Amended in Assembly June 5, 2014

Amended in Senate January 9, 2014

Senate Bill No. 508

Introduced by Senator Hernandez

February 21, 2013

An act to amend Sections 14005.20, 14005.26, 14005.27, 14005.28, 14005.30, 14005.64, 14051, 14148, and 14148.5 of, and to add begin delete Section 14005.285 end delete begin insert Sections 14005.285, 14005.287, and 14005.288 end insert to, the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 508, as amended, Hernandez. Medi-Cal: eligibility.

(1) 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. Existing law requires, with some exceptions, a Medi-Cal applicant’s or beneficiary’s income and resources be determined based on modified adjusted gross income (MAGI), as specified. Existing law requires the department to establish income eligibility thresholds for those eligibility groups whose eligibility will be determined using MAGI-based financial methods.

This bill would codify the income eligibility thresholds established by the department and would make other related and conforming changes.

(2) Existing law requires the department to implement specified provisions of federal law 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, as specified.

This bill would instead require the department to implement those provisions to provide Medi-Cal benefits to an individual until his or her 26th birthday if he or she was in foster care on his or her 18th birthday or begin delete lost his or her eligibility for foster care assistance due to having reached the maximum age for that assistance. end delete begin insert such higher age at which the state’s or tribe’s foster care assistance ends under federal law. The bill would, if permitted under future federal regulations or guidance, require the department to provide Medi-Cal benefits under these provisions to an individual who left foster care before reaching the age at which the state’s or tribe’s foster care assistance ends under federal law. end insert The bill would also require the department to exercise its option under federal law to extend Medi-Cal benefits to independent foster care adolescents, as specified.

begin insert

This bill would require the department to exercise its option under federal law to extend Medi-Cal benefits to individuals under 21 years of age placed in foster homes or private institutions and individuals under 21 years of age for whom a specified adoption agreement is in effect. The bill would require that all of the income considered when determining an individual’s eligibility under these provisions be disregarded.

end insert

Because counties are required to make eligibility determinations and this begin delete will end delete begin insert bill end insert would expand Medi-Cal eligibility, the bill would impose a state-mandated local program begin insert . end insert

(3) Existing law, for purposes of determining eligibility, defines, in part, a medically begin delete need end delete begin insert needy end insert family person as a parent or caretaker relative of a child who meets the deprivation requirements of Aid to Families with Dependent Children.

This bill would delete the requirement that the parent or caretaker relative meet the deprivation requirements.

(4) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14005.20 of the Welfare and Institutions
Code is amended to read:

14005.20.  

(a) The State Department of Health Care Services
shall adopt the option made available under Section
1902(a)(10)(A)(ii)(XII) of Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396a(a)(10)(A)(ii)(XII)) to pay allowable
tuberculosis related services for persons infected with tuberculosis.

(b) (1) Except as provided in paragraph (2), the income and
resources of these persons may not exceed the maximum amount
for a disabled person as described in Section 1902(a)(10)(A)(i) of
Title XIX of the federal Social Security Act (42 U.S.C. Sec.
1396a(a)(10)(A)(i)).

(2) Effective January 1, 2014, the income and resources of
individuals eligible under this section may not exceed the
maximum amount for a disabled person as described in Section
1902(a)(10)(A)(i) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396a(a)(10)(A)(i)), as determined, counted, and
valued in accordance with the requirements of Section 14005.64.

(c) The amendments made by the act that added this subdivision
shall be implemented only if and to the extent that federal financial
participation is available and any necessary federal approvals have
been obtained.

SEC. 2.  

Section 14005.26 of the Welfare and Institutions Code
is amended to read:

14005.26.  

(a)  begin insert (1) end insert begin insert   end insert Except as provided in subdivision (b), the
department shall exercise the option pursuant to Section
1902(a)(l0)(A)(ii)(XIV) of the federal Social Security Act (42
U.S.C. Sec. 1396a(a)(10)(A)(ii)(XIV)) to provide full-scope
benefits with no share of cost under this chapter and Chapter 8
(commencing with Section 14200) to optional targeted low-income
children pursuant to Section 1905(u)(2)(B) of the federal Social
Security Act (42 U.S.C. Sec. 1396d(u)(2)(B)), with family incomes
up to and including 200 percent of the federal poverty level. The
department shall seek federal approval of a state plan amendment
to implement this subdivision.

begin insert

(2) (A) Pursuant to Section 1902(r)(2) of the federal Social
Security Act (42 U.S.C. Sec. 1396a(r)(2)), the department shall
adopt the option to use less restrictive income and resource
methodologies to exempt all resources and disregard income at
or above 200 percent and up to and including 250 percent of the
federal poverty level for the individuals described in paragraph
(1). The department shall seek federal approval of a state plan
amendment to implement this subdivision.

end insert begin insert

(B) This paragraph shall be inoperative on January 1, 2014.

end insert

(b) Effective January 1, 2014, the federal poverty level
percentage income eligibility threshold used pursuant to
subdivision (c) of Section 14005.64 to determine eligibility for
medical assistance under subdivision (a) shall equal 261 percent
of the federal poverty level.

(c) For purposes of carrying out the provisions of this section,
the department may adopt the option pursuant to Section
1902(e)(13) of the federal Social Security Act (42 U.S.C. Sec.
1396a(e)(13)) to rely upon findings of the Managed Risk Medical
Insurance Board (MRMIB) regarding one or more components of
eligibility.

(d) (1) (A) Except as provided in subparagraph (B), the
department shall exercise the option pursuant to Section 1916A
of the federal Social Security Act (42 U.S.C. Sec. 1396o-1) to
impose premiums for individuals described in subdivision (a)
whose family income has been determined to be above 150 percent
and up to and including 200 percent of the federal poverty begin delete level. end delete
begin insert level, after application of the income disregard pursuant to
paragraph (2) of subdivision (a). end insert The department shall not impose
premiums under this subdivision for individuals described in
subdivision (a) whose family income has been determined to be
at or below 150 percent of the federal poverty begin delete level. end delete begin insert level, after
application of the income disregard pursuant to paragraph (2) of
subdivision (a). end insert The department shall obtain federal approval for
the implementation of this subdivision.

