Bill Text: CA SB1002 | 2013-2014 | Regular Session | Introduced

California Senate Bill 1002 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Low-income individuals: eligibility determinations.

Spectrum: Bipartisan Bill

Status: (Vetoed) 2014-09-28 - In Senate. Consideration of Governor's veto pending. [SB1002 Detail]

Download: California-2013-SB1002-Introduced.html
BILL NUMBER: SB 1002	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator De Le�n

                        FEBRUARY 13, 2014

   An act to amend Section 14005.37 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1002, as introduced, De Le�n. Medi-Cal: redetermination.
   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 generally requires a county to redetermine a Medi-Cal
beneficiary's eligibility to receive Medi-Cal benefits every 12
months and whenever the county receives information about changes in
a beneficiary's circumstances that may affect his or her eligibility
for Medi-Cal benefits. Under existing law, when a redetermination is
performed due to a change in circumstances, if a county determines
that the beneficiary remains eligible for Medi-Cal benefits, the
county must begin a new 12-month eligibility period.
   This bill would require a county, when a redetermination is
performed due to a change in circumstances, and the county received
the information about the change in circumstance in a CalFresh
application, or gathered the information about the change in
circumstances during a CalFresh redetermination, and the beneficiary
is determined eligible to receive CalFresh benefits, to begin the new
12-month eligibility period on a date that would align the
beneficiary's Medi-Cal eligibility period with his or her household
CalFresh certification period. The bill would also require the
county, in certain circumstances, to begin a new 12-month Medi-Cal
eligibility period that would align a beneficiary's eligibility
period with his or her CalFresh household certification period. The
bill would provide that these provisions only be implemented to the
extent permitted by federal law and to the extent that they do not
violate federal maintenance of effort rules. By imposing additional
duties on counties, this 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 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.  This act shall be known, and may be cited, as The
Aligning Opportunities for Health Act of 2014.
  SEC. 2.  Section 14005.37 of the Welfare and Institutions Code is
amended to read:
   14005.37.  (a) Except as provided in  subdivision (n) and in
 Section 14005.39, a county shall perform redeterminations of
eligibility for Medi-Cal beneficiaries every 12 months and shall
promptly redetermine eligibility whenever the county receives
information about changes in a beneficiary's circumstances that may
affect eligibility for Medi-Cal benefits. 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
  CalWORKs  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 and a beneficiary's Medi-Cal 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 benefits under any
basis and due process rights guaranteed under this division have been
met. For the purposes of this subdivision, for a beneficiary who is
subject to the use of MAGI-based financial methods, the determination
of whether the beneficiary is eligible for Medi-Cal benefits under
any basis shall include, but is not limited to, a determination of
eligibility for Medi-Cal benefits on a basis that is exempt from the
use of MAGI-based financial methods only if either of the following
occurs:
   (A) The county assesses the beneficiary as being potentially
eligible under a program that is exempt from the use of MAGI-based
financial methods, including, but not limited to, on the basis of
age, blindness, disability, or the need for long-term care services
and supports.
   (B) The beneficiary requests that the county determine whether he
or she is eligible for Medi-Cal benefits on a basis that is exempt
from the use of MAGI-based financial methods.
   (e) (1) For purposes of acquiring information necessary to conduct
the eligibility redeterminations described in this section, a county
shall 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 information
contained in the beneficiary's file or other information, including
more recent information available to the county, including, but not
limited to, Medi-Cal, CalWORKs, and CalFresh case files of the
beneficiary or of any of his or her immediate family members, which
are open, or were closed within the last 90 days, information
accessed through any databases accessed under Sections 435.948,
435.949, and 435.956 of Title 42 of the Code of Federal Regulations,
and wherever feasible, other sources of relevant information
reasonably available to the county or to the county via the
department.
   (2) In the case of an annual redetermination, if, based upon
information obtained pursuant to paragraph (1), the county is able to
make a determination of continued eligibility, the county shall
notify the beneficiary of both of the following:
   (A) The eligibility determination and the information it is based
on.
   (B) That the beneficiary is required to inform the county via the
Internet, by telephone, by mail, in person, or through other commonly
available electronic means, in counties where such electronic
communication is available, if any information contained in the
notice is inaccurate but that the beneficiary is not required to sign
and return the notice if all information provided on the notice is
accurate.
   (3) The county shall make all reasonable efforts not to send
multiple notices during the same time period about eligibility. The
notice of eligibility renewal shall contain other related information
such as if the beneficiary is in a new Medi-Cal program.
   (4) In the case of a redetermination due to a change in
circumstances, if a county determines that the change in
