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SB-1073 Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.(2019-2020)

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Date Published: 04/03/2020 09:00 PM
SB1073:v98#DOCUMENT

Amended  IN  Senate  April 03, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 1073


Introduced by Senator Lena Gonzalez
(Principal coauthor: Assembly Member Petrie-Norris)

February 18, 2020


An act to add Section 14124.15 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 1073, as amended, Lena Gonzalez. 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 provisions.
Existing federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state may 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.
Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or 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, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk.
This bill would require the State Department of Health Care Services to designate the WIC Program and its local WIC agencies as Express Lane agencies, and to use WIC Program eligibility determinations to meet Medi-Cal program eligibility requirements, including financial eligibility and state residence. The bill would require the department, in collaboration with specified entities, such as program offices for the WIC Program and local WIC agencies, to complete various tasks, including receiving eligibility findings and information from WIC records on WIC recipients to process their Medi-Cal program expedited eligibility determination. The bill would require the department to eliminate procedural burdens imposed on Medi-Cal program applicants by implementing specified policies, such as providing presumptive eligibility and WIC-based verification of Medi-Cal program eligibility for WIC Program recipients, and would provide that express lane eligibility benefits are identical to the benefits provided to children who receive full-scope Medi-Cal program benefits without a share of cost. recipients. The bill would require the department to conduct a feasibility study to assess and design electronic express lane eligibility systems pathways between the Medi-Cal program and the WIC Program, and to maximize federal Medicaid funding for systems modifications. The bill would condition the implementation of these provisions on the department obtaining federal approval.
Because counties are responsible for making eligibility determinations under the Medi-Cal program, and by modifying eligibility requirements and processes, 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.

 The Legislature finds and declares all of the following:
(a) The prioritization of young children and families is a critical component of realizing a “California for All.”
(b) California has demonstrated its commitment to provide health care coverage for low-income children and young adults in California, irrespective of their immigration status.
(c) As a smart government strategy, the state can streamline children and pregnant person’s enrollment in the Medi-Cal program using the eligibility information previously collected from another state program.
(d) To address the decrease in the number of enrolles in the Medi-Cal program and the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), the state must develop additional streamlining strategies to enroll eligible children and families into those programs.
(e) To respond to the “chilling effect” of pending federal regulations on public charge and related activities, the state must proactively promote a culture of inclusion and enrollment by widening the entry doors to state programs, thereby welcoming eligible persons to receive California services.
(f) The WIC Program is trusted and exempt from pending federal regulations on public charge. Hence, the WIC Program is a critical entry point for enrollment to other state programs, including the Medi-Cal program.
(g) When state agencies have the ability to access information that may establish eligibility for other services offered by state programs, children and families should be granted those services with minimal red tape and coordination among state programs on the behalf of families.
(h) As the state assesses and develops system interfaces between systems administered and operated by the Medi-Cal program and the WIC Program to streamline applications and enrollment, California should expedite enrollment for those children and pregnant persons enrolled in one of these programs to ensure that they are enrolled in both programs.
(i) California’s investments in services and structures that protect and care for all children will advance solutions in the best interests of our children and state’s future.
(j) Trusted programs like the WIC Program can also serve as effective partners to identify and help enroll young adults who are newly eligible for the Medi-Cal program as of January 2020.

SEC. 2.

 Section 14124.15 is added to the Welfare and Institutions Code, immediately following Section 14124.14, to read:

14124.15.
 (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 program eligibility determinations, advocates, and other stakeholders, shall do all of the following:
(1) Conduct regular data matches to identify which WIC Program recipients are not enrolled in the Medi-Cal program and which Medi-Cal program beneficiaries are eligible for, but not enrolled in, the WIC Program.
(2) (A) Notify WIC Program recipients about their Medi-Cal program eligibility. eligibility, using multiple forms of communication, including, but not limited to, written notifications. Notification shall include a request for the recipient to consent to enroll in the Medi-Cal program through an express lane eligibility for children and expedited enrollment with verification based on WIC findings for pregnant persons. Consent may be given by text message or written signature, over the telephone, or internet.
(B) Notify Medi-Cal program beneficiaries about their WIC Program eligibility. eligibility by multiple forms of communication, including, but not limited to, all currently utilized methods for WIC and Medi-Cal program notifications. This notification shall detail their adjunctive eligibility for the WIC Program, and any followup process necessary to complete WIC enrollment, including the contact information of their local WIC Program site. Local WIC Program sites may follow up with the Medi-Cal program beneficiaries on this matter. shall follow up with the targeted Medi-Cal program beneficiaries to finalize their WIC enrollment.
(C) Notice, as specified in this paragraph, includes text messaging. messaging, if that capacity exists.
(3) Receive potentially relevant eligibility findings and information from WIC records on WIC recipients to process their Medi-Cal program expedited eligibility determination.
(b) The department shall designate 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)). The department shall use WIC Program eligibility determinations to meet Medi-Cal program eligibility requirements, including 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.
(c) The express lane eligibility enrollment specified in this section shall rely on the WIC Program eligibility information, verification process, and findings of the WIC Program. The Medi-Cal program shall only seek verification for eligibility information if that information has not been provided as part of the WIC Program and the information is necessary to finalize a determination.
(d) To the maximum extent permitted by federal law, and with respect to the express lane eligibility and verification of eligible person’s Medicaid program eligibility based on WIC Program findings, the department shall eliminate procedural burdens otherwise imposed on Medi-Cal program 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 sources, such as governmental agencies, 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 Program benefits.
(3) Providing presumptive eligibility and WIC-based verification of Medi-Cal program eligibility for WIC Program recipients.

(e)The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal program benefits without a share of cost, and only a Medi-Cal program provider may provide those health care services that are designated benefits.

(f)

(e) 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 children and families described in this section.

(g)

(f) The department shall promote and offer support to the WIC Program for the execution of Medi-Cal program enrollment of this section.

(h)

(g) (1) The department shall conduct a feasibility study to assess and design both of the following electronic express lane eligibility systems pathways:
(A) A pathway to expedite ongoing Medi-Cal program enrollment for WIC Program applicants and participants.
(B) A pathway to expedite WIC Program enrollment for Medi-Cal program applicants eligible for the WIC Program.

(2)As part of the feasibility design, the department shall maximize federal Medicaid funding for systems modifications to ensure that federal funds consist of 90 percent of the total funds needed for this endeavor. The feasibility study shall also consider additional design factors, including the impact on workforce, opportunities for workers to have input on transition, and training on an electronic express lane eligibility systems pathway.

(2) As part of the feasibility design, the department shall design the system interface modifications in a manner that maximizes the use of enhanced federal Medicaid funding as allowed in Section 1396b(a)(3) of Title 42 of the United States Code and federal guidance as set forth in 76 Federal Register 21950 and 21951 (April 19, 2011).

(i)

(h) 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. 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.