(B) Effective January 1, 2014, the department shall impose a
premium pursuant to subparagraph (A) for individuals whose
family income has been determined to be above 160 percent and
up to and including 261 percent of the federal poverty level, as
determined, counted, and valued in accordance with the
requirements of Section 14005.64.

(2) (A) Monthly premiums imposed under this section shall
equal thirteen dollars ($13) per child with a maximum contribution
of thirty-nine dollars ($39) per family.

(B) Families that pay three months of required premiums in
advance shall receive the fourth consecutive month of coverage
with no premium required. For purposes of the discount provided
by this subparagraph, family contributions paid in the Healthy
Families Program for children transitioned to Medi-Cal pursuant
to Section 14005.27 shall be credited as Medi-Cal premiums paid.

(C) Families that pay the required premium by an approved
means of electronic funds transfer, including credit card payment,
shall receive a 25-percent discount from the required premium. If
the department and the Managed Risk Medical Insurance Board
determine that it is feasible, the department shall treat an
authorization for electronic funds transfer or credit card payment
to the Healthy Families Program as an authorization for electronic
funds transfer or credit card payment to Medi-Cal.

(e) This section shall be implemented only to the extent that all
necessary federal approvals and waivers described in this section
have been obtained and the enhanced rate of federal financial
participation under Title XXI of the federal Social Security Act
(42 U.S.C. Sec. 1397aa et seq.) is available for targeted low-income
children pursuant to that act.

(f) The department shall not enroll targeted low-income children
described in this section in the Medi-Cal program until all
necessary federal approvals and waivers have been obtained, and
no sooner than January 1, 2013.

(g) (1)  begin delete To end delete begin insert (A) end insert begin insert   end insert begin insert Except as provided in subparagraph (B), to end insert the
extent the new budget methodology pursuant to paragraph (6) of
subdivision (a) of Section 14154 is not fully operational, for the
purposes of implementing this section, for individuals described
in subdivision (a) whose family income has been determined to
be up to and including begin delete 160 end delete begin insert 150 end insert percent of the federal poverty begin delete level, end delete
begin insert level, as determined pursuant to paragraph (2) of subdivision (a), end insert
the department shall utilize the budgeting methodology for this
population as contained in the November 2011 Medi-Cal Local
Assistance Estimate for Medi-Cal county administration costs for
eligibility operations.

begin insert

(B) Effective January 1, 2014, to the extent the new budget
methodology pursuant to paragraph (6) of subdivision (a) of
Section 14154 is not fully operational, for purposes of
implementing this section for individuals whose family income has
been determined to be up to and including 160 percent of the
federal poverty level, the department shall utilize the budgeting
methodology for this population as contained in the November
2011 Medi-Cal Local Assistance Estimate for Medi-Cal county
administration costs for eligibility operations.

end insert

(2)  begin delete For end delete begin insert (A) end insert begin insert   end insert begin insert Except as provided in subparagraph (B), for end insert
purposes of implementing this section, the department shall include
in the Medi-Cal Local Assistance Estimate an amount for Medi-Cal
eligibility operations associated with the individuals whose family
income is determined to be above begin delete 160 end delete begin insert 150 end insert percent and up to and
including begin delete 261 end delete begin insert 200 end insert percent of the federal poverty begin delete level. end delete begin insert level, after
application of the income disregard pursuant to paragraph (2) of
subdivision (a). end insert In developing an estimate for this activity, the
department shall consider the projected number of final eligibility
determinations each county will process and projected county
costs. Within 60 days of the passage of the annual Budget Act, the
department shall notify each county of their allocation for this
activity based upon the amount allotted in the annual Budget Act
for this purpose.

begin insert

(B) Effective January 1, 2014, for purposes of implementing
this section, the department shall include in the Medi-Cal Local
Assistance Estimate an amount for Medi-Cal eligibility operations
associated with the individuals whose family income is determined
to be above 160 percent and up to and including 261 percent of
the federal poverty level.

end insert

(h) When the new budget methodology pursuant to paragraph
(6) of subdivision (a) of Section 14154 is fully operational, the
new budget methodology shall be utilized to reimburse counties
for eligibility determinations made for individuals pursuant to this
section.

(i) Eligibility determinations and annual redeterminations made
pursuant to this section shall be performed by county eligibility
workers.

(j) In conducting eligibility determinations for individuals
pursuant to this section and Section 14005.27, the following
reporting and performance standards shall apply to all counties:

(1) Counties shall report to the department, in a manner and for
a time period prescribed by the department, in consultation with
the County Welfare Directors Association, the number of
applications processed on a monthly basis, a breakout of the
applications based on income using the federal percentage of
poverty levels, the final disposition of each application, including
information on the approved Medi-Cal program, if applicable, and
the average number of days it took to make the final eligibility
determination for applications submitted directly to the county and
from the single point of entry (SPE).

(2) Notwithstanding any other begin delete provision of end delete law, the following
performance standards shall be applied to counties regarding
eligibility determinations for individuals eligible pursuant to this
section:

(A) For children whose applications are received by the county
human services department from the SPE, the following standards
shall apply:

(i) Applications for children who are granted accelerated
enrollment by the SPE shall be processed according to the
timeframes specified in subdivision (d) of Section 14154.

(ii) Applications for children who are not granted accelerated
enrollment by the SPE due to the existence of an already active
Medi-Cal case shall be processed according to the timeframes
specified in subdivision (d) of Section 14154.

(iii) For applications for children who are not described in clause
(i) or (ii), 90 percent shall be processed within 10 working days
of being received, complete and without client errors.

(iv) If an application described in this section also contains
adults, and the adult applicants are required to submit additional
information beyond the information provided for the children, the
county shall process the eligibility for the child or children without
delay, consistent with this section while gathering the necessary
information to process eligibility for the adults.

(B) The department, in consultation with the County Welfare
Directors Association, shall develop reporting requirements for
the counties to provide regular data to the state regarding the
timeliness and outcomes of applications processed by the counties
that are received from the SPE.

(C) Performance thresholds and corrective action standards as
set forth in Section 14154 shall apply.

(D) For applications submitted directly to the county, these
applications shall be processed by the counties in accordance with
the performance standards established under subdivision (d) of
Section 14154.

(3) This subdivision shall be implemented no sooner than
January 1, 2013.

(4) Twelve months after implementation of this section pursuant
to subdivision (f), the department shall provide enrollment
information regarding individuals determined eligible pursuant to
subdivision (a) to the fiscal and appropriate policy committees of
the Legislature.

