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Summary: Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. This bill would, to the extent that federal financial participation is available, and pursuant to a demonstration project or waiver of federal law, require the department to establish pilot projects in up to 4 counties, as specified, to develop effective health care models to provide services to persons who are dually eligible under both the Medi-Cal and Medicare programs. This bill would require the department to, no later than April 1, 2011, identify health care models that may be included in a pilot project , to develop a timeline and process for selecting, financing, monitoring, and evaluating the pilot projects , and to provide this timeline and process to certain committees of the Legislature . This bill contains other related provisions and other existing laws. |
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Digest: Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions.
Existing federal law provides for the federal Medicare Program,
which is a public health insurance program for persons 65 years of
age and older and specified persons with disabilities who are under
65 years of age.
This bill would, to the extent that federal financial
participation is available, and pursuant to a demonstration project
or waiver of federal law, require the department to establish pilot
projects in up to 4 counties, as specified, to develop effective
health care models to provide services to persons who are dually
eligible under both the Medi-Cal and Medicare programs. This bill
would require the department to, no later than January 1,
2012, April 1, 2011, identify health care models
that may be included in a pilot project and
, to develop a timeline and process for selecting, financing,
monitoring, and evaluating the pilot projects , and to provide
this timeline and process to certain committees of the Legislature
.
Existing law requires the department to seek a demonstration
project or federal waiver of Medicaid law to implement specified
objectives, which may include better care coordination for seniors
and persons with disabilities and children with special health care
needs.
This bill would, in furtherance of the waiver or
demonstration project and to the extent that federal financial
participation is available, permit the department to develop
a pilot project that would require seniors and persons
with disabilities who do not have other health coverage to
be assigned as mandatory enrollees into new and existing managed
care health plans or county alternative models of care, as specified.
This bill would provide that enrollment of seniors and persons with
disabilities shall be accomplished using a phased-in process and
shall not commence until necessary federal approvals have been
acquired, or until February 1, 2011, whichever is later. The bill
would impose various requirements upon managed care health plans and
county alternative models of care participating in the demonstration
program.
This bill would, commencing January 1, 2011, require all
Medi-Cal managed care health plans and other managed care
arrangements, as specified, to submit data, including encounter data
and financial data, for the development of rates, monitoring
performance, and ensuring quality. beginning January
1, 2012, require managed care health plans and county alternative
models of care to comply with quality submission standards developed
by the department as prescribed.
This bill would require the department, in conjunction with the
implementation of the pilot project, to work with counties to develop
a method to be used in determining the appropriate contribution to
cover the nonfederal share of inpatient hospital expenses for seniors
and persons with disabilities in the Medi-Cal program.
Existing law, the Robert W. Crown California Children's Services
Act, requires the department and each county to administer the
California Children Services (CCS) program for treatment services for
persons under 21 years of age diagnosed with severe chronic disease
or severe physical limitations, as specified.
This bill also would, in furtherance of the waiver or
demonstration project, require the Director of Health Care Services
to establish, by January 1, 2012, models of organized health care
delivery systems, as specified, for children eligible for services
under the CCS program. This bill would provide that, to the extent
permitted by federal law, the department may require eligible
individuals to enroll in these models. This bill would also permit
the Managed Risk Medical Insurance Board to elect, with the consent
of the director, to permit children enrolled in the Healthy Families
Program who are eligible for CCS services to enroll in these
organized health care delivery models.
Existing law provides for the Health Care Coverage Initiative,
which is a federal waiver demonstration project established to expand
health care coverage to low-income uninsured individuals who are not
currently eligible for the Medi-Cal program, the Healthy Families
Program, or the Access for Infants and Mothers program.
Existing law provides for the repeal of this
the department's authority under the Health Care
Coverage Initiative upon the execution of a declaration by the
Director of Health Care Services specifying that the demonstration
project has been terminated.
This bill would, alternatively, authorize the director to execute
a declaration continuing the demonstration project to the extent
authorized by a successor federal waiver or demonstration project.
This bill would, in this regard, only to the extent
that federal financial participation is available and only to
the extent that federal financial participation is not jeopardized
, require the department to, on or after September 1, 2010, but
no later than January 1, 2011, or 180 days after federal approval
is obtained, seek of a successor
demonstration project or federal waiver of Medicaid law to
establish authorize local Coverage Expansion and
Enrollment Demonstration (CEED) projects, as specified, to provide
scheduled health care benefits for uninsured adults 19 to 64,
inclusive, years of age with incomes up to 200% of the federal
poverty level who are not otherwise eligible for Medi-Cal or
Medicare. This bill would require CEED projects to be designed and
implemented with the systems and program elements necessary to
facilitate the transition of those eligible individuals to the
Medi-Cal program, or alternatively, to coverage through the state
health insurance exchange, by 2014, pursuant to the provisions of
federal and state law, and the terms and conditions of specified
successor federal waivers or demonstrations projects.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no. |