SB 1

Bill Subjects

Abstract

Existing law establishes various public programs to provide health care coverage to eligible children, including the Medi-Cal program administered by the State Department of Health Care Services and county welfare agencies, and the Healthy Families Program administered by the Managed Risk Medical Insurance Board. Children through 18 years of age are eligible for health care coverage under these programs if they meet certain household income and other criteria including specified citizenship and immigration status requirements. Under existing law, the applicant's signed statement as to the value or amount of income is accepted for eligibility purposes under the Healthy Families Program if documentation cannot otherwise be provided. This bill would expand eligibility for the Medi-Cal program and the Healthy Families Program by modifying the income requirements applicable to those programs, and by making coverage available regardless of citizenship or immigration status, as specified. The bill would require a parent or caretaker relative of a child applying for the Medi-Cal program to sign a specified attestation under penalty of perjury regarding the child's immigration status, as specified, thereby expanding the crime of perjury and imposing a state-mandated local program. The bill would require the Managed Risk Medical Insurance Board, by July 1, 2011, to implement a process for an applicant's self-certification of income and income deductions for purposes of establishing eligibility for the Healthy Families Program. The bill would require the Managed Risk Medical Insurance Board and the State Department of Health Care Services, by July 1, 2011, to simplify the annual renewal forms for children enrolled in the Healthy Families Program or the Medi-Cal program and to establish a process to allow families to renew their child's coverage by telephone. The bill would require the Managed Risk Medical Insurance Board and the State Department of Health Care Services to make specified technological improvements to the existing eligibility determination and enrollment systems for the Medi-Cal program and the Healthy Families Program and to develop a process to transition the enrollment of children from local children's health initiatives into those programs. The bill would also make various related modifications to the Medi-Cal program and the Healthy Families Program and would require the State Department of Health Care Services and the Managed Risk Medical Insurance Board to maximize federal matching funds for the Medi-Cal program and the Healthy Families Program. Because the expansion of, and modifications to, the Medi-Cal program would impose certain duties on counties relative to administration of that program, the bill would impose a state-mandated local program. Existing law establishes the Healthy Families Presumptive Eligibility Program, administered by the Managed Risk Medical Insurance Board, to provide a child who, among other requirements, has been receiving full-scope Medi-Cal benefits with health care benefits while the board determines the child's eligibility for the Healthy Families Program. Existing law also creates a Medi-Cal presumptive eligibility program to provide a child who, among other requirements, has been receiving benefits under the Healthy Families Program with health care benefits until a Medi-Cal eligibility determination is made. This bill would require the Managed Risk Medical Insurance Board and the State Department of Health Care Services to monitor those programs to ensure children are timely enrolled in the presumptive eligibility benefits for which they are eligible. Existing law requires the state to administer, to the extent allowed under federal law, and only if federal financial participation is available, the Medi-Cal to Healthy Families Presumptive Eligibility Program to provide a child not receiving no-cost Medi-Cal benefits or Healthy Families benefits who meets specified eligibility requirements, including the income requirements of the Healthy Families Program, with benefits identical to full-scope benefits under the Medi-Cal program with no share of cost for the period during which the child has an application pending for coverage under the Healthy Families Program. This bill would establish, to the extent allowed by federal law and to the extent federal financial participation is available, the Medi-Cal Presumptive Eligibility Program that would provide a child not receiving no-cost Medi-Cal benefits or Healthy Families Program benefits who meets specified eligibility requirements with presumptive eligibility benefits identical to full-scope benefits under the Medi-Cal program with no share of cost until the child's eligibility for the Medi-Cal program is determined, as specified. The bill would require the county to forward the child's application to the Healthy Families Program if it finds the child eligible for the Medi-Cal program with a share of cost. The bill would require this program to be implemented by July 1, 2011. Under existing law, the Robert W. Crown California Children's Services Act, the State Department of Health Care Services and each county administer the California Children Services Program (CCS program) for treatment services for persons under the age of 21 years diagnosed with severe chronic disease or severe physical limitations, as specified. Existing law limits eligibility for those services to persons in families with an annual adjusted gross income of $40,000 or less. This bill would change that eligibility limitation to persons in a family with an annual, or equivalent monthly income, that is equal to or less than $40,000, or that meets the income eligibility requirements for the Healthy Families Program, as specified. The bill would also create the Healthy Families Buy-In Program (buy-in program) and would require the Managed Risk Medical Insurance Board to implement that program by July 1, 2011. Under the buy-in program, the coverage provided under the Healthy Families Program would be available to children whose household income exceeds 300% of the federal poverty level and who meet other specified criteria. The bill would specify that coverage under the buy-in program would include services provided under the CCS program for children eligible for the CCS program and would deem the child's family financially eligible for benefits under the CCS program. Because the bill would thereby expand eligibility for the CCS program, which is administered by a county's public health or social welfare department, it would impose a state-mandated local program. The bill would specify the family contribution required for children enrolled in the buy-in program. Existing law requires the state to reimburse counties for 50% of the amount required to meet state administrative standards for that portion of the county caseload under the CCS program that is ineligible for Medi-Cal, to the extent funds are available in the state budget. This bill would also require the state to reimburse counties for 100% of the amount required to provide CCS program services to children enrolled in the buy-in program. Existing law, the California Special Supplemental Food Program for Women, Infants, and Children (WIC) , authorizes establishment of a statewide program, administered by the State Department of Public Health, for providing nutritional food supplements to low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk. The program, which implements a program authorized under existing federal law, provides for the redemption of nutrition coupons by recipients at any authorized retail food vendor. Existing law requires the Managed Risk Medical Insurance Board and the department, in collaboration with WIC program offices and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program and the Healthy Families Program for children applying to the WIC program. Existing law requires the WIC gateway system to be constructed with the capacity to be used by entities operating the WIC program. This bill would require all WIC local agencies that serve large numbers of participants and a high proportion of uninsured participants, as specified, to use the WIC gateway system only to the extent funding is available, as specified, and would permit all other local WIC agencies to use the WIC gateway system at their option. Existing law creates the Healthy Families Fund, and provides that money in the fund is continuously appropriated for purposes of the Healthy Families Program. This bill would provide that the Managed Risk Medical Insurance Board may implement the provisions of the bill expanding the Healthy Families Program only to the extent that funds are appropriated for those purposes in the annual Budget Act or in another statute. 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.