(k) (1) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
for purposes of this transition, 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. It is the intent of the Legislature that the
department be allowed temporary authority as necessary to
implement program changes until completion of the regulatory
process.

(2) 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, 2014.
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) To implement this section, the department may enter into
and continue contracts with the Healthy Families Program
administrative vendor, for the purposes of implementing and
maintaining the necessary systems and activities for providing
health care coverage to optional targeted low-income children in
the Medi-Cal program for purposes of accelerated enrollment
application processing by single point of entry,
noneligibility-related case maintenance and premium collection,
maintenance of the Health-E-App Web portal, call center staffing
and operations, certified application assistant services, and
reporting capabilities. To further implement this section, the
department may also enter into a contract with the Health Care
Options Broker of the department for purposes of managed care
enrollment activities. The contracts entered into or amended under
this section may initially be completed on a noncompetitive bid
basis and are exempt from the Public Contract Code. Contracts
thereafter shall be entered into or amended on a competitive bid
basis and shall be subject to the Public Contract Code.

(m) (1) If at any time the director determines that this section
or any part of this section may jeopardize the state’s ability to
receive federal financial participation under the federal Patient
Protection and Affordable Care Act (Public Law 111-148), or any
amendment or extension of that act, or any additional federal funds
that the director, in consultation with the Department of Finance,
determines would be advantageous to the state, the director shall
give notice to the fiscal and policy committees of the Legislature
and to the Department of Finance. After giving notice, this section
or any part of this section shall become inoperative on the date
that the director executes a declaration stating that the department
has determined, in consultation with the Department of Finance,
that it is necessary to cease to implement this section or a part or
parts thereof, in order to receive federal financial participation,
any increase in the federal medical assistance percentage available
on or after October 1, 2008, or any additional federal funds that
the director, in consultation with the Department of Finance, has
determined would be advantageous to the state.

(2) The director shall retain the declaration described in
paragraph (1), shall provide a copy of the declaration to the
Secretary of begin delete the end delete State, the Secretary of the Senate, the Chief Clerk
of the Assembly, and the Legislative Counsel, and shall post the
declaration on the department’s Internet Web site.

(3) In the event that the director makes a determination under
paragraph (1) and this section ceases to be implemented, the
children shall be enrolled back into the Healthy Families Program.

SEC. 3.  

Section 14005.27 of the Welfare and Institutions Code
is amended to read:

14005.27.  

(a) Individuals enrolled in the Healthy Families
Program pursuant to Part 6.2 (commencing with Section 12693)
of Division 2 of the Insurance Code on June 27, 2012, and who
are determined eligible to receive benefits pursuant to begin delete subdivisions
(a) or end delete begin insert subdivision (a) of Section 14005.26, or, effective January
1, 2014, subdivision end insert (b) of Section 14005.26, shall be transitioned
into Medi-Cal, pursuant to this section.

(b) To the extent necessary and for the purposes of carrying out
the provisions of this section, in performing initial eligibility
determinations for children enrolled in the Healthy Families
Program pursuant to Part 6.2 (commencing with Section 12693)
of Division 2 of the Insurance Code, the department shall adopt
the option pursuant to Section 1902(e)(13) of the federal Social
Security Act (42 U.S.C. Sec. 1396a(e)(13)) to allow the department
or county human services departments to rely upon findings made
by the Managed Risk Medical Insurance Board (MRMIB)
regarding one or more components of eligibility. The department
shall seek federal approval of a state plan amendment to implement
this subdivision.

(c) To the extent necessary, the department shall seek federal
approval of a state plan amendment or a waiver to provide
presumptive eligibility for the optional targeted low-income
category of eligibility pursuant to Section 14005.26 for individuals
presumptively eligible for or enrolled in the Healthy Families
Program pursuant to Part 6.2 (commencing with Section 12693)
of Division 2 of the Insurance Code. The presumptive eligibility
shall be based upon the most recent information contained in the
individual’s Healthy Families Program file. The timeframe for the
presumptive eligibility shall begin no sooner than January 1, 2013,
and shall continue until a determination of Medi-Cal eligibility is
made, which determination shall be performed within one year of
the individual’s Healthy Families Program annual review date.

(d) (1) The California Health and Human Services Agency, in
consultation with the Managed Risk Medical Insurance Board, the
State Department of Health Care Services, the Department of
Managed Health Care, and diverse stakeholders groups, shall
provide the fiscal and policy committees of the Legislature with
a strategic plan for the transition of the Healthy Families Program
pursuant to this section by no later than October 1, 2012. This
strategic plan shall, at a minimum, address all of the following:

(A) State, county, and local administrative components which
facilitate a successful subscriber transition such as communication
and outreach to subscribers and applicants, eligibility processing,
enrollment, communication, and linkage with health plan providers,
payments of applicable premiums, and overall systems operation
functions.

(B) Methods and processes for diverse stakeholder engagement
throughout the entire transition, including all phases of the
transition.

(C) State monitoring of managed care health plans’ performance
and accountability for provision of services, and initial quality
indicators for children and adolescents transitioning to Medi-Cal.

(D) Health care and dental delivery system components such
as standards for informing and enrollment materials, network
adequacy, performance measures and metrics, fiscal solvency, and
related factors that ensure timely access to quality health and dental
care for children and adolescents transitioning to Medi-Cal.

(E) Inclusion of applicable operational steps, timelines, and key
milestones.

(F) A time certain for the transfer of the Healthy Families
Advisory Board, as described in Part 6.2 (commencing with Section
12693) of Division 2 of the Insurance Code, to the State
Department of Health Care Services.

(2) The intent of this strategic plan is to serve as an overall guide
for the development of each plan for each phase of this transition,
pursuant to paragraphs (1) to (8), inclusive, of subdivision (e), to
ensure clarity and consistency in approach and subscriber
continuity of care. This strategic plan may also be updated by the
California Health and Human Services Agency as applicable and
provided to the Legislature upon completion.

(e) (1) The department shall transition individuals from the
Healthy Families Program to the Medi-Cal program in four phases,
as follows:

(A) Phase 1. Individuals enrolled in a Healthy Families Program
health plan that is a Medi-Cal managed care health plan shall be
enrolled in the same plan no earlier than January 1, 2013, pursuant
to the requirements of this section and Section 14011.6, and to the
extent the individual is otherwise eligible under this chapter and
Chapter 8 (commencing with Section 14200).

