Mandates determines that
this act contains other 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.

begin insert

begin insert SEC. 28. end insert   

end insert

begin insert This act shall become operative only if Senate Bill 1
of the 2013-14 First Extraordinary Session is enacted and takes
effect. end insert