BILL NUMBER: SB 87	CHAPTERED
	BILL TEXT

	CHAPTER   1088
	FILED WITH SECRETARY OF STATE   SEPTEMBER 30, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 30, 2000
	PASSED THE SENATE   AUGUST 31, 2000
	PASSED THE ASSEMBLY   AUGUST 30, 2000
	AMENDED IN ASSEMBLY   AUGUST 29, 2000
	AMENDED IN ASSEMBLY   AUGUST 25, 2000
	AMENDED IN ASSEMBLY   JUNE 8, 2000
	AMENDED IN ASSEMBLY   MAY 16, 2000
	AMENDED IN ASSEMBLY   JULY 8, 1999
	AMENDED IN SENATE   MAY 28, 1999
	AMENDED IN SENATE   MARCH 8, 1999

INTRODUCED BY   Senator Escutia

                        DECEMBER 7, 1998

   An act to amend Section 14005.81 of, and to add Sections 14005.31,
14005.32, 14005.33, 14005.34, 14005.35, 14005.36, 14005.37,
14005.38, and 14005.39 to, the Welfare and Institutions Code,
relating to health.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 87, Escutia.  Medi-Cal:  eligibility.
   Existing law 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 creates various bases for the establishment of
Medi-Cal eligibility.
   This bill would make changes in Medi-Cal eligibility criteria and
procedures in instances when eligibility on one basis has terminated.
  The bill would provide for the transfer of a Medi-Cal beneficiary's
benefits to an appropriate transitional Medi-Cal program, under
specified circumstances.  It would also provide for eligibility
redetermination procedures when a Medi-Cal beneficiary's
circumstances change so as to affect his or her eligibility
generally, and specifically in cases in which the CalWORKs benefits
of Medi-Cal beneficiaries have been terminated.
   Because each county is required to administer Medi-Cal eligibility
determination provisions, the bill would constitute a state-mandated
local program.
   The bill would require that the foregoing provisions be
implemented not later than July 1, 2001, but only to the extent that
federal financial participation is available.
   The bill would require the department, in consultation with
specified parties, to conduct a study of the feasibility of adopting
a mechanism whereby, to the extent federal financial participation is
available, a Medi-Cal managed care plan shall be notified whenever
the eligibility of a Medi-Cal beneficiary is being redetermined.
  The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state.  Statutory provisions establish procedures for making that
reimbursement, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
   This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 14005.31 is added to the Welfare and
Institutions Code, to read:
   14005.31.  (a) (1) Subject to paragraph (2), for any person whose
eligibility for benefits under Section 14005.30 has been determined
with a concurrent determination of eligibility for cash aid under
Chapter 2 (commencing with Section 11200), loss of eligibility or
termination of cash aid under Chapter 2 (commencing with Section
11200) shall not result in a loss of eligibility or termination of
benefits under Section 14005.30 absent the existence of a factor that
would result in loss of eligibility for benefits under Section
14005.30 for a person whose eligibility under Section 14005.30 was
determined without a concurrent determination of eligibility for
benefits under Chapter 2 (commencing with Section 11200).
   (2) Notwithstanding paragraph (1), a person whose eligibility
would otherwise be terminated pursuant to that paragraph shall not
have his or her eligibility terminated until the transfer procedures
set forth in Section 14005.32 or the redetermination procedures set
forth in Section 14005.37 and all due process requirements have been
met.
   (b) The department shall, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, prepare a simple, clear, consumer-friendly notice, which
shall be used by the counties in order to inform Medi-Cal
beneficiaries whose eligibility for cash aid under Chapter 2
(commencing with Section 11200) has ended, but whose eligibility for
benefits under Section 14005.30 continues pursuant to subdivision
(a), that their benefits will continue.  To the extent feasible, the
notice shall be sent out at the same time as the notice of
discontinuation of cash aid, and shall include all of the following:

   (1) A statement that Medi-Cal benefits will continue even though
cash aid under the CalWORKs program has been terminated.
   (2) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (3) A statement that the Medi-Cal beneficiary does not need to
fill out monthly or quarterly status reports in order to remain
eligible for Medi-Cal, but shall be required to submit an annual
reaffirmation form.  The notice shall remind individuals whose cash
aid ended under the CalWORKs program as a result of not submitting a
status report that he or she should review his or her circumstances
to determine if changes have occurred that should be reported to the
Medi-Cal eligibility worker.
   (4) A statement describing the responsibility of the Medi-Cal
beneficiary to report to the county, within 10 days, significant
changes that may affect eligibility.
