Today's Law As Amended


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AB-4 Medi-Cal: eligibility.(2019-2020)



As Amends the Law Today


SECTION 1.

 Section 14007.8 of the Welfare and Institutions Code is amended to read:

14007.8.
 (a) (1) An individual who is 25 years of age or younger, and who  does not have satisfactory immigration status or is unable to establish satisfactory immigration status status,  as required by Section 14011.2, shall be eligible for the full scope of Medi-Cal benefits, if they are otherwise eligible for benefits under this chapter.
(2) (A) After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of this paragraph, but no sooner than May 1, 2022, an individual who is 50 years of age or older, and who does not have satisfactory immigrant status or is unable to establish satisfactory immigration status as required by Section 14011.2, shall be eligible for An individual enrolled in Medi-Cal pursuant to subdivision (d) of Section 14007.5 shall be enrolled in  the full scope of Medi-Cal benefits, if they are otherwise eligible for benefits under this chapter. otherwise eligible, and they shall not be required to file a new application for Medi-Cal. 
(B) The effective date of enrollment into the Medi-Cal program for an individual described in this paragraph, and enrolled in the Medi-Cal program pursuant to subdivision (d) of Section 14007.5, shall be on the same day on which the systems are operational to begin processing new applications pursuant to the director’s determination described in subparagraph (A).
(3) (A) An individual enrolled in the Medi-Cal program pursuant to this section and subdivision (d) of Section 14007.5 shall not be required to file a new application for the Medi-Cal program.
(B) (i)  The enrollment specified in subparagraph (A) shall be conducted completed  pursuant to an eligibility and enrollment plan, plan  and shall include outreach strategies developed by the department in consultation with interested stakeholders, including, but not limited to, counties, health care service plans, health care providers, consumer advocates, and the Legislature.
(ii) The eligibility and enrollment plan shall ensure, to the maximum extent possible, and for purposes of the Medi-Cal managed care delivery system, that an individual may maintain their primary care provider as their assigned primary care provider in the Medi-Cal managed care health plan’s provider network without disruption, if the provider is a contracted in-network provider within that Medi-Cal managed care health plan. For county health care access programs that assign individuals to a medical home or a primary care provider, the department shall work with counties, Medi-Cal managed care health plans, health care providers, consumer advocates, and other interested stakeholders, to ensure that an individual may maintain their primary care provider as their assigned primary care provider upon their enrollment into the Medi-Cal program, if the provider is a contracted in-network provider within the applicable Medi-Cal managed care health plan.
(iii) This paragraph does not limit the ability of an individual enrolled in Medi-Cal pursuant to this section to select either a different health care provider or, if there is more than one Medi-Cal managed care health plan available in the county where they reside, a different Medi-Cal managed care health plan, consistent with subdivision (g) of Section 14087.305 and paragraph (7) of subdivision (d) of Section 14089.
(C) The department shall provide monthly updates to the appropriate policy and fiscal committees of the Legislature on the status of the implementation of this section.
(b) To the extent permitted by state and federal law, an individual eligible under this section shall be required to enroll in a Medi-Cal managed care health plan. Enrollment in a Medi-Cal managed care health plan shall not preclude a beneficiary from being enrolled  enrolling  in any other children’s Medi-Cal specialty program that  for which  they would otherwise be eligible for. eligible. 
(c) The department shall seek any necessary federal approvals to obtain federal financial participation in implementing this section. Benefits for services under this section shall be provided with state-only funds only if federal financial participation is not available for those services.
(c) (d)  (1)  The department  department, in collaboration with counties and designated public hospitals identified in subdivision (f) of Section 14184.10,  shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim  If  federal financial participation to the extent that the department determines it is available. is significantly or adversely impacted, including an adverse impact on the Global Payment Program, as described in Section 14184.40, the department shall work with the designated public hospitals to mitigate any financial losses for purposes of maintaining the anticipated levels of federal funding that were likely to exist but for the implementation of this section. 
(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds appropriated for this purpose.
(d) (e)  This section shall be implemented only to the extent it is in compliance with Section 1621(d) of Title 8 of the United States Code.
(e) (f)  (1) 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 any necessary regulations are adopted. 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.
(2) 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.
(f) (g)  In implementing this section, the department may contract, as necessary, on a bid or nonbid basis. This subdivision establishes an accelerated process for issuing contracts pursuant to this section. Those contracts, and any other contracts entered into pursuant to this subdivision, may be on a noncompetitive bid basis and shall be exempt from both of  the following:
(1) Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code and any policies, procedures, or regulations authorized by that part.
(2) Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code.
(2) (3)  Review or approval of contracts by the Department of General Services.
(h) The amendments to this section made by the act that added this subdivision during the 2019–20 Regular Session of the Legislature shall be implemented only to the extent that the Legislature makes an appropriation in the annual Budget Act or other measure for that purpose.
SEC. 2.
 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.