Bill Text: CA SB438 | 2009-2010 | Regular Session | Introduced

California Senate Bill 438 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Charter schools: freedom of speech and of the press.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2010-08-18 - Chaptered by Secretary of State. Chapter 142, Statutes of 2010. [SB438 Detail]

Download: California-2009-SB438-Introduced.html
BILL NUMBER: SB 438	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Yee

                        FEBRUARY 26, 2009

   An act to add Section 12693.766 to, and to add Part 6.25
(commencing with Section 12694.10) to Division 2 of, the Insurance
Code, and to amend Sections 14005.30 and 14011.6 of the Welfare and
Institutions Code, relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 438, as introduced, Yee. Health care coverage: Cal-Health Act.
   Existing law provides for creation of various programs to provide
health care services to persons with limited incomes and meeting
various eligibility requirements. These programs include the Healthy
Families Program administered by the Managed Risk Medical Insurance
Board and the Medi-Cal program administered by the State Department
of Health Care Services and county welfare departments.
   This bill would require the board, in consultation with the
department, to begin, on or before July 1, 2010, the transfer of
initial and ongoing eligibility determinations for the Healthy
Families Program to the county welfare department. By imposing new
duties on those county departments, the bill would impose a
state-mandated local program.
   The bill would also create the Cal-Health Program, which would
provide coordination of the Healthy Families and Medi-Cal programs by
the Secretary of California Health and Human Services, with the
assistance of the board, the department, and county welfare
departments. The bill would authorize participating providers, to the
extent permitted under federal law, to screen and temporarily enroll
a child in the Medi-Cal program or the Healthy Families Program at
the time medical care is provided, and would require reimbursement of
the provider to the same extent as if the child were fully enrolled
in the program in which he or she is temporarily enrolled. The bill
would require preschools and elementary schools and licensed
hospitals, clinics, and other health facilities to inform parents or
primary caretakers of a child about Cal-Health, and in the case of
urgent or emergency services, the bill would require that parents or
primary caretakers of a child be informed about the program and given
an opportunity to apply after services have been rendered.
   Under existing law, the State Department of Health Care Services
is required, to the extent federal financial participation is
available, to exercise an option under federal law to expand Medi-Cal
eligibility by establishing the amount of countable resources
individuals or families are allowed to retain at a specified level
and to adopt an income disregard for applicants equal to the
difference between a specified income standard and the amount equal
to 100% of the federal poverty level applicable to the size of the
family.
   This bill would, instead, require the department, to the extent
federal financial participation is available, to exercise that option
to simplify Medi-Cal eligibility by exempting all resources from
consideration in making eligibility determinations and to adopt an
income disregard for applicants equal to the difference between that
income standard and the amount equal to 133% of the federal poverty
level applicable to the size of the family. The bill would also
require, subject to approval of any necessary state plan amendments,
the department to implement a program for accelerated enrollment of
pregnant women in the Medi-Cal program and would make each county
welfare department a qualified entity for determining eligibility for
Medi-Cal benefits for children and pregnant women. Because the bill
would increase duties on those county departments, 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.
   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.  This act shall be known and may be cited as the
Cal-Health Act.
  SEC. 2.  Section 12693.766 is added to the Insurance Code, to read:

   12693.766.  (a) Notwithstanding any other provision of this part,
on or before July 1, 2010, the board, in consultation with the State
Department of Health Care Services, shall begin the transfer of
initial and ongoing eligibility determinations for the program to the
county departments. The counties shall assume full responsibility
for the eligibility determinations for the program by January 1,
2011.
   (b) The board and the department shall consult with stakeholders,
including counties and advocates for program clients, in the
development of procedures for transferring the responsibility for
determinations to the county level.
   (c) Upon transfer of program eligibility determinations to the
county level, the collection of family contributions and
participating health plan selection may continue to be contracted to
a private entity. In order to maximize efficiency, it is the intent
of the Legislature that plan selection and collection of
contributions be incorporated, to the extent possible, into the
Medi-Cal managed care enrollment broker contract administered by the
State Department of Health Care Services.
  SEC. 3.  Part 6.25 (commencing with Section 12694.10) is added to
Division 2 of the Insurance Code, to read:

