BILL NUMBER: SB 4	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JULY 7, 2015
	AMENDED IN SENATE  JUNE 1, 2015
	AMENDED IN SENATE  APRIL 28, 2015
	AMENDED IN SENATE  APRIL 6, 2015

INTRODUCED BY   Senator Lara
   (Principal coauthor: Assembly Member Bonta)
   (Coauthors: Senators Hall, Hancock, Hernandez, Hill, Hueso,
Mitchell, Monning, Pan, and Wolk)
   (Coauthors: Assembly Members Alejo,  Chiu,  Levine,
Lopez, and Thurmond)

                        DECEMBER 1, 2014

   An act to add Section 100522 to the Government Code, and to
 add Sections 14102.1 and 14102.2 to   amend
Section 14007.8 of  the Welfare and Institutions Code, relating
to health care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 4, as amended, Lara. Health care coverage: immigration status.
   Existing law, the federal Patient Protection and Affordable Care
Act (PPACA), requires each state to establish an American Health
Benefit Exchange that facilitates the purchase of qualified health
plans by qualified individuals and qualified small employers, and
meets certain other requirements. PPACA specifies that an individual
who is not a citizen or national of the United States or an alien
lawfully present in the United States shall not be treated as a
qualified individual and may not be covered under a qualified health
plan offered through an exchange. Existing law creates the California
Health Benefit Exchange for the purpose of facilitating the
enrollment of qualified individuals and qualified small employers in
qualified health plans as required under PPACA. 
   Existing law governs health care service plans and insurers. A
willful violation of the provisions governing health care service
plans is a crime. 
   This bill would require the Secretary of  the  California
Health and Human Services  Agency  to apply to the United
States Department of Health and Human Services for a waiver to allow
individuals who are not eligible to obtain health coverage because of
their immigration status to obtain coverage from the California
Health Benefit Exchange. The bill would require  , after that
waiver has been granted,  the California Health Benefit Exchange
to offer  California  qualified health benefit plans, as
specified, to these individuals. The bill would require that
individuals eligible to purchase California qualified health plans
pay the cost of coverage without federal assistance.  These
requirements would become operative when federal approval of the
waiver is granted. 
   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.  The federal Medicaid Program
provisions prohibit payment to a state for medical assistance
furnished to an alien who is not lawfully admitted for permanent
residence or otherwise permanently residing in the United States
under color of law.  Existing law extends eligibility
for full-scope Medi-Cal benefits to individuals under 19 years of age
who do not have, or are unable to establish, satisfactory
immigration status, commencing after the Director of Health Care
Services determines that systems have been programmed for
implementation of this extension, but in no case sooner than May 1,
2016. Existing law requires these individuals to enroll in a Medi-Cal
managed care health plan in those counties in which a Medi-Cal
managed care health plan is available.  
   This bill would extend eligibility for full-scope Medi-Cal
benefits to individuals under 19 years of age who are otherwise
eligible for those benefits but for their immigration status. The
bill would also extend eligibility for either limited scope Medi-Cal
benefits or full-scope Medi-Cal benefits to individuals 19 years of
age and older who are otherwise eligible for those benefits but for
their immigration status if the department determines that sufficient
funding is available. The bill would require these individuals to
enroll into Medi-Cal managed care health plans, and to pay copayments
and premium contributions, to the extent required of otherwise
eligible Medi-Cal recipients who are similarly situated. The bill
would require that benefits for those services be provided with
state-only funds only if federal financial participation is not
available. 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.  
   This bill would require the State Department of Health Care
Services to develop a transition plan for individuals under 19 years
of age who are enrolled in restricted-scope Medi-Cal as of the
effective date of the bill, and who are otherwise eligible for
full-scope Medi-Cal coverage but for their immigration status, to
transition directly to full-scope Medi-Cal coverage. The bill would
require the department to notify these individuals, as specified.
 
   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. 

