BILL NUMBER: SB 82 INTRODUCED
BILL TEXT
INTRODUCED BY Senators Vasconcellos, Escutia, and Solis
DECEMBER 7, 1998
An act to amend Section 14007.5 of, and to add Section 14007.7 to,
the Welfare and Institution Code, relating to human services.
LEGISLATIVE COUNSEL'S DIGEST
SB 82, as introduced, Vasconcellos. Medi-Cal.
Under existing California law, any alien who is otherwise eligible
for Medi-Cal services, but who does not meet specified requirements
relating to residency status, is only eligible for care and services
that are necessary for the treatment of an emergency medical
condition and medical care directly related to the emergency and for
medically necessary pregnancy-related services. However, the federal
Personal Responsibility and Work Opportunity Reconciliation Act of
1996 makes any alien who is not a qualified alien, as defined,
ineligible for federal public benefits, including medical assistance
under the federal medicaid program for assistance other than care and
services necessary for the treatment of an emergency medical
condition. Federal law also prohibits a state from providing defined
state public benefits to certain aliens, unless state legislation is
enacted subsequent to the effective date of the act, August 22,
1996.
This bill would provide that any alien who is otherwise eligible
for Medi-Cal services, but who does not meet specified requirements
relating to residency status, is eligible for medically necessary
pregnancy-related services.
This bill would provide that these provisions would not become
operative until July 1, 2000, unless an appropriation is made for
purposes of implementing this bill in either the Budget Act of 1999
or in another statute enacted during the 1999 portion of the
1999-2000 Regular Session, in which case these provisions would
become operative on the later of the effective date of this bill or
the effective date of the statute enacting the appropriation.
Under existing law, counties are responsible for determining
eligibility for Medi-Cal benefits. By making certain aliens eligible
for Medi-Cal benefits, this bill would increase county
responsibilities in eligibility determinations, and would result in a
state-mandated local program.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Prenatal care has long been recognized as a means of reducing
the incidence of low birth weight infants and of birth complications
by identifying mothers at risk of adverse birth outcomes and by
providing medical, nutritional, and educational interventions
necessary to reduce the risk of those outcomes.
(b) Studies show that for every one dollar ($1) spent on prenatal
care services, three dollars ($3) are saved in medical costs
associated with pregnancy, birth, and postnatal care. The
fifty-eight million dollar ($58,000,000) savings by denying prenatal
care to undocumented women will be more than offset by costs of care
for maternal complications and low birth weight babies ranging up to
one hundred twenty million dollars ($120,000,000) annually.
(c) While the cost of prenatal care and normal delivery is under
three thousand dollars ($3,000), the cost of a low birth weight baby,
including the first year of care, averages seventeen thousand
dollars ($17,000). Charges for initial hospitalization can reach one
million dollars ($1,000,000).
(d) Since any infant born in the United States is deemed a
citizen, all the costs associated with an infant's adverse birth
outcome will be covered by the state through Medi-Cal and other
programs.
(e) Infants with adverse birth outcomes are more likely than other
infants to experience long-term medical, educational, and social
problems, demanding additional long-term costs borne by the state.
(f) Studies have shown that prenatal care is not a magnet for
illegal immigration.
SEC. 2. Section 14007.5 of the Welfare and Institutions Code is
amended to read:
14007.5. (a) Aliens shall be eligible for Medi-Cal, whether
federally funded or state-funded, only to the same extent as
permitted under federal law and regulations for receipt of federal
financial participation under Title XIX of the Social Security Act,
except as otherwise provided in this section and Section 14007.7
.
(b) In accordance with Section 1903(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396b(v)(1)), an alien shall only be
eligible for the full scope of Medi-Cal benefits, if the alien has
been lawfully admitted for permanent residence, or is otherwise
permanently residing in the United States under color of law.
For purposes of this section, aliens "permanently residing in the
United States under color of law" shall be interpreted to include all
aliens residing in the United States with the knowledge and
permission of the Immigration and Naturalization Service and whose
departure the Immigration and Naturalization Service does not
contemplate enforcing and with respect to whom federal financial
participation is available under Title XIX of the Social Security
Act.
(c) Any alien whose immigration status has been adjusted either to
lawful temporary resident or lawful permanent resident in accordance
with the provisions of Section 210, 210A, or 245A of the federal
Immigration and Nationality Act, and who meets all other eligibility
requirements, shall be eligible only for care and services under
Medi-Cal for which the alien is not disqualified pursuant to those
sections of the federal act.
(d) Any alien who is otherwise eligible for Medi-Cal services, but
who does not meet the requirements under subdivision (b) or (c),
shall only be eligible for care and services that are necessary for
the treatment of an emergency medical condition and medical care
directly related to the emergency, as defined in federal law
, and for medically necessary pregnancy-related services .