(B) Phase 2. Individuals enrolled in a Healthy Families Program
managed care health plan that is a subcontractor of a Medi-Cal
managed health care plan, to the extent possible, shall be enrolled
into a Medi-Cal managed health care plan that includes the
individuals’ current plan pursuant to the requirements of this
section and Section 14011.6, and to the extent the individuals are
otherwise eligible under this chapter and Chapter 8 (commencing
with Section 14200). The transition of individuals described in
this subparagraph shall begin no earlier than April 1, 2013.

(C) Phase 3. Individuals enrolled in a Healthy Families Program
plan that is not a Medi-Cal managed care plan and does not contract
or subcontract with a Medi-Cal managed care plan shall be enrolled
in a Medi-Cal managed care plan in that county. Enrollment shall
include consideration of the individuals’ primary care providers
pursuant to the requirements of this section and Section 14011.6,
and to the extent the individuals are otherwise eligible under this
chapter and Chapter 8 (commencing with Section 14200). The
transition of individuals described in this subparagraph shall begin
no earlier than August 1, 2013.

(D) Phase 4.

(i) Individuals residing in a county that is not a Medi-Cal
managed care county shall be provided services under the Medi-Cal
fee-for-service delivery system, subject to clause (ii). The transition
of individuals described in this subparagraph shall begin no earlier
than September 1, 2013.

(ii) In the event the department creates a managed health care
system in the counties described in clause (i), individuals residing
in those counties shall be enrolled in managed health care plans
pursuant to this chapter and Chapter 8 (commencing with Section
14200).

(2) For the transition of individuals pursuant to subparagraphs
(A), (B), (C), and (D) of paragraph (1), implementation plans shall
be developed to ensure state and county systems readiness, health
plan network adequacy, and continuity of care with the goal of
ensuring there is no disruption of service and there is continued
access to coverage for all transitioning individuals. If an individual
is not retained with his or her current primary care provider, the
implementation plan shall require the managed care plan to report
to the department as to how continuity of care is being provided.
Transition of individuals described in subparagraphs (A), (B), (C),
and (D) of paragraph (1) shall not occur until 90 days after the
department has submitted an implementation plan to the fiscal and
policy committees of the Legislature. The implementation plans
shall include, but not be limited to, information on health and
dental plan network adequacy, continuity of care, eligibility and
enrollment requirements, consumer protections, and family
notifications.

(3) The following requirements shall be in place prior to
implementation of Phase 1, and shall be required for all phases of
the transition:

(A) Managed care plan performance measures shall be integrated
and coordinated with the Healthy Families Program performance
standards including, but not limited to, child-only Healthcare
Effectiveness Data and Information Set (HEDIS) measures, and
measures indicative of performance in serving children and
adolescents. These performance measures shall also be in
compliance with all performance requirements under the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and
Safety Code) and existing Medi-Cal managed care performance
measurements and standards as set forth in this chapter and Chapter
8 (commencing with Section 14200) of Title 22 of the California
Code of Regulations, and all-plan letters, including, but not limited
to, network adequacy and linguistic services, and shall be met prior
to the transition of individuals pursuant to Phase 1.

(B) Medi-Cal managed care health plans shall allow enrollees
to remain with their current primary care provider. If an individual
does not remain with the current primary care provider, the plan
shall report to the department as to how continuity of care is being
provided.

(4) (A) As individuals are transitioned pursuant to
subparagraphs (A), (B), (C), and (D) of paragraph (1), for
individuals residing in all counties except the Counties of
Sacramento and Los Angeles, their dental coverage shall transition
to fee-for-service dental coverage and may be provided by their
current provider if the provider is a Medi-Cal fee-for-service dental
provider.

(B) For individuals residing in the County of Sacramento, their
dental coverage shall continue to be provided by their current
dental managed care plan if their plan is a Medi-Cal dental
managed care plan. If their plan is not a Medi-Cal dental managed
care plan, they shall select a Medi-Cal dental managed care plan.
If they do not choose a Medi-Cal dental managed care plan, they
shall be assigned to a plan with preference to a plan with which
their current provider is a contracted provider. Any children in the
Healthy Families Program transitioned into Medi-Cal dental
managed care plans shall also have access to the beneficiary dental
exception process, pursuant to Section 14089.09. Further, the
Sacramento advisory committee, established pursuant to Section
14089.08, shall be consulted regarding the transition of children
in the Healthy Families Program into Medi-Cal dental managed
care plans.

(C) (i) For individuals residing in the County of Los Angeles,
for purposes of continuity of care, their dental coverage shall
continue to be provided by their current dental managed care plan
if that plan is a Medi-Cal dental managed care plan. If their plan
is not a Medi-Cal dental managed care plan, they may select a
Medi-Cal dental managed care plan or choose to move into
Medi-Cal fee-for-service dental coverage.

(ii) It is the intent of the Legislature that children transitioning
to Medi-Cal under this section have a choice in dental coverage,
as provided under existing law.

(5) Dental health plan performance measures and benchmarks
shall be in accordance with Section 14459.6.

(6) Medi-Cal managed care health and dental plans shall report
to the department, as frequently as specified by the department,
specified information pertaining to transition implementation,
enrollees, and providers, including, but not limited to, grievances
related to access to care, continuity of care requests and outcomes,
and changes to provider networks, including provider enrollment
and disenrollment changes. The plans shall report this information
by county, and in the format requested by the department.

(7) The department may develop supplemental implementation
plans to separately account for the transition of individuals from
the Healthy Families Program to specific Medi-Cal delivery
systems.

(8) The department shall consult with the Legislature and
stakeholders, including, but not limited to, consumers, families,
consumer advocates, counties, providers, and health and dental
plans, in the development of implementation plans described in
paragraph (3) for individuals who are transitioned to Medi-Cal in
Phase 2, Phase 3, and Phase 4, as described in subparagraphs (B),
(C), and (D) of paragraph (1).

(9) (A) The department shall consult and collaborate with the
Department of Managed Health Care in assessing Medi-Cal
managed care health plan network adequacy in accordance with
the Knox-Keene Health Care Service Plan Act of 1975 (Chapter
2.2 (commencing with Section 1340) of Division 2 of the Health
and Safety Code) for purposes of the developed transition plans
pursuant to paragraph (2) for each of the phases.