   This bill would require individuals enrolled in restricted-scope
Medi-Cal at the time the director makes the above-described
determination to be transitioned to full-scope Medi-Cal within 30
days of that determination. The bill would also require that an
individual who is eligible pursuant to these provisions enroll in a
Medi-Cal managed care health plan if the individual would otherwise
have been required to enroll in that plan. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program:  yes   no  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  (a) The Legislature finds and declares all of the
following:
   (1) No child in California should endure suffering and pain due to
a lack of access to health care services.
   (2) No individual in California should be excluded from obtaining
coverage through the California Health Benefit Exchange by reason of
immigration status.
   (3) Expanding access and increasing enrollment in comprehensive
health care coverage benefits the health and welfare of all
Californians. 
   (4) Longstanding California law provides full-scope Medi-Cal to
United States citizens, lawful permanent residents, and individuals
permanently residing in the United States under color of law,
including those granted deferred action.  
   (b) It is the intent of the Legislature in enacting this act to
extend full-scope Medi-Cal eligibility to every child in California
who is currently ineligible for Medi-Cal due to his or her
immigration status, as long as he or she meets the other requirements
of the Medi-Cal program.  
   (c) 
    (b)  It is  further  the intent of the
Legislature to ensure that all Californians are eligible to obtain
health care coverage through the  exchange.  
Exchange.  
   (d) 
    (c)  It is further the intent of the Legislature to
increase opportunities for enrollment in comprehensive coverage for
adults, regardless of immigration status, through the enactment of
this bill. 
   (e) 
    (d)  It is further the intent of the Legislature that
all Californians who are otherwise eligible for Medi-Cal, a qualified
health plan offered through the California Health Benefit Exchange,
or affordable employer-based health coverage, enroll in that
coverage, and obtain the care that they need.
  SEC. 2.  Section 100522 is added to the Government Code, to read:
   100522.  (a) The Secretary of California Health and Human Services
shall apply to the United States Department of Health and Human
Services for a waiver authorized under Section 1332 of the federal
act as defined in subdivision (e) of Section 100501 in order to allow
persons otherwise not able to obtain coverage by reason of
immigration status through the Exchange to obtain coverage from the
Exchange by waiving the requirement that the Exchange offer only
qualified health plans  solely for the purpose of offering
coverage to persons otherwise not able to obtain coverage by reason
of immigration status  .
   (b) The Exchange shall offer  California  qualified
health  benefit  plans that shall be subject to the
requirements of this title, including all of those requirements
applicable to qualified health plans. In addition, California
qualified health plans shall be subject to the requirements of
Section 1366.6 of the Health and Safety Code and Section 10112.3 of
the Insurance Code in the same manner as qualified health plans.
   (c) Persons eligible to purchase California qualified health plans
shall pay the cost of coverage without federal advanced premium tax
credit, federal cost-sharing reduction, or any other federal
assistance.
   (d) Subdivisions (b) and (c) of this section shall become
operative upon federal approval of the waiver pursuant to subdivision
(a).
   (e) For purposes of this section, a "California qualified health
plan" means a product offered to those not otherwise eligible to
purchase coverage from the Exchange by reason of immigration status
and that comply with each of the requirements of state law and the
Exchange for a qualified health plan. 
  SEC. 3.    Section 14102.1 is added to the Welfare
and Institutions Code, to read:
   14102.1.  (a) (1) Notwithstanding any other law, an individual
under 19 years of age who meets all of the eligibility requirements
for full-scope Medi-Cal benefits under this chapter, but for his or
her immigration status, shall be eligible for full-scope Medi-Cal
benefits.
   (2) Notwithstanding any other law, an individual 19 years of age
or older who meets all of the eligibility requirements for full-scope
Medi-Cal benefits under this chapter, but for his or her immigration
status, may be enrolled for full-scope Medi-Cal benefits, pursuant
to paragraph (3).
   (3) When a county completes the Medi-Cal eligibility determination
process for an individual 19 years of age or older who meets all of
the eligibility requirements for full-scope Medi-Cal benefits under
this chapter, but for his or her immigration status, the county shall
transmit this information to the department to determine if
sufficient funding is available for this individual to receive
full-scope Medi-Cal benefits. If sufficient funding is available, the
individual shall be eligible for full-scope benefits. If sufficient
funding is not available, the individual shall be eligible for
limited scope Medi-Cal benefits.
   (b) This section shall not apply to individuals eligible for
coverage pursuant to Section 14102.
   (c) Individuals who are eligible under subdivision (a) shall be
required to enroll into Medi-Cal managed care health plans to the
extent required of otherwise eligible Medi-Cal recipients who are
similarly situated.
   (d) Individuals who are eligible under subdivision (a) shall pay
copayments and premium contributions to the extent required of
otherwise eligible Medi-Cal recipients who are similarly situated.
   (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) Eligibility for full-scope benefits for an individual 19 years
of age or older pursuant to subdivision (a) shall not be an
entitlement. The department shall have the authority to determine
eligibility, determine the number of individuals who may be enrolled,
establish limits on the number enrolled, and establish processes for
waiting lists needed to maintain program expenditures within
available funds.
   (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. The
department shall adopt regulations by July 1, 2018, 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. Commencing
July 1, 2016, 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 pursuant to
Section 14102.2.  
  SEC. 4.    Section 14102.2 is added to the Welfare
and Institutions Code, to read:
   14102.2.  (a) (1) Except as provided in subdivision (c),
individuals under 19 years of age who are enrolled in restricted
scope Medi-Cal as of December 31, 2015, and who are eligible under
Section 14102.1, shall be transitioned directly to full-scope
coverage under the Medi-Cal program in accordance with the
requirements of this section. The department shall develop a