circumstances does not affect the beneficiary's eligibility status,
the county shall not send the beneficiary a notice unless required to
do so by federal law.
   (f) (1) In the case of an annual eligibility redetermination, if
the county is unable to determine continued eligibility based on the
information obtained pursuant to paragraph (1) of subdivision (e),
the beneficiary shall be so informed and shall be provided with an
annual renewal form, at least 60 days before the beneficiary's annual
redetermination date, that is prepopulated with information that the
county has obtained and that identifies any additional information
needed by the county to determine eligibility. The form shall include
all of the following:
   (A) The requirement that he or she provide any necessary
information to the county within 60 days of the date that the form is
sent to the beneficiary.
   (B) That the beneficiary may respond to the county via the
Internet, by mail, by telephone, in person, or through other commonly
available electronic means if those means are available in that
county.
   (C) That if the beneficiary chooses to return the form to the
county in person or via mail, the beneficiary shall sign the form in
order for it to be considered complete.
   (D) The telephone number to call in order to obtain more
information.
   (2) The county shall attempt to contact the beneficiary via the
Internet, by telephone, or through other commonly available
electronic means, if those means are available in that county, during
the 60-day period after the prepopulated form is mailed to the
beneficiary to collect the necessary information if the beneficiary
has not responded to the request for additional information or has
provided an incomplete response.
   (3) If the beneficiary has not provided any response to the
written request for information sent pursuant to paragraph (1) within
60 days from the date the form is sent, the county shall terminate
his or her eligibility for Medi-Cal benefits following the provision
of timely notice.
   (4) If the beneficiary responds to the written request for
information during the 60-day period pursuant to paragraph (1) but
the information provided is not complete, the county shall follow the
procedures set forth in paragraph (3) of subdivision (g) to work
with the beneficiary to complete the information.
   (5) (A) The form required by this subdivision shall be developed
by the department in consultation with the counties and
representatives of eligibility workers and consumers.
   (B) For beneficiaries whose eligibility is not determined using
MAGI-based financial methods, the county may use existing renewal
forms until the state develops prepopulated renewal forms to provide
to beneficiaries. The department shall develop prepopulated renewal
forms for use with beneficiaries whose eligibility is not determined
using MAGI-based financial methods by January 1, 2015.
   (g) (1) In the case of a redetermination due to change in
circumstances, if a county cannot obtain sufficient information to
redetermine eligibility pursuant to subdivision (e), the county shall
send to the beneficiary a form that is prepopulated with the
information that the county has obtained and that states the
information needed to renew eligibility. The county shall only
request information related to the change in circumstances. 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 county shall only request information for
nonapplicants necessary to make an eligibility determination or for a
purpose directly related to the administration of the state Medicaid
plan. The form shall advise the individual to provide any necessary
information to the county via the Internet, by telephone, by mail, in
person, or through other commonly available electronic means and, if
the individual will provide the form by mail or in person, to sign
the form. The form shall include a telephone number to call in order
to obtain more information. The form shall be developed by the
department in consultation with the counties, representatives of
consumers, and eligibility workers. A Medi-Cal beneficiary shall have
30 days from the date the form is mailed pursuant to this
subdivision to respond. Except as provided in paragraph (2), failure
to respond prior to the end of this 30-day period shall not impact
his or her Medi-Cal eligibility.
   (2) 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 this
subdivision marked as undeliverable shall result in an immediate
notice of action terminating Medi-Cal eligibility.
   (3) During the 30-day period after the date of mailing of a form
to the Medi-Cal beneficiary pursuant to this subdivision, the county
shall attempt to contact the beneficiary by telephone, in writing, or
other commonly available electronic means, in counties where such
electronic communication is available, to request the necessary
information if the beneficiary has not responded to the request for
additional information or has provided an incomplete response. If the
beneficiary does not supply the necessary information to the county
within the 30-day limit, a 10-day notice of termination of Medi-Cal
eligibility shall be sent.
   (h) Beneficiaries shall be required to report any change in
circumstances that may affect their eligibility within 10 calendar
days following the date the change occurred.
   (i) If within 90 days of termination of a Medi-Cal beneficiary's
eligibility or a change in eligibility status pursuant to this
section, the beneficiary submits to the county a signed and completed
form or otherwise provides the needed information to the county,
eligibility shall be redetermined by the county and if the
beneficiary is found eligible, or the beneficiary's eligibility
status has not changed, whichever applies, the termination shall be
rescinded as though the form were submitted in a timely manner.
