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 is authorized to 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 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.

Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.

This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment pathway, designating the WIC Program and its local WIC agencies as Express Lane agencies and using WIC eligibility determinations to meet Medi-Cal eligibility requirements. The bill would require the pathway to perform specified functions to streamline Medi-Cal enrollment and maximize health care coverage. The bill would require that benefits for applicants enrolling in the Medi-Cal program using the pathway be provided immediately through accelerated enrollment for children and presumptive eligibility for pregnant women. The bill would also require the pathway to modify the existing WIC enrollment system and Medi-Cal eligibility and enrollment systems to electronically transfer to WIC the WIC Program the Medi-Cal eligibility determinations and contact information of Medi-Cal enrollees who are eligible for WIC the WIC Program for the purpose of enrolling those Medi-Cal enrollees in WIC. local WIC agencies contacting prospective WIC enrollees to complete their enrollment in the WIC Program.

The bill would, while the automated enrollment pathway is being developed, require the department, in coordination with the WIC Program and local WIC agencies to, among other things, conduct regular data matches to identify which WIC recipients are not enrolled in the Medi-Cal program and which Medi-Cal beneficiaries are eligible for, but not enrolled in, the WIC Program, and to provide specify specified notices about program eligibility to those persons. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition their implementation on the department obtaining all necessary federal approvals. The bill would also require the department to complete the project approval lifecycle process, as specified, for the automated enrollment pathway prior to implementing these provisions.

Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, 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.