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AB-2579 Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.(2017-2018)

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Date Published: 06/26/2018 09:00 PM
AB2579:v97#DOCUMENT

Amended  IN  Senate  June 26, 2018
Amended  IN  Assembly  March 23, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2579


Introduced by Assembly Member Burke
(Coauthors: Assembly Members Arambula, Wood, Chiu, Friedman, and Gonzalez Fletcher)

February 15, 2018


An act to repeal Section 12694 of the Insurance Code, and to add Section 14124.14 14124.16 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 2579, as amended, Burke. Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.
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 program provisions. Existing law establishes the Medi-Cal Access Program, which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is within specified thresholds of the federal poverty level, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified.
Existing federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid Program program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid Program. program.
Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, infants, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk.
Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.
This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, operational no later than January 1, 2019, 2020, allowing children applying to the WIC Program to obtain express lane eligibility for, and to facilitate application for enrollment in, the Medi-Cal program, and allowing pregnant women applying to the WIC Program to obtain presumptive eligibility for the Medi-Cal program or the Medi-Cal Access Program, to the extent federal financial participation is available. The bill would also require the system to perform specified functions relating to the eligibility of those persons under the programs. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition the implementation of the provisions on the department obtaining all necessary federal approvals. Because
Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, 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 the statutory provisions noted above.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 12694 of the Insurance Code is repealed.
12694.

(a)The board and the department, in collaboration with program offices for the California Special Supplemental Food Program for Women, Infants, and Children (WIC or the WIC program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway system developed by the department and the board that performs, but is not limited to performing, the following functions:

(1)To the extent that federal financial participation is available, allowing children applying to the WIC program to submit a simple electronic application to simultaneously obtain presumptive eligibility for Medi-Cal and Healthy Families under Title XIX (42) U.S.C. 1396 et seq.) and Title XXI (42 U.S.C. 1397aa et seq.) of the Social Security Act and apply for enrollment into the Medi-Cal program or the Healthy Families Program with the consent of their parent or guardian.

(2)Modify the existing WIC enrollment system to obtain the minimum required data for enrollment in Medi-Cal and Healthy Families in order to provide an electronic transactional platform that is connected to the simple electronic application referenced in paragraph (1) and allowing for an interface between that application, the Medi-Cal Eligibility Data System (MEDS), and the Medi-Cal program or the Healthy Families Program, as relevant.

(3)Providing an automated real-time connection with MEDS for the purpose of checking an applicant’s enrollment status.

(4)Allowing for the electronic transfer of information to the Medi-Cal program or the Healthy Families Program, as relevant, for the purpose of making the final eligibility determination.

(5)Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program or the Healthy Families Program to complete the eligibility determination. The department and the Managed Risk Medical Insurance Board shall comply with all applicable privacy and confidentiality provisions under federal and state law.

(b)The automated enrollment gateway system shall be constructed with the capacity to be used by entities operating the WIC program.

(c)The WIC application process shall be modified to provide an electronic application described in subdivision (a), which shall contain the information necessary to apply for the automated enrollment gateway system, supplemented by information required to apply for enrollment into the Medi-Cal program or the Healthy Families Program.

(d)Benefits for applicants opting to simultaneously obtain presumptive eligibility for enrollment under this section shall continue until a final eligibility determination is made for the Medi-Cal program or the Healthy Families Program pursuant to Section 14011.8 of the Welfare and Institutions Code.

(e)Operation of the automated enrollment gateway system for the WIC program shall occur within a timely and appropriate period as determined by the department and the board, in consultation with the stakeholders as provided in subdivision (a) subject to a specific appropriation being provided for that purpose in the Budget Act or in subsequent legislation. The automated enrollment gateway system shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.

(f)The WIC program shall collect income and residency information necessary for the Medi-Cal program and the Healthy Families Program documentation requirements for applications submitted through the automated enrollment gateway system. To the extent allowed by the federal government, the Medi-Cal and Healthy Families programs shall rely on income information obtained by WIC and upon the income verification process performed by WIC. The Medi-Cal and Healthy Families programs shall collect and verify citizenship and immigration information as required under those programs.

(g)Consistent with the provisions of this section, the Medi-Cal and Healthy Families programs may collect additional information needed to verify eligibility in those programs.

(h)Counties shall accept and process for a Medi-Cal eligibility determination applications provided by the WIC gateway system and ensure timely processing of these applications and a timely eligibility determination and ending of presumptive eligibility.

(i)The presumptive eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.

(j)The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 of the Welfare and Institutions Code and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway system as described in this section.

(k)The state shall promote and offer support to the WIC program for the use of the simple electronic application and the automated enrollment gateway system.

(l)The board shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.

(m)The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other provision of law, only when all necessary federal approvals have been obtained shall this section be implemented.

SECTION 1.Section 14124.14 is added to the Welfare and Institutions Code, to read:

SEC. 2.

 Section 14124.16 is added to the Welfare and Institutions Code, to read:

14124.14.14124.16.
 (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway system developed by the department that performs, but is not limited to performing, all of the following functions:
(1) To the extent that federal financial participation is available, allowing children applying to the WIC Program to submit a simple electronic application to simultaneously obtain express lane eligibility for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) and Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act and, for children, apply for enrollment into the Medi-Cal program with the consent of their parent or guardian, and allowing pregnant women applying to the WIC Program to submit a simple electronic application to simultaneously obtain presumptive eligibility for the Medi-Cal program or the Medi-Cal Access Program (MCAP).
(2) Modifying the existing WIC enrollment system to obtain the minimum required data for enrollment in the Medi-Cal program in order to provide an electronic transactional platform that is connected to the simple electronic application referenced in paragraph (1) and allowing for an interface between that WIC application, the Medi-Cal Eligibility Data System (MEDS), and the Medi-Cal program.
(3) Providing an automated real-time connection with MEDS for the purpose of checking an applicant’s enrollment status and registering express lane eligibility or presumptive eligibility status.
(4) Allowing for the electronic transfer of information to the Medi-Cal program for the purpose of completing the application and making the final eligibility determination.
(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.
(b) The automated enrollment gateway system shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program.
(c) The WIC application process shall be modified to provide an electronic application described in subdivision (a), which shall contain the information necessary to apply for automated Medi-Cal enrollment, and supplemented by the Medi-Cal program with any additional information required to apply for enrollment into the Medi-Cal program.
(d) Benefits for applicants opting to simultaneously obtain express lane eligibility or presumptive eligibility for enrollment under this section shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.
(e) Operation of the automated enrollment gateway system by the WIC Program, the Medi-Cal program, and MCAP shall occur within a timely and appropriate period as determined by the department, in consultation with the stakeholders as provided in subdivision (a), but no later than January 1, 2019. 2020. The automated enrollment gateway system shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.
(f) The WIC Program shall collect income and residency information necessary for the Medi-Cal program documentation requirements for applications submitted through the automated enrollment gateway system. To the extent allowed by the federal government, the Medi-Cal program shall rely on income and residency information obtained by the WIC Program and upon the income verification process performed by the WIC Program. The Medi-Cal program shall collect and verify citizenship and immigration information as required under that program.
(g) Consistent with this section, the Medi-Cal program may collect additional information needed to verify eligibility in that program.
(h) Counties shall accept and process applications provided by the WIC gateway system for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.
(i) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.
(j) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway system as described in this section.
(k) The state shall promote and offer support to the WIC Program for the use of the simple electronic application and the automated enrollment gateway system.
(l) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.

SEC. 2.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.