Bill Text: CA ABX11 | 2013-2014 | Regular Session | Amended

California Assembly Bill 1 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: eligibility.

Spectrum: Partisan Bill (Democrat 17-0)

Status: (Passed) 2013-06-27 - Chaptered by Secretary of State. Chapter 3, Statutes of 2013-14 First Extraordinary Session. [ABX11 Detail]

Download: California-2013-ABX11-Amended.html
BILL NUMBER: ABX1 1	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 4, 2013

INTRODUCED BY   Assembly Member John A. P�rez
   (  Coauthor:   Assembly Member 
 Pan   Coauthors:   Assembly Members
  Alejo,   Blumenfield,   Bocanegra, 
 Campos,   Eggman,   Garcia,   Gomez,
  Hernandez,   Pan,   V. Manuel P�rez,
  and Quirk-Silva  )
    (   Coauthors:   Senators  
Calderon,   Correa,   De Le�n,   Hueso,
  and Lara   ) 

                        JANUARY 28, 2013

   An act to amend Section 12698.30 of the Insurance Code, and to
amend Sections  14005.31, 14005.32,   14005.36,
14005.39,  14132, and 15926 of, to amend and repeal Sections
 14005.38,  14008.85, 14011.16, and 14011.17 of, to amend,
repeal, and add Sections 14005.18, 14005.28, 14005.30,  14005.31,
14005.32,  14005.37, 14007.1, 14007.6, and 14012 of, 
and  to add Sections  14000.7,  14005.60, 14005.62,
14005.63, 14005.64, 14005.65,  14007.15, 14014.5, 14015.7,
14055, 14057, 14102, 14102.5,  and 14132.02 to,  and to add
and repeal Section 14015.5 of,  the Welfare and Institutions
Code, relating to health.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1, as amended, John A. P�rez. Medi-Cal: 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.
   This bill would, commencing January 1, 2014, implement various
provisions of the federal Patient Protection and Affordable Care Act
(Affordable Care Act), as amended, by, among other things, modifying
provisions relating to determining eligibility for certain groups.
The bill would, in this regard, extend Medi-Cal eligibility to
specified adults  and former foster children  and would
require that income eligibility be determined based on modified
adjusted gross income (MAGI), as prescribed. The bill would prohibit
the use of an asset or resources test for individuals whose financial
eligibility for Medi-Cal is determined based on the application of
MAGI. The bill would also add, commencing January 1, 2014, benefits,
services, and coverage included in the essential health benefits
package, as adopted by the state and approved by the United States
Secretary of Health and Human Services, to the schedule of Medi-Cal
benefits.
   Because counties are required to make Medi-Cal eligibility
determinations and this bill would expand Medi-Cal eligibility, the
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 these
statutory provisions.  
   This bill would require that a person who wishes to apply for an
insurance affordability program, as defined, be allowed to file an
application on his or her own behalf or on behalf of his or her
family and would authorize a person to be accompanied, assisted, and
represented in the application and renewal process by an individual
or organization of his or her choice. This bill would also require
the department, to the extent required by federal law, to provide
assistance to any applicant or beneficiary who requests help with the
application or redetermination.  
   The bill would require the California Health Benefit Exchange
(Exchange) to implement a workflow transfer protocol, as prescribed,
for persons calling the customer service center operated by the
Exchange for the purpose of applying for an insurance affordability
program, to ascertain which individuals are potentially eligible for
Medi-Cal. This bill would also prescribe the authority the
department, the Exchange, and the counties would have, until July 1,
2015, to perform Medi-Cal eligibility determinations.  
   Existing law requires the department to adopt regulations for use
by the county in determining whether an applicant is a resident of
the state and of the county, subject to the requirements of federal
law. Existing law requires that the regulations require that state
residency be established only if certain requirements are met,
including the requirement that the applicant makes specified
declarations under penalty of perjury.  
   This bill would revise those provisions to, among other things,
further prescribe the circumstances under which state residency may
be established and to require the department to electronically verify
an individual's state residency using certain sources and would set
forth how an individual may establish state residency if the
department is unable to electronically verify his or her state
residency. The bill would, for purposes of establishing state
residency, authorize an individual to make various declarations under
penalty of perjury, and would authorize other individuals, such as
parents or legal guardians, to make various declarations under
penalty of perjury regarding the individual's state residency if the
individual is incapable of indicating intent. By expanding the crime
of perjury, the bill would impose a state-mandated local program.
 
   Existing law requires Medi-Cal beneficiaries, with some
exceptions, to file semiannual status reports to ensure that
beneficiaries make timely and accurate reports of any change in
circumstance that may affect their eligibility and requires, with
some exceptions, a county to promptly redetermine eligibility
whenever a county receives information about changes in a beneficiary'
s circumstances that may affect eligibility for Medi-Cal benefits.
 
   This bill would, commencing January 1, 2014, revise these
provisions to, among other things, delete the semiannual status
report requirement and require a county to perform redeterminations
every 12 months. The bill would require any forms signed by the
beneficiary for purposes of redetermining eligibility to be signed
under penalty of perjury. By expanding the crime of perjury, the 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 with regard to certain mandates no
reimbursement is required by this act for a specified reason. 

   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so 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.
State-mandated 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 United States is the only industrialized country in the
world without a universal health insurance system.
   (b) (1) In 2006, the United States Census reported that 46 million
Americans did not have health insurance.
   (2) In California in 2009, according to the UCLA Center for Health
Policy Research's "The State of Health Insurance in California:
Findings from the 2009 California Health Interview Survey," 7.1
million Californians were uninsured in 2009, amounting to 21.1
percent of nonelderly Californians who had no health insurance
coverage for all or some of 2009, up nearly 2 percentage points from
2007.
   (c) On March 23, 2010, President Obama signed the Patient
Protection and Affordable Care Act (Public Law 111-148), which was
amended by the Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), and together are referred to as the Affordable
Care Act of 2010 (Affordable Care Act).
   (d) The Affordable Care Act is the culmination of decades of
movement toward health reform, and is the most fundamental
legislative transformation of the United States health care system in
40 years.
   (e) As a result of the enactment of the Affordable Care Act,
according to estimates by the UCLA Center for Health Policy Research
and the UC Berkeley Labor Center, using the California Simulation of
Insurance Markets, in 2019, after the Affordable Care Act is fully
implemented:
   (1) Between 89 and 92 percent of Californians under 65 years of
age will have health coverage.
   (2) Between 1.2 and 1.6 million individuals will be newly enrolled
in Medi-Cal.
   (f) It is the intent of the Legislature to ensure full
implementation of the Affordable Care Act, including the Medi-Cal
expansion for individuals with incomes below 133 percent of the
federal poverty level, so that millions of uninsured Californians can
receive health care coverage.
  SEC. 2.  Section 12698.30 of the Insurance Code is amended to read:

   12698.30.  (a) (1) Subject to paragraph (2), at a minimum,
coverage shall be provided to subscribers during one pregnancy, and
for 60 days thereafter, and to children less than two years of age
who were born of a pregnancy covered under this program to a woman
enrolled in the program before July 1, 2004.
   (2) Commencing January 1, 2014, at a minimum, coverage shall be
provided to subscribers during one pregnancy, and until the end of
the month in which the 60th day thereafter occurs, and to children
less than two years of age who were born of a pregnancy covered under
this program to a woman enrolled in the program before July 1, 2004.

   (b) Coverage provided pursuant to this part shall include, at a
minimum, those services required to be provided by health care
service plans approved by the United States Secretary of Health and
Human Services as a federally qualified health care service plan
pursuant to Section 417.101 of Title 42 of the Code of Federal
Regulations.
   (c) Coverage shall include health education services related to
tobacco use.
   (d) Medically necessary prescription drugs shall be a required
benefit in the coverage provided under this part.
   SEC. 3.    Section 14000.7 is added to the  
Welfare and Institutions Code   , to read:  
   14000.7.  (a) The department shall provide assistance to any
applicant or beneficiary that requests help with the application or
redetermination process to the extent required by federal law.
   (b) The assistance provided under subdivision (a) shall be
available to the individual in person, over the telephone, and
online, and in a manner that is accessible to individuals with
disabilities and those who have limited English proficiency.
   (c) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law.
   (d) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (e) This section shall become operative on January 1, 2014. 
   SEC. 3.   SEC. 4.   Section 14005.18 of
the Welfare and Institutions Code is amended to read:
   14005.18.  (a) A woman is eligible, to the extent required by
federal law, as though she were pregnant, for all pregnancy-related
and postpartum services for a 60-day period beginning on the last day
of pregnancy.
   For purposes of this section, "postpartum services" means those
services provided after childbirth, child delivery, or miscarriage.
   (b) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 4.   SEC. 5.   Section 14005.18 is
added to the Welfare and Institutions Code, to read:
   14005.18.  (a) To help prevent premature delivery and low
birthweights, the leading causes of infant and maternal morbidity and
mortality, and to promote women's overall health, well-being, and
financial security and that of their families, it is imperative that
pregnant women enrolled in Medi-Cal be provided with all medically
necessary services. Therefore, a woman is eligible, to the extent
required by federal law, as though she were pregnant, for all
pregnancy-related and postpartum services for a  60-day
 period beginning on the last day of pregnancy and
continuing until the end of the month in which the 60th day of
postpartum occurs.
   (b) For purposes of this section, the following definitions shall
apply:
   (1) "Pregnancy-related services" means, at a minimum, all services
required under the state  plan unless federal approval is
granted after January 1, 2014, pursuant to the procedure under the
Preamble to the Final Rule at page 17149 of volume 77 of the Federal
Register (March 23, 2012) to provide fewer benefits during pregnancy.
  plan. 
   (2) "Postpartum services" means those services provided after
child birth, child delivery, or miscarriage.
   (c) This section shall become operative January 1, 2014.
   SEC. 5.   SEC. 6.   Section 14005.28 of
the Welfare and Institutions Code is amended to read:
   14005.28.  (a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall exercise its option under Section 1902(a)(10)(A)(ii)
(XVII) of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)
(10)(A)(ii)(XVII)) to extend Medi-Cal benefits to independent foster
care adolescents, as defined in Section 1905(w)(1) of the federal
Social Security Act (42 U.S.C. Sec. 1396d(w)(1)).
   (b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, and if the
state plan amendment described in subdivision (a) is approved by the
federal Health Care Financing Administration, the department may
implement subdivision (a) without taking any regulatory action and by
means of all-county letters or similar instructions. 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.
   (c) The department shall implement subdivision (a) on October 1,
2000, but only if, and to the extent that, the department has
obtained all necessary federal approvals. 
   (d) The department shall identify and track all former independent
foster care adolescents who, on or after January 1, 2013, lost
Medi-Cal coverage as a result of attaining 21 years of age. 

   (e) 
    (d)  This section shall remain in effect only until
January 1, 2014, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2014, deletes or
extends that date. 
  SEC. 6.    Section 14005.28 is added to the
Welfare and Institutions Code, to read:
   14005.28.  (a) Commencing January 1, 2014, and to the extent
federal financial participation is available pursuant to an approved
state plan amendment, the department shall implement Section 1902(a)
(10)(A)(i)(IX) of the federal Social Security Act (42 U.S.C. Sec.
1396a(a)(10)(A)(i)(IX)) to provide Medi-Cal benefits to a former
foster care adolescent until his or her 26th birthday.
   (1) A foster care adolescent who was in foster care on his or her
18th birthday shall be deemed eligible for the benefits provided
pursuant to this section and shall be enrolled to receive these
benefits until his or her 26th birthday without any interruption in
coverage and without requiring a new application.
   (2) The department shall develop procedures to identify
individuals who meet the criteria in paragraph (1), including, but
not limited to, former foster care adolescents who lost Medi-Cal
coverage as a result of attaining 21 years of age, and reenroll them
in Medi-Cal.
   (3) The department shall develop and implement a simplified
redetermination form for this program. A recipient qualifying for the
benefits extended pursuant to this section shall fill out and return
this form only if information previously reported to the department
is no longer accurate. Failure to return the form alone will not
constitute a basis for termination of Medi-Cal. If the form is
returned as undeliverable and the county is otherwise unable to
establish contact, the recipient shall remain eligible for
fee-for-service Medi-Cal until such time as contact is reestablished
or ineligibility is established, and to the extent federal financial
participation is available. The department may terminate eligibility
if it determines that the recipient is no longer eligible only after
ineligibility is established and all due process requirements are met
in accordance with state and federal law.
   (4) This section shall be implemented to the extent that federal
financial participation is available, and any necessary federal
approvals are obtained.
   (b) This section shall become operative January 1, 2014. 

   SEC. 7.    Section 14005.28 is added to the 
 Welfare and Institutions Code   , to read:  
   14005.28.  (a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall implement Section 1902(a)(10)(A)(i)(IX) of the
federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(i)(IX))
to provide Medi-Cal benefits to an individual who is in foster care
on his or her 18th birthday until his or her 26th birthday. In
addition, the department shall implement the option in paragraph (3)
of subdivision (b) of Section 435.150 of Title 42 of the Code of
Federal Regulations to provide Medi-Cal benefits to individuals that
were in foster care and enrolled in Medicaid in any state.
   (1) A foster care adolescent who is in foster care on his or her
18th birthday shall be enrolled to receive benefits under this
section without any interruption in coverage and without requiring a
new application.
   (2) The department shall develop procedures to identify and enroll
individuals who meet the criteria for Medi-Cal eligibility in this
subdivision, including, but not limited to, former foster care
adolescents who were in foster care on their 18th birthday and who
lost Medi-Cal coverage as a result of attaining 21 years of age. The
department shall work with counties to identify and conduct outreach
to former foster care adolescents who lost Medi-Cal coverage during
the 2013 calendar year as a result of attaining 21 years of age, to
ensure they are aware of the ability to reenroll under the coverage
provided pursuant to this section.
   (3) (A) The department shall develop and implement a simplified
redetermination form for this program. A beneficiary qualifying for
the benefits extended pursuant to this section shall fill out and
return this form only if information known to the department is no
longer accurate or is materially incomplete.
   (B) The department shall seek federal approval to institute a
renewal process that allows a beneficiary receiving benefits under
this section to remain on Medi-Cal after a redetermination form is
returned as undeliverable and the county is otherwise unable to
establish contact. If federal approval is granted, the recipient
shall remain eligible for services under the Medi-Cal fee-for-service
program until the time contact is reestablished or ineligibility is
established, and to the extent federal financial participation is
available.
   (C) The department shall terminate eligibility only after it
determines that the recipient is no longer eligible and all due
process requirements are met in accordance with state and federal
law.
   (b) This section shall be implemented only if and to the extent
that federal financial participation is available.
   (c) This section shall become operative January 1, 2014. 
   SEC. 7.   SEC. 8.   Section 14005.30 of
the Welfare and Institutions Code is amended to read:
   14005.30.  (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) made available to and exercised by the
state.
   (2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
   (3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u-1(b)(2)
(C) of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012. The department shall
implement this paragraph only if, and to the extent that the State
Child Health Insurance Program waiver described in Section 12693.755
of the Insurance Code extending Healthy Families Program eligibility
to parents and certain other adults is approved and implemented.
   (b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to expand eligibility for Medi-Cal under subdivision (a) by
establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).
   (c) To the extent federal financial participation is available,
the department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1) and the amount
equal to 100 percent of the federal poverty level applicable to the
size of the family. A recipient shall be entitled to the same
disregard, but only to the extent it is more beneficial than, and is
substituted for, the earned income disregard available to recipients.

