BILL NUMBER: SB 87 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 8, 1999
INTRODUCED BY Senator Escutia
DECEMBER 7, 1998
An act to add Section Sections 12693.705
and 12693.76 to the Insurance Code, and to amend Section
14012 of, and to add Section 14005.24 to , the
Welfare and Institutions Code, relating to health , and making
an appropriation therefor .
LEGISLATIVE COUNSEL'S DIGEST
SB 87, as amended, Escutia. Healthy Families :
and Medi-Cal programs : eligibility of
children.
Existing
(1) Existing law provides for the Healthy Families
program Program , under which qualified children
are provided with access to health coverage. Under existing
law, in order to be eligible, an applicant must be applying on behalf
of a child, who meets certain requirements, including meeting the
citizenship and immigration status requirements established by
federal law, and meeting specified family income requirements.
This bill would provide that, to the extent permitted by federal
law and in accordance with the requirements of the bill, a child
between 12 months and 19 years of age shall be presumptively eligible
for the Healthy Families Program when the child has been determined
by a qualified entity to meet the family income requirement to be
eligible for the Healthy Families Program. This bill would provide
that a person who is otherwise eligible for participation who entered
the United States after August 22, 1996, shall not be denied
eligibility based on the child's date of entry into the United
States.
Existing law continuously appropriates money from the Healthy
Families Fund for purposes of implementation of the Healthy Families
Program.
This bill, by liberalizing an eligibility criterion for
participation within this program and thereby covering a new pool of
participants, would make the moneys in this continuously appropriated
fund available for a new or expanded purpose, and would thereby make
an appropriation.
(2) Existing law separately provides for the Medi-Cal
program, administered by the State Department of Health Services,
under which qualified low-income persons are provided with health
care services. Existing law requires reaffirmation of
eligibility for Medi-Cal benefits for persons, whose eligibility is
not determined on the basis of eligibility for CalWORKs program
benefit recipients and supplemental security income benefit
recipients, on an annual basis or at other times as required by the
State Department of Health Services.
This bill would provide that, to the extent permitted by federal
law and in accordance with the requirements of the bill, a
child between 12 months and 19 years of age shall be presumptively
eligible for the Healthy Families program, and a child
under 19 years of age shall be presumptively eligible for medically
necessary Medi-Cal services. This bill would revise the
reaffirmation of eligibility requirement to limit reaffirmations of
eligibility for Medi-Cal benefits on any basis other than annually to
apply only to persons who are 19 years of age or older.
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. Section 12693.705 is added to the Insurance, Code,
to read:
12693.705. A person who is otherwise eligible for participation
who entered the United States after August 12, 1996, shall not be
denied eligibility based on his or her date of entry into the United
States.
SEC. 2. Section 12693.76 is added to the Insurance Code, to
read:
12693.76. (a) To the extent permitted by federal law and this
section, a child older than 12 months of age and less than 19 years
of age shall be presumptively eligible for benefits under this part.
(b) A qualified entity, as defined in subdivision (c), may
determine that a child older than 12 months of age and less than 19
years of age is presumptively eligible for medically necessary
services under this part, if the qualified entity determines, without
verification, that the child's family income does not exceed the
amount permitted for Healthy Families Program eligibility.
When a child has been determined to be presumptively eligible under
this subdivision, the child's parent or guardian shall have eight
weeks in which to submit a complete Healthy Families Program
application. If an application is submitted during this time
period, the child's presumptive eligibility shall not be terminated
until a final eligibility determination has been made by the board.
(c) For purposes of this section, "qualified entity" means all of
the following:
(1) Traditional children's health care providers, including
pediatricians and health professionals who deliver services in
community health centers.
(2) Child care centers.
(3) School nurses.
(4) Community-based programs that provide services to children.
(5) Women, Infant Infants , and
Children programs.
(6) Headstart programs.
(7) State or local agencies that determine eligibility for
subsidized child care under the federal Child Care and Development
Block Grant.
SEC. 2.
SEC. 3. Section 14005.24 is added to the Welfare and
Institutions Code, to read:
14005.24. (a) To the extent permitted by federal law and this
section, a child under 19 years of age shall be presumptively
eligible for benefits under this chapter.
(b) A qualified entity, as defined in subdivision (c), may
determine that a child under 19 years of age is presumptively
eligible for medically necessary services under this chapter, if the
qualified entity determines, without verification, that the child's
family income does not exceed the amount permitted for Medi-Cal
eligibility. When a child has been determined to be presumptively
eligible under this subdivision, the child's parent or guardian shall
have eight weeks in which to submit a complete Medi-Cal application.
If an application is submitted during this time period, the child's
presumptive eligibility shall not be terminated until a final
Medi-Cal eligibility determination has been made by the county.
(c) For purposes of this section, "qualified entity" means all of
the following:
(1) Traditional children's health care providers, including
pediatricians and health professionals who deliver services in
community health centers.
(2) Child care centers.
(3) School nurses.
(4) Community-based programs that provide services to children.
(5) Women, Infant Infants , and
Children programs.
(6) Headstart programs.
(7) State or local agencies that determine eligibility for
subsidized child care under the federal Child Care and Development
Block Grant.
SEC. 4. Section 14012 of the Welfare and Institutions Code is
amended to read:
14012. Reaffirmation shall be filed annually and
. With respect to the determination of eligibility for
any person 19 years of age or older, reaffirmation may be
required at other times in accordance with general standards
established by the department.