(B) For purposes of individuals transitioning in Phase 1, as
described in subparagraph (A) of paragraph (1), network adequacy
shall be assessed as described in this paragraph and findings from
this assessment shall be provided to the fiscal and appropriate
policy committees of the Legislature 60 days prior to the effective
date of implementing this transition.

(10) The department shall provide monthly status reports to the
fiscal and policy committees of the Legislature on the transition
commencing no later than February 15, 2013. This monthly status
transition report shall include, but not be limited to, information
on health plan grievances related to access to care, continuity of
care requests and outcomes, changes to provider networks,
including provider enrollment and disenrollment changes, and
eligibility performance standards pursuant to subdivision (n). A
final comprehensive report shall be provided within 90 days after
completion of the last phase of transition.

(f) (1) The department and MRMIB shall work collaboratively
in the development of notices for individuals transitioned pursuant
to paragraph (1) of subdivision (e).

(2) The state shall provide written notice to individuals enrolled
in the Healthy Families Program of their transition to the Medi-Cal
program at least 60 days prior to the transition of individuals in
Phase 1, as described in subparagraph (A) of paragraph (1) of
subdivision (e), and at least 90 days prior to transition of
individuals in Phases 2, 3, and 4, as described in subparagraphs
(B), (C), and (D) of paragraph (1) of subdivision (e).

(3) Notices developed pursuant to this subdivision shall ensure
individuals are informed regarding the transition, including, but
not limited to, how individuals’ systems of care may change, when
the changes will occur, and whom they can contact for assistance
when choosing a Medi-Cal managed care plan, if applicable,
including a toll-free telephone number, and with problems they
may encounter. The department shall consult with stakeholders
regarding notices developed pursuant to this subdivision. These
notices shall be developed using plain language, and written
translation of the notices shall be available for those who are
limited English proficient or non-English speaking in all Medi-Cal
threshold languages.

(4) The department shall designate department liaisons
responsible for the coordination of the Healthy Families Program
and may establish a children’s-focused section for this purpose
and to facilitate the provision of health care services for children
enrolled in Medi-Cal.

(5) The department shall provide a process for ongoing
stakeholder consultation and make information publicly available,
including the achievement of benchmarks, enrollment data,
utilization data, and quality measures.

(g) (1) In order to aid the transition of Healthy Families Program
enrollees, MRMIB, on the effective date of the act that added this
section and continuing through the completion of the transition of
Healthy Families Program enrollees to the Medi-Cal program,
shall begin requesting and collecting from health plans contracting
with MRMIB pursuant to Part 6.2 (commencing with Section
12693) of Division 2 of the Insurance Code, information about
each health plan’s provider network, including, but not limited to,
the primary care and all specialty care providers assigned to
individuals enrolled in the health plan. MRMIB shall obtain this
information in a manner that coincides with the transition activities
described in subdivision (d), and shall provide all of the collected
information to the department within 60 days of the department’s
request for this information to ensure timely transitions of Healthy
begin delete Family end delete begin insert Families end insert Program enrollees.

(2) The department shall analyze the existing Healthy Families
Program delivery system network and the Medi-Cal fee-for-service
provider networks, including, but not limited to, Medi-Cal dental
providers, to determine overlaps of the provider networks in each
county for which there are no Medi-Cal managed care plans or
dental managed care plans. To the extent there is a lack of existing
Medi-Cal fee-for-service providers available to serve the Healthy
Families Program enrollees, the department shall work with the
Healthy Families Program provider community to encourage
participation of those providers in the Medi-Cal program, and
develop a streamlined process to enroll them as Medi-Cal
providers.

(3) (A) MRMIB, within 60 days of a request by the department,
shall provide the department any data, information, or record
concerning the Healthy Families Program as is necessary to
implement the transition of enrollment required pursuant to this
section.

(B) Notwithstanding any other begin delete provision of end delete law, all of the
following shall apply:

(i) The term “data, information, or record” shall include, but is
not limited to, personal information as defined in Section 1798.3
of the Civil Code.

(ii) Any data, information, or record shall be exempt from
disclosure under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code) and any other law, to the same extent that it
was exempt from disclosure or privileged prior to the provision
of the data, information, or record to the department.

(iii) The provision of any such data, information, or record to
the department shall not constitute a waiver of any evidentiary
privilege or exemption from disclosure.

(iv) The department shall keep all data, information, or records
provided by MRMIB confidential to the full extent permitted by
law, including, but not limited to, the California Public Records
Act (Chapter 3.5 (commencing with Section 6250) of Division 7
of Title 1 of the Government Code), and consistent with MRMIB’s
contractual obligations to keep the data, information, or records
confidential.

(h) This section shall be implemented only to the extent that all
necessary federal approvals and waivers have been obtained and
the enhanced rate of federal financial participation under Title XXI
of the federal Social Security Act (42 U.S.C. Sec. 1397aa et seq.)
is available for targeted low-income children pursuant to that act.

(i) (1) (A) Except as provided in subparagraph (B), the
department shall exercise the option pursuant to Section 1916A
of the federal Social Security Act (42 U.S.C. Sec. 1396o-1) to
impose premiums for individuals described in subdivision (a) begin delete or
(b) end delete of Section 14005.26 whose family income has been determined
to be above 150 percent and up to and including 200 percent of
the federal poverty begin delete level. end delete begin insert level, after application of the income
disregard pursuant to paragraph (2) of subdivision (a) of Section
14005.26. end insert The department shall not impose premiums under this
subdivision for individuals described in subdivision (a) begin delete or (b) end delete of
Section 14005.26 whose family income has been determined to
be at or below 150 percent of the federal poverty begin delete level. end delete begin insert level, after
application of the income disregard pursuant to paragraph (2) of
subdivision (a) of Section 14005.26. end insert The department shall obtain
federal approval for the implementation of this subdivision.

(B) Effective January 1, 2014, the family income range for the
imposition of premiums pursuant to subparagraph (A) begin insert for
individuals described in subdivision (a) or (b) of Section 14005.26 end insert
shall be above 160 percent and shall go up to and include 261
percent of the federal poverty level as determined, counted, and
valued in accordance with the requirements of Section 14005.64.
The department shall not impose premiums for eligible individuals
whose family income has been determined to be at or below 160
percent of the federal poverty level.

