BILL NUMBER: SB 997 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Lara
FEBRUARY 10, 2016
An act to amend Section 14007.8 of the Welfare and Institutions
Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 997, as introduced, Lara. Health care coverage: immigration
status.
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 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 individuals under 19 years of age enrolled
in restricted-scope Medi-Cal at the time the director makes the
above-described determination to be enrolled in the full scope of
Medi-Cal benefits, if otherwise eligible, pursuant to an eligibility
and enrollment plan, as specified. Existing law requires an
individual who is eligible pursuant to these provisions to enroll in
a Medi-Cal managed care health plan, where available, but does not
preclude a beneficiary from being enrolled in any other children's
Medi-Cal specialty program that he or she would otherwise be eligible
for.
This bill, until January 1, 2019, authorizes the enrollment of
eligible children who, as of May 1, 2016, were enrolled in
comprehensive, low-cost coverage provided by a health care service
plan with a total enrollment in excess of five million lives, in
full-scope Medi-Cal with the same health care service plan,
notwithstanding any other law or existing Medi-Cal managed care
contract. The bill would prohibit the child from being enrolled in
fee-for-service Medi-Cal or another Medi-Cal managed care plan unless
a responsible adult seeks enrollment in fee-for-service Medi-Cal or
another Medi-Cal managed care plan after the child obtains full-scope
Medi-Cal benefits. The bill would require the department to provide
notice to the family before the child's transition to full-scope
Medi-Cal, as specified.
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. The Legislature finds and declares all of the
following:
(a) No child in California should endure suffering and pain due to
a lack of access to health care services.
(b) Expanding access and increasing enrollment in comprehensive
health care coverage benefits the health and welfare of all
Californians.
(c) Through the enactment of Senate Bill 75, the California
Legislature has extended eligibility for full-scope Medi-Cal benefits
to all children in California, regardless of immigration status.
(d) Prior to the enactment of Senate Bill 75, some children who
otherwise would have been ineligible for full-scope Medi-Cal benefits
as a result of their immigration status obtained comprehensive,
low-cost coverage as a result of the community benefit program of a
health care service plan with an enrollment of more than 5,000,000
Californians. It is the intent of the Legislature in enacting this
act to provide for continuity of care for these children, while
allowing them to be enrolled in full-scope Medi-Cal.
SEC. 2. 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) (A) Individuals under 19 years of age enrolled in Medi-Cal
pursuant to subdivision (d) of Section 14007.5 at the time the
director makes the determination described in paragraph (1) shall be
enrolled in the full scope of Medi-Cal benefits, if otherwise
eligible, pursuant to an eligibility and enrollment plan. This plan
shall include outreach strategies developed by the department in
consultation with interested stakeholders, including, but not limited
to, counties, health care service plans, consumer advocates, and the
Legislature. Individuals subject to this subparagraph shall not be
required to file a new application for Medi-Cal.
(B) The effective date of enrollment into Medi-Cal for individuals
described in subparagraph (A) shall be on the same day on which the
systems are operational to begin processing new applications pursuant
to the director's determination described in paragraph (1).
(C) Beginning January 31, 2016, and until the director makes the
determination described in paragraph (1), the department shall
provide monthly updates to the appropriate policy and fiscal
committees of the Legislature on the status of the implementation of
this section.
(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. Enrollment in a Medi-Cal
managed care health plan shall not preclude a beneficiary from being
enrolled in any other children's Medi-Cal specialty program that he
or she would otherwise be eligible for.
(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.
(h) (1) In order to maximize continuity of care and coverage,
children eligible for full-scope Medi-Cal pursuant to this section
who, as of May 1, 2016, were enrolled in comprehensive, low-cost
coverage provided by a health care service plan with a total
enrollment in excess of five million lives, shall be enrolled in
full-scope Medi-Cal with the same health care service plan,
notwithstanding any other law or existing Medi-Cal managed care
contract.
(2) A child subject to this subdivision shall not be enrolled in
fee-for-service Medi-Cal or another Medi-Cal managed care plan
unless, after the child obtains full-scope Medi-Cal benefits, a
responsible adult seeks enrollment in fee-for-service Medi-Cal or
another Medi-Cal managed care plan consistent with law.
(3) Before the child's transition to full-scope Medi-Cal pursuant
to paragraph (1), the department shall provide the family with
timely, linguistically appropriate notice of the transition.
(4) This subdivision shall be implemented only until January 1,
2019.