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 pathway developed by the department that performs, but is not limited to performing, all of the following functions:(1) Designating the WIC Program and its local WIC agencies as Express Lane agencies pursuant to Section 1396a(e)(13)(F) of Title 42 of the United States Code (Section 203 of the federal Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3)) and using WIC eligibility determinations to meet eligibility requirements, including, but not limited to, financial eligibility and state residence, for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act.
(2) For individuals applying for, or enrolled in, the WIC Program, directing the WIC Program to electronically convey relevant WIC eligibility findings and information to the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) or Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act to maximize and expedite potentially eligible individuals’ receipt of Medi-Cal health care coverage through the federal express lane eligibility under Section 1396a(e)(13) of Title 42 of the United States Code, and to the maximum extent permitted by federal law, including applicable data privacy and security safeguards.
(3) Taking all steps authorized by federal law to streamline the enrollment of WIC applicants and recipients in the Medi-Cal program and to maximize health care coverage for eligible individuals, by implementing policies that include, but are not limited to, both of the following:
(A) Using the WIC Program’s final findings of household income to verify financial eligibility for the Medi-Cal program.
(B) Using the WIC application signature as an application signature for the Medi-Cal program.
(4) Modifying the existing WIC enrollment system and the single streamlined application of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) to electronically transfer, via extraction, transformation, loading, and other system functions, the WIC eligibility information for children and women to the Medi-Cal program for the purpose of obtaining Medi-Cal eligibility determinations using express lane eligibility for those individuals not yet enrolled.
(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.
(6) Modifying the existing WIC enrollment system and the Medi-Cal eligibility and enrollment systems to electronically transfer to the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for the WIC Program for the purpose of local WIC agencies contacting prospective WIC enrollees to complete their enrollment in the WIC Program.
(b) The automated enrollment pathway shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program, for the purpose of enrollment in the Medi-Cal and WIC programs.
(c) The WIC application process shall be modified to streamline enrollment in the Medi-Cal program and to maximize coverage of eligible individuals by doing both of the following:
(1) Using simplified and streamlined consent procedures for individuals to authorize the electronic transfer to the Medi-Cal program of potentially relevant information from the WIC application, including social security numbers, if provided, and from WIC Program records and eligibility findings.
(2) Electronically transferring information to the Medi-Cal program via CalHEERS to achieve both of the following goals:
(A) Establishing Medi-Cal eligibility for WIC applicants and recipients not yet enrolled in the Medi-Cal program, including, but not limited to, a process for granting express lane eligibility for children and verifying women’s Medi-Cal eligibility based on WIC findings.
(B) Enrolling the individuals described in subparagraph (A) immediately in the Medi-Cal program to begin their receipt of benefits.
(d) Benefits for applicants enrolling in the Medi-Cal program using the automated enrollment pathway described in subdivision (a) shall be provided immediately through accelerated enrollment for children under Section 14015.5 and all-county letter No. 16-16 issued by the department, and initially Section 14011.6, and presumptive eligibility for pregnant women under Section 14148.7, and 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 pathway by the WIC Program and the Medi-Cal program shall occur within a timely and appropriate period, as determined by the department, in consultation with the stakeholders as provided in subdivision (a). The automated enrollment pathway shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.
(f) To the full extent permitted by federal law, the Medi-Cal program shall rely on the WIC eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information that is not already provided and that is necessary to finalize a determination.
(g) To the maximum extent permitted by federal law, the department shall eliminate procedural burdens otherwise imposed on applicants by implementing policies that include, but are not limited to, all of the following:
(1) Using eligibility findings and information from the WIC Program and other reliable third-party data sources to establish eligibility without the need for individuals to provide attestations or documentation.
(2) Providing express lane eligibility to children based on their receipt of WIC benefits.
(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal eligibility for women.
(h) The single streamlined application in CalHEERS and county Medi-Cal agencies shall accept and process applications provided by the automated enrollment pathway 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) While the automated enrollment pathway is being developed, the department, in coordination with the WIC Program and local WIC agencies, shall do all of the following:
(1) Conduct regular data matches to identify which WIC recipients are not enrolled in Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program.
(2) (A) Notify WIC recipients about their Medi-Cal eligibility. This notification shall include the ability to enroll in Medi-Cal via express lane eligibility with the WIC recipient’s consent.
(B) Notify Medi-Cal beneficiaries about their WIC eligibility. This notification shall detail the followup process necessary to complete WIC enrollment.
(3) Receive potentially relevant eligibility findings and information from WIC records regarding consenting WIC recipients in order to process their Medi-Cal eligibility determination.
(j) 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.
(k) 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 pathway as described in this section.
(l) The department shall promote and offer support to the WIC Program for the use of the automated enrollment pathway.
(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. 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.
(n) The department shall complete the project approval lifecycle process, as specified in Section 19 of the Statewide Information Management Manual and Sections 4819.34 to 4819.39, inclusive, and Sections 4920 to 4928, inclusive, of the State Administrative Manual, for the automated enrollment pathway prior to implementing this section.