   (5) A telephone number to call for more information.
   (6) A statement that the Medi-Cal beneficiary's eligibility worker
will not change, or, if the case has been reassigned, the new worker'
s name, address, and telephone number, and the hours during which the
county's eligibility workers can be contacted.
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
  SEC. 2.  Section 14005.32 is added to the Welfare and Institutions
Code, to read:
   14005.32.  (a) (1) If the county has evidence clearly
demonstrating that a beneficiary is not eligible for benefits under
this chapter pursuant to Section 14005.30 , but is eligible for
benefits under this chapter pursuant to other provisions of law, the
county shall transfer the individual to the corresponding Medi-Cal
program.  Eligibility under Section 14005.30 shall continue until the
transfer is complete.
   (2) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties, to inform beneficiaries that their Medi-Cal
benefits have been transferred pursuant to paragraph (1) and to
inform them about the program to which they have been transferred.
To the extent feasible, the notice shall be issued with the notice of
discontinuance from cash aid, and shall include all of the
following:
   (A) A statement that Medi-Cal benefits will continue under another
program, even though aid under Chapter 2 (commencing with Section
11200) has been terminated.
   (B) The name of the program under which benefits will continue,
and an explanation of that program.
   (C) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (D) A statement that the Medi-Cal beneficiary does not need to
fill out monthly or quarterly status reports in order to remain
eligible for Medi-Cal, but shall be required to submit an annual
reaffirmation form.  In addition, if the person or persons to whom
the notice is directed has been found eligible for transitional
Medi-Cal as described in Section 14005.8, 14005.81, or 14005.85, the
statement shall explain the reporting requirements and duration of
benefits under those programs, and shall further explain that, at the
end of the duration of these benefits, a redetermination, as
provided for in Section 14005.37 shall be conducted to determine
whether benefits are available under any other provision of law.
   (E) A statement describing the beneficiary's responsibility to
report to the county, within 10 days, significant changes that may
affect eligibility or share of cost.
   (F) A telephone number to call for more information.
   (G) A statement that the beneficiary's eligibility worker will not
change, or, if the case has been reassigned, the new worker's name,
address, and telephone number, and the hours during which the county'
s Medi-Cal eligibility workers can be contacted.
   (b) No later than September 1, 2001, the department shall submit a
federal waiver application seeking authority to eliminate the
reporting requirements imposed by transitional medicaid under Section
1925 of the federal Social Security Act (Title 42 U.S.C. Sec.
1396r-6).
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
  SEC. 3.  Section 14005.33 is added to the Welfare and Institutions
Code, to read:
   14005.33.  (a) If a Medi-Cal beneficiary's Medi-Cal eligibility
worker is changed, notice shall be sent to the beneficiary within 10
days of the change.  This notice shall include the worker's name,
address, and telephone number, and the beneficiary's Medi-Cal case
number, and hours during which the county's Medi-Cal eligibility
workers may be contacted by the beneficiary.
   (b) This section shall be implemented on or before July 1, 2001.
  SEC. 4.  Section 14005.34 is added to the Welfare and Institutions
Code, to read:
   14005.34.  (a) For an individual whose cash aid was terminated
pursuant to Chapter 2 (commencing with Section 11200), but whose
Medi-Cal eligibility was continued either pursuant to subdivision (a)
of Section 14005.31 or pursuant to a transfer of eligibility under
Section 14005.32, the Medi-Cal beneficiary's annual reaffirmation
date under Section 14012 shall be no earlier than 12 months from the
date on which the most recent annual CalWORKs cash aid eligibility
determination was conducted, or, if no such determination was
conducted, 12 months from the date cash aid was granted.
   (b) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
  SEC. 5.  Section 14005.35 is added to the Welfare and Institutions
Code, to read:
   14005.35.  (a) The department, in consultation with the counties
and representatives of consumers, managed care plans, and Medi-Cal
providers, shall study the feasibility of adopting a mechanism
whereby, to the extent federal financial participation is available,
a Medi-Cal managed care plan shall be notified whenever the
eligibility of a Medi-Cal beneficiary enrolled in that plan is being
redetermined, including notice of the date upon which any forms must
be submitted to the county by the beneficiary.