      PART 6.25.  CAL-HEALTH PROGRAM


   12694.10.  It shall be the responsibility of the State of
California to make its best efforts to provide that all persons who
are eligible for the Healthy Families Program or the Medi-Cal
program, or other governmental health care coverage or assistance,
are enrolled in programs and services for which they are eligible.
   12694.11.  There is hereby created the California Health Care
Program (Cal-Health) to coordinate the Medi-Cal program (Chapter 7
(commencing with Section 14000) of Part 3 of Division 9 of the
Welfare and Institutions Code) and the Healthy Families Program (Part
6.2 (commencing with Section 12693)) for the purpose of marketing to
those who are potentially eligible for a single unified program in
an attempt to reduce possible confusion. The duties and functions of
establishing Cal-Health shall be carried out by the Secretary of
California Health and Human Services, with the assistance of the
State Department of Health Care Services, which is defined for the
purposes of this part as the "department," and the Managed Risk
Medical Insurance Board, which is defined for the purposes of this
part as the "board," and the county welfare departments, which are
defined for the purposes of this part as the "counties." The
coordinated Medi-Cal and Healthy Families programs established by
this part shall be known as Cal-Health.
   12694.13.  (a) The department and board, in consultation with the
counties and client advocates, shall make any changes necessary to
the existing Medi-Cal and Healthy Families joint application in order
to enable persons to apply for benefits under the Cal-Health
structure.
   (b) The department and board, in consultation with the counties,
provider representatives, and client advocates, shall develop an
electronic process by which participating providers may screen and
temporarily enroll eligible children into the Medi-Cal program or the
Healthy Families Program, as provided in subdivisions (c) and (d).
During the period of temporary enrollment, providers shall be
reimbursed for services to the same extent as if the eligible child
were fully enrolled in the program in which he or she is temporarily
enrolled. A purpose of temporary enrollment under this section is to
facilitate and accelerate the final eligibility determination by the
counties.
   (c) To the extent permitted by Section 1396r-1a of Title 42 of the
United States Code and Section 457.355 of Title 42 of the Code of
Federal Regulations, the state shall exercise its option to allow
participating providers to screen and temporarily enroll a child who
meets initial screening requirements into the Medi-Cal program or the
Healthy Families Program for 60 days pending a final eligibility
determination by the counties. No child shall be temporarily enrolled
into a program more than one time during a 12-month period. The
procedures governing the preenrollment process for the Medi-Cal
program and the Healthy Families Program pursuant to Section 14011.7
of the Welfare and Institutions Code, including, but not limited to,
the requirement that providers be certified by the state and that a
Medi-Cal application be submitted on the child's behalf within 60
days after the date the child is temporarily enrolled into the
programs shall be used to implement the temporary enrollment of
children under this section.
   (d) The Cal-Health enrollment and application process shall secure
sufficient information to ensure that the counties are able to
perform screening and referral for children not eligible for programs
within Cal-Health, but potentially eligible for other state health
care programs.
   12694.15.  To the extent permitted by federal law and
notwithstanding any other provision of law, there shall not be an
assets test for Section 1931(b) of the Medi-Cal program for adults
and children.
   12694.17.  Preschools and public elementary and secondary schools,
with respect to each enrolled child, shall inform the parent or
primary caretaker living with the child at least once each year about
Cal-Health and its eligibility requirements, and shall allow an
application to be submitted at the preschool or school.
   12694.18.  (a) All licensed hospitals, clinics, and other health
facilities shall inform the parent or primary caretaker of a child
who is seen or admitted about Cal-Health and its eligibility
requirements at the time the person or child is seen or admitted, and
may participate in the temporary eligibility and accelerated
enrollment process described in Section 12694.13.
   (b) In the case of urgent or emergency services, parents and
primary caretakers of a child shall be informed about Cal-Health and
given an opportunity to apply on behalf of eligible children after
services have been rendered and, in the case of inpatient admission,
during discharge planning.
  SEC. 4.  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   reaffirmation
 under Section 14012. The department shall implement this
paragraph only if, and to the extent that the  federal 
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   simplify  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)
  exempting all resources  .
   (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   133
 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) 
    (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 implement, without taking regulatory
action, subdivisions (a) and (b)  of this section 
by means of an 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. 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.
  SEC. 5.  Section 14011.6 of the Welfare and Institutions Code is
amended to read:
   14011.6.  (a) To the extent federal financial participation is
available, the department shall exercise the option provided in
Section 1920a of the federal Social Security Act (42 U.S.C. Sec.
1396r-1a) to implement a program for accelerated enrollment of
children  and pregnant women  .
   (b) The department shall designate  the single point of
entry, as defined in subdivision (c), as the   each
county welfare department as a  qualified entity for determining
eligibility under this section. 
   (c) The single point of entry, as defined in subdivision (d),
shall route any applications it receives directly to the appropriate
county for an accelerated eligibility determination pursuant to this
section.  
   (c) 
    (d)  For purposes of this section, "single point of
entry" means the centralized processing entity that accepts and
screens applications for benefits under the Medi-Cal  Program
  program  for the purpose of forwarding them to
the appropriate counties. 
   (d) 
    (e)  The department shall implement this section only
if, and to the extent that, federal financial participation is
available. 
   (e) 
    (f)  The department shall seek federal approval of any
state plan amendments necessary to implement this section. When
federal approval of the state plan amendment or amendments is
received, the department shall commence implementation of this
section on the first day of the second month following the month in
which federal approval of the state plan amendment or amendments is
received, or on July 1,  2002   2010 ,
whichever is later. 
   (f) 
    (g)  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. 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) 
    (h)  Upon the receipt of an application for a child
 who has coverage pursuant to the accelerated enrollment
program, a   or a pregnant woman from the single point
of entry pursuant to subdivision (c) directly fro   m a
parent, or from another source on behalf of the child, or from a
pregnant woman, a county shall determine whether the child or
pregnant woman appears eligible for Medi-Cal benefits and, if so,
grant accelerated enrollment to the child or pregnant woman. Upon the
granting of accelerated enrollment for a child or pregnant woman,
the  county shall determine whether the child  or pregnant
woman  is eligible for Medi-Cal benefits. If the county
determines that the child  or pregnant woman  does not meet
the eligibility requirements for participation in the Medi-Cal
program, the county shall report this finding to the Medical
Eligibility Data System so that accelerated enrollment coverage
benefits are discontinued  . The information to be reported
shall consist of the minimum data elements necessary to discontinue
that coverage for the child. This subdivision shall become operative
on July 1, 2002, or the date that the program for accelerated
enrollment coverage for children takes effect, whichever is later.
  and shall determine whether the child or pregnant
woman is eligible for the Healthy Families Program. 
  SEC. 6.  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.