Bill Text: CA AB2402 | 2021-2022 | Regular Session | Amended
Bill Title: Medi-Cal: continuous eligibility.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Engrossed - Dead) 2022-08-30 - Ordered to inactive file at the request of Senator Eggman. [AB2402 Detail]
Download: California-2021-AB2402-Amended.html
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Amended
IN
Senate
August 18, 2022 |
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Amended
IN
Senate
August 11, 2022 |
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Amended
IN
Senate
June 27, 2022 |
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Amended
IN
Assembly
March 17, 2022 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 2402
| Introduced by Assembly Member Blanca Rubio (Coauthor: Assembly Member Wood) (Coauthor: Senator Rubio) |
February 17, 2022 |
An act to amend Section 15853 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2402, as amended, Blanca Rubio.
Medi-Cal: continuous eligibility.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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.
Under existing law, beginning no earlier than January 1, 2025, a child under 5 years of age is continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age, subject to specified circumstances. Existing law makes this provision contingent on obtaining all necessary federal approvals, an appropriation, and a determination by the department that systems have been programmed to implement certain provisions.
Existing law establishes the County Health Initiative Matching Fund, administered by the department, through which an applicant county, county agency, a local initiative, or a county organized health system that provides an intergovernmental transfer, as specified, is authorized to submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to certain children. For purposes of eligibility, existing law requires the child to meet specified citizenship and immigration status requirements, that their family income be at or below 317% of the federal poverty level or, at the option of the applicant, at or below 411% of the federal poverty level, and that the child not qualify for Medi-Cal with no share of cost or for other certain Medi-Cal programs.
This bill would require
require, beginning no earlier than January 1, 2025, that the application also specify that the applicant will provide continuous eligibility for a child under the program until the child is 5 years of age if the child is not determined to be eligible for Medi-Cal during that time, except as specified. The bill would condition implementation of this provision on receipt of any necessary federal approvals. approvals, an appropriation, and a determination by the department, as described above. The bill would also remove the above-described reference to citizenship and immigration status requirements.
Because counties are required to make Medi-Cal eligibility determinations, and to the extent that this bill would expand Medi-Cal eligibility, the
bill would impose 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.
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 the statutory provisions noted above.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 15853 of the Welfare and Institutions Code is amended to read:15853.
(a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing comprehensive health insurance coverage to any child who meets specified requirements that are applicable to persons participating in the program established by Title XXI of the Social Security Act, and whose family income is at or below 317 percent of the federal poverty level or, at the option of the applicant, at or below 411 percent of the federal poverty level, in specific geographic areas, as published quarterly in the Federal Register by the United States Department of Health and Human Services, as determined, counted and valued in accordance with the requirements of Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, and which child meets both of the following requirements:(A) Does not qualify for the optional targeted low-income children group or the Access program.
(B) Does not qualify for Medi-Cal with no share of cost pursuant to Chapter 7 (commencing with Section 14000) of Part 3.
(2) In its application, the applicant shall specify the income level at or below 411 percent of the federal poverty level for which it will provide coverage.
(3) The application shall also specify that the applicant will provide continuous eligibility for a child under the program until
the child is five years of age if the child is not determined to be eligible for Medi-Cal during that time, except for the reasons permitting redetermination specified in Section 14005.255. This paragraph shall be implemented only to the extent that any necessary federal approvals for that continuous eligibility are obtained.
(A) Implementation of this paragraph is contingent on all of the following conditions:
(i) Any necessary federal approvals for that continuous eligibility have been obtained by the department.
(ii) The Legislature has appropriated funding to implement Section 14005.255 after a determination that ongoing General Fund resources are available to support the ongoing implementation of Section 14005.255 in the 2024–25 fiscal year and subsequent fiscal years.
(iii) The department has determined that systems have been programmed to implement Section 14005.255.
(B) The department shall issue a declaration certifying the date that all conditions in subparagraph (A) have been met. The department shall post the declaration on its internet website and provide a copy of the declaration to the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel. This paragraph
shall become operative on January 1, 2025, or the date certified by the department pursuant to this subparagraph, whichever is later.
(4) The intergovernmental transfer amount is limited to the expenditures that would be eligible for federal financial participation.
(b) The proposal shall guarantee at least one year of intergovernmental transfer funding by the applicant at a level that ensures compliance with the requirements of any applicable approved federal waiver or state plan amendment as well as the department’s requirements for the sound operation of the proposed project, and shall, on an annual basis, either commit to fully funding the necessary intergovernmental amount or withdraw from the program. The department may identify specific geographical areas
that, compared to the national level, have a higher cost of living or housing or a greater need for additional health services, using data obtained from the most recent federal census, the federal Consumer Expenditure Survey, or from other sources. The proposal may include an administrative mechanism for outreach and eligibility.
(c) The applicant may include in its proposal reimbursement of medical, dental, vision, or mental health services delivered to children who are eligible under the Access program or under the Medi-Cal program as an optional targeted low-income children group beneficiary, if these services are part of an overall program with the measurable goal of enrolling served children in the Access program or the optional targeted low-income children group.
(d) If a
child is determined to be eligible for benefits for the treatment of an eligible medical condition under the California Children’s Services Program pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, the health, dental, or vision plan providing services to the child pursuant to this chapter shall not be responsible for the provision of, or payment for, those authorized services for that child. The proposal from an applicant shall contain provisions to ensure that a child whom the health, dental, or vision plan reasonably believes would be eligible for services under the California Children’s Services Program is referred to that program. The California Children’s Services Program shall provide case management and authorization of services if the child is found to be eligible for the California Children’s Services Program. Diagnosis
and treatment services that are authorized by the California Children’s Services Program shall be performed by paneled providers for that program and approved special care centers of that program and approved by the California Children’s Services Program. All other services provided under the proposal from the applicant shall be made available pursuant to this chapter to a child who is eligible for services under the California Children’s Services Program.
(e) Notwithstanding any other provision of this section, an applicant may submit a proposal to the department for the purposes of providing comprehensive health insurance coverage to children whose coverage is not eligible for funding under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq.), or to a combination of children whose coverage is eligible for funding under
Title XXI of the Social Security Act and children whose coverage is not eligible for that funding. To be approved by the department, these proposals shall comply with both of the following requirements:
(1) Meet all applicable requirements for funding under this chapter, except for availability of funding through Title XXI of the Social Security Act.
(2) Provide for the administration of children’s coverage by the department through the administrative infrastructure serving the Medi-Cal program, and through health care service plans serving the Medi-Cal program.
(f) Implementation of this section is conditioned on the department obtaining necessary federal approval of these provisions.
(g) Notwithstanding any other provision of this part, the status of any application previously submitted to, and approved by, the Managed Risk Medical Insurance Board pursuant to Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code shall not be altered as a result of the assumption by the department, pursuant to this chapter, of the responsibilities previously exercised by the Managed Risk Medical Insurance Board.