  SEC. 6.  Section 14005.36 is added to the Welfare and Institutions
Code, to read:
   14005.36.  (a) The county shall undertake outreach efforts to
beneficiaries receiving benefits under this chapter, in order to
maintain the most up-to-date home addresses, telephone numbers, and
other necessary contact information, and to encourage and assist with
timely submission of the annual reaffirmation form, and, when
applicable, transitional Medi-Cal program reporting forms and to
facilitate the Medi-Cal redetermination process when one is required
as provided in Section 14005.37.  In implementing this subdivision, a
county may collaborate with community-based organizations, provided
that confidentiality is protected.
   (b) The department shall encourage and facilitate efforts by
managed care plans to report updated beneficiary contact information
to counties.
   (c) The department and each county shall incorporate, in a timely
manner, updated contact information received from managed care plans
pursuant to subdivision (b) into the beneficiary's Medi-Cal case file
and into all systems used to inform plans of their beneficiaries'
enrollee status.  Updated Medi-Cal beneficiary contact information
shall be limited to the beneficiary's telephone number, change of
address information, and change of name.  The county may attempt to
verify that the information it receives from the plan is accurate
before updating the beneficiary's case file.  The department shall
develop a consent form that may be used by the counties to record the
beneficiary's consent to use the information received from a managed
care plan to update the beneficiary's file.
   (d) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
  SEC. 7.  Section 14005.37 is added to the Welfare and Institutions
Code, to read:
   14005.37.  (a) Except as provided in Section 14005.39, whenever a
county receives information about changes in a beneficiary's
circumstances that may affect eligibility for Medi-Cal benefits, the
county shall promptly redetermine eligibility.  The procedures for
redetermining Medi-Cal eligibility described in this section shall
apply to all Medi-Cal beneficiaries.
   (b)  Loss of eligibility for cash aid under that program shall not
result in a redetermination under this section unless the reason for
the loss of eligibility is one that would result in the need for a
redetermination for a person whose eligibility for Medi-Cal under
Section 14005.30 was determined without a concurrent determination of
eligibility for cash aid under the CalWORKs program.
   (c) A loss of contact, as evidenced by the return of mail marked
in such a way as to indicate that it could not be delivered to the
intended recipient or that there was no forwarding address, shall
require a prompt redetermination according to the procedures set
forth in this section.
   (d) Except as otherwise provided in this section, Medi-Cal
eligibility shall continue during the redetermination process
described in this section. A Medi-Cal beneficiary's eligibility shall
not be terminated under this section until the county makes a
specific determination based on facts clearly demonstrating that the
beneficiary is no longer eligible for Medi-Cal under any basis and
due process rights guaranteed under this division have been met.
   (e) For purposes of acquiring information necessary to conduct the
eligibility determinations described in subdivisions (a) to (d),
inclusive, a county shall make every reasonable effort to gather
information available to the county that is relevant to the
beneficiary's Medi-Cal eligibility prior to contacting the
beneficiary.  Sources for these efforts shall include, but are not
limited to, Medi-Cal, CalWORKs, and Food Stamp Program case files of
the beneficiary or of any of his or her immediate family members,
which are open or were closed within the last 45 days, and wherever
feasible, other sources of relevant information reasonably available
to the counties.
   (f) If a county cannot obtain information necessary to redetermine
eligibility pursuant to subdivision (e), the county shall attempt to
reach the beneficiary by telephone in order to obtain this
information, either directly or in collaboration with community-based
organizations so long as confidentiality is protected.
   (g) If a county's efforts pursuant to subdivisions (e) and (f) to
obtain the information necessary to redetermine eligibility have
failed, the county shall send to the beneficiary a form, which shall
highlight the information needed to complete the eligibility
determination.  The county shall not request information or
documentation that has been previously provided by the beneficiary,
that is not absolutely necessary to complete the eligibility
determination, or that is not subject to change.  The form shall be
accompanied by a simple, clear, consumer-friendly cover letter, which
shall explain why the form is necessary, the fact that it is not
necessary to be receiving CalWORKs benefits to be receiving Medi-Cal
benefits, the fact that receipt of Medi-Cal benefits does not count
toward any time limits imposed by the CalWORKs program, the various
bases for Medi-Cal eligibility, including disability, and the fact
that even persons who are employed can receive Medi-Cal benefits.
The cover letter shall include a telephone number to call in order to
obtain more information.  The form and the cover letter shall be
developed by the department in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers.  A Medi-Cal beneficiary shall have no less than 20 days
from the date the form is mailed pursuant to this subdivision to
respond.  Except as provided in subdivision (h), failure to respond
prior to the end of this 20-day period shall not impact his or her
Medi-Cal eligibility.