(2) All premiums imposed under this section shall equal the
family contributions described in paragraph (2) of subdivision (d)
of Section 12693.43 of the Insurance Code and shall be reduced
in conformity with subdivisions (e) and (f) of Section 12693.43
of the Insurance Code.

(j) The department shall not enroll targeted low-income children
described in this section in the Medi-Cal program until all
necessary federal approvals and waivers have been obtained, or
no sooner than January 1, 2013.

(k) (1) (A) Except as provided in subparagraph (B), to the
extent the new budget methodology pursuant to paragraph (6) of
subdivision (a) of Section 14154 is not fully operational, for the
purposes of implementing this section, for individuals described
in subdivision (a) whose family income has been determined to
be at or below 150 percent of the federal poverty begin delete level, end delete begin insert level, after
application of the disregard pursuant to paragraph (2) of
subdivision (a) of Section 14005.26, end insert the department shall utilize
the budgeting methodology for this population as contained in the
November 2011 Medi-Cal Local Assistance Estimate for Medi-Cal
county administration costs for eligibility operations.

(B) Effective January 1, 2014, the federal poverty level
percentage used under subparagraph (A) begin insert for individuals described
in subdivision (a) end insert shall equal 160 percent of the federal poverty
level as determined, counted, and valued in accordance with the
requirements of Section 14005.64.

(2) (A)  begin delete For end delete begin insert Except as provided in subparagraph (B), for end insert
purposes of implementing this section, the department shall include
in the Medi-Cal Local Assistance Estimate an amount for Medi-Cal
eligibility operations associated with the transfer of Healthy
Families Program enrollees eligible pursuant to subdivision (a) of
Section 14005.26 and whose family income is determined to be
above begin delete 160 end delete begin insert 150 end insert percent and up to and including begin delete 261 end delete begin insert 200 end insert percent
of the federal poverty begin delete level. end delete begin insert level, after application of the income
disregard pursuant to paragraph (2) of subdivision (a) of Section
14005.26. end insert In developing an estimate for this activity, the
department shall consider the projected number of final eligibility
determinations each county will process and projected county
costs. Within 60 days of the passage of the annual Budget Act, the
department shall notify each county of their allocation for this
activity based upon the amount allotted in the annual Budget Act
for this purpose.

begin insert

(B) Effective January 1, 2014, for purposes of implementing
this section, the department shall include in the Medi-Cal Local
Assistance Estimate an amount for Medi-Cal eligibility operations
associated with the transfer of Healthy Families Program enrollees
eligible pursuant to subdivision (a) or (b) of Section 14005.26 and
whose family income is determined to be above 160 percent and
up to and including 261 percent of the federal poverty level.

end insert

(l) When the new budget methodology pursuant to paragraph
(6) of subdivision (a) of Section 14154 is fully operational, the
new budget methodology shall be utilized to reimburse counties
for eligibility determinations made for individuals pursuant to this
section.

(m) Except as provided in subdivision (b), eligibility
determinations and annual redeterminations made pursuant to this
section shall be performed by county eligibility workers.

(n) In conducting the eligibility determinations for individuals
pursuant to this section and Section 14005.26, the following
reporting and performance standards shall apply to all counties:

(1) Counties shall report to the department, in a manner and for
a time period determined by the department, in consultation with
the County Welfare Directors Association, the number of
applications processed on a monthly basis, a breakout of the
applications based on income using the federal percentage of
poverty levels, the final disposition of each application, including
information on the approved Medi-Cal program, if applicable, and
the average number of days it took to make the final eligibility
determination for applications submitted directly to the county and
from the single point of entry (SPE).

(2) Notwithstanding any other law, the following performance
standards shall be applied to counties for eligibility determinations
for individuals eligible pursuant to this section:

(A) For children whose applications are received by the county
human services department from the SPE, the following standards
shall apply:

(i) Applications for children who are granted accelerated
enrollment by the SPE shall be processed according to the
timeframes specified in subdivision (d) of Section 14154.

(ii) Applications for children who are not granted accelerated
enrollment by the SPE due to the existence of an already active
Medi-Cal case shall be processed according to the timeframes
specified in subdivision (d) of Section 14154.

(iii) For applications for children who are not described in clause
(i) or (ii), 90 percent shall be processed within 10 working days
of being received, complete and without client errors.

(iv) If an application described in this section also contains
adults, and the adult applicants are required to submit additional
information beyond the information provided for the children, the
county shall process the eligibility for the child or children without
delay, consistent with this section while gathering the necessary
information to process eligibility for the adults.

(B) The department, in consultation with the County Welfare
Directors Association, shall develop reporting requirements for
the counties to provide regular data to the state regarding the
timeliness and outcomes of applications processed by the counties
that are received from the SPE.

(C) Performance thresholds and corrective action standards as
set forth in Section 14154 shall apply.

(D) For applications received directly by the county, these
applications shall be processed by the counties in accordance with
the performance standards established under subdivision (d) of
Section 14154.

(3) This subdivision shall be implemented no sooner than
January 1, 2013.

(4) Twelve months after implementation of this section pursuant
to subdivision (e), the department shall provide enrollment
information regarding individuals determined eligible pursuant to
subdivision (a) to the fiscal and appropriate policy committees of
the Legislature.

(o) (1) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
for purposes of this transition, 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. It is the intent of the Legislature that the
department be allowed temporary authority as necessary to
implement program changes until completion of the regulatory
process.

(2) 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, 2014.
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.

(p) To implement this section, the department may enter into
and continue contracts with the Healthy Families Program
administrative vendor, for the purposes of implementing and
maintaining the necessary systems and activities for providing
health care coverage to optional targeted low-income children in
the Medi-Cal program for purposes of accelerated enrollment
application processing by single point of entry,
noneligibility-related case maintenance and premium collection,
maintenance of the Health-E-App Web portal, call center staffing
and operations, certified application assistant services, and
reporting capabilities. To further implement this section, the
department may also enter into a contract with the Health Care
Options Broker of the department for purposes of managed care
enrollment activities. The contracts entered into or amended under
this section may initially be completed on a noncompetitive bid
basis and are exempt from the Public Contract Code. Contracts
thereafter shall be entered into or amended on a competitive bid
basis and shall be subject to the Public Contract Code.

