Amended in Senate April 20, 2016

Amended in Senate April 6, 2016

Senate Bill No. 997

Introduced by Senator Lara

February 10, 2016

An act to add and repeal begin delete Section end delete begin insert Sections end insert 14007.81 begin insert and 14007.82 end insert of 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, would authorize 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 5 million lives, in full-scope Medi-Cal with the same health care service plan, notwithstanding any other begin delete law or existing Medi-Cal managed care contract. end delete begin insert law. The bill would provide that this authorization is applicable only in a county in which a health care service plan with a total enrollment in excess of 5 million lives has a contract or a subcontract for Medi-Cal managed care. The bill would also, until January 1, 2019, authorize the enrollment of eligible children who, as of May 1, 2016, were enrolled in comprehensive, low-cost coverage provided by a Medi-Cal managed care health plan, in full-scope Medi-Cal with the same Medi-Cal managed care health plan, notwithstanding any other law. end insert The bill would require a health care service plan begin insert or Medi-Cal managed care health plan end insert described above to provide specified begin delete information end delete begin insert information, subject to approval by the department, end insert to the child’s representative regarding the child’s transition into the Medi-Cal program. The bill would require the department to provide notice to the child’s representative before the child’s transition to full-scope Medi-Cal, and would require this notice to contain specified begin delete 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. end delete begin insert information. end insert The bill would require the department, using begin delete its third-party liability database, end delete begin insert information provided to it by health care service plans, end insert 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. begin insert The bill would require a Medi-Cal managed care health plan and its designees to work with the department and its designees to facilitate continuity of care and data sharing for the purpose of implementing these provisions. end insert

begin insert

This bill would require the department to adopt necessary regulations to implement these provisions, and until those regulations are adopted, would authorize the department to implement these provisions by means of all-county letters, provider bulletins, or other similar instructions without taking regulatory action. The bill would require the department to provide a semiannual status report to the Legislature on the implementation of these provisions, as specified.

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.

SEC. 2.  

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

14007.81.  

(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

begin delete law or existing Medi-Cal managed care contract. end delete begin insert law. This
requirement shall apply only in a county in which a health care
service plan with a total enrollment in excess of five million lives
has a contract or a subcontract for Medi-Cal managed care. end insert

(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 begin insert the end insert law.

(2) The information provided pursuant to this subdivision shall
be begin insert subject to approval by the department and shall be end insert provided in
a fair and accurate manner begin delete 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. end delete begin insert that informs the child’s
representative of the availability of other Medi-Cal managed care
health plans and how to contact the department to obtain coverage. end insert

(c) In order to facilitate continuity of care and coverage, the
department shall, using begin delete its third-party liability database, end delete
begin insert information provided to it by health care service plans consistent
with Section 14124.90, end insert 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)  begin delete Before the child’s transition to full-scope Medi-Cal pursuant
to subdivision (a), the end delete begin insert The end insert department shall provide the child’s
representative with timely, linguistically appropriate notice of begin delete the
transition. end delete begin insert the child’s enrollment into Medi-Cal and health plan
options. end insert 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 begin delete provider in those counties end delete
begin insert provider, including those instances end insert 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 begin delete such end delete begin insert Medi-Cal managed care health end insert
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).

begin delete

(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.

end delete

(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 begin delete January 1, 2017. end delete begin insert the
effective date of this section. end insert

begin insert

(g) (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.

end insert begin insert

(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 report on the status of the
implementation of this section to the Legislature on a semiannual
basis. The submission of the report shall comply with Section 9795
of the Government Code.

end insert begin delete

(g)

end delete

begin insert (h) end insert  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.

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 14007.82 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14007.82. 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 Medi-Cal
managed care health plan shall be enrolled in full-scope Medi-Cal
with the same Medi-Cal managed care health plan pursuant to the
requirements of this subdivision, notwithstanding any other law.

(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 and obtain
full-scope Medi-Cal benefits under this chapter.

(B)  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) for
the child’s county of residence, or through fee-for-service
Medi-Cal, consistent with the law.

(C) That, if the child is determined eligible for full-scope
Medi-Cal and does not take any action pursuant to subparagraph
(B), the child will be enrolled in the Medi-Cal managed care health
plan described in subdivision (a).

(2) The information provided pursuant to this subdivision shall
be subject to approval by the department and provided in a fair
and accurate manner that informs the child’s representative of the
availability of other Medi-Cal managed care health plans and how
to contact the department to obtain coverage.

(c) A Medi-Cal managed care health plan described in
subdivision (a) and its designees shall work with the department
and its designees to facilitate continuity of care and data sharing
to the extent permissible for the purposes of implementing this
section and delivering full-scope Medi-Cal services.

(d) The department shall provide the child’s representative with
timely, linguistically appropriate notice of the child’s enrollment
into Medi-Cal and of health plan options consistent with the
applicable provisions of subdivision (d) of Section 14007.81. The
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, including those
instances 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 (3), 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 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 Medi-Cal managed care health 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 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).

(e) (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 report on the status of the
implementation of this section to the Legislature on a semiannual
basis. The submission of the report shall comply with Section 9795
of the Government Code.

(f) 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