   (h) If the purpose for a redetermination under this section is a
loss of contact with the Medi-Cal beneficiary, as evidenced by the
return of mail marked in such a way as to indicate that it could not
be delivered to the intended recipient or that there was no
forwarding address, a return of the form described in subdivision (g)
marked as undeliverable shall result in an immediate notice of
action terminating Medi-Cal eligibility.
   (i) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), a beneficiary does
not submit the completed form to the county, the county shall send
the beneficiary a written notice of action stating that his or her
eligibility shall be terminated 10 days from the date of the notice
and the reasons for that determination, unless the beneficiary
submits a completed form prior to the end of the 10-day period.
   (j) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), the  beneficiary
submits an incomplete form, the county shall attempt to contact the
beneficiary by telephone and in writing to request the necessary
information.  If the beneficiary does not supply the necessary
information to the county within 10 days from the date the county
contacts the beneficiary in regard to the incomplete form, a 10-day
notice of termination of Medi-Cal eligibility shall be sent.
   (k) If, within 30 days of termination of a Medi-Cal beneficiary's
eligibility pursuant to subdivision (h), (i), or (j), the beneficiary
submits to the county a completed form, eligibility shall be
determined as though the form was submitted in a timely manner and if
a beneficiary is found eligible, the termination under subdivision
(h), (I), or (j) shall be rescinded.
   (l) If the information reasonably available to the county pursuant
to the redetermination procedures of subdivisions (d), (e), (g), and
(m) does not indicate a basis of eligibility, Medi-Cal benefits may
be terminated so long as due process requirements have otherwise been
met.
   (m) The department shall, with the counties and representatives of
consumers, including those with disabilities, and Medi-Cal
providers, develop a timeframe for redetermination of Medi-Cal
eligibility based upon disability, including ex parte review, the
redetermination form described in subdivision (g), timeframes for
responding to county or state requests for additional information,
and the forms and procedures to be used.  The forms and procedures
shall be as consumer-friendly as possible for people with
disabilities.  The timeframe shall provide a reasonable and adequate
opportunity for the Medi-Cal beneficiary to obtain and submit medical
records and other information needed to establish eligibility for
Medi-Cal based upon disability.
   (n) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (o) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
  SEC. 8.  Section 14005.38 is added to the Welfare and Institutions
Code, to read:
   14005.38.  To the extent feasible, the department shall use the
redetermination form required by subdivision (g) of Section 14005.37
as the annual reaffirmation form.
  SEC. 9.  Section 14005.39 is added to the Welfare and Institutions
Code, to read:
   14005.39.  (a) If a county has facts clearly demonstrating that a
Medi-Cal beneficiary cannot be eligible for Medi-Cal due to an event,
such as death or change of state residency, Medi-Cal benefits shall
be terminated without a redetermination under Section 14005.37.
   (b) Whenever Medi-Cal eligibility is terminated without a
redetermination, as provided in subdivision (a), the Medi-Cal
eligibility worker shall document that fact or event causing the
eligibility termination in the beneficiary's file, along with a
written certification that a full redetermination could not result in
a finding of Medi-Cal eligibility. Following this written
certification, a notice of action specifying the basis for
termination of Medi-Cal eligibility shall be sent to the beneficiary.

   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
  SEC. 10.  Section 14005.81 of the Welfare and Institutions Code is
amended to read:
   14005.81.  (a) Effective October 1, 1998, in addition to the two
six-month periods of transitional Medi-Cal benefits provided in
Section 14005.8, the state shall fund and provide one additional
12-month period of transitional Medi-Cal to persons age 19 years and
older who have received 12 months of transitional Medi-Cal under
Section 14005.8 and who continue to meet the requirements applicable
to the additional six-month extension period provided for in Section
14005.8, except that once a beneficiary has been determined eligible
for an additional 12 months of Medi-Cal benefits under this section,
the beneficiary shall not be required to  submit the status reports
imposed by federal law.  The benefits provided under this section
shall commence on the day following the last day of receipt of
benefits under Section 14005.8.
   (b) In the case of an alien who has received 12 months of
transitional Medi-Cal under Section 14005.8, the benefits provided
under this section shall be limited to those benefits that would be
available to that person under Section 14005.8.
   (c) It is the intent of the Legislature that the department seek a
mechanism for securing federal financial participation in connection
with pregnancy-related benefits provided under this section.
  SEC. 11.  Notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
costs mandated by the state, reimbursement to local agencies and
school districts for those costs shall be made pursuant to Part 7
(commencing with Section 17500) of Division 4 of Title 2 of the
Government Code.  If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.