Amended in Senate May 6, 2014

Amended in Senate April 7, 2014

Senate Bill No. 1341

Introduced by Senator Mitchell

February 21, 2014

An act to amend Section 10823 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1341, as amended, Mitchell. Medi-Cal: Statewide Automated Welfare System.

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 the Office of Systems Integration in the State Department of Social Services to implement a statewide automated welfare system for 6 specified public assistance programs, including Medi-Cal.

This bill would require the Statewide Automated Welfare System to be the system of record for Medi-Cal and to contain all Medi-Cal eligibility rules and case management functionality. The bill would, notwithstanding this provision, authorize the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) to house the business rules necessary for an eligibility determination to be made, as specified, pursuant to the federal Patient Protection and Affordable Care Act. The bill would, if begin delete the department exercises end delete that authority begin insert is exercised end insert , require CalHEERS to make the business rules available to the Statewide Automated Welfare System consortia to determine Medi-Cal eligibility. The bill would specify, effective January 1, 2016, the manner in which the functionality to create and send notices of action for the Medi-Cal and premium tax credit programs would be implemented, including a requirement that the Statewide Automated Welfare System be used to generate noticing language and notice of action documents.

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

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

SECTION 1.  

Section 10823 of the Welfare and Institutions
Code, as amended by Section 9 of Chapter 13 of the First
Extraordinary Session of the Statutes of 2011, is amended to read:

10823.  

(a) (1) The Office of Systems Integration shall
implement a statewide automated welfare system for the following
public assistance programs:

(A) The CalWORKs program.

(B) CalFresh.

(C) The Medi-Cal program.

(D) The foster care program.

(E) The refugee program.

(F) County medical services programs.

(2) Statewide implementation of the statewide automated welfare
system for the programs listed in paragraph (1) shall be achieved
through no more than four county consortia, including the Interim
Statewide Automated Welfare System Consortium, and the Los
Angeles Eligibility, Automated Determination, Evaluation, and
Reporting System.

(3) Notwithstanding paragraph (2), the Office of Systems
Integration shall migrate the 35 counties that currently use the
Interim Statewide Automated Welfare System (SAWS) into the
C-IV system within the following timeline:

(A) Complete Migration System Test and begin User Acceptance
Testing on or before June 30, 2009.

(B) Complete implementation in at least five counties by
February 28, 2010.

(C) Complete implementation in at least 14 additional counties
on or before May 31, 2010.

(D) Complete implementation in all 35 counties on or before
August 31, 2010.

(E) Decommission the Interim Statewide Automated Welfare
System on or before January 31, 2011.

(4) Notwithstanding paragraph (2), the Office of Systems
Integration shall oversee the migration of the 39 counties
composing the C-IV Consortium into a system jointly designed
by the 39 counties plus Los Angeles County under the LEADER
Replacement System contract. This migration shall result in a new
consortium to replace the LEADER and C-IV Consortia.

(5) The consortia and the state shall take any action necessary
to ensure that the current SAWS maintenance and operations
agreements are extended for the LEADER and C-IV Consortia,
pending the completion of the LEADER Replacement System and
migration of the C-IV Consortium as set forth in paragraph (4),
and for the continuation of the Welfare Client Data System
Consortium.

(6) Each SAWS consortium shall provide a seat on its governing
body for a representative of the state and shall allow for the
stationing of state staff at the project site.

(b) Nothing in subdivision (a) transfers program policy
responsibilities related to the public assistance programs specified
in subdivision (a) from the State Department of Social Services
or the State Department of Health Care Services to the Office of
Systems Integration.

(c) (1) On February 1 of each year, the Office of Systems
Integration shall provide an annual report to the appropriate
committees of the Legislature on the statewide automated welfare
system implemented under this section. The report shall address
the progress of state and consortia activities and any significant
schedule, budget, or functionality changes in the project.

(2) The report provided pursuant to this subdivision in 2012
shall also include the projected timeline and key milestones for
the development of the LEADER Replacement System and of the
new consortium described in paragraph (4) of subdivision (a).

(d) Notwithstanding any other law, the Statewide Automated
Welfare System consortia shall have the authority to expend within
approved annual state budgets for each system as follows:

(1) Make changes within any line item, provided that the change
does not create additional project costs in the current or in a future
budget year.

(2) Make a change of up to one hundred thousand dollars
($100,000) or 10 percent of the total for the line item from which
the funds are derived, whichever is greater, between line items
with notice to the Office of Systems Integration, provided that the
change does not create additional project costs in the current or in
a future budget year.

(3) Make requests to the Office of Systems Integration for
changes between line items of greater than one hundred thousand
dollars ($100,000) or 10 percent of the total for the line item from
which the funds are derived, which do not increase the total cost
in the current or a future budget year. The Office of Systems
Integration shall take action to approve or deny the request within
10 days.

(e) (1) The Statewide Automated Welfare System shall be the
system of record for Medi-Cal and shall contain all Medi-Cal
eligibility rules and case management functionality.

(2) Notwithstanding paragraph (1), the business rules necessary
for an eligibility determination to be made under the Modified
Adjusted Gross Income (MAGI) rules pursuant to the federal
Patient Protection and Affordable Care Act (Public Law 111-148)
may be housed in the California Healthcare Eligibility, Enrollment,
and Retention System developed pursuant to Section 15926,
hereafter referred to as CalHEERS. If begin delete the department exercises end delete
that authority begin insert is exercised end insert , the business rules contained in
CalHEERS shall be made available to the Statewide Automated
Welfare System consortia, through an automated interface, in order
for the consortia to determine eligibility for Medi-Cal under the
MAGI rules.

(3) Effective January 1, 2016, the functionality to create and
send notices of action for Medi-Cal and premium tax credit
programs, as described in Section 36B of Title 26 of the United
States Code, shall be implemented consistent with the following:

(A) Except as specified in subparagraphs (B) and (C), the
Statewide Automated Welfare System shall be used to generate
noticing language and notice of action documents and to send
notice of action documents for all Medi-Cal programs, including,
but not limited to, MAGI and non-MAGI based programs.

(B) If begin delete the department exercises its end delete authority begin insert is exercised end insert pursuant
to paragraph (2), CalHEERS shall be used to generate noticing
language for the premium tax credit program, including, but not
limited to, Medi-Cal denial noticing language related to tax subsidy
approvals, and shall be used to generate and send notice of action
documents for the premium tax credit only program.

(C) If begin delete the department exercises its end delete authority begin insert is exercised end insert pursuant
to paragraph (2), in any mixed eligibility cases that include an
approval or approvals for MAGI Medi-Cal eligibility
determinations, non-MAGI Medi-Cal eligibility determinations,
or both, and premium tax credit approvals, the Statewide
Automated Welfare System shall be used to combine the noticing
language for Medi-Cal programs generated by the Statewide
Automated Welfare System and the noticing language for the
premium tax credit program generated by CalHEERS into one
notice, and the Statewide Automated Welfare System shall be used
to send the document, as one combined notice, for all programs.