   (d) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec. 401
 and following)   et seq.)  arising from
cost-of-living adjustments shall be disregarded commencing in the
month that these social security benefit payments are increased by
the cost-of-living adjustment through the month before the month in
which a change in the federal poverty level requires the department
to modify the income disregard pursuant to subdivision (c) and in
which new income limits for the program established by this section
are adopted by the department.
   (e) Subdivision (b) shall be applied retroactively to January 1,
1998.
   (f) 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, without taking regulatory action,
subdivisions (a) and (b) of this section by means of an  all
county   all-county  letter or similar instruction.
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.
   (g) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 8.   SEC. 9.   Section 14005.30 is
added to the Welfare and Institutions Code, to read:
   14005.30.  (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, known as the Section
1931(b) program, including any options under Section 1396u-1(b)(2)(C)
made available to and exercised by the state.
   (2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
   (b) Commencing January 1, 2014, pursuant to Section 1396a(e)(14)
(C) of Title 42 of the United States Code, there shall be no assets
test and no deprivation test for any individual under this section.
   (c) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec. 401
et seq.) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the federal
poverty level requires the department to modify the income disregard
pursuant to subdivision (c) and in which new income limits for the
program established by this section are adopted by the department.
   (d) This section shall become operative January 1, 2014.
   SEC. 9.   SEC. 10.   Section 14005.31 of
the Welfare and Institutions Code is amended to read:
   14005.31.  (a) (1) Subject to paragraph (2), for any person whose
eligibility for benefits under Section 14005.30 has been determined
with a concurrent determination of eligibility for cash aid under
Chapter 2 (commencing with Section 11200), loss of eligibility or
termination of cash aid under Chapter 2 (commencing with Section
11200) shall not result in a loss of eligibility or termination of
benefits under Section 14005.30 absent the existence of a factor that
would result in loss of eligibility for benefits under Section
14005.30 for a person whose eligibility under Section 14005.30 was
determined without a concurrent determination of eligibility for
benefits under Chapter 2 (commencing with Section 11200).
   (2) Notwithstanding paragraph (1), a person whose eligibility
would otherwise be terminated pursuant to that paragraph shall not
have his or her eligibility terminated until the transfer procedures
set forth in Section 14005.32 or the redetermination procedures set
forth in Section 14005.37 and all due process requirements have been
met.
   (b) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties, to inform Medi-Cal beneficiaries whose
eligibility for cash aid under Chapter 2 (commencing with Section
11200) has ended, but whose eligibility for benefits under Section
14005.30 continues pursuant to subdivision (a), that their benefits
will continue. To the extent feasible, the notice shall be sent out
at the same time as the notice of discontinuation of cash aid, and
shall include all of the following:
   (1) A statement that Medi-Cal benefits will continue even though
cash aid under the CalWORKs program has been terminated.
   (2) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (3)  (A)    A statement that the
Medi-Cal beneficiary does not need to fill out monthly status
reports in order to remain eligible for Medi-Cal, but  may
  shall  be required to submit a semiannual status
report and annual reaffirmation forms. The notice shall remind
individuals whose cash aid ended under the CalWORKs program as a
result of not submitting a status report that he or she should review
his or her circumstances to determine if changes have occurred that
should be reported to the Medi-Cal eligibility worker. 
   (B) Commencing January 1, 2014, the semiannual status report
requirement shall not be included in the statement described in
subparagraph (A). 
   (4) A statement describing the responsibility of the Medi-Cal
beneficiary to report to the county, within 10 days, significant
changes that may affect eligibility.
   (5) A telephone number to call for more information.
   (6) A statement that the Medi-Cal beneficiary's eligibility worker
will not change, or, if the case has been reassigned, the new worker'
s name, address, and telephone number, and the hours during which the
county's eligibility workers can be contacted.
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of  all county  
all-county  letters or similar instructions. 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. Comprehensive
implementing instructions shall be issued to the counties no later
than March 1, 2001. 
   (e) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date. 
  SEC. 11.    Section 14005.31 is added to the 
 Welfare and Institutions Code   , to read:  
   14005.31.  (a) (1) Subject to paragraph (2), for any person whose
eligibility for benefits under Section 14005.30 has been determined
with a concurrent determination of eligibility for cash aid under
Chapter 2 (commencing with Section 11200), loss of eligibility or
termination of cash aid under Chapter 2 (commencing with Section
11200) shall not result in a loss of eligibility or termination of
benefits under Section 14005.30 absent the existence of a factor that
would result in loss of eligibility for benefits under Section
14005.30 for a person whose eligibility under Section 14005.30 was
determined without a concurrent determination of eligibility for
benefits under Chapter 2 (commencing with Section 11200).
   (2) Notwithstanding paragraph (1), a person whose eligibility
would otherwise be terminated pursuant to that paragraph shall not
have his or her eligibility terminated until the transfer procedures
set forth in Section 14005.32 or the redetermination procedures set
forth in Section 14005.37 and all due process requirements have been
met.
   (b) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties to inform Medi-Cal beneficiaries whose
eligibility for cash aid under Chapter 2 (commencing with Section
11200) has ended, but whose eligibility for benefits under Section
14005.30 continues pursuant to subdivision (a), that their benefits
will continue. To the extent feasible, the notice shall be sent out
at the same time as the notice of discontinuation of cash aid, and
shall include all of the following:
   (1) A statement that Medi-Cal benefits will continue even though
cash aid under the CalWORKs program has been
                            terminated.
   (2) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (3) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but may be required to submit annual reaffirmation forms.
The notice shall remind individuals whose cash aid ended under the
CalWORKs program as a result of not submitting a status report that
he or she should review his or her circumstances to determine if
changes have occurred that should be reported to the Medi-Cal
eligibility worker.
   (4) A statement describing the responsibility of the Medi-Cal
beneficiary to report to the county, within 10 days, significant
changes that may affect eligibility.
   (5) A telephone number to call for more information.
   (6) A statement that the Medi-Cal beneficiary's eligibility worker
will not change, or, if the case has been reassigned, the new worker'
s name, address, and telephone number, and the hours during which the
county's eligibility workers can be contacted.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted.
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. Beginning six
months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (d) This section shall become operative on January 1, 2014. 
   SEC. 10.   SEC. 12.   Section 14005.32
of the Welfare and Institutions Code is amended to read:
   14005.32.  (a) (1) If the county has evidence clearly
demonstrating that a beneficiary is not eligible for benefits under
this chapter pursuant to Section 14005.30, but is eligible for
benefits under this chapter pursuant to other provisions of law, the
county shall transfer the individual to the corresponding Medi-Cal
program. Eligibility under Section 14005.30 shall continue until the
transfer is complete.
   (2) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties, to inform beneficiaries that their Medi-Cal
benefits have been transferred pursuant to paragraph (1) and to
inform them about the program to which they have been transferred. To
the extent feasible, the notice shall be issued with the notice of
discontinuance from cash aid, and shall include all of the following:

   (A) A statement that Medi-Cal benefits will continue under another
program, even though aid under Chapter 2 (commencing with Section
11200) has been terminated.
   (B) The name of the program under which benefits will continue,
and an explanation of that program.
   (C) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (D)  (i)    A statement that the
Medi-Cal beneficiary does not need to fill out monthly status
reports in order to remain eligible for Medi-Cal, but  may
  shall  be required to submit a semiannual status
report and annual reaffirmation forms. In addition, if the person or
persons to whom the notice is directed has been found eligible for
transitional Medi-Cal as described in Section 14005.8 or 14005.85,
the statement shall explain the reporting requirements and duration
of benefits under those programs, and shall further explain that, at
the end of the duration of these benefits, a redetermination, as
provided for in Section 14005.37 shall be conducted to determine
whether benefits are available under any other provision of law.

   (ii) Commencing January 1, 2014, the semiannual status report
requirement shall not be included in the statement described in
clause (i). 
   (E) A statement describing the beneficiary's responsibility to
report to the county, within 10 days, significant changes that may
affect eligibility or share of cost.
   (F) A telephone number to call for more information.
   (G) A statement that the beneficiary's eligibility worker will not
change, or, if the case has been reassigned, the new worker's name,
address, and telephone number, and the hours during which the county'
s Medi-Cal eligibility workers can be contacted.
   (b) No later than September 1, 2001, the department shall submit a
federal waiver application seeking authority to eliminate the
reporting requirements imposed by transitional medicaid under Section
1925 of the federal Social Security Act (Title 42 U.S.C. Sec.
1396r-6).
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of  all county  
all-county  letters or similar instructions. 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. Comprehensive
implementing instructions shall be issued to the counties no later
than March 1, 2001. 
   (e) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date. 
   SEC. 13.    Section 14005.32 is added to the 
 Welfare and Institutions Code   , to read:  
   14005.32.  (a) (1) If the county has evidence clearly
demonstrating that a beneficiary is not eligible for benefits under
this chapter pursuant to Section 14005.30, but is eligible for
benefits under this chapter pursuant to other provisions of law, the
county shall transfer the individual to the corresponding Medi-Cal
program in conformity with and subject to the requirements of Section
14005.37. Eligibility under Section 14005.30 shall continue until
the transfer is complete.
   (2) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties to inform beneficiaries that their Medi-Cal
benefits have been transferred pursuant to paragraph (1) and to
inform them about the program to which they have been transferred. To
the extent feasible, the notice shall be issued with the notice of
discontinuance from cash aid, and shall include all of the following:

   (A) A statement that Medi-Cal benefits will continue under another
program, even though aid under Chapter 2 (commencing with Section
11200) has been terminated.
   (B) The name of the program under which benefits will continue and
an explanation of that program.
   (C) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (D) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but may be required to submit annual reaffirmation forms.
In addition, if the person or persons to whom the notice is directed
has been found eligible for transitional Medi-Cal as described in
Section 14005.8 or 14005.85, the statement shall explain the
reporting requirements and duration of benefits under those programs
and shall further explain that, at the end of the duration of these
benefits, a redetermination, as provided in Section 14005.37, shall
be conducted to determine whether benefits are available under any
other law.
   (E) A statement describing the beneficiary's responsibility to
report to the county, within 10 days, significant changes that may
affect eligibility or share of cost.
   (F) A telephone number to call for more information.
   (G) A statement that the beneficiary's eligibility worker will not
change, or, if the case has been reassigned, the new worker's name,
address, and telephone number, and the hours during which the county'
s Medi-Cal eligibility workers can be contacted.
   (b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted.
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. Beginning six
months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (c) This section shall become operative on January 1, 2014. 
   SEC. 14.    Section 14005.36 of the  
Welfare and Institutions Code   is amended to read: 
   14005.36.  (a) The county shall undertake outreach efforts to
beneficiaries receiving benefits under this chapter, in order to
maintain the most up-to-date home addresses, telephone numbers, and
other necessary contact information, and to encourage and assist with
timely submission of the annual reaffirmation form, and, when
applicable, transitional Medi-Cal program reporting forms and to
facilitate the Medi-Cal redetermination process when one is required
as provided in Section 14005.37. In implementing this subdivision, a
county may collaborate with community-based organizations, provided
that confidentiality is protected.
   (b) The department shall encourage and facilitate efforts by
managed care plans to report updated beneficiary contact information
to counties.
   (c) The department and each county shall incorporate, in a timely
manner, updated contact information received from managed care plans
pursuant to subdivision (b) into the beneficiary's Medi-Cal case file
and into all systems used to inform plans of their beneficiaries'
enrollee status. Updated Medi-Cal beneficiary contact information
shall be limited to the beneficiary's telephone number, change of
address information, and change of name. The county  may
  shall  attempt to verify that the information it
receives from the plan is accurate  , which may include, but is
not limited to, making contact with the beneficiary,  before
updating the beneficiary's case file.  The department shall
develop a consent form that may be used by the counties to record the
beneficiary's consent to use the information received from a managed
care plan to update the beneficiary's file. 
   (d) This section shall be implemented  on or before July
1, 2001, but  only to the extent that federal financial
participation under Title XIX of the federal Social Security Act
 (Title 42   (42  U.S.C. Sec. 1396 
and following)   et seq.)  is available. 
   (e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
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. Comprehensive
implementing instructions shall be issued to the counties no later
than March 1, 2001.  
   (e) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law. 
   SEC. 11.   SEC. 15.   Section 14005.37
of the Welfare and Institutions Code is amended to read:
   14005.37.  (a) Except as provided in Section 14005.39, whenever a
county receives information about changes in a beneficiary's
circumstances that may affect eligibility for Medi-Cal benefits, the
county shall promptly redetermine eligibility. The procedures for
redetermining Medi-Cal eligibility described in this section shall
apply to all Medi-Cal beneficiaries.
   (b)  Loss of eligibility for cash aid under that program shall not
result in a redetermination under this section unless the reason for
the loss of eligibility is one that would result in the need for a
redetermination for a person whose eligibility for Medi-Cal under
Section 14005.30 was determined without a concurrent determination of
eligibility for cash aid under the CalWORKs program.
   (c) A loss of contact, as evidenced by the return of mail marked
in such a way as to indicate that it could not be delivered to the
intended recipient or that there was no forwarding address, shall
require a prompt redetermination according to the procedures set
forth in this section.
   (d) Except as otherwise provided in this section, Medi-Cal
eligibility shall continue during the redetermination process
described in this section. A Medi-Cal beneficiary's eligibility shall
not be terminated under this section until the county makes a
specific determination based on facts clearly demonstrating that the
beneficiary is no longer eligible for Medi-Cal under any basis and
due process rights guaranteed under this division have been met.
   (e) For purposes of acquiring information necessary to conduct the
eligibility determinations described in subdivisions (a) to (d),
inclusive, a county shall make every reasonable effort to gather
information available to the county that is relevant to the
beneficiary's Medi-Cal eligibility prior to contacting the
beneficiary. Sources for these efforts shall include, but are not
limited to, Medi-Cal, CalWORKs, and CalFresh case files of the
beneficiary or of any of his or her immediate family members, which
are open or were closed within the last 45 days, and wherever
feasible, other sources of relevant information reasonably available
to the counties.
   (f) If a county cannot obtain information necessary to redetermine
eligibility pursuant to subdivision (e), the county shall attempt to
reach the beneficiary by telephone in order to obtain this
information, either directly or in collaboration with community-based
organizations so long as confidentiality is protected.
   (g) If a county's efforts pursuant to subdivisions (e) and (f) to
obtain the information necessary to redetermine eligibility have
failed, the county shall send to the beneficiary a form, which shall
highlight the information needed to complete the eligibility
determination. The county shall not request information or
documentation that has been previously provided by the beneficiary,
that is not absolutely necessary to complete the eligibility
determination, or that is not subject to change. The form shall be
accompanied by a simple, clear, consumer-friendly cover letter, which
shall explain why the form is necessary, the fact that it is not
necessary to be receiving CalWORKs benefits to be receiving Medi-Cal
benefits, the fact that receipt of Medi-Cal benefits does not count
toward any time limits imposed by the CalWORKs program, the various
bases for Medi-Cal eligibility, including disability, and the fact
that even persons who are employed can receive Medi-Cal benefits. The
cover letter shall include a telephone number to call in order to
obtain more information. The form and the cover letter shall be
developed by the department in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers. A Medi-Cal beneficiary shall have no less than 20 days
from the date the form is mailed pursuant to this subdivision to
respond. Except as provided in subdivision (h), failure to respond
prior to the end of this 20-day period shall not impact his or her
Medi-Cal eligibility.
   (h) If the purpose for a redetermination under this section is a
loss of contact with the Medi-Cal beneficiary, as evidenced by the
return of mail marked in such a way as to indicate that it could not
be delivered to the intended recipient or that there was no
forwarding address, a return of the form described in subdivision (g)
marked as undeliverable shall result in an immediate notice of
action terminating Medi-Cal eligibility.
   (i) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), a beneficiary does
not submit the completed form to the county, the county shall send
the beneficiary a written notice of action stating that his or her
eligibility shall be terminated 10 days from the date of the notice
and the reasons for that determination, unless the beneficiary
submits a completed form prior to the end of the 10-day period.
   (j) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), the beneficiary
submits an incomplete form, the county shall attempt to contact the
beneficiary by telephone and in writing to request the necessary
information. If the beneficiary does not supply the necessary
information to the county within 10 days from the date the county
contacts the beneficiary in regard to the incomplete form, a 10-day
notice of termination of Medi-Cal eligibility shall be sent.
   (k) If, within 30 days of termination of a Medi-Cal beneficiary's
eligibility pursuant to subdivision (h), (i), or (j), the beneficiary
submits to the county a completed form, eligibility shall be
determined as though the form was submitted in a timely manner and if
a beneficiary is found eligible, the termination under subdivision
(h), (i), or (j) shall be rescinded.
   (  l  ) If the information reasonably available to the
county pursuant to the redetermination procedures of subdivisions
(d), (e), (g), and (m) does not indicate a basis of eligibility,
Medi-Cal benefits may be terminated so long as due process
requirements have otherwise been met.
   (m) The department shall, with the counties and representatives of
consumers, including those with disabilities, and Medi-Cal
providers, develop a timeframe for redetermination of Medi-Cal
eligibility based upon disability, including ex parte review, the
redetermination form described in subdivision (g), timeframes for
responding to county or state requests for additional information,
and the forms and procedures to be used. The forms and procedures
shall be as consumer-friendly as possible for people with
disabilities. The timeframe shall provide a reasonable and adequate
opportunity for the Medi-Cal beneficiary to obtain and submit medical
records and other information needed to establish eligibility for
Medi-Cal based upon disability.
   (n) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.) is available.
   (o) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all-county letters or similar instructions.
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. Comprehensive
implementing instructions shall be issued to the counties no later
than March 1, 2001.
   (p) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 12.   SEC. 16.   Section 14005.37
is added to the Welfare and Institutions Code, to read:
   14005.37.  (a) Except as provided in Section 14005.39,  a
county shall perform redeterminations of eligibility for Medi-Cal
beneficiaries every 12 months and shall promp   tly
redetermine eligibility  whenever  a   the
 county receives information about changes in a beneficiary's
circumstances that may affect eligibility for Medi-Cal 
benefits, the county shall promptly redetermine eligibility 
 benefits  . The procedures for redetermining Medi-Cal
eligibility described in this section shall apply to all Medi-Cal
beneficiaries.
   (b)  Loss of eligibility for cash aid under that program shall not
result in a redetermination under this section unless the reason for
the loss of eligibility is one that would result in the need for a
redetermination for a person whose eligibility for Medi-Cal under
Section 14005.30 was determined without a concurrent determination of
eligibility for cash aid under the CalWORKs program.
   (c) A loss of contact, as evidenced by the return of mail marked
in such a way as to indicate that it could not be delivered to the
intended recipient or that there was no forwarding address, shall
require a prompt redetermination according to the procedures set
forth in this section.
   (d) Except as otherwise provided in this section, Medi-Cal
eligibility shall continue during the redetermination process
described in this  section. A   section and a
beneficiary's  Medi-Cal  beneficiary's 
eligibility shall not be terminated under this section until the
county makes a specific determination based on facts clearly
demonstrating that the beneficiary is no longer eligible for Medi-Cal
 benefits  under any basis and due process rights
guaranteed under this division have been met.
   (e) (1) For purposes of acquiring information necessary to conduct
the eligibility  determinations  
redeterminations  described in  subdivisions (a) to (d),
inclusive   this section  , a county shall gather
information available to the county that is relevant to the
beneficiary's Medi-Cal eligibility prior to contacting the
beneficiary. Sources for these efforts shall include  , but
are   information contained in the beneficiary's file or
other information, including more recent information available to
the county, including, but  not limited to, Medi-Cal, CalWORKs,
and CalFresh case files of the beneficiary or of any of his or her
immediate family members, which are open or were closed within the
last 45 days, information accessed through any databases accessed
 by the agency  under Sections 435.948, 435.949, and
435.956 of Title 42 of the Code of Federal Regulations, and wherever
feasible, other sources of relevant information reasonably available
to the  counties  county  . 
   (2) If the county is able to renew eligibility based on such
information, the county shall notify the individual of both of the
following:  
   (2) In the case of an annual redetermination, if, based upon
information obtained pursuant to paragraph (1), the county is able to
make a determination of continued eligibility, the county shall
notify the beneficiary of both of the following: 
   (A) The eligibility determination and  basis 
 the information it is based on  .
   (B) That the  individual   beneficiary 
is required to inform the county via the Internet, by telephone, by
mail, in person, or through other commonly available electronic
means, in counties where such electronic communication is available,
if any information contained in the notice is inaccurate but that the
 individual   beneficiary  is not required
to sign and return the notice if all information provided on the
notice is accurate.
   (3) The county shall make all reasonable efforts not to send
multiple notices during the same time period about eligibility. The
notice of eligibility renewal shall contain other related information
such as if the  individual   beneficiary 
is in a new Medi-Cal program. 
   (4) In the case of a redetermination due to a change in
circumstances, if a county determines that the change in
circumstances does not affect the beneficiary's eligibility status,
the county shall not send the beneficiary a notice unless required to
do so by federal law.  
   (f) (1) In the case of an annual eligibility redetermination, if
the county is unable to determine continued eligibility based on the
information obtained pursuant to paragraph (1) of subdivision (e),
the beneficiary shall be
so informed and shall be provided with an annual renewal form that is
prepopulated with information that the county has obtained and that
identifies any additional information needed by the county to
determine eligibility. The form shall be accompanied by a cover
letter advising the beneficiary of all of the following:  
   (A) The requirement that he or she provide any necessary
information to the county within 60 days of the date that the form is
sent to the beneficiary.  
   (B) That the beneficiary may respond to the county via the
Internet, by mail, by telephone, in person, or through other commonly
available electronic means if those means are available in that
county.  
   (C) That if the beneficiary chooses to return the form to the
county in person or via mail, the beneficiary shall sign the form in
order for it to be considered complete.  
   (D) The phone number to call in order to obtain more information.
 
