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AB-1994 Eligibility.(2019-2020)



Current Version: 07/14/20 - Amended Senate         Compare Versions information image


AB1994:v96#DOCUMENT

Amended  IN  Senate  July 14, 2020
Amended  IN  Assembly  March 16, 2020
Amended  IN  Assembly  March 10, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1994


Introduced by Assembly Member Holden
(Principal coauthor: Assembly Member Blanca Rubio)
(Coauthor: Assembly Member Waldron)(Coauthors: Assembly Members Waldron and Wicks)

January 27, 2020


An act to amend Section 14011.10 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1994, as amended, Holden. Eligibility.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 law provides for the suspension of Medi-Cal benefits to an inmate of a public institution, which ends on the date they are no longer an inmate of a public institution or one year from the date they become an inmate of a public institution, whichever is sooner. Existing law requires county welfare departments to notify the department within 10 days of receiving information that an individual who is receiving Medi-Cal is or will be an inmate of a public institution. Existing law generally requires a county to redetermine a Medi-Cal beneficiary’s eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiary’s circumstances that may affect their eligibility for Medi-Cal benefits.
Existing federal law, the SUPPORT for Patients and Communities Act, prohibits a state from terminating Medi-Cal eligibility for an eligible juvenile if they are an inmate of a public institution, authorizes the suspension of Medicaid benefits to that eligible juvenile, and requires a state to conduct a redetermination of Medicaid eligibility or process an application for medical assistance under the Medicaid program for an eligible juvenile who is an inmate of a public institution. Under existing state law, commencing October 1, 2020, the suspension of Medi-Cal benefits to an inmate of a public institution who is a juvenile, as defined in federal law, ends when the individual is no longer an eligible juvenile pursuant to federal law or one year from the date the individual becomes an inmate of a public institution, whichever is later.
This bill would instead require require, commencing October 1, 2020, the suspension of Medi-Cal benefits to an inmate of a public institution who is not a juvenile, as defined, to end on the date they are no longer an inmate of a public institution or 3 years from the date they become an inmate of a public institution, whichever is sooner. The bill would conform state law with those specified federal provisions, and would impose those responsibilities on county welfare departments. The bill would require the county welfare department to suspend Medi-Cal benefits to an eligible juvenile in conformity with the above-specified suspension standard. Because counties are required to make Medi-Cal eligibility determinations, and the bill would expand Medi-Cal determinations of eligibility for eligible juveniles of public institutions, the bill would impose a state-mandated local program. also require, commencing October 1, 2020, the suspension of Medi-Cal benefits to an inmate of a public institution who is a juvenile, as defined, on the date that the individual is no longer an inmate of a public institution or 3 years after the date the individual is no longer an eligible juvenile under federal law, whichever is later.

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: YESNO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14011.10 of the Welfare and Institutions Code is amended to read:

14011.10.
 (a) Except as provided in Sections 14053.7 and 14053.8, benefits provided under this chapter to an individual who is an inmate of a public institution shall be suspended in accordance with Section 1396d(a)(29)(A) of Title 42 of the United States Code as provided in subdivisions (c) and (d).
(b) A county welfare department shall notify the department within 10 days of receiving information that an individual on Medi-Cal in the county is or will be an inmate of a public institution.
(c) Until October 1, 2020, if an individual is a Medi-Cal beneficiary on the date they become an inmate of a public institution, their benefits under this chapter and under Chapter 8 (commencing with Section 14200) shall be suspended effective the date they become an inmate of a public institution. The suspension shall end on the date they are no longer an inmate of a public institution or one year from the date they become an inmate of a public institution, whichever is sooner.
(d) Commencing October 1, 2020, if an individual is a Medi-Cal beneficiary on the date they become an inmate of a public institution, their benefits under this chapter and under Chapter 8 (commencing with Section 14200) shall be suspended effective the date they become an inmate of a public institution. The suspension shall end according to the following:
(1) For an individual who is not defined as a juvenile under Section 1396a(nn)(1)(A) or 1396a(nn)(1)(B) of Title 42 of the United States Code, the suspension shall end on the date the individual is no longer an inmate of a public institution or one year three years from the date the individual becomes an inmate of a public institution, whichever is sooner.
(2) For an individual who is defined as a juvenile under Section 1396a(nn)(1)(A) or 1396a(nn)(1)(B) of Title 42 of the United States Code, the suspension shall end in accordance with Section 1396a(a)(84) of Title 42 of the United States Code, or one year from the date the individual becomes an inmate of a public institution, on the date that the individual is no longer an inmate of a public institution or three years after the date the individual is no longer an eligible juvenile pursuant to Section 1396a(a)(84) of Title 42 of the United States Code, whichever is later.
(e) The department, in consultation with stakeholders, including the County Welfare Directors Association of California and advocates, shall develop and implement a redetermination of eligibility, to the extent required by federal law, pursuant to Section 14005.37, for individuals referenced in paragraph (2) of subdivision (d) whose eligibility is suspended pursuant to this section.
(f) This section does not create a state-funded benefit or program. Health care services under this chapter and Chapter 8 (commencing with Section 14200) shall not be available to inmates of public institutions whose Medi-Cal benefits have been suspended under this section.
(g) This section shall be implemented only if and to the extent allowed by federal law. This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approval of state plan amendments or other federal approvals have been obtained.
(h) This section shall be implemented on January 1, 2010, or the date when all necessary federal approvals are obtained, whichever is later.
(i) By January 1, 2010, or the date when all necessary federal approvals are obtained, whichever is later, the department, in consultation with the Chief Probation Officers of California and the County Welfare Directors Association of California, shall establish the protocols and procedures necessary to implement this section, including any needed changes to the protocols and procedures previously established to implement Section 14029.5.
(j) The department shall determine whether federal financial participation will be jeopardized by implementing this section and shall implement this section only if and to the extent that federal financial participation is not jeopardized.
(k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of all-county letters or similar instructions without taking regulatory action. 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.