(q) (1) If at any time the director determines that this section
or any part of this section may jeopardize the state’s ability to
receive federal financial participation under the federal Patient
Protection and Affordable Care Act (Public Law 111-148), or any
amendment or extension of that act, or any additional federal funds
that the director, in consultation with the Department of Finance,
determines would be advantageous to the state, the director shall
give notice to the fiscal and policy committees of the Legislature
and to the Department of Finance. After giving notice, this section
or any part of this section shall become inoperative on the date
that the director executes a declaration stating that the department
has determined, in consultation with the Department of Finance,
that it is necessary to cease to implement this section or a part or
parts thereof in order to receive federal financial participation, any
increase in the federal medical assistance percentage available on
or after October 1, 2008, or any additional federal funds that the
director, in consultation with the Department of Finance, has
determined would be advantageous to the state.

(2) The director shall retain the declaration described in
paragraph (1), shall provide a copy of the declaration to the
Secretary of begin delete the end delete State, the Secretary of the Senate, the Chief Clerk
of the Assembly, and the Legislative Counsel, and shall post the
declaration on the department’s Internet Web site.

(3) In the event that the director makes a determination under
paragraph (1) and this section ceases to be implemented, the
children shall be enrolled back into the Healthy Families Program.

SEC. 4.  

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 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 until his or her 26th
birthday if he or she was in foster care on his or her 18th birthday
or begin delete lost his or her eligibility for foster care assistance due to having
reached the maximum age for that assistance. end delete begin insert such higher age at
which the state’s or tribe’s foster care assistance ends under Title
IV-E of the federal Social Security Act (42 U.S.C. Sec. 670 et seq.). end insert
In addition, the department shall implement the federal option to
provide Medi-Cal benefits to individuals who were in foster care
and enrolled in Medicaid in any state.

(1) A foster care adolescent who was in foster care in this state
on his or her 18th birthday, or begin delete who has lost his or her eligibility
for foster care assistance in this state due to having reached the
maximum age for that assistance, end delete begin insert such higher age at which the
state’s or tribe’s end insert begin insert foster care assistance ends under Title IV-E of
the federal Social Security Act (42 U.S.C. Sec. 670 et seq.), end insert 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.

begin insert

(b) If future federal regulations or guidance permit Medi-Cal
benefits to be provided under 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 individuals who left foster care before reaching the age at which
the state’s or tribe’s foster care assistance ends under Title IV-E
of the federal Social Security Act (42 U.S.C. Sec. 670 et. seq.),
then the department shall implement this section in accordance
with those regulations or guidance.

end insert begin delete

(b)

end delete

begin insert ( end insert begin insert c) end insert  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, interpret, or make specific this
section by means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions until the time any necessary
regulations are adopted. The department shall adopt regulations
by July 1, 2017, 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, in compliance with
Section 9795 of the Government Code, until regulations have been
adopted.

begin delete

(c)

end delete

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

begin delete

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

end delete

SEC. 5.  

Section 14005.285 is added to the Welfare and
Institutions Code, to read:

14005.285.  

(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,
the department may 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 any necessary
regulations are adopted. The department shall adopt regulations
by July 1, 2017, 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, in compliance with
Section 9795 of the Government Code, until regulations have been
adopted.

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

begin insert

begin insert SEC. 6. end insert   

end insert

begin insert Section 14005.287 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14005.287. end insert   

(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)(I) of the federal Social Security Act (42 U.S.C.
Sec. 1396a(a)(10)(A)(ii)(I)) to extend Medi-Cal benefits to
individuals under 21 years of age placed in foster homes or private
institutions for whom a public agency is assuming full or partial
financial responsibility.

(b) Pursuant to Section 1902(r)(2) of the federal Social Security
Act (42 U.S.C. Sec. 1396a(r)(2)), all of the income considered
when determining an individual’s eligibility under this section
shall be disregarded.

(c) 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, interpret, or make specific this
section by means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions until the time any necessary
regulations are adopted. The department shall adopt regulations
by July 1, 2017, in accordance with the requirements of Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code.

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

end insert

begin insert

begin insert SEC. 7. end insert   

end insert

begin insert Section 14005.288 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14005.288. end insert   

(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)(VIII) of the federal Social Security Act (42
U.S.C. Sec. 1396a(a)(10)(A)(ii)(VIII)) to extend Medi-Cal benefits
to individuals under 21 years of age for whom an adoption
agreement, other than an agreement under Title IV-E of the federal
Social Security Act (42 U.S.C. Sec. 671 et seq.), between the state
and the adoptive parent or parents is in effect.

(b) Pursuant to Section 1902(r)(2) of the federal Social Security
Act (42 U.S.C. Sec. 1396a(r)(2)), all of the income considered
when determining an individual’s eligibility under this section
shall be disregarded.

(c) 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, interpret, or make specific this
section by means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions until the time any necessary
regulations are adopted. The department shall adopt regulations
by July 1, 2017, in accordance with the requirements of Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code.

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

end insert

begin delete SEC. 6. end delete
begin insert SEC. 8. end insert   

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

14005.30.  

(a) 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 with family incomes that do
not exceed 109 percent of the federal poverty level.

(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.

(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.

(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.

(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.

(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 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.

(f) 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, interpret, or make specific this
section by means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions until the time any necessary
regulations are adopted. The department shall adopt regulations
by July 1, 2017, 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, in compliance with
Section 9795 of the Government Code, 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.

begin delete

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

end delete

begin delete SEC. 7. end delete
begin insert SEC. 9. end insert   

Section 14005.64 of the Welfare and Institutions Code
is amended to read:

14005.64.  

(a) Effective January 1, 2014, and notwithstanding
any other begin delete provision of end delete 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. Sec. 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.

(3) The income eligibility threshold levels required under this
subdivision shall be as follows for the identified coverage groups:

(A) For those pregnant women and infants eligible under Section
1396a(a)(10)(A)(i)(IV) of Title 42 of the United States Code, 208
percent of the federal poverty level.

(B) For those children one to five years of age, inclusive, eligible
under Section 1396a(a)(10)(A)(i)(VI) of Title 42 of the United
States Code, 142 percent of the federal poverty level.