   (2) The county shall attempt to contact the beneficiary via the
Internet, by telephone, or through other commonly available
electronic means, if those means are available in that county, during
the 60-day period to collect the necessary information.  
   (3) If the beneficiary has not provided any response to the
written request for information sent pursuant to paragraph (1) within
60 days from the date the form is sent, the county shall terminate
his or her eligibility for Medi-Cal benefits following the provision
of timely notice.  
   (4) If the beneficiary responds to the written request for
information during the 60-day period pursuant to paragraph (1) but
the information provided is not complete, the county shall follow the
procedures set forth in subdivision (g) to work with the beneficiary
to complete the information.  
   (5) (A) The form and cover letter required by this subdivision
shall be developed by the department in consultation with the
counties and representatives of eligibility workers and consumers.
 
   (B) For beneficiaries whose eligibility is not determined using
MAGI-based financial methods, the county may use existing renewal
forms until the state develops prepopulated renewal forms to provide
to beneficiaries. The department shall develop prepopulated renewal
forms for use with beneficiaries whose eligibility is not determined
using MAGI-based financial methods by January 1, 2015.  

   (f) If 
    (g)     (1)     In the
case of a redetermination due to change in circumstances, if  a
county cannot obtain  sufficient  information 
necessary  to redetermine eligibility pursuant to
subdivision (e), the county shall attempt to reach the beneficiary by
telephone and other commonly available electronic means, in counties
where such electronic communication is available, in order to obtain
this information, either directly or in collaboration with
community-based organizations so long as confidentiality is
protected. 
   (g) 
    (2)  If a county's efforts pursuant to
subdivisions   subdivision  (e) and  (f)
  paragraph (1) of this subdivision  to obtain the
information necessary to redetermine eligibility have failed, the
county shall send to the beneficiary a form  containing
  stating the  information  available to
the county  needed to renew eligibility.  The county
shall only request information related to the change in
circumstances.  The county shall not request information or
documentation that has been previously provided by the beneficiary,
that is not absolutely necessary to complete the eligibility
determination, or that is not subject to change. The county shall
 not   only  request information for
nonapplicants necessary to make an eligibility 
determination. The form shall be accompanied by a simple, clear,
consumer-friendly cover letter, that shall explain why the form is
necessary, the fact that it is not necessary to be receiving CalWORKs
benefits to be receiving Medi-Cal benefits, the fact that receipt of
Medi-Cal benefits does not count toward any time limits imposed by
the CalWORKs program, the various bases for Medi-Cal eligibility,
including disability, and the fact that even persons who are employed
can receive Medi-Cal benefits.   determination or for a
purpose directly related to the administration of the state Medicaid
plan.  The form shall advise the individual to provide any
necessary information to the county via the Internet, by telephone,
by mail, in person, or through other commonly available electronic
means and  , if the individual will provide the form by mail or
in person,  to sign the  renewal  form. The
 cover letter   form  shall include a
telephone number to call in order to obtain more information. The
form  and the cover letter  shall be developed by
the department in consultation with the counties  and
  ,  representatives of consumers,  managed
care plans, and Medi-Cal providers   and eligibility
workers  . A Medi-Cal beneficiary shall have no less than 20
days from the date the form is mailed pursuant to this subdivision to
respond. Except as provided in  subdivision (h) 
 paragraph (3)  , failure to respond prior to the end of
this 20-day period shall not impact his or her Medi-Cal eligibility.

   (h) 
    (3)  If the purpose for a redetermination under this
section is a loss of contact with the Medi-Cal beneficiary, as
evidenced by the return of mail marked in such a way as to indicate
that it could not be delivered to the intended recipient or that
there was no forwarding address, a return of the form described in
 this  subdivision  (g)  marked as
undeliverable shall result in an immediate notice of action
terminating Medi-Cal eligibility. 
   (i) 
    (4)  If, within 20 days of the date of mailing of a form
to the Medi-Cal beneficiary pursuant to  this  subdivision
 (g)  , a beneficiary does not submit the completed
form to the county  or otherwise provide the needed information
to the county  , the county shall send the beneficiary a written
notice of action stating that his or her eligibility shall be
terminated 10 days from the date of the notice and the reasons for
that determination, unless the beneficiary submits a completed form
 or otherwise provides the needed information to the county 
prior to the end of the 10-day period. 
   (j) 
    (5)  If, within 20 days of the date of mailing of a form
to the Medi-Cal beneficiary pursuant to  this  subdivision
 (g)  , the beneficiary submits an incomplete form,
the county shall attempt to contact the beneficiary by telephone, in
writing,  and   or  other commonly
available electronic means, in counties where such electronic
communication is available, to request the necessary information. If
the beneficiary does not supply the necessary information to the
county within 10 days from the date the county contacts the
beneficiary in regard to the incomplete form, a 10-day notice of
termination of Medi-Cal eligibility shall be sent. 
   (k) (1) Until January 1, 2014, if within 30 days of termination of
a Medi-Cal beneficiary's eligibility pursuant to subdivision (h),
(i), or (j), the beneficiary submits to the county a completed form,
eligibility shall be determined as though the form was submitted in a
timely manner and if a beneficiary is found eligible, the
termination under subdivision (h), (i), or (j) shall be rescinded.
 
   (2) Commencing January 1, 2014, if 
    (h)     If  within 90 days of
   termination of a Medi-Cal beneficiary's eligibility  or a
change in eligibility status  pursuant to  subdivision
(h), (i), or (j),   this section,  the beneficiary
submits to the county a  signed and  completed form  or
otherwise provides the needed information to the county  ,
eligibility shall be  determined as though the form was
submitted in a timely manner   redetermined by the
county  and if  a   the  beneficiary
is found eligible, the termination  under subdivision (h),
(i), or (j)  shall be rescinded. 
   (l) 
    (i)  If the information available to the county pursuant
to the redetermination procedures of  subdivisions (d), (e),
(g), and (m)   this section  does not indicate a
basis of eligibility, Medi-Cal benefits may be terminated so long as
due process requirements have otherwise been met. 
   (m) 
    (j)  The department shall, with the counties and
representatives of consumers, including those with disabilities, and
Medi-Cal  providers   eligibility workers 
, develop a timeframe for redetermination of Medi-Cal eligibility
based upon disability, including ex parte review, the redetermination
 form   forms  described in 
subdivision   subdivisions (f) and  (g), timeframes
for responding to county or state requests for additional
information, and the forms and procedures to be used. The forms and
procedures shall be as consumer-friendly as possible for people with
disabilities. The timeframe shall provide a reasonable and adequate
opportunity for the Medi-Cal beneficiary to obtain and submit medical
records and other information needed to establish eligibility for
Medi-Cal based upon disability. 
   (n) 
    (k)  The county shall consider blindness as continuing
until the reviewing physician determines that a beneficiary's vision
has improved beyond the  applicable  definition of blindness
contained in the plan. 
   (o) 
    (l)  The county shall consider disability as continuing
until the review team determines that a beneficiary's disability no
longer meets the  applicable  definition of disability
contained in the plan. 
   (p) 
    (m)  If a county has enough information available to it
to renew eligibility with respect to all eligibility criteria, the
county shall begin a new 12-month eligibility period. 
   (q)
    (n)   For individuals determined ineligible for Medi-Cal
 by a county following the redetermination procedures set forth
in this section  , the county shall determine eligibility for
other  state health subsidy   insurance
affordability  programs and  comply with the procedures
in Section 15926   if the individual is found to be
eligible, the county   shall, as appropriate, transfer the
individual's electronic account to other insurance affordability
programs via a secure electronic interface  . 
   (r) 
    (o)  Any renewal form or notice shall be accessible to
persons who are limited-English proficient and persons with
disabilities consistent with all federal and state requirements. 

   (p) The requirements to provide information in subdivision (b) and
to report changes in circumstances in subdivision (c) may be
provided through any of the modes of submission allowed in Section
435.907(a) of Title 42 of the Code of Federal Regulations, including
an Internet Web site identified by the department, telephone, mail,
in person, and other commonly available electronic means as
authorized by the department.  
   (q) Forms required to be signed by a beneficiary pursuant to this
section shall be signed under penalty of perjury. Electronic
signatures, telephonic signatures, and handwritten signatures
transmitted by electronic transmission shall be accepted.  
   (r) For purposes of this section, "MAGI-based financial methods"
means income calculated using the financial methodologies described
in Section 1396a(e)(14) of Title 42 of the United States Code, and as
added by the federal Patient Protection and Affordable Care Act
(Public Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152), and any
subsequent amendments.  
   (s) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.  
   (s) 
    (t)  This section shall become operative January 1,
2014.
   SEC. 17.    Section 14005.38 of the  
Welfare and Institutions Code   is amended to read: 
   14005.38.   (a)    To the extent feasible, the
department shall use the redetermination form required by subdivision
(g) of Section 14005.37 as the annual reaffirmation form. 
   (b) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date. 
   SEC. 18.    Section 14005.39 of the  
Welfare and Institutions Code   is amended to read: 
   14005.39.  (a) If a county has facts clearly demonstrating that a
Medi-Cal beneficiary cannot be eligible for Medi-Cal due to an event,
such as death or change of state residency, Medi-Cal benefits shall
be terminated without a redetermination under Section 14005.37.
   (b) Whenever Medi-Cal eligibility is terminated without a
redetermination, as provided in subdivision (a), the Medi-Cal
eligibility worker shall  document   record
 that fact or event causing the eligibility termination in the
beneficiary's file, along with a  written 
certification that a full redetermination could not result in a
finding of Medi-Cal eligibility. Following this  written
 certification, a notice of action specifying the basis for
termination of Medi-Cal eligibility shall be sent to the beneficiary.

   (c) This section shall be implemented  on or before July
1, 2001, but  only  if and  to the extent that
federal financial participation under Title XIX of the federal Social
Security Act  (Title 42   (42  U.S.C. Sec.
1396  and following)   et. seq.)  is
available  and necessary federal approvals have been obtained
 .
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of  all county  
all-county  letters or similar instructions. 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. 
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001. 
   SEC. 13.   SEC. 19.   Section 14005.60
is added to the Welfare and Institutions Code, to read:
   14005.60.  (a) Commencing January 1, 2014, the department shall
provide eligibility for Medi-Cal benefits for any person who meets
the eligibility requirements of Section 1902(a)(10)(A)(i)(VIII) of
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)
(10)(A)(i)(VIII)).
   (b) Persons who qualify under subdivision (a) and are currently
enrolled in a Low Income Health Program (LIHP) under California's
Bridge to Reform Section 1115(a) Medicaid Demonstration shall be
transitioned to the Medi-Cal program under this section in accordance
with the transition plan as approved by the federal Centers for
Medicare and Medicaid Services. With respect to plan enrollment, a
LIHP enrollee shall be  simultaneously notified by the department
at least 60 days prior to January 1, 2014, of  all of the
following:
   (1)  Notified which   Which  Medi-Cal
health plan or plans contain his or her existing medical home
provider. 
   (2) Notified that he or she can select a health plan that contains
his or her existing medical home provider.  
   (3) Provided the opportunity to choose a different health plan if
there is more than one plan available in the county where he or she
resides.  
   (4) Informed that if he or she does not affirmatively choose a
plan or there is only one plan in the county where he or she resides,
he or she shall be enrolled into the Medi-Cal managed care plan that
contains his or her LIHP medical home provider, if the medical home
provider contracts with a Medi-Cal managed care plan.  
   (2) That the LIHP enrollee, subject to his or her ability to
choose or change plans as described in paragraph (3), will be
assigned to a health plan that includes his or her medical home and
will be enrolled effective January 1, 2014. If the enrollee wants to
keep his or her medical home, no additional action will be required.
 
   (3) The opportunity to choose a different health plan prior to
January 1, 2014, if there is more than one plan available in the
county where he or she resides. Instructions on how to choose or
change plans shall be included in the notice, along with a packet of
information about the available plans in the LIHP enrollee's county.
 