SECTION 1.Section 14011.10 of the Welfare and Institutions Code is amended to read:
14011.10.

(a)Except as provided in subdivision (d), Sections 14053.7 and 14053.8, benefits provided under this chapter to an individual who is an inmate of a public institution shall be suspended in accordance with Section 1396d(a)(29)(A) of Title 42 of the United States Code as provided in subdivision (c).

(b)A county welfare department shall notify the department within 10 days of receiving information that an individual on Medi-Cal in the county is or will be an inmate of a public institution.

(c)If an individual is a Medi-Cal beneficiary on the date they become an inmate of a public institution, and their benefits under this chapter and under Chapter 8 (commencing with Section 14200) are suspended pursuant to this section, the effective date of the suspension is the date that they become an inmate of a public institution. The suspension shall end on the date they are no longer an inmate of a public institution or three years from the date they become an inmate of a public institution, whichever is sooner.

(d)(1)For purposes of this subdivision, the following definitions apply:

(A)“Eligible juvenile” means a juvenile who is an inmate of a public institution, and the county welfare department determines either of the following with respect to the juvenile:

(i)The juvenile was eligible for benefits under the Medi-Cal program immediately before becoming an inmate of the public institution.

(ii)The juvenile is eligible for benefits under the Medi-Cal program while an inmate of the public institution.

(B)“Juvenile” means an individual who is either of the following:

(i)Under 21 years of age.

(ii)Under 26 years of age, formerly in foster care, and otherwise meets the description set forth in Section 1396a(10)(A)(i)(IX) of Title 42 of the United States Code.

(2)The county welfare department shall suspend benefits provided under this chapter to an eligible juvenile pursuant to subdivision (c). During the period that the eligible juvenile is an inmate of a public institution, their Medi-Cal eligibility shall not be terminated.

(3)(A)Pursuant to the SUPPORT for Patients and Communities Act (House Resolution 6 (2018) (Public Law 115-271)), prior to the release of an eligible juvenile, as described in clause (i) of subparagraph (A) of paragraph (1), from a public institution, the county welfare department shall conduct a redetermination of eligibility for the Medi-Cal program, as specified in Section 14005.37, for that individual without requiring a new application from the eligible juvenile.

(B)If the county welfare department determines, pursuant to the redetermination specified in subparagraph (A), that the eligible juvenile meets eligibility requirements for the Medi-Cal program, Medi-Cal eligibility shall be restored upon the eligible juvenile’s release from the public institution.

(C)If an individual who is an eligible juvenile, as described in clause (ii) of subparagraph (A) of paragraph (1), the county welfare department shall process any application for medical assistance submitted by, or on behalf of, the individual for the purpose of making a determination of Medi-Cal eligibility for that individual to receive medical assistance under the Medi-Cal program upon the release of that individual from the public institution.

(e)This section does not create a state-funded benefit or program. Health care services under this chapter and Chapter 8 (commencing with Section 14200) shall be unavailable to inmates of public institutions whose Medi-Cal benefits have been suspended under this section.

(f)This section shall be implemented only if and to the extent allowed by federal law. This section shall be implemented only to the extent that any necessary federal approval of state plan amendments or other federal approvals are obtained.

(g)If any part of this section is in conflict with or does not comply with federal law, this entire section shall be inoperative.

(h)This section shall be implemented on January 1, 2010, or the date when all necessary federal approvals are obtained, whichever is later.

(i)By January 1, 2010, or the date when all necessary federal approvals are obtained, whichever is later, the department, in consultation with the Chief Probation Officers of California and the County Welfare Directors Association of California, shall establish the protocols and procedures necessary to implement this section, including any needed changes to the protocols and procedures previously established to implement Section 14029.5.

(j)The department shall determine whether federal financial participation will be jeopardized by implementing this section and shall implement this section only if and to the extent that federal financial participation is not jeopardized.

(k)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of all-county letters or similar instructions without taking regulatory action. 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.

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.