BILL NUMBER: SB 785 AMENDED
BILL TEXT
AMENDED IN SENATE JANUARY 12, 2004
AMENDED IN SENATE APRIL 28, 2003
INTRODUCED BY Senator Ortiz
FEBRUARY 21, 2003
An act to amend Section 14124.91 of add
Section 14016.51 to the Welfare and Institutions Code, relating
to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 785, as amended, Ortiz. Medi-Cal benificiary
: 3rd-party coverage managed
health care plan option .
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, pursuant to which medical
benefits are provided to public assistance recipients and other
low-income persons.
Existing law requires the department, whenever it is
cost-effective, to pay the premium for 3rd-party health coverage for
beneficiaries under the Medi-Cal program.
This bill would require the department, notwithstanding the above
requirement, to give beneficiaries the option of enrolling in, or
maintaining enrollment in, an employer-sponsored health benefits plan
for which they are eligible, at the time they apply for the Medi-Cal
program, if the department determines that it would be
cost-effective to do so. The bill would provide that for these
beneficiaries, the employer-sponsored health benefits plan would
serve as their primary source of health coverage and the Medi-Cal
program would serve as secondary coverage. It would also require the
department to screen persons applying for the Medi-Cal program to
determine whether they are eligible for, or enrolled in, an
employer-sponsored health benefits plan that would qualify for this
option, and to seek any waivers or federal approval necessary to
implement the bill , at the time Medi-Cal eligibility
is determined or redetermined for an applicant or beneficiary who
resides in an area served by a managed health care plan in which
Medi-Cal beneficiaries may enroll, that a county ensure that the
applicant or beneficiary personally attend a presentation at which
the applicant or beneficiary is informed of the managed care and
fee-for-service options available regarding methods of receiving
Medi-Cal benefits. Existing law requires, no later than 30 days
following the date that a Medi-Cal beneficiary or applicant is
determined eligible, that the beneficiary or applicant indicate his
or her choice in writing between 2 health care options, as a
condition of coverage for Medi-Cal benefits.
Existing law permits an applicant for Medi-Cal benefits to apply
by mailing in a simplified application package. Existing law also
provides for a single point of entry program in which a centralized
processing entity accepts and screens applications for Medi-Cal
benefits for the purpose of forwarding them to the appropriate
counties.
This bill would authorize the department to modify the Medi-Cal
mail-in application form and single point-of-entry application form
to inform applicants in counties served by managed health care plans
of their option to enroll directly in a managed care plan and how
they may exercise that option.
Under existing law, each county is responsible for Medi-Cal
eligibility determinations.
By modifying the Medi-Cal eligibility determination process, this
bill would increase the responsibilities of counties in the
administration of the Medi-Cal program, thereby imposing 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, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
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: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14124.91 of the Welfare and Institutions
SECTION 1. Section 14016.51 is added to the Welfare and
Institutions Code, to read:
14016.51. (a) Notwithstanding Section 14016.5, the department, if
it determines it would be feasible and beneficial, may modify the
Medi-Cal mail-in application form and single-point-of-entry
application form to inform applicants in counties served by managed
care plans of their option to enroll directly in a managed care plan
and how they may exercise that option.
(b) The department shall ensure that any changes that it
implements pursuant to subdivision (a) are consistent with federal
law.
SEC. 2. Notwithstanding Section 17610 of the Government Code, 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. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.
Code is amended to read:
14124.91. (a) The State Department of Health Services, whenever
it is cost-effective, shall pay the premium for third-party health
coverage for beneficiaries under this chapter. The State Department
of Health Services shall, when a beneficiary's third-party health
coverage would lapse due to loss of employment or change in health
status, lack of sufficient income or financial resources, or any
other reason, continue the health coverage by paying the costs of
continuation of group coverage pursuant to federal law or converting
from a group to an individual plan, whenever it is cost-effective.
Notwithstanding any other provision of a contract or of law, the time
period for the department to exercise either of these options shall
be 60 days from the date of lapse of the policy.
(b) (1) Notwithstanding subdivision (a), the department shall give
beneficiaries the option of enrolling, or maintaining enrollment, in
an employer-sponsored health benefits plan for which they are
eligible, at the time they apply for the Medi-Cal program, if the
department determines that it would be cost-effective to do so. For
these beneficiaries, the employer-sponsored health benefits plan
shall serve as their primary source of health coverage and the
Medi-Cal program shall serve as secondary coverage. The department
shall screen persons applying for the Medi-Cal program to determine
whether they are eligible for, or enrolled in, an employer-sponsored
health benefits plan that would qualify for the option provided under
this paragraph.
(2) The department shall seek any waivers or federal approval
necessary to implement this subdivision.
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