   (4) If his or her existing medical home provider is not contracted
with any Medi-Cal managed care health plan, he or she will receive
all provider and health plan information required to be sent to new
enrollees. If he or she does not affirmatively select one of the
available Medi-Cal managed care plans within 30 days of receipt of
the notice, he or she will automatically be assigned a plan through
the department prescribed auto-assignment process.  
   (c) In counties where no Medi-Cal managed care health plans are
available, LIHP enrollees shall be (1) notified that they will be
transitioned to fee-for-service Medi-Cal as of January 1, 2014, (2)
informed if their LIHP medical home provider is a Medi-Cal
fee-for-service provider, (3) provided instructions on how to access
services, (4) given a list of Medi-Cal fee-for-service providers by
area of practice with contact information for each provider, and (5)
provided any other information that is required to be sent to new
enrollees.  
   (d) The department shall consult with stakeholders in developing
the notice required by this section, including representatives of
Medi-Cal beneficiaries, representatives of public hospitals, and
representatives of county social service departments.  
   (c) 
    (e)  In order to ensure that no persons lose health care
coverage in the course of the transition, the department shall
require that notices of the January 1, 2014, change be sent to LIHP
enrollees upon their LIHP redetermination in 2013 and again at least
90 days prior to the transition. Pursuant to Section 1902(k)(1) and
Section 1937(b)(1)(D) of the federal Social Security Act (42 U.S.C.
Sec. 1396a(k)(1); 42 U.S.C. Sec. 1396u-7(b)(1)(D)), the department
shall seek approval from the United States Secretary of Health and
Human Services to establish a benchmark benefit package that includes
the same benefits, services, and coverage that are provided to all
other full-scope Medi-Cal enrollees, supplemented by any benefits,
services, and coverage included in the essential health benefits
package adopted by the state  pursuant to Section 1367.005 of the
Health and Safety Code and Section 10112.27 of the Insurance Code
 and approved by the United States Secretary of Health and Human
Services under Section 18022 of Title 42 of the United States Code
 , and any successor essential health benefit package adopted by
the state  .
   SEC. 14.   SEC. 20.   Section 14005.62
is added to the Welfare and Institutions Code, to read:
   14005.62.  Commencing January 1, 2014, the department shall accept
an individual's attestation of information and verify information
pursuant to Section 15926.2. 
  SEC. 15.    Section 14005.63 is added to the
Welfare and Institutions Code, to read:
   14005.63.  (a) Commencing January 1, 2014, a person who wishes to
apply for a state health subsidy program, as defined in subdivision
(a) of Section 15926, shall be allowed to file an application on his
or her own behalf or on behalf of his or her family. The individual
also has the right to be accompanied, assisted, and represented in
the application and renewal process by an individual or organization
of his or her own choice. If the individual for any reason is unable
to apply or renew on his or her own behalf, any of the following
persons may file the application for the applicant:
   (1) The individual's guardian, conservator, or executor.
   (2) A public agency representative.
   (3) The individual's legal counsel, relative, friend, or other
spokesperson of his or her choice.
   (b) A person who wishes to challenge a decision concerning his or
her eligibility for or receipt of benefits from a state health
subsidy program has the right to represent himself or herself or use
legal counsel, a relative, a friend, or other spokesperson of his or
her choice. 
   SEC. 21.    Section 14005.63 is added to the 
 Welfare and Institutions Code   , to read: 
   14005.63.  (a) A person who wishes to apply for an insurance
affordability program shall be allowed to file an application on his
or her own behalf or on behalf of his or her family. Subject to the
requirements of Section 14014.5, an individual also may be
accompanied, assisted, and represented in the application and renewal
process by an individual or organization of his or her own choice.
If the individual, for any reason, is unable to apply or renew on his
or her own behalf, any of the following persons may assist in the
application process or during a renewal of eligibility:
   (1) The individual's guardian, conservator, a person authorized to
make health care decisions on behalf of the individual pursuant to
an advance health care directive, or executor or administrator of the
individual's estate.
   (2) A public agency representative.
   (3) The individual's legal counsel, relative, friend, or other
spokesperson of his or her choice.
   (b) A person who wishes to challenge a decision concerning his or
her eligibility for or receipt of benefits from an insurance
affordability program has the right to represent himself or herself
or use legal counsel, a relative, a friend, or other spokesperson of
his or her choice subject to the requirements of Section 14014.5.
   (c) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law.
   (d) This section shall be implemented on October 1, 2013, or when
all necessary federal approvals have been obtained, whichever is
later, and only if and to the extent that federal financial
participation is available. 
   SEC. 16.   SEC. 22.   Section 14005.64
is added to the Welfare and Institutions Code, to read:
   14005.64.  (a) This section implements Section 1902(e)(14)(C) of
the federal Social Security Act (42 U.S.C. Sec. 1396a(e)(14)(C)) and
Section 435.603(g) of Title 42 of the Code of Federal Regulations,
which prohibits the use of an assets test for individuals whose
income eligibility is determined based on modified adjusted gross
income (MAGI), and Section 2002 of the federal Patient Protection and
Affordable Care Act (Affordable Care Act) (42 U.S.C. Sec. 1396a(e)
(14)(I)) and Section 435.603(d) of Title 42 of the Code of Federal
Regulations, which requires a 5-percent income disregard for
individuals whose income eligibility is determined based on MAGI.
   (b) In the case of individuals whose financial eligibility for
Medi-Cal is determined based on the application of MAGI pursuant to
Section 435.603 of Title 42 of the Code of Federal Regulations, the
eligibility determination shall not include any assets or resources
test.
   (c) The department shall implement the 5-percent income disregard
for individuals whose income eligibility is determined based on MAGI
in Section 2002 of the Affordable Care Act (42 U.S.C. Sec. 1396a(e)
(14)(I)) and Section 435.603(d) of Title 42 of the Code of Federal
Regulations.
   (d) The department shall adopt an equivalent income level for each
eligibility group whose income level will be converted to MAGI. The
equivalent income level shall not be less than the dollar amount of
all income exemptions, exclusions, deductions, and disregards in
effect on March 23, 2010, plus the existing income level expressed as
a percent of the federal poverty level for each eligibility group so
as to ensure that the use of MAGI income methodology does not result
in populations who would have been eligible under this chapter and
Part 6.3 (commencing with Section 12695) of Division 2 of the
Insurance Code losing coverage. 
   (e) The department shall include individuals under 19 years of
age, or in the case of full-time students, under 21 years of age, in
the household for purposes of determining eligibility under Section
1396a(e)(14) of Title 42 of the United States Code, as added by the
federal Patient
Protection and Affordable Care Act (Public Law 111-148), and as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152) and any subsequent amendments, as
provided in Section 435.603(f)(3) of Title 42 of the Code of Federal
Regulations. 
   (e) 
    (f)  This section shall become operative on January 1,
2014.
   SEC. 17.   SEC. 23.   Section 14005.65
is added to the Welfare and Institutions Code, to read:
   14005.65.  In accordance with the state's options under Section
435.603(h) of Title 42 of the Code of Federal Regulations, the
department shall adopt procedures to take into account projected
future changes in income and family size, for individuals whose
Medi-Cal income eligibility is determined using MAGI-based methods,
in order to grant or maintain eligibility for those individuals who
may be ineligible or become ineligible if only the current monthly
income and family size are considered.
   (a) For current beneficiaries whose eligibility has already been
approved, the department shall base financial eligibility on
projected annual household income for the remainder of the current
calendar year if the current monthly income would render the
beneficiary ineligible due to fluctuating income.
   (b) For applicants, the department shall, in determining the
current monthly household income and family size, base an initial
determination of eligibility on the projected annual household income
and family size for the upcoming year if considering the current
monthly income and family size in isolation would render an applicant
ineligible.
   (c) In the procedures adopted pursuant to this section, the
department shall implement a reasonable method to account for a
reasonably predictable decrease in income and increase in family
size, as evidenced by a history of predictable fluctuations in income
or other clear indicia of a future decrease in income and increase
in family size. The department shall not assume potential future
increases in income or decreases in family size to make an applicant
or beneficiary ineligible in the current month.
   (d) This section shall become operative on January 1, 2014.
   SEC. 18.   SEC. 24.   Section 14007.1 of
the Welfare and Institutions Code is amended to read:
   14007.1.  (a) The department shall adopt regulations for use by
the county welfare department in determining whether an applicant is
a resident of this state and of the county subject to the
requirements of federal law. The regulations shall require that state
residency is not established unless the applicant does both of the
 following.   following: 
   (1) The applicant produces one of the following:
   (A) A recent California rent or mortgage receipt or utility bill
in the applicant's name.
   (B) A current California motor vehicle driver's license or
California Identification Card issued by the  California
 Department of Motor Vehicles in the applicant's name.
   (C) A current California motor vehicle registration in the
applicant's name.
   (D) A document showing that the applicant is employed in this
state.
   (E) A document showing that the applicant has registered with a
public or private employment service in this state.
   (F) Evidence that the applicant has enrolled his or her children
in a school in this state.
   (G) Evidence that the applicant is receiving public assistance in
this state.
   (H) Evidence of registration to vote in this state.
   (2) The applicant declares, under penalty of perjury, that all of
the following apply:
   (A) The applicant does not own or lease a principal residence
outside this state.
   (B) The applicant is not receiving public assistance outside this
state. As used in this subdivision, "public assistance" does not
include unemployment insurance benefits.
   (b) A denial of a determination of residency may be appealed in
the same manner as any other denial of eligibility. The
Administrative Law Judge shall receive any proof of residency offered
by the applicant and may inquire into any facts relevant to the
question of residency. A determination of residency shall not be
granted unless a preponderance of the credible evidence supports the
applicant's intent to remain indefinitely in this state.
   (c) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date. 
  SEC. 19.    Section 14007.1 is added to the
Welfare and Institutions Code, to read:
   14007.1.  (a) An individual 21 years of age or older shall be
considered a resident of this state for the purposes of determining
his or her eligibility for Medi-Cal benefits if he or she attests
that he or she lives in this state and that he or she either intends
to reside in this state or has entered this state with a job
commitment or to seek employment. The individual shall not be
required to have a fixed address or to be currently employed to be
considered a resident of this state.
   (b) (1) An individual under 21 years of age shall be considered a
resident of this state for the purposes of determining his or her
eligibility for Medi-Cal benefits if he or she satisfies the
requirements of subdivision (a), is capable of indicating intent, and
is emancipated from his or her parent or parents or is married.
   (2) An individual under 21 years of age who does not satisfy the
requirements of paragraph (1), and who is not living in an
institution, not eligible for Medi-Cal based on his or her receipt of
assistance under Title IV-E of the federal Social Security Act, and
not receiving a state supplementary payment, as defined in Section
435.403(f) of Title 42 of the Code of Federal Regulations, shall be
considered a resident of this state for the purposes of determining
his or her eligibility for Medi-Cal benefits if he or she lives in
this state, whether or not he or she has a fixed address, or his or
her parent or parents, or other caretaker, with whom he or she
resides satisfies the requirements of subdivision (a).
   (c) The state of residency for an individual who is incapable of
stating intent or who is living in an institution shall be determined
in accordance with Section 435.403 of Title 42 of the Code of
Federal Regulations.
   (d) A denial of a determination of residency may be appealed in
the same manner as any other denial of eligibility. The
administrative law judge shall receive any proof of residency offered
by the individual and may inquire into any facts relevant to the
question of residency. A determination of residency shall be granted
if a preponderance of the credible evidence supports a finding that
the individual meets the requirements of either subdivision (a) or
(b).
   (e) This section shall be interpreted in a manner consistent with
federal law.
   (f) This section shall become operative on January 1, 2014.

   SEC. 25.    Section 14007.1 is added to the 
 Welfare and Institutions Code   , to read:  
   14007.1.  (a) The department shall electronically verify an
individual's state residency using information from the federal
Supplemental Nutrition Assistance Program, the CalWORKS program, the
California Health Benefit Exchange, the Franchise Tax Board, the
Department of Motor Vehicles, the state agency administering the
state's unemployment compensation laws, and the electronic service
established in accordance with Section 435.949 of Title 42 of the
Code of Federal Regulations, and other available sources. If the
department is unable to electronically verify an individual's state
residency using these electronic data sources, an individual may
establish state residency as set forth in this section.
   (b) If the individual is 21 years of age or older, is capable of
indicating intent, and is not residing in an institution, state
residency is established when the individual does both of the
following.
   (1) The individual provides one of the following:
   (A) A recent California rent or mortgage receipt or utility bill
in the individual's name.
   (B) A current California motor vehicle driver's license or
California Identification Card issued by the Department of Motor
Vehicles in the individual's name.
   (C) A current California motor vehicle registration in the
individual's name.
   (D) A document showing that the individual is employed in this
state or is seeking employment in the state.
   (E) A document showing that the individual has registered with a
public or private employment service in this state.
   (F) Evidence that the individual has enrolled his or her children
in a school in this state.
   (G) Evidence that the individual is receiving public assistance in
this state.
   (H) Evidence of registration to vote in this state.
   (I) A declaration by the individual under penalty of perjury that
he or she intends to reside in this state and does not have a fixed
address and cannot provide any of the documents identified in
subparagraphs (A) to (H), inclusive.
   (J) A declaration by the individual under penalty of perjury that
he or she has entered the state with a job commitment or is seeking
employment in the state and cannot provide any of the documents
identified in subparagraphs (A) to (H), inclusive.
   (2) The individual declares, under penalty of perjury, that both
of the following apply:
   (A) The individual does not own or lease a principal residence
outside this state.
   (B) The individual is not receiving public assistance outside this
state. For purposes of this subdivision, "public assistance" shall
not include unemployment insurance benefits.
   (c) If the individual is 21 years or age or older, is incapable of
indicating intent, and is not residing in an institution, state
residency is established when the parent, legal guardian of the
individual, or any other person with knowledge declares, under
penalty of perjury, that the individual is residing in this state.
   (d) If the individual is 21 years of age or older, is residing in
an institution, and became incapable of indicating intent before
reaching 21 years of age, state residency is established by any of
the following:
   (1) When the parent applying for Medi-Cal on the individual's
behalf (A) declares under penalty of perjury that the individual's
parents reside in separate states and (B) establishes that he or she
(the parent) is a resident of this state in accordance with the
requirements of this section.
   (2) When the legal guardian applying for Medi-Cal on the
individual's behalf (A) declares under penalty of perjury that
parental rights have been terminated and (B) establishes that he or
she (the legal guardian) is a resident of this state in accordance
with the requirements of this section.
   (3) When the parent or parents applying for Medi-Cal on the
individual's behalf establishes in accordance with the requirements
of this section that he, she, or they (the parent or parents), were a
resident of this state at the time the individual was placed in the
institution.
   (4) When the legal guardian applying for Medi-Cal on the
individual's behalf (A) declares under penalty of perjury that
parental rights have been terminated and (B) establishes in
accordance with the requirements of this section that he or she (the
legal guardian) was a resident of this state at the time the
individual was placed in the institution.
   (5) When the parent, or parents, applying for Medi-Cal on the
individual's behalf (A) provides a document from the institution that
demonstrates that the individual is institutionalized in this state
and (B) establishes in accordance with the requirements of this
section that he, she, or they (the parent or parents), are a resident
of this state.
   (6) When the legal guardian applying for Medi-Cal on the
individual's behalf (A) provides a document from the institution that
demonstrates that the individual is institutionalized in this state,
(B) declares under penalty of perjury that parental rights have been
terminated, and (C) establishes in accordance with the requirements
of this section that he or she (the legal guardian) is a resident of
this state.
   (7) When the individual or party applying for Medi-Cal on the
individual's behalf (A) provides a document from the institution that
demonstrates that the individual is institutionalized in this state,
(B) declares under penalty of perjury that the individual has been
abandoned by his or her parents and does not have a legal guardian,
and (C) establishes that he or she (the individual or party applying
for Medi-Cal on the individual's behalf) is a resident of this state
in accordance with the requirements of this section.
   (e) Except when another state has placed the individual in the
institution, if the individual is 21 years of age or older, is
residing in an institution, and became incapable of indicating intent
on or after reaching 21 years of age, state residency is established
when the person filing the application on the individual's behalf
provides a document from the institution that demonstrates that the
individual is institutionalized in this state.
   (f) If the individual is 21 years of age or older, is capable of
indicating intent, and is residing in an institution, state residency
is established when the individual (1) provides a document from the
institution that demonstrates that the individual is
institutionalized in this state, and (2) declares under penalty of
perjury that he or she intends to reside in this state.
   (g) If the individual is under 21 years of age, is married or
emancipated from his or her parents, is capable of indicating intent,
and is not residing in an institution, state residency is
established in accordance with subdivision (b).
   (h) If the individual is under 21 years of age, is not living in
an institution, and is not described in subdivision (g), state
residency is established by any of the following:
   (1) When the individual resides with his or her parent or parents
and the parent or parents establish that he, she, or they (the parent
or parents), as the case may be, are a resident of this state in
accordance with the requirements of subdivision (b).
   (2) When the individual resides with a caretaker relative and the
caretaker relative establishes that he, she, or they (the caretaker
relative or caretaker relatives), are a resident of this state in
accordance with the requirements of subdivision (b).
   (3) When the person with whom the individual is residing is not
the individual's parent or caretaker relative and he or she (A)
declares under penalty of perjury that the individual is residing
with him or her, and (B) establishes that he or she (the person with
whom the individual is residing) is a resident of this state in
accordance with the requirements of subdivision (b).
   (4) When the individual does not reside with his or her parents or
with a caretaker relative and he or she declares under penalty of
perjury that he or she is living in this state.
   (i) If the individual is under 21 years of age, is
institutionalized, and is not married or emancipated, state residency
is established in accordance with paragraphs (3), (4), (5), (6) and
(7) of subdivision (d).
   (j) A denial of a determination of residency may be appealed in
the same manner as any other denial of eligibility. The
administrative law judge shall receive any proof of residency offered
by the individual and may inquire into any facts relevant to the
question of residency. A determination of residency shall not be
granted unless a preponderance of the credible evidence supports that
the individual is a resident of this state under Section 14007.15.
   (k) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law.
   (l) For purposes of this section, the definitions in subdivision
(i) of Section 14007.15 shall apply.
   (m) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (n) This section shall become operative on January 1, 2014. 
   SEC. 26.    Section 14007.15 is added to the 
 Welfare and Institutions Code   ,  immediately
following Section 14007.1  , to read:  
   14007.15.  (a) Except as provided in subdivision (f), an
individual is a resident of this state if he or she is 21 years of
age or older, is not residing in an institution, is living in the
state, and any of the following apply:
   (1) The individual intends to reside in this state, including
individuals who do not have a fixed address.
   (2) The individual has entered this state with a job commitment or
is seeking employment in this state, regardless of whether he or she
is currently employed.
   (3) The individual is incapable of indicating intent.
   (b) Except as provided in subdivision (f), an individual that is
21 years of age or older, is residing in an institution, and became
incapable of indicating intent before reaching 21 years of age is a
resident of this state if any of the following apply:
   (1) The individual's parents reside in separate states and the
parent applying for Medi-Cal on the individual's behalf is a resident
of this state under this section.
   (2) The parental rights have been terminated and a legal guardian
has been appointed for the individual and the legal guardian applying
for Medi-Cal on the individual's behalf is a resident of this state
under this section.
   (3) The individual's parent or parents, or legal guardian if
parental rights have been terminated, was a resident of this state
under this section at the time the individual was placed in the
institution.
   (4) The individual is institutionalized in this state and the
parent or parents, or legal guardian if parental rights have been
terminated, applying for Med-Cal on the individual's behalf is a
resident of this state under this section.
   (5) The individual is institutionalized in this state, has been
abandoned by his or her parent or parents, does not have a legal
guardian, and the individual or party that filed the Medi-Cal
application on the individual's behalf is a resident of this state
under this section.
   (c) Except as provided in subdivision (f) and except where another
state has placed the individual in the institution, an individual is
a resident of this state if he or she is 21 years of age or older,
is institutionalized in this state, and became incapable of
indicating intent on or after reaching 21 years of age.
   (d) Except as provided in subdivision (f), an individual is a
resident of this state if he or she is 21 years of age or older, is
institutionalized in this state, and intends to reside in this state.

