Amended in Senate April 6, 2016

Senate Bill No. 997

Introduced by Senator Lara

February 10, 2016

An act to begin delete amend end delete begin insert add and repeal end insert Section begin delete 14007.8 of end delete begin insert 14007.81 of end insert the Welfare and Institutions Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

SB 997, as amended, 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, begin delete authorizes end delete begin insert would authorize end insert 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 begin delete five end delete begin insert 5 end insert 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. begin delete 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. end delete begin insert The bill would require a health care service plan described above to provide specified information to the child’s representative regarding the child’s transition into the Medi-Cal program. end insert The bill would require the department to provide notice to the begin delete family end delete begin insert child’s representative end insert before the child’s transition to full-scope begin delete Medi-Cal, as specified. end delete begin insert Medi-Cal, and would require this notice to contain specified information, including that the child may choose not to transition into the Medi-Cal program, and what this choice will mean for his or her health care coverage and access to health care services. The bill would require the department, using its third-party liability database, to determine whether prior to May 1, 2016, an eligible child was enrolled in coverage with a health care service plan with a total enrollment in excess of 5 million lives. end insert

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.

begin delete

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.

end delete

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14007.81 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , end insert immediately following Section 14007.8 begin insert , to read: end insert

begin insert

begin insert 14007.81. end insert   

(a) In order to maximize continuity of care and
coverage, children eligible for full-scope Medi-Cal benefits
pursuant to Section 14007.8 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 if he or she is determined eligible for full-scope
Medi-Cal benefits under this chapter, notwithstanding any other
law or existing Medi-Cal managed care contract.

(b) (1) The health care service plan described in subdivision
(a) shall provide the following information to the child’s
representative:

(A) How the child may be determined eligible for full-scope
Medi-Cal benefits under this chapter.

(B) How the child may remain enrolled with the health care
service plan from which the child obtained health care coverage
as of May 1, 2016, if the child’s representative chooses.

(C) How the child may obtain coverage from another Medi-Cal
managed care health plan contracting with the department under
this chapter or Chapter 8 (commencing with Section 14200) or
through fee-for-service Medi-Cal, consistent with law.

(2) The information provided pursuant to this subdivision shall
be provided in a fair and accurate manner consistent with the
regulations adopted by the board of the California Health Benefit
Exchange for the regulation of certified plan-based enrollers
pursuant to Section 100503 of the Government Code.

(c) In order to facilitate continuity of care and coverage, the
department shall, using its third-party liability database, determine
whether prior to May 1, 2016, a child who is eligible for full-scope
Medi-Cal benefits pursuant to Section 14007.8 was enrolled in
coverage with a health care service plan with a total enrollment
in excess of five million lives.

(d) Before the child’s transition to full-scope Medi-Cal pursuant
to subdivision (a), the department shall provide the child’s
representative with timely, linguistically appropriate notice of the
transition. This notice shall contain all of the following
information:

(1) Which Medi-Cal managed care health plan or plans contain
the child’s existing primary care provider in those counties in
which the health care service plan does not directly contract as a
Medi-Cal managed care health plan with the department under
this chapter or Chapter 8 (commencing with Section 14200).

(2) That the child, subject to his or her ability to change his or
her health plan as described in paragraph (4), will be assigned to
his or her existing health care service plan if enrolled in full-scope
Medi-Cal benefits after May 1, 2016. If the child wants to keep his
or her primary care provider, no additional action will be required.

(3) That if the child’s existing primary care provider is not
contracted with any Medi-Cal managed care health plan in the
enrollee’s county of residence or if the enrollee’s existing health
care service plan is not an available Medi-Cal managed care
health plan in the child’s county of residence, he or she will receive
all provider and health plan information required to be sent to
new enrollees. If the child 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 will automatically be assigned a
plan through the department-prescribed auto-assignment process.

(4) That the child may choose any available Medi-Cal managed
care health plan and primary care provider in his or her county
of residence, 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.

(5) That the child does not need to take any action to retain his
or her health plan and primary care provider if he or she is
enrolled in full-scope Medi-Cal benefits pursuant to subdivision
(a).

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

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

(e) The health care service plan described in subdivision (a)
and its designees shall work with the department and its designees
to facilitate continuity of care and data sharing for the purposes
of delivering Medi-Cal services.

(f) This section shall apply only to an enrollee in a service area
of the health care service plan approved as of January 1, 2017.

(g) This section shall remain in effect only until January 1, 2019,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2019, deletes or extends that date.

end insert