SB 1073

Bill Subjects

Abstract

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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state may rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program. Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or WIC Program) , which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible 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. This bill would require the State Department of Health Care Services to designate the WIC Program and its local WIC agencies as Express Lane agencies, and to use WIC Program eligibility determinations to meet Medi-Cal program eligibility requirements, including financial eligibility and state residence. The bill would require the department, in collaboration with specified entities, such as program offices for the WIC Program and local WIC agencies, to complete various tasks, including receiving eligibility findings and information from WIC records on WIC recipients to process their Medi-Cal program expedited eligibility determination. The bill would require the department to eliminate procedural burdens imposed on Medi-Cal program applicants by implementing specified policies, such as providing presumptive eligibility and WIC-based verification of Medi-Cal program eligibility for WIC Program recipients. The bill would require the department to conduct a feasibility study to assess and design electronic express lane eligibility systems pathways between the Medi-Cal program and the WIC Program, and to maximize federal Medicaid funding for systems modifications. The bill would condition the implementation of these provisions on the department obtaining federal approval. Because counties are responsible for making eligibility determinations under the Medi-Cal program, and by modifying eligibility requirements and processes, this 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 the statutory provisions noted above.