   (e) Except as provided in subdivision (f), an individual that is
under 21 years of age is a resident of this state if one of the
following apply:
   (1) The individual is not residing in an institution, is capable
of indicating intent, is married or is emancipated from his or her
parents, is living in this state, and one of the following apply:
   (A) The individual intends to reside in this state, which includes
an individual who does not have a fixed address.
   (B) The individual has entered this state with a job commitment or
is seeking employment in this state, regardless of whether he or she
is currently employed.
   (2) The individual is not described in paragraph (1) and is not
living in an institution, and any of the following apply:
   (A) The individual resides in this state, including without a
fixed address.
   (B) The individual resides with his or her parent or parents or a
caretaker relative who is a resident of this state under this
section.
   (3) The individual is institutionalized, is not married or
emancipated, and any of the following apply:
   (A) The individual's parent or parents, or legal guardian if
parental rights have been terminated, was a resident of this state
under this section at the time of placement in the institution.
   (B) The individual is institutionalized in this state and his or
her parent or parents, or legal guardian if parental rights have been
terminated, who files the application on the individual's behalf is
a resident of this state under this section.
   (C) The individual is institutionalized in this state, has been
abandoned by his or her parents, does not have a legal guardian, and
the individual or party that files the application on the individual'
s behalf is a resident of this state under this section.
   (f) An individual who is receiving a state supplementary payment
(SSP) is a resident of the state paying the SSP.
   (g) An individual who lives in this state and is receiving foster
care or adoption assistance under Title IV-E of the federal Social
Security Act is a resident of this state.
   (h) (1) If this state or an agent of this state arranges for an
individual to be placed in an institution located in another state,
the individual is a resident of this state.
   (2) The following actions do not constitute a placement by this
state:
   (A) Providing basic information to the individual about another
state's Medicaid program and information about the availability of
health care services and facilities in another state.
   (B) Assisting an individual to locate an institution in another
state when the individual is capable of indicating intent and
independently decides to move to the other state.
   (3) When a competent individual leaves the facility in which he or
she was placed by this state, that individual's state of residence
is the state where the individual is physically located.
   (4) If this state initiates a placement in another state because
it lacks an appropriate facility to provide services to the
individual, the individual is a resident of this state.
   (i) For the purposes of this section and Section 14007.1, the
following definitions apply:
   (1) "Incapable of indicating intent" means when an individual is
considered to be any of the following:
   (A) Determined to have an I.Q. of 49 or less or to have a mental
age of 7 years or younger based upon tests administered by a properly
licensed mental health or developmental disabilities professional.
   (B) Found to be incapable of indicating intent based on medical
documentation provided by a physician, psychologist, or other person
licensed by the state in the field of mental health or developmental
disabilities.
   (C) Been judicially determined to be legally incompetent.
   (2) "Institution" shall have the same meaning as that term is
defined in Section 435.1010 of Title 42 of the Code of Federal
Regulations. For the purposes of determining residency under
subdivision (h), the term also includes licensed foster care homes
providing food, shelter, and supportive services to one or more
persons unrelated to the proprietor.
    (j) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law.
   (k) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (l) This section shall become operative on January 1, 2014. 
   SEC. 20.   SEC. 27.   Section 14007.6 of
the Welfare and Institutions Code is amended to read:
   14007.6.  (a) A recipient who maintains a residence outside of
this state for a period of at least two months shall not be eligible
for services under this chapter where the county has made inquiry of
the recipient pursuant to Section 11100, and where the recipient has
not responded to this inquiry by clearly showing that he or she has
(1) not established residence elsewhere; and (2) been prevented by
illness or other good cause from returning to this state.
   (b) If a recipient whose services are terminated pursuant to
subdivision (a) reapplies for services, services shall be restored
provided all other eligibility criteria are met if this individual
can prove both of the following:
   (1) His or her permanent residence is in this state.
   (2) That residence has not been established in any other state
which can be considered to be of a permanent nature.
   (c) This section shall remain in effect only until January 1,
2014, and as of that date is repealed unless a later enacted statute,
that is enacted before January 1, 2014, deletes or extends that
date.
   SEC. 21.   SEC. 28.   Section 14007.6 is
added to the Welfare and Institutions Code, to read:
   14007.6.  (a) A recipient who maintains a residence outside of
this state for a period of at least two months shall not be eligible
for services under this chapter where the county has made inquiry of
the recipient pursuant to Section 11100, and where the recipient has
not responded to this inquiry by clearly showing that he or she has
(1) not established residence elsewhere; or (2) been prevented by
illness or other good cause from returning to this state.
   (b) If a recipient whose services are terminated pursuant to
subdivision (a) reapplies for services, services shall be restored
provided all other eligibility criteria are met  if this
individual can prove both of the following:   and the
individual is considered a resident pursuant to Section 14007.15.
 
   (1) His or her residence is in this state.  
   (2) That residence has not been established in any other state
which can be considered to be of a permanent nature.  
   (c) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law.  
   (d) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.  
   (c) 
    (e)  This section shall become operative on January 1,
2014.
   SEC. 22.   SEC. 29.   Section 14008.85
of the Welfare and Institutions Code is amended to read:
   14008.85.  (a) To the extent federal financial participation is
available, a parent who is the principal wage earner shall be
considered an unemployed parent for purposes of establishing
eligibility based upon deprivation of a child where any of the
following applies:
   (1) The parent works less than 100 hours per month as determined
pursuant to the rules of the Aid to Families with Dependent Children
program as it existed on July 16, 1996, including the rule allowing a
temporary excess of hours due to intermittent work.
   (2) The total net nonexempt earned income for the family is not
more than 100 percent of the federal poverty level as most recently
calculated by the federal government. The department may adopt
additional deductions to be taken from a family's income.
   (3) The parent is considered unemployed under the terms of an
existing federal waiver of the 100-hour rule for recipients under the
program established by Section 1931(b) of the federal Social
Security Act (42 U.S.C. Sec. 1396u-1).
   (b) 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 an  all
county   all-county  letter or similar instruction
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.
   (c) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 23.   SEC. 30.   Section 14011.16
of the Welfare and Institutions Code is amended to read:
   14011.16.  (a) Commencing August 1, 2003, the department shall
implement a requirement for beneficiaries to file semiannual status
reports as part of the department's procedures to ensure that
beneficiaries make timely and accurate reports of any change in
circumstance that may affect their eligibility. The department shall
develop a simplified form to be used for this purpose. The department
shall explore the feasibility of using a form that allows a
beneficiary who has not had any changes to so indicate by checking a
box and signing and returning the form.
   (b) Beneficiaries who have been granted continuous eligibility
under Section 14005.25 shall not be required to submit semiannual
status reports. To the extent federal financial participation is
available, all children under 19 years of age shall be exempt from
the requirement to submit semiannual status reports.
   (c) For any period of time that the continuous eligibility period
described in paragraph (1) of subdivision (a) of Section 14005.25 is
reduced to six months, subdivision (b) shall become inoperative, and
all children under 19 years of age shall be required to file
semiannual status reports.
   (d) Beneficiaries whose eligibility is based on a determination of
disability or on their status as aged or blind shall be exempt from
the semiannual status report requirement described in subdivision
(a). The department may exempt other groups from the semiannual
status report requirement as necessary for simplicity of
administration.
   (e) When a beneficiary has completed, signed, and filed a
semiannual status report that indicated a change in circumstance,
eligibility shall be redetermined.
   (f) 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.
   (g) This section shall be implemented only if and to the extent
federal financial participation is available.
   (h) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 24.   SEC. 31.   Section 14011.17
of the Welfare and Institutions Code is amended to read:
   14011.17.  The following persons shall be exempt from the
semiannual reporting requirements described in Section 14011.16:
   (a) Pregnant women whose eligibility is based on pregnancy.
   (b) Beneficiaries receiving Medi-Cal through Aid for Adoption of
Children Program.
   (c) Beneficiaries who have a public guardian.
   (d) Medically indigent children who are not living with a parent
or relative and who have a public agency assuming their financial
responsibility.
   (e) Individuals receiving minor consent services.
   (f) Beneficiaries in the Breast and Cervical Cancer Treatment
Program.
   (g) Beneficiaries who are CalWORKs recipients and custodial
parents whose children are CalWORKs recipients.
   (h) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 25.   SEC. 32.   Section 14012 of
the Welfare and Institutions Code is amended to read:
   14012.  (a) Reaffirmation shall be filed annually and may be
required at other times in accordance with general standards
established by the department.
   (b) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
   SEC. 26.   SEC. 33.   Section 14012 is
added to the Welfare and Institutions Code, to read:
   14012.  (a) This section implements Section 435.916(a)(1) of Title
42 of the Code of Federal Regulations, which applies to the
eligibility of Medi-Cal beneficiaries whose financial eligibility is
determined using modified adjusted gross income (MAGI) based income.
   (b) To the extent required by federal law or regulations, the
eligibility of Medi-Cal beneficiaries whose financial eligibility is
determined using a MAGI-based income shall be renewed once every 12
months, and no more frequently than every 12 months.
   (c) This section shall become operative on January 1, 2014.
   SEC. 34.    Section 14014.5 is added to the 
 Welfare and Institutions Code   , to read:  
   14014.5.  (a) It is the intent of the Legislature to protect
individual privacy and the integrity of Medi-Cal and other insurance
affordability programs by restricting the disclosure of personal
identifying information to prevent identity theft, abuse, or fraud in
situations where an insurance affordability program applicant or
beneficiary appoints an authorized representative to assist him or
her in obtaining health care benefits.
   (b) The department, in consultation with the California Health
Benefit Exchange, shall implement policies and prescribe forms,
notices, and other safeguards to ensure the privacy and protection of
the rights of applicants who appoint an authorized representative
consistent with the provisions of Section 1902 of the federal Social
Security Act (42 U.S.C. Sec. 1396a) and Section 435.908 of Title 42
of the Code of Federal Regulations.
   (c) All insurance affordability programs shall obtain completed
authorization forms pursuant to subdivision (b) prior to making the
final determination concerning the eligibility or renewal to which
the authorization applies.
   (d) An authorization pursuant to this section shall do both of the
following:
   (1) Specify what authority the applicant or beneficiary is
granting to the authorized representative and what notices, if any,
should be sent to the authorized representative in addition to the
applicant or beneficiary.
   (2) Be effective until the applicant or beneficiary cancels or
modifies the authorization or appoints a new authorized
representative, or the authorized representative informs the agency
that he or she is no longer acting in that capacity or there is a
change in the legal authority on which the authority was based. The
notice shall conform to all federal requirements.
   (e) An authorization pursuant to this section may be canceled or
modified at any time for any reason by the insurance affordability
program applicant or beneficiary by submitting notice of cancellation
or modification to the appropriate insurance affordability program
in accordance with policies and forms developed pursuant to
subdivision (b).
   (f) The agency shall accept electronic, including telephonically
recorded, signatures, and handwritten signatures transmitted by
facsimile or other electronic transmission.
   (g) For purposes of this section all of the following definitions
shall apply:
   (1) "Authorized representative" means:
   (A) (i) Any individual appointed in writing, on a form designated
by the department, by a competent person that is an applicant for or
beneficiary of any insurance affordability program, to act in place
or on behalf of the applicant or beneficiary for purposes related to
the insurance affordability program, including, but not limited to,
accompanying, assisting, or representing the applicant in the
application process or the beneficiary in the redetermination of
eligibility process, as specified by the applicant or beneficiary.
   (ii) Legal documentation of authority to act on behalf of the
applicant or beneficiary under state law, including, but not limited
to, a court order establishing legal guardianship or a valid power of
attorney to make health care decisions, shall service in place of a
written appointment by the applicant or beneficiary.
   (2) "Competent" means being able to act on one's own behalf in
business and personal matters.
   (h) An authorized representative of an applicant or beneficiary of
an insurance affordability program who also is employed by or is a
contractor for any type of health care provider or facility shall
fully disclose in writing to the applicant or beneficiary that the
authorized representative is employed by or contracting with such a
provider or facility and of any potential conflicts of interest.
   (i) All notices regarding the insurance affordability program,
including, but not limited to, those related to the application,
redetermination, or actions taken by the agency, shall be sent to the
applicant or beneficiary, and to the authorized representative if
authorized by the applicant or beneficiary.
   (j) (1) If an applicant or beneficiary is not competent and has
not appointed an appropriately authorized representative pursuant to
this section or that appointment is no longer effective, any of the
individuals identified in subparagraphs (A) to (C), inclusive, may be
recognized by the hearing officer as the authorized representative
to represent the applicant or beneficiary at the state hearing
regarding a notice of action if, at the hearing, he or she
demonstrates that the applicant or beneficiary is not competent and
that lack of competency is the reason that he or she has not been
authorized by the applicant or beneficiary to act as the applicant's
or beneficiary's authorized representative. The individuals that may
be recognized are:
   (A) A relative of the applicant or beneficiary or a person
appointed by the relative.
   (B) A person with knowledge of the applicant's or beneficiary's
circumstances that completed and signed the Statement of Facts on the
applicant's or beneficiary's behalf.
   (C) An applicant's or beneficiary's legal counsel or advocate
working under the supervision of an attorney.
   (2) If an applicant or beneficiary is not competent and has not
appointed an appropriately authorized representative pursuant to this
section or that appointment is no longer effective, the hearing
officer may allow an individual with knowledge about the applicant's
or beneficiary's circumstances to represent the applicant or
beneficiary at the hearing if (A) the hearing officer determines that
the representation is in the applicant or beneficiary's best
interests and (B) there is not a person who qualifies under paragraph
(1) that is available to represent the applicant or beneficiary.
   (k) (1) Pursuant to Section 435.923(e) of Title 42 of the Code of
Federal Regulations, a provider or staff member or volunteer of an
organization who intends to serve as an authorized representative
shall provide a signed written agreement that he or she will adhere
to requirements set forth in the Code of Federal Regulations for
authorized representatives, including Section 447.10 of Title 42,
subpart F of Part 431 of Title 45, and Section 155.260(f) of Title
45. The department shall work with counties and consumer advocates to
develop a standard agreement form that may be used for this purpose.