For purposes of this section, the term "emergency medical condition"
means a medical condition manifesting itself by acute symptoms of
sufficient severity, including severe pain, such that the absence of
immediate medical attention could reasonably be expected to result in
any of the following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction to any bodily organ or part. It is the
intent of this section to entitle eligible individuals to inpatient
and outpatient services that are necessary for the treatment of the
emergency medical condition in the same manner as administered by
the department through regulations and provisions of federal law.
(e) Pursuant to Section 14001.2, each county department shall
require that each applicant for, or beneficiary of, Medi-Cal,
including a child, shall provide his or her social security
number account number, or numbers, if he or she has more
than one social security number.
(f) (1) In order to be eligible for benefits under subdivision (b)
or (c), an alien applicant or beneficiary shall present alien
registration documentation or other proof of satisfactory immigration
status from the United States Immigration and Naturalization
Service.
(2) Any alien who meets all other program requirements but who
lacks documentation of alien registration or other proof of
satisfactory immigration status shall be provided a reasonable
opportunity to submit the evidence. For purposes of this paragraph,
"reasonable opportunity" means 30 days or the time it actually takes
the county to process the Medi-Cal application, whichever is longer.
(3) During the reasonable opportunity period under paragraph (2),
the county department shall process the applicant's application for
medical assistance in a manner that conforms to its normal processing
procedures and timeframes.
(g) (1) The county department shall grant only the Medi-Cal
benefits set forth in subdivision (d) of this section or in
Section 14007.7 to any individual who, after 30 calendar days
or the time it actually takes the county to process the Medi-Cal
application, whichever is longer, has failed to submit documents
constituting reasonable evidence indicating a satisfactory
immigration status for Medi-Cal purposes, or who is reported by the
Immigration and Naturalization Service to lack a satisfactory
immigration status for Medi-Cal purposes.
(2) If an alien has been receiving Medi-Cal benefits based on
eligibility established prior to the effective date of this section
and that individual, upon redetermination of eligibility for
benefits, fails to submit documents constituting reasonable evidence
indicating a satisfactory immigration status for Medi-Cal purposes,
the county department shall discontinue the Medi-Cal benefits, except
for the care and services set forth in subdivision (d) of this
section or Section 14007.7 . The county department shall
provide adequate notice to the individual of any adverse action and
shall accord the individual an opportunity for a fair hearing if he
or she requests one.
(h) To the extent permitted by federal law and regulations, an
alien applying for services under subdivisions (b) and (c) shall be
granted eligibility for the scope of services to which he or she
would otherwise be entitled if, at the time the county department
makes the determination about his or her eligibility, the alien meets
either of the following requirements:
(1) He or she has not had a reasonable opportunity to submit
documents constituting reasonable evidence indicating satisfactory
immigration status.
(2) He or she has provided documents constituting reasonable
evidence indicating a satisfactory immigration status, but the county
department has not received timely verification of the alien's
immigration status from the Immigration and Naturalization Service.
(3) The verification process shall protect the privacy of all
participants. An alien's immigration status shall be subject to
verification by the Immigration and Naturalization Service, to the
extent required for receipt of federal financial participation in the
Medi-Cal program.
(i) If an alien does not declare status as a lawful permanent
resident or alien permanently residing under color of law, or as an
alien legalized under Section 210, 210A, or 245A of the federal
Immigration and Nationality Act (P.L. 82-414), Medi-Cal coverage
under subdivision (d) of this section or Section 14007.7
shall be provided to the individual if he or she is otherwise
eligible.
(j) If an alien subject to this section is not fluent in English,
the county department shall provide an understandable explanation of
the requirements of this section in a language in which the alien is
fluent.
(k) Aliens who were receiving long-term care or renal dialysis
services (1) on the day prior to the effective date of the amendment
to paragraph (1) of subdivision (f) of Section 1 of Chapter 1441 of
the Statutes of 1988 at the 1991-92 Regular Session of the
Legislature and (2) under the authority of paragraph (1) of
subdivision (f) of Section 1 of Chapter 1441 of the Statutes of 1988
as it read on June 30, 1992, shall continue to receive these
services. The authority for continuation of long-term care or renal
dialysis services in this subdivision shall not apply to any person
whose long-term care or renal dialysis services end for any reason
after the effective date of the amendment described in this
subdivision.
SEC. 3. Section 14007.7 is added to the Welfare and Institutions
Code, to read:
14007.7. Any alien who is otherwise eligible for Medi-Cal
services, but who does not meet the requirements under subdivision
(b) or (c) of Section 14007.5, shall be eligible for medically
necessary pregnancy-related services.
SEC. 4. 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.
Notwithstanding Section 17580 of the Government Code, unless
otherwise specified, the provisions of this act shall become
operative on the same date that the act takes effect pursuant to the
California Constitution.
SEC. 5. Sections 2 and 3 of this act shall not become operative
until July 1, 2000, unless an appropriation is made for purposes of
implementing this act in either the Budget Act of 1999 or in another
statute enacted during the 1999 portion of the 1999-2000 Regular
Session, in which case Sections 2 and 3 of this act shall become
operative on the later of the effective date of this act or the
effective date of the statute enacting the appropriation.