Today's Law As Amended


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SB-56 Medi-Cal: eligibility.(2021-2022)



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, younger  and who does not have satisfactory immigration status or is unable to establish satisfactory immigration status as required by Section 14011.2, 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 subparagraph, but no sooner than May  Effective July  1, 2022, an individual who is 50 60  years of age or older, and who does not have satisfactory immigration immigrant  status or is unable to establish satisfactory immigration 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.
(B) After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of this subparagraph, but no later than January 1, 2024, an individual who is 26 to 49 years of age, inclusive, and who does not have satisfactory immigration 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.  Implementation of this paragraph shall be subject to an appropriation in the annual Budget Act or any other act approved by the Legislature for the express purpose of this paragraph. 
(C) 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 either subparagraph (A) or (B), as applicable.
(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) The enrollment specified in subparagraph (A) shall be conducted complete  pursuant to an eligibility and enrollment 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.
(C) (i) For individuals described in subparagraph (B) of paragraph (2), the eligibility and enrollment plan shall enable, to the maximum extent the department determines possible, an individual to maintain their primary care provider or medical home as their assigned primary care provider in the Medi-Cal managed care health plan provider network without disruption, if the provider is a contracted network provider with that Medi-Cal managed care health plan. The department shall work with counties, Medi-Cal managed care health plans, health care providers, consumer advocates, and other interested stakeholders, to identify and maintain that linkage, to the maximum extent the department determines possible.
(ii) This subparagraph does not limit the ability of an individual enrolled in Medi-Cal pursuant to subparagraph (B) of paragraph (2) to select either, or both, a different primary 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.
(D) (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) If, in determining the projected budget condition for the upcoming fiscal year, the Department of Finance projects a positive ending balance in the Special Fund for Economic Uncertainties for the upcoming fiscal year and each of the ensuing three fiscal years that exceeds the cost of providing individuals who are 60 years of age or older, and who do not have satisfactory immigration statuses or are unable to establish satisfactory immigration statuses as required by Section 14011.2 for the full scope of Medi-Cal benefits, if they are otherwise eligible for benefits under this chapter, the benefits to such individuals shall be prioritized for inclusion in the budget for the upcoming fiscal year.
(b) (c)  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 in any other children’s Medi-Cal specialty program that they would otherwise be eligible for.
(c) (d)  (1)  The department shall maximize federal  seek any necessary federal approvals to obtain federal  financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim  section. Benefits for services under this section shall be provided with state-only funds if  federal financial participation to the extent that the department determines it is available. is unavailable for those services. 
(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)  (1)  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) (A)  Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code and any policies, procedures, or regulations authorized by that part.
(B) Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code.
(2) (C)  Review or approval of contracts by the Department of General Services.
(2) Paragraph (1) does not apply to any contracts newly entered into, or renewed, on or after January 1, 2022.
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.