   (2) Pursuant to 435.923(e) of Title 45 of the Code of Federal
Regulations, the regulations developed pursuant to this section shall
require authorized representatives to comply with all applicable
state and federal laws regarding conflicts of interest and
confidentiality of information.
   (3) The standard agreement form developed pursuant to paragraph
(1) shall include a notification regarding the requirements of this
subdivision and a statement that by signing the agreement, the
individual named as an authorized representative agrees to abide by
those requirements.
   (l) To the extent otherwise required by Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department shall adopt emergency regulations
implementing this section no later than July 1, 2015. The department
may thereafter readopt the emergency regulations pursuant to that
chapter. The adoption and readoption, by the department, of
regulations implementing this section shall be deemed to be an
emergency and necessary to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe facts showing the need
for immediate action and from review by the Office of Administrative
Law.
   (m) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (n) This section shall be implemented on October 1, 2013, or when
all necessary federal approvals have been obtained, whichever is
later. 
   SEC. 35.    Section 14015.5 is added to the 
 Welfare and Institutions Code   , to read:  
   14015.5.  (a) Notwithstanding any other provision of state law,
the department shall retain or delegate the authority to perform
Medi-Cal eligibility determinations as set forth in this section.
   (b) If after an assessment and verification for potential
eligibility for Medi-Cal benefits using the applicable MAGI-based
income standard of all persons that apply through an electronic or a
paper application processed by CalHEERS, which is jointly managed by
the department and the Exchange, and to the extent required by
federal law and regulation is completed, the Exchange and the
department may electronically determine the applicant's eligibility
for Medi-Cal benefits using only the information initially provided
online, or through the written application submitted by, or on behalf
of, the applicant, and without further staff review to verify the
accuracy of the submitted information, the Exchange and the
department shall determine that applicant's eligibility for the
Medi-Cal program using the applicable MAGI-based income standard.
   (c) Except as provided in subdivision (b) and Section 14015.7, the
county of residence shall be responsible for eligibility
determinations and ongoing case management for the Medi-Cal program.
   (d) (1) Notwithstanding any other provision of state law, the
Exchange shall be authorized to provide information regarding
available Medi-Cal managed health care plan selection options to
applicants determined to be eligible for Medi-Cal benefits using the
MAGI-based income standard and allow those applicants to choose an
available managed health care plan.
   (2) The Exchange is authorized to record an applicant's health
plan selection into CalHEERS for reporting to the department.
CalHEERS shall have the ability to report to the department the
results of an applicant's health plan selection.
   (e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted.
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. Beginning six
months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (f) For the purposes of this section, the following definitions
shall apply:
   (1) "ACA" means the federal Patient Protection and Affordable Care
Act (Public Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152).
   (2) "CalHEERS" means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.
   (3) "Exchange" means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.
   (4) "MAGI-based income" means income calculated using the
financial methodologies described in Section 1396a(e)(14) of Title 42
of the United States Code as added by ACA and any subsequent
amendments.
   (g) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (h) This section shall become operative on October 1, 2013.
   (i) This section shall become inoperative on July 1, 2015, and, as
of January 1, 2016, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2016, deletes or
extends the dates on which it becomes inoperative and is repealed.

   SEC. 36.    Section 14015.7 is added to the 
 Welfare and Institutions Code   , to read: 
   14015.7.  (a) (1) Notwithstanding any other law, for persons who
call the customer service center operated by the Exchange for the
purpose of applying for an insurance affordability program, the
Exchange shall implement a workflow transfer protocol that consists
of only those questions that are essential to reliably ascertain
whether the caller's household appears to include any individuals who
are potentially eligible for Medi-Cal benefits and to determine an
appropriate point of referral. The workflow transfer protocol and
referral procedures used by the Exchange shall be developed and
implemented in conjunction with and subject to review and approval by
the department.
   (2) (A) Except as provided in paragraph (3), if, after applying
the transfer protocol specified in paragraph (1), the Exchange
determines that the caller's household appears to include one or more
individuals who are potentially eligible for Medi-Cal benefits using
the applicable MAGI-based income standard, the Exchange shall refer
the caller to his or her county of residence or other appropriate
county resource for completion of the federally required assessment.
The county shall proceed with the assessment and also perform any
required eligibility determination.
   (B) Subject to any income limitations that may be imposed by the
Exchange, and subject to review and approval from the department, if
after applying the
transfer protocol specified in paragraph (1) the Exchange determines
that the caller's household appears to include an individual who is
pregnant, or who is potentially eligible for Medi-Cal benefits on a
basis other than using a MAGI-based income standard because an
applicant is potentially disabled, 65 years of age or older, or
potentially in need of long-term care services, the Exchange shall
refer the caller to his or her county of residence or other
appropriate county resource for completion of the federally required
assessment. The county shall proceed with the assessment and also
perform any required eligibility determination.
   (3) Notwithstanding any other law, only during the initial open
enrollment period established by the Exchange, and in no case after
June 30, 2014, if after applying the transfer protocol specified in
paragraph (1) the Exchange determines that the caller's household
appears to include both individuals who are potentially eligible for
Medi-Cal benefits using the applicable MAGI-based income standard and
individuals who are not potentially eligible for Medi-Cal benefits,
the Exchange shall proceed with its assessment and if it is
subsequently determined that an applicant or applicants are
potentially eligible for Medi-Cal benefits using the applicable
MAGI-based income standard, the Exchange shall initially determine
the applicant or applicants eligibility for Medi-Cal benefits. If
determined eligible, the applicant's or applicants' coverage shall
start on January 1, 2014, or on the date of the determination,
whichever is later. The county of residence shall be responsible for
final confirmation of eligibility determinations relying on data
provided by and verifications done by the Exchange and the county
shall perform only that additional work that is necessary for the
county to prepare and send out the required notice to the applicant
regarding the result of the eligibility determination and shall not
impose any additional burdens upon the applicant. The county of
residence shall be responsible for sending out the required notices
of all Medi-Cal eligibility determinations.
   (4) Notwithstanding any other law, if after applying the transfer
protocol specified in paragraph (1) the Exchange determines that the
caller's household appears to only include individuals who are not
potentially eligible for Medi-Cal benefits, the Exchange shall
proceed with its assessment of eligibility. If it is subsequently
determined that an applicant or applicants are potentially eligible
for Medi-Cal benefits using the applicable MAGI-based income
standard, the Exchange shall initially determine the applicant or
applicants eligibility for Medi-Cal benefits. If determined eligible,
the applicant's or applicants' coverage shall start on January 1,
2014, or on the date of the determination, whichever is later. The
county of residence shall be responsible for final confirmation of
eligibility determinations relying on data provided by and
verifications done by the Exchange and the county shall perform only
that additional work that is necessary for the county to prepare and
send out the required notice to the applicant regarding the result of
the eligibility determination and shall not impose any additional
burdens upon the applicant. The county of residence shall be
responsible for sending out the required notices of all Medi-Cal
eligibility determinations.
   (5) Subject to any income limitations that may be imposed by the
Exchange, and subject to review and approval from the department, if
after assessing the potential eligibility of an applicant, which
shall include enrolling the individual in Exchange-based coverage if
eligible and, if the determination is being made pursuant to
subdivision (3), determining initial eligibility for MAGI-based
Medi-Cal, the Exchange determines that the applicant is pregnant, or
is potentially eligible for Medi-Cal benefits on a basis other than
using a MAGI-based income standard because the applicant is
potentially disabled, 65 years of age or older, or potentially in
need of long-term care services, or if the applicant requests a full
Medi-Cal eligibility determination, the Exchange shall, consistent
with federal law and regulations, transmit all information provided
by or on behalf of the applicant, and any information obtained or
verified by the Exchange, to the applicant's county of residence or
other appropriate county resource via secure electronic interface,
promptly and without undue delay, for a full Medi-Cal eligibility
determination.
   (6) Except as otherwise provided in this section and subdivision
(b) of Section 14015.5, the county of residence shall be responsible
for eligibility determinations and ongoing case management for the
Medi-Cal program.
   (7) Implementation of the protocols and referral procedures in
this subdivision shall be subject to the terms specified in the
agreements established under subdivision (b).
   (b) The department, Exchange, and each county consortia shall
jointly enter into an interagency agreement that specifies the
operational parameters and performance standards pertaining to the
transfer protocol. After consulting with counties, consumer
advocates, and labor organizations that represent employees of the
customer service center operated by the Exchange and employees of
county customer service centers, the Exchange and the department
shall determine and implement the performance standards that shall be
incorporated into these agreements.
   (c) Prior to October 1, 2014, the Exchange and the department, in
consultation with counties, consumer advocates, and labor
organizations that represent employees of the customer service center
operated by the Exchange and employees of county customer service
centers, shall review and determine the efficacy of the enrollment
procedures established in this section.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted.
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. Beginning six
months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (e) For the purposes of this section, the following definitions
shall apply:
   (1) "ACA" means the federal Patient Protection and Affordable Care
Act (Public Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152).
   (2) "CalHEERS" means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.
   (3) "Exchange" means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.
   (4) "MAGI-based income" means income calculated using the
financial methodologies described in Section 1396a(e)(14) of Title 42
of the United States Code as added by ACA and any subsequent
amendments.
   (f) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
   (g) This section shall become operative on October 1, 2013. 
   SEC. 37.    Section 14055 is added to the  
Welfare and Institutions Code   , to read:  
   14055.  (a) For the purposes of this chapter, "caretaker relative"
means a relative of a dependent child by blood, adoption, or
marriage with whom the child is living, who assumes primary
responsibility for the child's care, and who is one of the following:

   (1) The child's father, mother, grandfather, grandmother, brother,
sister, stepfather, stepmother, stepbrother, stepsister, great
grandparent, uncle, aunt, nephew, niece, great-great grandparent,
great uncle or aunt, first cousin, great-great-great grandparent,
great-great uncle or aunt, or first cousin once removed.
   (2) The spouse or registered domestic partner of one of the
relatives identified in paragraph (1), even after the marriage is
terminated by death or divorce or the domestic partnership has been
legally terminated.
   (b) This section shall become operative on January 1, 2014. 
   SEC. 38.    Section 14057 is added to the  
Welfare and Institutions Code   , to read:  
   14057.  (a) For the purposes of this chapter, "insurance
affordability program" means a program that is one of the following:
   (1) The state's Medi-Cal program under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et seq.).
   (2) The state's children's health insurance program (CHIP) under
Title XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa
et seq.).
   (3) A program that makes available to qualified applicants
coverage in a qualified health plan through the California Health
Benefit Exchange, established pursuant to Title 22 (commencing with
Section 100500) of the Government Code, with advance payment of the
premium tax credit established under Section 36B of the Internal
Revenue Code.
   (4) A program that makes available coverage in a qualified health
plan through the California Health Benefit Exchange, established
pursuant to Title 22 (commencing with Section 100500) of the
Government Code, with cost-sharing reductions established under
Section 1402 of the federal Patient Protection and Affordable Care
Act (Public Law 111-148), and any subsequent amendments to that act.
   (b) This section shall become operative on January 1, 2014. 
   SEC. 39.    Section 14102 is added to the  
Welfare and Institutions Code   , to read:  
   14102.  (a) (1) Notwithstanding any other law and except as
otherwise provided in this section, any individual who is 21 years of
age or older, who does not have minor children eligible for
Medi-Cal, and would be eligible for full-scope Medi-Cal benefits
pursuant to Section 1902(a)(10)(A)(i)(VIII) of Title XIX of the
federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII))
but for the five-year eligibility limitation under Section 1613 of
Title 8 of the United States Code and who is otherwise eligible for
state-only funded full-scope benefits shall be ineligible for those
state-only funded benefits if he or she is eligible for, and is not
barred from enrolling in because he or she is outside of an available
enrollment period for coverage with an advanced premium tax credit
offered through the Exchange.
   (2) On or after January 1, 2015, if an individual is eligible for
and does not enroll in coverage offered through the Exchange with an
advanced premium tax credit during his or her first available
enrollment period, that individual shall be ineligible for the
state-only funded benefits referenced in paragraph (1), except as
provided in paragraph (3).
   (3) An individual shall be ineligible for Medi-Cal pursuant to
this section only if and when he or she is able to receive the
premium assistance, cost sharing, and benefits described in
subdivision (c). Disenrollment from state-only Medi-Cal shall only
occur during an available enrollment period in the Exchange.
   (4) The department shall inform and assist such individuals on
enrolling in coverage through the Exchange with the premium
assistance, cost sharing, and benefits described in subdivision (c)
and the process for disenrollment from Medi-Cal, if applicable, in a
way that ensures seamless transition between coverage, including, but
not limited to, developing processes to coordinate with the county
entities that administer eligibility for coverage in Medi-Cal and the
Exchange.
   (b) (1) An individual who is a state-only Medi-Cal person as
defined in Section 14052 shall not be subject to subdivision (a) or
(c).
   (c) An individual subject to subdivision (a) who is enrolled in
coverage through the Exchange with an advanced premium tax credit
shall be eligible for the following:
   (1) Those Medi-Cal benefits for which he or she would have been
eligible but for the five-year eligibility limitation only to the
extent that they are not available through his or her individual
health plan.
   (2) The department shall pay on behalf of the beneficiary:
   (A) The beneficiary's insurance premium costs for an individual
health plan, minus the beneficiary's premium tax credit authorized by
Section 36B of Title 26 of the United States Code and its
implementing regulations.
   (B) The beneficiary's cost-sharing charges so that the individual
has the same cost-sharing charges as he or she would have in the
Medi-Cal program.
   (d) For purposes of this section, the following definitions shall
apply:
   (1) "Cost-sharing charges" means any expenditure required by or on
behalf of an enrollee by his or her individual health plan with
respect to essential health benefits and includes deductibles,
coinsurance, copayments, or similar charges, but excludes premiums,
and spending for noncovered services.
   (2) "Exchange" means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.
   (e) Benefits for services under this section shall be provided
with state-only funds only if federal financial participation is not
available for those services. The department shall maximize federal
financial participation in implementing this section to the extent
allowable.
   (f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted.
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. Beginning six
months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (g) This section shall become operative on January 1, 2014. 
   SEC. 40.    Section 14102.5 is added to the 
 Welfare and Institutions Code   , to read:  
   14102.5.  (a) The department shall, in collaboration with the
Exchange, the counties, consumer advocates, and the Statewide
Automated Welfare System consortia, develop and prepare one or more
reports that shall be issued on at least a quarterly basis and shall
be made publicly available within 30 days following the end of each
quarter, for the purpose of informing the California Health and Human
Services Agency, the Exchange, the Legislature, and the public about
the enrollment process for all insurance affordability programs. The
reports shall comply with federal reporting requirements and shall,
at a minimum, include the following information, to be derived from,
as appropriate depending on the data element, CalHEERS, MEDS, or the
Statewide Automated Welfare System:
   (1) For applications received for insurance affordability programs
through any venue, all of the following:
   (A) The number of applications received through each venue.
   (B) The number of applicants included on those applications.
   (C) Applicant demographics, including, but not limited to, gender,
age, race, ethnicity, and primary language.
   (D) The disposition of applications, including all of the
following:
   (i) The number of eligibility determinations that resulted in an
approval for coverage.
   (ii) The program or programs for which the individuals in clause
(i) were determined eligible.
   (iii) The number of applications that were denied for any coverage
and the reason or reasons for the denials.
   (E) The number of days for eligibility determinations.
   (2) With regard to health plan selection, all of the following:
   (A) The health plans that are selected by applicants enrolled in
an insurance affordability program, reported by the program.
   (B) The number of Medi-Cal enrollees who do not select a health
plan but are defaulted into a plan.
   (3) For annual redeterminations conducted for beneficiaries, all
of the following:
   (A) The number of redeterminations processed.
   (B) The number of redeterminations that resulted in continued
eligibility for the same program.
   (C) The number of redeterminations that resulted in a change in
eligibility to a different program.
   (D) The number of redeterminations that resulted in a finding of
ineligibility for any program and the reason or reasons for the
findings of ineligibility.
   (E) The number of days for redeterminations to be completed.
   (4) With regard to disenrollments not related to a redetermination
of eligibility, all of the following:
   (A) The number of beneficiary disenrollments.
   (B) The reasons for the disenrollments.
   (C) The number of disenrollments that are caused by an individual
disenrolling from one insurance affordability program and enrolling
into another.
   (5) The number of applications for insurance affordability
programs that were filed with the help of an assister or navigator.
   (6) The total number of grievances and appeals filed by applicants
and enrollees regarding eligibility for insurance affordability
programs, the basis for the grievance, and the outcomes of the
appeals.
   (b) The department shall collect the information necessary for
these reports and develop these reports using data obtained from the
Statewide Automated Welfare System, CalHEERS, MEDS, and any other
appropriate state information management systems.
   (c) For purposes of this section, the following definitions shall
apply:
   (1) "CalHEERS" means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.
   (2) "Exchange" means the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500) of
the Government Code.
   (3) "Statewide Automated Welfare System" means the system
developed pursuant to Section 10823.
   (4) "MEDS" means the Medi-Cal Eligibility Data System.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted.
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. Beginning six
months after the effective date of this section, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (e) This section shall become operative on January 1, 2014. 
   SEC. 27.   SEC. 41.   Section 14132 of
the Welfare and Institutions Code is amended to read:
   14132.  The following is the schedule of benefits under this
chapter:
   (a) Outpatient services are covered as follows:
   Physician, hospital or clinic outpatient, surgical center,
respiratory care, optometric, chiropractic, psychology, podiatric,
occupational therapy, physical therapy, speech therapy, audiology,
acupuncture to the extent federal matching funds are provided for
acupuncture, and services of persons rendering treatment by prayer or
healing by spiritual means in the practice of any church or
religious denomination insofar as these can be encompassed by federal
participation under an approved plan, subject to utilization
controls.
   (b) (1) Inpatient hospital services, including, but not limited
to, physician and podiatric services, physical therapy and
occupational therapy, are covered subject to utilization controls.
   (2) For Medi-Cal fee-for-service beneficiaries, emergency services
and care that are necessary for the treatment of an emergency
medical condition and medical care directly related to the emergency
medical condition. This paragraph shall not be construed to change
the obligation of Medi-Cal managed care plans to provide emergency
services and care. For the purposes of this paragraph, "emergency
services and care" and "emergency medical condition" shall have the
same meanings as those terms are defined in Section 1317.1 of the
Health and Safety Code.
   (c) Nursing facility services, subacute care services, and
services provided by any category of intermediate care facility for
the developmentally disabled, including podiatry, physician, nurse
practitioner services, and prescribed drugs, as described in
subdivision (d), are covered subject to utilization controls.
Respiratory care, physical therapy, occupational therapy, speech
therapy, and audiology services for patients in nursing facilities
and any category of intermediate care facility for the
developmentally disabled are covered subject to utilization controls.

