Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services that are medically necessary are provided to qualified, low-income persons through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law generally requires Medi-Cal managed care plan contractors to be licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975. Under the act, a health care service plan is required to provide access to medically necessary health care services to its enrollees who have been displaced by a state of emergency, and existing law enumerates actions that a plan may be required to take to meet the needs of its enrollees during the state of emergency.

This bill would require a Medi-Cal managed care health plan to ensure that an enrollee who remains in a general acute care hospital continues to receive medically necessary postacute care services at the general acute care hospital if specified requirements are met, including that the Medi-Cal managed care health plan is unable to locate a postacute care facility within the plan’s network, as a result of a state of emergency, for purposes of transferring the enrollee to the postacute care facility. The bill would condition the implementation of these requirements to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.