   (j) If the information available to the county pursuant to the
redetermination procedures of this section does not indicate a basis
of eligibility, Medi-Cal benefits may be terminated so long as due
process requirements have otherwise been met.
   (k) The department shall, with the counties and representatives of
consumers, including those with disabilities, and Medi-Cal
eligibility workers, develop a timeframe for redetermination of
Medi-Cal eligibility based upon disability, including ex parte
review, the redetermination forms described in subdivisions (f) and
(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.
   (l) The county shall consider blindness as continuing until the
reviewing physician determines that a beneficiary's vision has
improved beyond the applicable definition of blindness contained in
the plan.
   (m) The county shall consider disability as continuing until the
review team determines that a beneficiary's disability no longer
meets the applicable definition of disability contained in the plan.
   (n)  (1)    In the case of a redetermination due
to a change in circumstances, if a county determines that the
beneficiary remains eligible for Medi-Cal benefits, the county shall
begin a new 12-month eligibility period.  If the county 
 received the information about the change in circumstances in a
CalFresh application or gathered the information about the change in
circumstances during a CalFresh recertification, and the beneficiary
is determined eligible to receive CalFresh benefits, then the county
shall begin the new 12-month eligibility period on a date that aligns
the beneficiary's eligibility period with his or her household
CalFresh certification period.  
   (2) (A) If a county receives an application for CalFresh benefits
from a Medi-Cal beneficiary who is not receiving CalWORKs benefits,
or redetermines or recertifies eligibility for CalFresh benefits for
a Medi-Cal beneficiary who is not receiving CalWORKs benefits, and no
information contained in the CalFresh application, or no information
gathered during the CalFresh redetermination or recertification
process, requires the county to redetermine the beneficiary's
eligibility for Medi-Cal pursuant to this section, and the
beneficiary is determined eligible to receive CalFresh benefits, the
county shall begin a new 12-month Medi-Cal eligibility period that
aligns the beneficiary's eligibility period with his or her CalFresh
household certification period, unless doing so would increase the
beneficiary's share of cost or reduce Medi-Cal benefits for any
member of the beneficiary's CalFresh family budget unit, in which
case the beneficiary's Medi-Cal eligibility period and CalFresh
certification period shall remain unaligned.  
   (B) This paragraph shall not be construed to permit a CalFresh
recipient who is otherwise ineligible for Medi-Cal benefits to
receive Medi-Cal benefits.  
   (3) This subdivision shall be implemented to the extent permitted
by federal law and to the extent that this action does not violate
federal maintenance of effort rules. 
   (o) For individuals determined ineligible for Medi-Cal by a county
following the redetermination procedures set forth in this section,
the county shall determine eligibility for other insurance
affordability programs and if the individual is found to be eligible,
the county shall, as appropriate, transfer the individual's
electronic account to other insurance affordability programs via a
secure electronic interface.
   (p) Any renewal form or notice shall be accessible to persons who
are limited-English proficient and persons with disabilities
consistent with all federal and state requirements.
   (q) The requirements to provide information in subdivisions (e)
and (g), and to report changes in circumstances in subdivision (h),
may be provided through any of the modes of submission allowed in
Section 435.907(a) of Title 42 of the Code of Federal Regulations,
including an Internet Web site identified by the department,
telephone, mail, in person, and other commonly available electronic
means as authorized by the department.
   (r) Forms required to be signed by a beneficiary pursuant to this
section shall be signed under penalty of perjury. Electronic
signatures, telephonic signatures, and handwritten signatures
transmitted by electronic transmission shall be accepted.
   (s) For purposes of this section, "MAGI-based financial methods"
means income calculated using the financial methodologies described
in Section 1396a(e)(14) of Title 42 of the United States Code, and as
added by the federal Patient Protection and Affordable Care Act
(Public Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152), and any
subsequent amendments.
   (t) When contacting a beneficiary under paragraphs (2) and (4) of
subdivision (f), and paragraph (3) of subdivision (g), a county shall
first attempt to use the method of contact identified by the
beneficiary as the preferred method of contact, if a method has been
identified.
   (u) The department shall seek federal approval to extend the
annual redetermination date under this section for a three-month
period for those Medi-Cal beneficiaries whose annual redeterminations
are scheduled to occur between January 1, 2014, and March 31, 2014.
   (v) 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 regulations are adopted. The
department shall adopt regulations by July 1, 2017, 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. Beginning
six months after the effective date of this section, and
notwithstanding Section 10231.5 of the Government Code, the
department shall provide a status report to the Legislature on a
semiannual basis, in compliance with Section 9795 of the Government
Code, until regulations have been adopted.
   (w) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (x) This section shall become operative on January 1, 2014.
  SEC. 3.  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.