   (d) (1) Purchase of prescribed drugs is covered subject to the
Medi-Cal List of Contract Drugs and utilization controls.
   (2) Purchase of drugs used to treat erectile dysfunction or any
off-label uses of those drugs are covered only to the extent that
federal financial participation is available.
   (3) (A) To the extent required by federal law, the purchase of
outpatient prescribed drugs, for which the prescription is executed
by a prescriber in written, nonelectronic form on or after April 1,
2008, is covered only when executed on a tamper resistant
prescription form. The implementation of this paragraph shall conform
to the guidance issued by the federal Centers  of 
 for  Medicare and Medicaid Services but shall not conflict
with state statutes on the characteristics of tamper resistant
prescriptions for controlled substances, including Section 11162.1 of
the Health and Safety Code. The department shall provide providers
and beneficiaries with as much flexibility in implementing these
rules as allowed by the federal government. The department shall
notify and consult with appropriate stakeholders in implementing,
interpreting, or making specific this paragraph.
   (B) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may take the actions specified in subparagraph (A) by
means of a provider bulletin or notice, policy letter, or other
similar instructions without taking regulatory action.
   (4) (A) (i) For the purposes of this paragraph, nonlegend has the
same meaning as defined in subdivision (a) of Section 14105.45.
   (ii) Nonlegend acetaminophen-containing products, with the
exception of children's acetaminophen-containing products, selected
by the department are not covered benefits.
   (iii) Nonlegend cough and cold products selected by the department
are not covered benefits. This clause shall be implemented on the
first day of the first calendar month following 90 days after the
effective date of the act that added this clause, or on the first day
of the first calendar month following 60 days after the date the
department secures all necessary federal approvals to implement this
section, whichever is later.
   (iv) Beneficiaries under the Early and Periodic Screening,
Diagnosis, and Treatment Program shall be exempt from clauses (ii)
and (iii).
   (B) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may take the actions specified in subparagraph (A) by
means of a provider bulletin or notice, policy letter, or other
similar                                              instruction
without taking regulatory action.
   (e) Outpatient dialysis services and home hemodialysis services,
including physician services, medical supplies, drugs and equipment
required for dialysis, are covered, subject to utilization controls.
   (f) Anesthesiologist services when provided as part of an
outpatient medical procedure, nurse anesthetist services when
rendered in an inpatient or outpatient setting under conditions set
forth by the director, outpatient laboratory services, and X-ray
services are covered, subject to utilization controls. Nothing in
this subdivision shall be construed to require prior authorization
for anesthesiologist services provided as part of an outpatient
medical procedure or for portable X-ray services in a nursing
facility or any category of intermediate care facility for the
developmentally disabled.
   (g) Blood and blood derivatives are covered.
   (h) (1) Emergency and essential diagnostic and restorative dental
services, except for orthodontic, fixed bridgework, and partial
dentures that are not necessary for balance of a complete artificial
denture, are covered, subject to utilization controls. The
utilization controls shall allow emergency and essential diagnostic
and restorative dental services and prostheses that are necessary to
prevent a significant disability or to replace previously furnished
prostheses which are lost or destroyed due to circumstances beyond
the beneficiary's control. Notwithstanding the foregoing, the
director may by regulation provide for certain fixed artificial
dentures necessary for obtaining employment or for medical conditions
that preclude the use of removable dental prostheses, and for
orthodontic services in cleft palate deformities administered by the
department's California Children Services Program.
   (2) For persons 21 years of age or older, the services specified
in paragraph (1) shall be provided subject to the following
conditions:
   (A) Periodontal treatment is not a benefit.
   (B) Endodontic therapy is not a benefit except for vital
pulpotomy.
   (C) Laboratory processed crowns are not a benefit.
   (D) Removable prosthetics shall be a benefit only for patients as
a requirement for employment.
   (E) The director may, by regulation, provide for the provision of
fixed artificial dentures that are necessary for medical conditions
that preclude the use of removable dental prostheses.
   (F) Notwithstanding the conditions specified in subparagraphs (A)
to (E), inclusive, the department may approve services for persons
with special medical disorders subject to utilization review.
   (3) Paragraph (2) shall become inoperative July 1, 1995.
   (i) Medical transportation is covered, subject to utilization
controls.
   (j) Home health care services are covered, subject to utilization
controls.
   (k) Prosthetic and orthotic devices and eyeglasses are covered,
subject to utilization controls. Utilization controls shall allow
replacement of prosthetic and orthotic devices and eyeglasses
necessary because of loss or destruction due to circumstances beyond
the beneficiary's control. Frame styles for eyeglasses replaced
pursuant to this subdivision shall not change more than once every
two years, unless the department so directs.
   Orthopedic and conventional shoes are covered when provided by a
prosthetic and orthotic supplier on the prescription of a physician
and when at least one of the shoes will be attached to a prosthesis
or brace, subject to utilization controls. Modification of stock
conventional or orthopedic shoes when medically indicated, is covered
subject to utilization controls. When there is a clearly established
medical need that cannot be satisfied by the modification of stock
conventional or orthopedic shoes, custom-made orthopedic shoes are
covered, subject to utilization controls.
   Therapeutic shoes and inserts are covered when provided to
beneficiaries with a diagnosis of diabetes, subject to utilization
controls, to the extent that federal financial participation is
available.
   (l) Hearing aids are covered, subject to utilization controls.
Utilization controls shall allow replacement of hearing aids
necessary because of loss or destruction due to circumstances beyond
the beneficiary's control.
   (m) Durable medical equipment and medical supplies are covered,
subject to utilization controls. The utilization controls shall allow
the replacement of durable medical equipment and medical supplies
when necessary because of loss or destruction due to circumstances
beyond the beneficiary's control. The utilization controls shall
allow authorization of durable medical equipment needed to assist a
disabled beneficiary in caring for a child for whom the disabled
beneficiary is a parent, stepparent, foster parent, or legal
guardian, subject to the availability of federal financial
participation. The department shall adopt emergency regulations to
define and establish criteria for assistive durable medical equipment
in accordance with 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).
   (n) Family planning services are covered, subject to utilization
controls.
   (o) Inpatient intensive rehabilitation hospital services,
including respiratory rehabilitation services, in a general acute
care hospital are covered, subject to utilization controls, when
either of the following criteria are met:
   (1) A patient with a permanent disability or severe impairment
requires an inpatient intensive rehabilitation hospital program as
described in Section 14064 to develop function beyond the limited
amount that would occur in the normal course of recovery.
   (2) A patient with a chronic or progressive disease requires an
inpatient intensive rehabilitation hospital program as described in
Section 14064 to maintain the patient's present functional level as
long as possible.
   (p) (1) Adult day health care is covered in accordance with
Chapter 8.7 (commencing with Section 14520).
   (2) Commencing 30 days after the effective date of the act that
added this paragraph, and notwithstanding the number of days
previously approved through a treatment authorization request, adult
day health care is covered for a maximum of three days per week.
   (3) As provided in accordance with paragraph (4), adult day health
care is covered for a maximum of five days per week.
   (4) As of the date that the director makes the declaration
described in subdivision (g) of Section 14525.1, paragraph (2) shall
become inoperative and paragraph (3) shall become operative.
   (q) (1) Application of fluoride, or other appropriate fluoride
treatment as defined by the department, other prophylaxis treatment
for children 17 years of age and under, are covered.
   (2) All dental hygiene services provided by a registered dental
hygienist in alternative practice pursuant to Sections 1768 and 1770
of the Business and Professions Code may be covered as long as they
are within the scope of Denti-Cal benefits and they are necessary
services provided by a registered dental hygienist in alternative
practice.
   (r) (1) Paramedic services performed by a city, county, or special
district, or pursuant to a contract with a city, county, or special
district, and pursuant to a program established under Article 3
(commencing with Section 1480) of Chapter 2.5 of Division 2 of the
Health and Safety Code by a paramedic certified pursuant to that
article, and consisting of defibrillation and those services
specified in subdivision (3) of Section 1482 of the article.
   (2) All providers enrolled under this subdivision shall satisfy
all applicable statutory and regulatory requirements for becoming a
Medi-Cal provider.
   (3) This subdivision shall be implemented only to the extent
funding is available under Section 14106.6.
   (s) In-home medical care services are covered when medically
appropriate and subject to utilization controls, for beneficiaries
who would otherwise require care for an extended period of time in an
acute care hospital at a cost higher than in-home medical care
services. The director shall have the authority under this section to
contract with organizations qualified to provide in-home medical
care services to those persons. These services may be provided to
patients placed in shared or congregate living arrangements, if a
home setting is not medically appropriate or available to the
beneficiary. As used in this section, "in-home medical care service"
includes utility bills directly attributable to continuous, 24-hour
operation of life-sustaining medical equipment, to the extent that
federal financial participation is available.
   As used in this subdivision, in-home medical care services,
include, but are not limited to:
   (1) Level of care and cost of care evaluations.
   (2) Expenses, directly attributable to home care activities, for
materials.
   (3) Physician fees for home visits.
   (4) Expenses directly attributable to home care activities for
shelter and modification to shelter.
   (5) Expenses directly attributable to additional costs of special
diets, including tube feeding.
   (6) Medically related personal services.
   (7) Home nursing education.
   (8) Emergency maintenance repair.
   (9) Home health agency personnel benefits which permit coverage of
care during periods when regular personnel are on vacation or using
sick leave.
   (10) All services needed to maintain antiseptic conditions at
stoma or shunt sites on the body.
   (11) Emergency and nonemergency medical transportation.
   (12) Medical supplies.
   (13) Medical equipment, including, but not limited to, scales,
gurneys, and equipment racks suitable for paralyzed patients.
   (14) Utility use directly attributable to the requirements of home
care activities which are in addition to normal utility use.
   (15) Special drugs and medications.
   (16) Home health agency supervision of visiting staff which is
medically necessary, but not included in the home health agency rate.

