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AB-1937 Medi-Cal: out-of-pocket pregnancy costs.(2021-2022)



Current Version: 03/16/22 - Amended Assembly

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AB1937:v98#DOCUMENT

Amended  IN  Assembly  March 16, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 1937

Introduced by Assembly Member Patterson
(Coauthors: Assembly Members Chen and Lackey)

February 10, 2022

An act to add Section 14005.186 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1937, as amended, Patterson. Medi-Cal: out-of-pocket pregnancy costs.
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. Under existing law, an individual is eligible for Medi-Cal benefits, as though the individual was pregnant, for all pregnancy-related and postpartum services for a one-year period beginning on the last day of pregnancy. Existing law also establishes the Medi-Cal Access Program, which provides health care services to a person who is pregnant or in their postpartum period and whose household income is between specific thresholds and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified.
This bill would require the department, on or before January 1, 2024, July 1, 2023, to establish a health expense account program for pregnant Medi-Cal beneficiaries and pregnant subscribers of the Medi-Cal Access Program. The bill would make a Medi-Cal beneficiary who is pregnant or a pregnant subscriber of the Medi-Cal Access Program eligible for reimbursement for “out-of-pocket pregnancy related pregnancy-related costs,” as defined, specified, in an amount not to exceed $1,000. $1,250. The bill would require the person to submit the request for reimbursement within 3 months of the end of the pregnancy in order to be reimbursed. The bill would require the department to seek to maximize federal financial participation in implementing the program. The bill would require the department, to the extent federal financial participation is unavailable, to implement the program only with state funds. The bill would require the department to contract out for purposes of implementing the health expense account program, as specified. The bill would authorize the department to implement the above-described provisions through all-county or plan letters, or similar instructions, and would require regulatory action no later than January 1, 2026.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14005.186 is added to the Welfare and Institutions Code, immediately following Section 14005.185, to read:

14005.186.
 (a) On or before, January 1, 2024, before July 1, 2023, the department shall establish a health expense account program for pregnant Medi-Cal beneficiaries and pregnant subscribers of the Medi-Cal Access Program established pursuant to Chapter 2 (commencing with Section 15810) of Part 3.3.
(b) (1) A person eligible pursuant to described in subdivision (a) shall be eligible for reimbursement for out-of-pocket pregnancy related pregnancy-related costs in an amount not to exceed one-thousand dollars ($1,000). one thousand two hundred fifty dollars ($1,250).
(2) (A) For purposes of this section, “out-of-pocket pregnancy-related costs” includes birth and infant care classes, doula services, midwifery care, lactation support services, prenatal vitamins, lab tests or screening, prenatal acupuncture or acupressure, and transportation expenses essential to medical care.
(B) A person described in subdivision (a) shall not have to seek approval or be denied reimbursement for care for that care to be considered an out-of-pocket pregnancy-related cost.
(3) The Department may authorize reimbursement for additional pregnancy-related expenses as it deems fit.
(c) A person eligible pursuant to described in subdivision (a) shall not be reimbursed for costs unless the request for reimbursement is submitted within three months after the last day of pregnancy.
(d) In implementing this section, the department shall seek to maximize federal financial participation. To the extent federal financial participation is unavailable, the department shall implement this section only with state funds.

(e)For purposes of this section, “out-of-pocket pregnancy related costs” includes, but is not limited to, birthing classes, hiring a doula, midwife care, purchasing a new car seat, crib, or other similar item.

(e) The department shall contract out for purposes of implementing this health expense account program. The department shall follow a competitive bid process.
(f) (1) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement, interpret, or make specific this section by means of all-county letters, bulletins, or similar written instructions from either department until regulations are adopted. These all-county letters or similar written instructions shall have the same force and effect as regulations.
(2) Regulations shall be adopted pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) by the department no later than January 1, 2026.