(C) For those children 6 to 18 years of age, inclusive, eligible
under Section 1396a(a)(10)(A)(i)(VII) of Title 42 of the United
States Code, 133 percent of the federal poverty 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.

begin delete SEC. 8. end delete
begin insert SEC. 10. end insert   

Section 14051 of the Welfare and Institutions Code
is amended to read:

14051.  

(a) “Medically needy person” means any of the
following:

(1) An aged, blind, or disabled person who meets the definition
of aged, blind, or disabled under the Supplemental Security Income
program and whose income and resources are insufficient to
provide for the costs of health care or coverage.

(2) A child in foster care for whom public agencies are assuming
financial responsibility, in whole or in part, or a person receiving
aid under Chapter 2.1 (commencing with Section 16115) of Part
4.

(3) A child who is eligible to receive Medi-Cal benefits pursuant
to interstate agreements for adoption assistance and related services
and benefits entered into under Chapter 2.6 (commencing with
Section 16170) of Part 4, to the extent federal financial
participation is available.

(b) “Medically needy family person” means a parent or caretaker
relative of a child or a child under 21 years of age or a pregnant
woman of any age with a confirmed pregnancy, exclusive of those
persons specified in subdivision (a), whose income and resources
are insufficient to provide for the costs of health care or coverage.

begin delete SEC. 9. end delete
begin insert SEC. 11. end insert   

Section 14148 of the Welfare and Institutions Code
is amended to read:

14148.  

(a) (1) (A) Except as provided in begin delete paragraph (2), end delete
begin insert subparagraph (B), end insert the department shall adopt the federal option
provided under Section 4101 of the Omnibus Budget Reconciliation
Act of 1987 (Public Law 100-203) to extend eligibility for medical
assistance under Medicaid to all pregnant women and infants with
family incomes not in excess of 185 percent of the federal poverty
level.

begin delete

(B) If a premium is imposed, the amount of the premium shall
not exceed 10 percent of the amount by which the family’s income,
less actual child care costs, exceeds 150 percent of the federal
poverty level as provided in Section 1916(c) of the federal Social
Security Act (42 U.S.C. Sec. 1396o(c)) as determined, counted,
and valued in accordance with the requirements of Section
14005.64. The department shall implement this section by
emergency regulation.

(2)

end delete

begin insert ( end insert begin insert B) end insert  Effective January 1, 2014, the federal poverty level
percentage income eligibility threshold used pursuant to
subdivision (c) of Section 14005.64 to determine eligibility for
medical assistance under this section pursuant to begin delete paragraph (1) end delete
begin insert subparagraph (A) end insert shall equal 208 percent of the federal poverty
level.

begin insert

(2) If a premium is imposed, the amount of the premium shall
not exceed 10 percent of the amount by which the family’s income,
less actual child care costs, exceeds 150 percent of the federal
poverty level as provided in Section 1916(c) of the federal Social
Security Act (42 U.S.C. Sec. 1396o(c)) as determined, counted,
and valued in accordance with the requirements of Section
14005.64. The department shall implement this section by
emergency regulation.

end insert

(b) Upon order of the Department of Finance, the begin delete State end delete
Controller shall transfer funds from Item 4260-101-001 of the
Budget Act of 1988 to Item 4260-111-001 of the Budget Act of
1988 during the 1988-89 fiscal year for the purpose of funding
outreach efforts for perinatal services.

(c) Notwithstanding subdivision (a), the state may limit
implementation of this section during the 1988-89 fiscal year,
based upon the availability of department funds. The department
may use maternal and child health funds to finance the increased
costs of implementing an expansion of Medi-Cal eligibility to
women and children with incomes of up to 185 percent of federal
poverty levels if both of the following conditions exist:

(1) The department has allocated for expenditure at least sixteen
million dollars ($16,000,000) in funds redirected from the Medi-Cal
program for that expansion.

(2) If, and to the extent, the department determines that estimates
of costs based on actual data indicate that the funds are needed to
cover costs.

(d) To assist Medi-Cal eligible pregnant women in receiving
prenatal care promptly, all pregnant women applying for Medi-Cal
shall be determined to have an immediate need. Counties, within
existing resources, shall expedite the eligibility determination
process for all pregnant women on the basis of their immediate
needs. Upon determination of eligibility, a Medi-Cal card shall be
issued immediately.

(e)  begin delete This section end delete begin insert The amendments made to subdivision (a) by
Senate Bill 508 during the 2013-14 Regular Session end insert 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 SEC. 10. end delete
begin insert SEC. 12. end insert   

Section 14148.5 of the Welfare and Institutions Code
is amended to read:

14148.5.  

(a)  begin delete (1) end delete begin delete   end delete State funded perinatal services shall be
provided under the Medi-Cal program to pregnant women and
state funded medical services to infants up to one year of age in
families with incomes above 185 percent, but not more than 208
percent, of the federal poverty level, in the same manner that these
services are being provided to the Medi-Cal population, including
eligibility requirements and integration of eligibility determinations
and payment of claims. 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
methodology set forth in Section 14005.64.

(b) Services provided under this section shall not be subject to
any share-of-cost requirements.

(c) (1) The department, in implementing the Medi-Cal program
and public health programs, in coordination with the Managed
Risk Medical Insurance begin delete Program’s end delete begin insert Board’s end insert Access for Infants and
Mothers component, may provide for outreach activities in order
to enhance participation and access to perinatal services. Funding
received pursuant to the federal provisions shall be used to expand
perinatal outreach activities. These outreach activities shall be
implemented if funding is provided for this purpose by an
appropriation in the annual Budget Act or other statute.

(2) Those outreach activities authorized by paragraph (1) shall
be targeted toward both Medi-Cal and non-Medi-Cal eligible high
risk or uninsured pregnant women and infants. Outreach activities
may include, but not be limited to, all of the following:

(A) Education of the targeted women on the availability and
importance of early prenatal care and referral to Medi-Cal and
other programs.

(B) Information provided through toll-free telephone numbers.

(C) Recruitment and retention of perinatal providers.

(d) Notwithstanding any other begin delete provision of end delete law, contracts
required to implement the provisions of this section shall be exempt
from the approval of the Director of General Services and from
the provisions of the Public Contract Code.

begin delete SEC. 11. end delete
begin insert SEC. 13. end insert   

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.