   (17) Therapy services.
   (18) Household appliances and household utensil costs directly
attributable to home care activities.
   (19) Modification of medical equipment for home use.
   (20) Training and orientation for use of life-support systems,
including, but not limited to, support of respiratory functions.
   (21) Respiratory care practitioner services as defined in Sections
3702 and 3703 of the Business and Professions Code, subject to
prescription by a physician and surgeon.
   Beneficiaries receiving in-home medical care services are entitled
to the full range of services within the Medi-Cal scope of benefits
as defined by this section, subject to medical necessity and
applicable utilization control. Services provided pursuant to this
subdivision, which are not otherwise included in the Medi-Cal
schedule of benefits, shall be available only to the extent that
federal financial participation for these services is available in
accordance with a home- and community-based services waiver.
   (t) Home- and community-based services approved by the United
States Department of Health and Human Services may be covered to the
extent that federal financial participation is available for those
services under waivers granted in accordance with Section 1396n of
Title 42 of the United States Code. The director may seek waivers for
any or all home- and community-based services approvable under
Section 1396n of Title 42 of the United States Code. Coverage for
those services shall be limited by the terms, conditions, and
duration of the federal waivers.
   (u) Comprehensive perinatal services, as provided through an
agreement with a health care provider designated in Section 14134.5
and meeting the standards developed by the department pursuant to
Section 14134.5, subject to utilization controls.
   The department shall seek any federal waivers necessary to
implement the provisions of this subdivision. The provisions for
which appropriate federal waivers cannot be obtained shall not be
implemented. Provisions for which waivers are obtained or for which
waivers are not required shall be implemented notwithstanding any
inability to obtain federal waivers for the other provisions. No
provision of this subdivision shall be implemented unless matching
funds from Subchapter XIX (commencing with Section 1396) of Chapter 7
of Title 42 of the United States Code are available.
   (v) Early and periodic screening, diagnosis, and treatment for any
individual under 21 years of age is covered, consistent with the
requirements of Subchapter XIX (commencing with Section 1396) of
Chapter 7 of Title 42 of the United States Code.
   (w) Hospice service which is Medicare-certified hospice service is
covered, subject to utilization controls. Coverage shall be
available only to the extent that no additional net program costs are
incurred.
   (x) When a claim for treatment provided to a beneficiary includes
both services which are authorized and reimbursable under this
chapter, and services which are not reimbursable under this chapter,
that portion of the claim for the treatment and services authorized
and reimbursable under this chapter shall be payable.
   (y) Home- and community-based services approved by the United
States Department of Health and Human Services for beneficiaries with
a diagnosis of AIDS or ARC, who require intermediate care or a
higher level of care.
   Services provided pursuant to a waiver obtained from the Secretary
of the United States Department of Health and Human Services
pursuant to this subdivision, and which are not otherwise included in
the Medi-Cal schedule of benefits, shall be available only to the
extent that federal financial participation for these services is
available in accordance with the waiver, and subject to the terms,
conditions, and duration of the waiver. These services shall be
provided to individual beneficiaries in accordance with the client's
needs as identified in the plan of care, and subject to medical
necessity and applicable utilization control.
   The director may under this section contract with organizations
qualified to provide, directly or by subcontract, services provided
for in this subdivision to eligible beneficiaries. Contracts or
agreements entered into pursuant to this division shall not be
subject to the Public Contract Code.
   (z) Respiratory care when provided in organized health care
systems as defined in Section 3701 of the Business and Professions
Code, and as an in-home medical service as outlined in subdivision
(s).
   (aa) (1) There is hereby established in the department, a program
to provide comprehensive clinical family planning services to any
person who has a family income at or below 200 percent of the federal
poverty level, as revised annually, and who is eligible to receive
these services pursuant to the waiver identified in paragraph (2).
This program shall be known as the Family Planning, Access, Care, and
Treatment (Family PACT) Program.
   (2) The department shall seek a waiver in accordance with Section
1315 of Title 42 of the United States Code, or a state plan amendment
adopted in accordance with Section 1396a(a)(10)(A)(ii)(XXI) of Title
42 of the United States Code, which was added to Section 1396a of
Title 42 of the United States Code by Section 2303(a)(2) of the
federal Patient Protection and Affordable Care Act (PPACA) (Public
Law 111-148), for a program to provide comprehensive clinical family
planning services as described in paragraph (8). Under the waiver,
the program shall be operated only in accordance with the waiver and
the statutes and regulations in paragraph (4) and subject to the
terms, conditions, and duration of the waiver. Under the state plan
amendment, which shall replace the waiver and shall be known as the
Family PACT successor state plan amendment, the program shall be
operated only in accordance with this subdivision and the statutes
and regulations in paragraph (4). The state shall use the standards
and processes imposed by the state on January 1, 2007, including the
application of an eligibility discount factor to the extent required
by the federal Centers for Medicare and Medicaid Services, for
purposes of determining eligibility as permitted under Section 1396a
(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code. To the
extent that federal financial participation is available, the program
shall continue to conduct education, outreach, enrollment, service
delivery, and evaluation services as specified under the waiver. The
services shall be provided under the program only if the waiver and,
when applicable, the successor state plan amendment are approved by
the federal Centers for Medicare and Medicaid Services and only to
the extent that federal financial participation is available for the
services. Nothing in this section shall prohibit the department from
seeking the Family PACT successor state plan amendment during the
operation of the waiver.
   (3) Solely for the purposes of the waiver or Family PACT successor
state plan amendment and notwithstanding any other provision of law,
the collection and use of an individual's social security number
shall be necessary only to the extent required by federal law.
   (4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005, and
24013, and any regulations adopted under these statutes shall apply
to the program provided for under this subdivision. No other
provision of law under the Medi-Cal program or the State-Only Family
Planning Program shall apply to the program provided for under this
subdivision.
   (5) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, without taking regulatory action, the
provisions of the waiver after its approval by the federal Health
Care Financing Administration and the provisions of this section by
means of an all-county letter or similar instruction to providers.
Thereafter, the department shall adopt regulations to implement this
section and the approved waiver 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. Beginning six months after the
effective date of the act adding this subdivision, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (6) In the event that the Department of Finance determines that
the program operated under the authority of the waiver described in
paragraph (2) or the Family PACT successor state plan amendment is no
longer cost effective, this subdivision shall become inoperative on
the first day of the first month following the issuance of a 30-day
notification of that determination in writing by the Department of
Finance to the chairperson in each house that considers
appropriations, the chairpersons of the committees, and the
appropriate subcommittees in each house that considers the State
Budget, and the Chairperson of the Joint Legislative Budget
Committee.
   (7) If this subdivision ceases to be operative, all persons who
have received or are eligible to receive comprehensive clinical
family planning services pursuant to the waiver described in
paragraph (2) shall receive family planning services under the
Medi-Cal program pursuant to subdivision (n) if they are otherwise
eligible for Medi-Cal with no share of cost, or shall receive
comprehensive clinical family planning services under the program
established in Division 24 (commencing with Section 24000) either if
they are eligible for Medi-Cal with a share of cost or if they are
otherwise eligible under Section 24003.
   (8) For purposes of this subdivision, "comprehensive clinical
family planning services" means the process of establishing
objectives for the number and spacing of children, and selecting the
means by which those objectives may be achieved. These means include
a broad range of acceptable and effective methods and services to
limit or enhance fertility, including contraceptive methods, federal
Food and Drug Administration approved contraceptive drugs, devices,
and supplies, natural family planning, abstinence methods, and basic,
limited fertility management. Comprehensive clinical family planning
services include, but are not limited to, preconception counseling,
maternal and fetal health counseling, general reproductive health
care, including diagnosis and treatment of infections and conditions,
including cancer, that threaten reproductive capability, medical
family planning treatment and procedures, including supplies and
followup, and informational, counseling, and educational services.
Comprehensive clinical family planning services shall not include
abortion, pregnancy testing solely for the purposes of referral for
abortion or services ancillary to abortions, or pregnancy care that
is not incident to the diagnosis of pregnancy. Comprehensive clinical
family planning services shall be subject to utilization control and
include all of the following:
   (A) Family planning related services and male and female
sterilization. Family planning services for men and women shall
include emergency services and services for complications directly
related to the contraceptive method, federal Food and Drug
Administration approved contraceptive drugs, devices, and supplies,
and followup, consultation, and referral services, as indicated,
which may require treatment authorization requests.
   (B) All United States Department of Agriculture, federal Food and
Drug Administration approved contraceptive drugs, devices, and
supplies that are in keeping with current standards of practice and
from which the individual may choose.
   (C) Culturally and linguistically appropriate health education and
counseling services, including informed consent, that include all of
the following:
   (i) Psychosocial and medical aspects of contraception.
   (ii) Sexuality.
   (iii) Fertility.
   (iv) Pregnancy.
   (v) Parenthood.
   (vi) Infertility.
   (vii) Reproductive health care.
   (viii) Preconception and nutrition counseling.
   (ix) Prevention and treatment of sexually transmitted infection.
   (x) Use of contraceptive methods, federal Food and Drug
Administration approved contraceptive drugs, devices, and supplies.
   (xi) Possible contraceptive consequences and followup.
   (xii) Interpersonal communication and negotiation of relationships
to assist individuals and couples in effective contraceptive method
use and planning families.
   (D) A comprehensive health history, updated at the next periodic
visit (between 11 and 24 months after initial examination) that
includes a complete obstetrical history, gynecological history,
contraceptive history, personal medical history, health risk factors,
and family health history, including genetic or hereditary
conditions.
   (E) A complete physical examination on initial and subsequent
periodic visits.
   (F) Services, drugs, devices, and supplies deemed by the federal
Centers for Medicare and Medicaid Services to be appropriate for
inclusion in the program.
   (9) In order to maximize the availability of federal financial
participation under this subdivision, the director shall have the
discretion to implement the Family PACT successor state plan
amendment retroactively to July 1, 2010.
   (ab) (1) Purchase of prescribed enteral nutrition products is
covered, subject to the Medi-Cal list of enteral nutrition products
and utilization controls.
   (2) Purchase of enteral nutrition products is limited to those
products to be administered through a feeding tube, including, but
not limited to, a gastric, nasogastric, or jejunostomy tube.
Beneficiaries under the Early and Periodic Screening, Diagnosis, and
Treatment Program shall be exempt from this paragraph.
   (3) Notwithstanding paragraph (2), the department may deem an
enteral nutrition product, not administered through a feeding tube,
including, but not limited to, a gastric, nasogastric, or jejunostomy
tube, a benefit for patients with diagnoses, including, but not
limited to, malabsorption and inborn errors of metabolism, if the
product has been shown to be neither investigational nor experimental
when used as part of a therapeutic regimen to prevent serious
disability or death.
   (4) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement the amendments to this subdivision made by
the act that added this paragraph by means of all-county letters,
provider bulletins, or similar instructions, without taking
regulatory action.
   (5) The amendments made to this subdivision by the act that added
this paragraph shall be implemented June 1, 2011, or on the first day
of the first calendar month following 60 days after the date the
department secures all necessary federal approvals to implement this
section, whichever is later.
   (ac) Diabetic testing supplies are covered when provided by a
pharmacy, subject to utilization controls.
   (ad) Commencing January 1, 2014, any benefits, services, and
coverage not otherwise described in this  section 
 chapter  that are included in the essential health benefits
package adopted by the state  pursuant to Section 1367.005 of
the Health and Safety Code and Section 10112.27 of the Insurance Code
 and approved by the United States Secretary of Health and
Human Services under Section 18022 of Title 42 of the United States
Code  , and any successor essential health benefit package
adopted by the state  .
   SEC. 28.   SEC. 42.   Section 14132.02
is added to the Welfare and Institutions Code, to read:
   14132.02.  (a) Pursuant to Sections 1902(k)(1) and 1937(b)(1)(D)
of the federal Social Security Act (42 U.S.C. Sec. 1396a(k)(1); 42
U.S.C. Sec. 1396u-7(b)(1)(D)), the department shall seek approval
from the United States Secretary of Health and Human Services to
establish a benchmark benefit package that includes the same
benefits, services, and coverage as is provided to all other
full-scope Medi-Cal enrollees, supplemented by any benefits,
services, and coverage included in the essential health benefits
package adopted by the state  pursuant to Section 1367.005 of the
Health and Safety Code and Section 10112.27 of the Insurance Code
 and approved by the secretary under Section 18022 of Title 42
of the United States Code  , and any suc   cessor
essential health benefit package adopted by the state  .
   (b) This section shall become operative January 1, 2014.
             SEC. 29.   SEC. 43.   Section
15926 of the Welfare and Institutions Code is amended to read:
   15926.  (a) The following definitions apply for purposes of this
part:
   (1) "Accessible" means in compliance with Section 11135 of the
Government Code, Section 1557 of the PPACA, and regulations or
guidance adopted pursuant to these statutes.
   (2) "Limited-English-proficient" means not speaking English as one'
s primary language and having a limited ability to read, speak,
write, or understand English. 
   (3) "State health subsidy programs" means the programs described
in Section 1413(e) of the PPACA.  
   (3) "Insurance affordability program" means a program that is one
of the following:  
   (A) The Medi-Cal program under Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.).  
   (B) The Healthy Families Program under Title XXI of the federal
Social Security Act (42 U.S.C. Sec. 1397aa et seq.).  
   (C) A program that makes available to qualified individuals
coverage in a qualified health plan through the California Health
Benefit Exchange established pursuant to Title 22 (commencing with
Section 100500) of the Government Code with advance payment of the
premium tax credit established under Section 36B of the Internal
Revenue Code.  
   (4) A program that makes available coverage in a qualified health
plan through the California Health Benefit Exchange established
pursuant to Title 22 (commencing with Section 100500) of the
Government Code with cost-sharing reductions established under
Section 1402 of PPACA and any subsequent amendments to that act.

   (b) An individual shall have the option to apply for 
state health subsidy   insurance affordability 
programs in person, by mail, online, by telephone, or by other
commonly available electronic means.
   (c) (1) A single, accessible, standardized paper, electronic, and
telephone application for  state health subsidy 
 insurance affordability  programs shall be developed by the
department in consultation with MRMIB and the board governing the
Exchange as part of the stakeholder process described in subdivision
(b) of Section 15925. The application shall be used by all entities
authorized to make an eligibility determination for any of the
 state health subsidy   insurance affordability
 programs and by their agents.
   (2) The application shall be tested and operational by the date as
required by the federal Secretary of Health and Human Services.
   (3) The application form shall, to the extent not inconsistent
with federal statutes, regulations, and guidance, satisfy all of the
following criteria:
   (A) The form shall include simple, user-friendly language and
instructions.
   (B) The form may not ask for information related to a nonapplicant
that is not necessary to determine eligibility in the applicant's
particular circumstances.
   (C) The form may require only information necessary to support the
eligibility and enrollment processes for  state health
subsidy   insurance affordability  programs.
   (D) The form may be used for, but shall not be limited to,
screening.
   (E) The form may ask, or be used otherwise to identify, if the
mother of an infant applicant under one year of age had coverage
through  a state health subsidy   an insurance
affordability  program for the infant's birth, for the purpose
of automatically enrolling the infant into the applicable program
without the family having to complete the application process for the
infant.
   (F) The form may include questions that are voluntary for
applicants to answer regarding demographic data categories, including
race, ethnicity, primary language, disability status, and other
categories recognized by the federal Secretary of Health and Human
Services under Section 4302 of the PPACA. 
   (G) Until January 1, 2016, the department shall instruct counties
to not reject an application that was in existence prior to January
1, 2014, but to accept the application and request any additional
information needed from the applicant in order to complete the
eligibility determination process. The department shall work with
counties and consumer advocates to develop the supplemental
questions. 
   (d) Nothing in this section shall preclude the use of a
provider-based application form or enrollment procedures for 
state health subsidy   insurance affordability 
programs or other health programs that differs from the application
form described in subdivision (c), and related enrollment procedures.
 Nothing in this section shall preclude the use of a joint
application, developed by the department and the State Department of
Social Services, that allows for an application to be made for
multiple programs,   including, but not limited to,
CalWORKs, CalFresh, and insurance affordability programs. 
   (e) The entity making the eligibility determination shall grant
eligibility immediately whenever possible and with the consent of the
applicant in accordance with the state and federal rules governing
 state health subsidy   insurance affordability
 programs.
   (f) (1) If the eligibility, enrollment, and retention system has
the ability to prepopulate an application form for insurance
affordability programs with personal information from available
electronic databases, an applicant shall be given the option, with
his or her informed consent, to have the application form
prepopulated. Before a prepopulated  renewal form or, if
available, prepopulated  application is submitted to the
entity authorized to make eligibility determinations, the individual
shall be given the opportunity to provide additional eligibility
information and to correct any information retrieved from a database.

   (2) All  state health subsidy  insurance
affordability  programs shall accept self-attestation, instead
of requiring an individual to produce a document, for age, date of
birth, family size, household income, state residence, pregnancy, and
any other applicable criteria needed to determine the eligibility of
an applicant or recipient, to the extent permitted by state and
federal law.
   (3) An applicant or recipient shall have his or her information
electronically verified in the manner required by the PPACA and
implementing federal regulations and guidance.
   (4) Before an eligibility determination is made, the individual
shall be given the opportunity to provide additional eligibility
information and to correct information.
   (5) The eligibility of an applicant shall not be delayed or denied
for any  state health subsidy   insurance
affordability  program unless the applicant is given a
reasonable opportunity, of at least the kind provided for under the
Medi-Cal program pursuant to Section 14007.5 and paragraph (7) of
subdivision (e) of Section 14011.2, to resolve discrepancies
concerning any information provided by a verifying entity.
   (6) To the extent federal financial participation is available, an
applicant shall be provided benefits in accordance with the rules of
the  state health subsidy   insurance
affordability  program, as implemented in federal regulations
and guidance, for which he or she otherwise qualifies until a
determination is made that he or she is not eligible and all
applicable notices have been provided. Nothing in this section shall
be interpreted to grant presumptive eligibility if it is not
otherwise required by state law, and, if so required, then only to
the extent permitted by federal law.
   (g) The eligibility, enrollment, and retention system shall offer
an applicant and recipient assistance with his or her application or
renewal for  a state health subsidy   an
insurance affordability  program in person, over the telephone,
 and  by mail,  online,  or through
other commonly available electronic means  and in a manner that
is accessible to individuals with disabilities and those who are
limited-English proficient.
   (h) (1) During the processing of an application, renewal, or a
transition due to a change in circumstances, an entity making
eligibility determinations for  a state health subsidy
  an insurance affordability  program shall ensure
that an eligible applicant and recipient of  state health
subsidy   insurance affordability  programs that
meets all program eligibility requirements and complies with all
necessary requests for information moves between programs without any
breaks in coverage and without being required to provide any forms,
documents, or other information or undergo verification that is
duplicative or otherwise unnecessary. The individual shall be
informed about how to obtain information about the status of his or
her application, renewal, or transfer to another program at any time,
and the information shall be promptly provided when requested.
   (2) The application or case of an individual screened as not
eligible for Medi-Cal on the basis of Modified Adjusted Gross Income
(MAGI) household income but who may be eligible on the basis of being
65 years of age or older, or on the basis of blindness or
disability, shall be forwarded to the Medi-Cal program for an
eligibility determination. During the period this application or case
is processed for a non-MAGI Medi-Cal eligibility determination, if
the applicant or recipient is otherwise eligible for  a state
health subsidy   an insurance affordability 
program, he or she shall be determined eligible for that program.
   (3) Renewal procedures shall include all available methods for
reporting renewal information, including, but not limited to,
face-to-face, telephone,  mail,  and online renewal  or
renewal through other commonly available electronic means  .
   (4) An applicant who is not eligible for  a state health
subsidy   an insurance affordability  program for a
reason other than income eligibility, or for any reason in the case
of applicants and recipients residing in a county that offers a
health coverage program for individuals with income above the maximum
allowed for the Exchange premium tax credits, shall be referred to
the county health coverage program in his or her county of residence.

   (i) Notwithstanding subdivisions (e), (f), and (j), before an
online applicant who appears to be eligible for the Exchange with a
premium tax credit or reduction in cost sharing, or both, may be
enrolled in the Exchange, both of the following shall occur:
   (1) The applicant shall be informed of the overpayment penalties
under the federal Comprehensive 1099 Taxpayer Protection and
Repayment of Exchange Subsidy Overpayments Act of 2011 (Public Law
112-9), if the individual's annual family income increases by a
specified amount or more, calculated on the basis of the individual's
current family size and current income, and that penalties are
avoided by prompt reporting of income increases throughout the year.
   (2) The applicant shall be informed of the penalty for failure to
have minimum essential health coverage.
   (j) The department shall, in coordination with MRMIB and the
Exchange board, streamline and coordinate all eligibility rules and
requirements among  state health subsidy  
insurance affordability  programs using the least restrictive
rules and requirements permitted by federal and state law. This
process shall include the consideration of methodologies for
determining income levels, assets, rules for household size,
citizenship and immigration status, and self-attestation and
verification requirements.
   (k) (1) Forms and notices developed pursuant to this section shall
be accessible and standardized, as appropriate, and shall comply
with federal and state laws, regulations, and guidance prohibiting
discrimination.
   (2) Forms and notices developed pursuant to this section shall be
developed using plain language and shall be provided in a manner that
affords meaningful access to limited-English-proficient individuals,
in accordance with applicable state and federal law, and at a
minimum, provided in the same threshold languages as required for
Medi-Cal managed care plans.
   (l) The department, the California Health and Human Services
Agency, MRMIB, and the Exchange board shall establish a process for
receiving and acting on stakeholder suggestions regarding the
functionality of the eligibility systems supporting the Exchange,
including the activities of all entities providing eligibility
screening to ensure the correct eligibility rules and requirements
are being used. This process shall include consumers and their
advocates, be conducted no less than quarterly, and include the
recording, review, and analysis of potential defects or enhancements
of the eligibility systems. The process shall also include regular
updates on the work to analyze, prioritize, and implement corrections
to confirmed defects and proposed enhancements, and to monitor
screening.
   (m) In designing and implementing the eligibility, enrollment, and
retention system, the department, MRMIB, and the Exchange board
shall ensure that all privacy and confidentiality rights under the
PPACA and other federal and state laws are incorporated and followed,
including responses to security breaches.
   (n) Except as otherwise specified, this section shall be operative
on  and after  January 1, 2014. 
  SEC. 30.    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. 
   SEC. 44.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution for certain costs that may be incurred by a local agency
or school district because, in that regard, this act creates a new
crime or infraction, eliminates a crime or infraction, or changes the
penalty for a crime or infraction, within the meaning of Section
17556 of the Government Code, or changes the definition of a crime
within the meaning of Section 6 of Article XIII B of the California
Constitution.  
   However, if the Commission on State Mandates determines that this
act contains other 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.
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Bill Text: CA ABX11 | 2013-2014 | Regular Session | Amended

California Assembly Bill 1 (Prior Session Legislation)

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