transition plan for those individuals under 19 years of age who are
enrolled in restricted scope Medi-Cal as of the effective date of the
act adding this section.
   (2) For purposes of this section, an "emergency care provider" is
defined as a hospital in the county of the individual's residence
where he or she received emergency care, if any.
   (b) Except as provided in subdivision (c), with respect to managed
care health plan enrollment, a restricted-scope enrollee who is
under 19 years of age and who applies and is determined eligible
before October 1, 2015, shall be notified by the department at least
60 days before January 1, 2016, in accordance with the department's
transition plan of all of the following:
   (1) Which Medi-Cal managed care health plan or plans contain his
or her existing emergency care provider, if the department has this
information and the emergency care provider is contracted with a
Medi-Cal managed care health plan.
   (2) That the restricted scope enrollee who is under 19 years of
age, 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 emergency care provider and enrolled effective January 1, 2014.
If the enrollee who is under 19 years of age wants to keep his or her
emergency care provider, no additional action shall be required if
the emergency care provider is contracted with a Medi-Cal managed
care health plan.
   (3) That the restricted scope enrollee who is under 19 years of
age may choose any available Medi-Cal managed care health plan and
primary care provider in his or her county of residence before
January 1, 2016, 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 restricted scope enrollee who is under 19 years
of age 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 emergency care provider as
part of the Medi-Cal managed care contracted network, if the
department has this information about the emergency care provider,
and the emergency care provider is contracted with a Medi-Cal managed
care health plan. If the emergency care provider is contracted with
more than one Medi-Cal managed care health plan, then the restricted
scope enrollee who is under 19 years of age shall be assigned to one
of the health plans containing his or her emergency care provider in
accordance with an assignment process established to ensure the
linkage.
   (5) That the enrollee who is under 19 years of age shall receive
all provider and health plan information required to be sent to new
enrollees. If the restricted scope enrollee who is under 19 years of
age is not assigned to two Medi-Cal managed care health plans
pursuant to paragraph (2), and does not affirmatively select one of
the available Medi-Cal managed care health plans within 30 days of
receipt of the notice, he or she shall automatically be assigned a
plan through the department-prescribed auto-assignment process.
   (6) That the restricted scope enrollee who is under 19 years of
age does not need to take any action to be transitioned to full-scope
Medi-Cal or to retain his or her emergency care provider, if the
emergency care provider is available pursuant to paragraph (2).
   (7) That the restricted scope enrollee who is under 19 years of
age may choose not to transition to the full-scope Medi-Cal program,
and what this choice will mean for his or her health care coverage
and access to health care services.
   (c) Individuals who are under 19 years of age, who qualify under
subdivision (a), and who apply and are determined eligible for
restricted scope after the date identified by the department, which
is not later than October 1, 2015, shall be considered late
enrollees. Late enrollees shall be notified in accordance with
subdivision (b), except according to a different timeframe, but will
transition to full-scope Medi-Cal coverage on January 1, 2016. Late
enrollees after the date identified in this subdivision shall be
transitioned pursuant to the department's restricted scope transition
plan process.
   (d) Emergency care providers that receive reimbursement for
restricted scope coverage shall work with the department and its
designees during the 2015 and 2016 calendar years to facilitate
enrollment and data sharing for the purposes of delivering Medi-Cal
services in the 2016 calendar year.  
  SEC. 5.    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. 
   SEC. 3.    Section 14007.8 of the   Welfare
and Institutions Code   is amended to read: 
   14007.8.  (a)  (1)    After the director
determines, and communicates that determination in writing to the
Department of Finance, that systems have been programmed for
implementation of this section, but no sooner than May 1, 2016, an
individual who is under 19 years of age and who does not have
satisfactory immigration status or is unable to establish
satisfactory immigration status as required by Section 14011.2 shall
be eligible for the full scope of Medi-Cal benefits, if he or she is
otherwise eligible for benefits under this chapter. 
   (2) Individuals enrolled in restricted-scope Medi-Cal at the time
the director makes the determination described in paragraph (1) shall
be transitioned to full-scope Medi-Cal within 30 days of the
director's determination. 
   (b) To the extent permitted by state and federal law, an
individual eligible under this section shall be required to enroll in
a Medi-Cal managed care health plan  in those counties in
which a Medi-Cal managed care health plan is available. 
 if the individual would otherwise have been required to enroll
in the plan. 
   (c) The department shall seek any necessary federal approvals to
obtain federal financial participation in implementing this section.
Benefits for services under this section shall be provided with
state-only funds only if federal financial participation is not
available for those services.
   (d) The department shall maximize federal financial participation
in implementing this section to the extent allowable.
   (e) This section shall be implemented only to the extent it is in
compliance with Section 1621(d) of Title 8 of the United States Code.

   (f) (1) 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 any necessary 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.
   (2) Commencing 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) In implementing this section, the department may contract, as
necessary, on a bid or nonbid basis. This subdivision establishes an
accelerated process for issuing contracts pursuant to this section.
Those contracts, and any other contracts entered into pursuant to
this subdivision, may be on a noncompetitive bid basis and shall be
exempt from the following:
   (1) Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code and any policies, procedures or regulations
authorized by that part.
   (2) Article 4 (commencing with Section 19130) of Chapter 5 of Part
2 of Division 5 of Title 2 of the Government Code.
   (3) Review or approval of contracts by the Department of General
Services.