SB 361

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 law authorizes the department to create the Health Homes Program (program) for enrollees with chronic conditions, as authorized under federal law. Existing law conditions the implementation of the program on federal approval and the availability of federal financial participation. Existing law prohibits the implementation of the program if additional General Fund moneys are used to fund the administration and costs of services, unless the department projects that the implementation of the program would not result in any net increase in ongoing General Fund costs for the Medi-Cal program. Existing law requires the nonfederal share for the program to be provided by funds from specified entities, including local governments. This bill would remove the prohibition on the use of General Fund moneys for the implementation of the program. The bill would limit the above restriction on sources for the nonfederal share only to the first 8 quarters of implementation of each phase of the program. Existing law authorizes the department to revise or terminate the program any time after the first 8 quarters of implementation if the department finds that the program fails to demonstrate certain results. This bill would remove the department's authority to revise or terminate the program as described above. Existing law requires the department to select providers with a viable plan to reach out to and engage frequent hospital or emergency department users and chronically homeless eligible individuals. This bill would require the outreach and engagement to be in person. The bill would, subject to an appropriation, require the department to require administering Medi-Cal managed care plans to take specified actions, relating to provider rates, partnerships, and reports, for purposes of adult beneficiaries who have a level of severity in certain conditions based on experiencing chronic homelessness, to increase program participation among members who are experiencing homelessness.