BILL NUMBER: SB 997	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 31, 2016
	AMENDED IN SENATE  APRIL 20, 2016
	AMENDED IN SENATE  APRIL 6, 2016

INTRODUCED BY   Senator Lara

                        FEBRUARY 10, 2016

   An act to add and repeal Sections 14007.81 and 14007.82 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 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  a
 comprehensive, low-cost coverage  program  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.  The bill would require a health care service plan or
Medi-Cal managed care health plan described above to provide
specified information, subject to approval by the department, 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,   of the
child's enrollment into Medi-Cal and health plan options,  and
would require this notice to contain specified information. The bill
would require the department, using information provided to it by
health care service plans, 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.
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.
   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.
   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.   Californians, as well as
coverage offered by other health plans.  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 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. 
   (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 the law.  

   (2) The information provided pursuant to this subdivision shall be
subject to approval by the department and shall be 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) 
    (b)  In order to facilitate continuity of care and
coverage, the department shall, using information provided to it by
health care service plans consistent with Section 14124.90, 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) 
    (c)  The department shall provide the child's
representative with timely, linguistically appropriate notice of the
child's enrollment into Medi-Cal and health plan options. 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, 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 (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 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.
   (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).

   (e) 
    (d)  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) 
    (e)  This section shall apply only to an enrollee in a
service area of the health care service plan approved as of the
effective date of this section. 
   (g) 
    (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 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. 
   (h) 
    (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.
  SEC. 3.  Section 14007.82 is added to the Welfare and Institutions
Code, to read:
   14007.82.  (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  a
 comprehensive, low-cost coverage  program  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) 
    (b)  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  by state and federal law  for the
purposes of implementing this  section and delivering
full-scope Medi-Cal services.   section.  
   (d) 
    (c)  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) 
    (d)  (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) 
    (e)  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.