Amended
IN
Assembly
August 19, 2024 |
Amended
IN
Senate
May 16, 2024 |
Amended
IN
Senate
March 21, 2024 |
Introduced by Senator Menjivar (Coauthors: Assembly Members Aguiar-Curry and Stephanie Nguyen) |
February 13, 2024 |
Existing law establishes a system of childcare and development services, administered by the State Department of Social Services, for children from infancy to 13 years of age. Existing law authorizes, upon departmental approval, the use of appropriated funds for alternative payment programs to allow for maximum parental choice. Existing law authorizes those programs to include, among other things, a subsidy that follows the family from one childcare provider to another, or choices among hours of service. Existing law requires the department to contract with local contracting agencies for alternative payment programs so that services are provided throughout the state.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive
health care services, through managed care or fee-for-service delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, early and periodic screening, diagnostic, and treatment (EPSDT) services are covered Medi-Cal benefits for individuals under 21 years of age.
This bill, subject to any necessary federal approvals and the availability of federal funding, would require the State Department of Health Care Services and the State Department of Social Services to develop a model memorandum of understanding (MOU), and would require the department to authorize Medi-Cal managed care plans and alternative payment agencies to enter an MOU that includes, at a minimum, the provisions included in the model.
For purposes of children of families receiving subsidized childcare services through an alternative payment program, and upon the consent of the parent or
guardian, the bill would require the plans and agencies to collaborate on informing and directing the family of a child who is eligible but not a beneficiary of the Medi-Cal program on how to enroll the child and on referring a child who is a Medi-Cal beneficiary to developmental screenings that are available under EPSDT services and administered through the plan. The bill would authorize the agency to perform certain related functions.
(a)The department shall authorize Medi-Cal managed care plans to enter into a memorandum of understanding (MOU) with alternative payment agencies. The MOU shall include, at a minimum, the provisions included in the model developed pursuant to subdivision (d).
(b)In accordance with the MOU, and for purposes of children of families receiving subsidized childcare services through an alternative payment program, the Medi-Cal managed care plan and alternative payment agency shall collaborate on both of the following upon the consent of the corresponding parent or guardian:
(1)If the child is
eligible for coverage under the Medi-Cal program but is not a Medi-Cal beneficiary, informing and directing the family on how to enroll the child into the Medi-Cal program.
(2)If the child is already a Medi-Cal beneficiary, or if the child is newly enrolled in Medi-Cal through the assistance described in paragraph (1), referring the child to developmental screenings that are available under early and periodic screening, diagnostic, and treatment (EPSDT) services, as covered under subdivision (v) of Section 14132, and that are administered through the Medi-Cal managed care plan.
(c)In accordance with the MOU, an alternative payment agency may address the systems of care coordination gap and may serve as the primary prevention coordination partner with expanded navigation and training
functions, for the purpose of implementing subdivision (b).
(d)The department, in consultation with the State Department of Social Services, shall develop a model template MOU to be used by Medi-Cal managed care plans and alternative payment agencies.
(e)For purposes of this section:
(1)“Alternative payment agency” means an agency that operates alternative payment programs under the Child Care and Development Services Act, as described in Chapter 3 (commencing with Section 10225) of Part 1.8.
(2)“Medi-Cal managed care plan” means an individual,
organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A)Article 2.7 (commencing with Section 14087.3).
(B)Article 2.8 (commencing with Section 14087.5).
(C)Article 2.81 (commencing with Section 14087.96).
(D)Article 2.82 (commencing with Section 14087.98).
(E)Article 2.91 (commencing with Section 14089).
(F)Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code.
(f)(1)The department shall seek any necessary federal approvals to implement this section.
(2)This section shall be implemented only to the extent that any necessary federal approvals have been obtained and federal financial participation is available.