Signed by Governor Gavin Newsom

Vote Smart's Synopsis:

Vote to amend and pass a bill that expands full-scope Medi-Cal eligibility to low-income adults 50 years of age or older, regardless of immigration status.

Highlights:

• Defines “Medi-Cal managed care plan” as any individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries (Sec. 355-5961.4-5).

• Requires the Department of Public Health to implement Enhanced Care Management (ECM) benefit designed to address the clinical and non-clinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans (Sec. 1-11).

• Requires the department to seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to those provisions as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program and requires the department to implement those extended waivers or flexibilities for which federal approval is obtained for a specified period of time ending December 31, 2022 (Sec. 1-19).

• Expands Medi-Cal eligibility to specified individuals who are 50 years of age and older and imposes a state-mandated local program (Sec. 1-22).

• Establishes the Advance Health Care Directive Registry, allowing individuals to register a written advance health care directive with the Secretary of State (Sec. 1-41).

• Require the Department of Public Health to seek federal approvals to implement these provisions and condition the implementation of these provisions on the department securing federal approval and the availability of federal financial participation. This law also authorizes the department to implement these provisions by various means, including provider bulletins, and to modify methodology and specified provisions under prescribed circumstances (Sec. 1-50).

• Establishes the Office of Medicare Innovation and Integration within the department which has the following duties (Sec. 361.a):

• Provide focused leadership and expertise on innovative models for Medicare beneficiaries in California, including Medicare-only beneficiaries, and individuals dually eligible for the Medicare and Medi-Cal programs;

• Support new and existing models and strategies to benefit Medicare-only beneficiaries in California, in collaboration with local, state, and federal partners and other stakeholders;

• Consider and develop strategies for Medicare and Medi-Cal enrollment, benefits, health care delivery systems, and data sharing and reporting, to improve health outcomes, quality, equity, and cost-effectiveness; and

• Develop innovative approaches to integrated models of care and coordinated access to long-term services and supports for Medicare-only beneficiaries and dually eligible beneficiaries.

• Establishes an individual is eligible, to the extent required by federal law, as though the individual was pregnant, for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy (Sec. 362.a).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that expands full-scope Medi-Cal eligibility to low-income adults 50 years of age or older, regardless of immigration status.

Highlights:

• Defines “Medi-Cal managed care plan” as any individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries (Sec. 355-5961.4-5).

• Requires the Department of Public Health to implement Enhanced Care Management (ECM) benefit designed to address the clinical and non-clinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans (Sec. 1-11).

• Requires the department to seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to those provisions as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program and requires the department to implement those extended waivers or flexibilities for which federal approval is obtained for a specified period of time ending December 31, 2022 (Sec. 1-19).

• Expands Medi-Cal eligibility to specified individuals who are 50 years of age and older and imposes a state-mandated local program (Sec. 1-22).

• Establishes the Advance Health Care Directive Registry, allowing individuals to register a written advance health care directive with the Secretary of State (Sec. 1-41).

• Require the Department of Public Health to seek federal approvals to implement these provisions and condition the implementation of these provisions on the department securing federal approval and the availability of federal financial participation. This law also authorizes the department to implement these provisions by various means, including provider bulletins, and to modify methodology and specified provisions under prescribed circumstances (Sec. 1-50).

• Establishes the Office of Medicare Innovation and Integration within the department which has the following duties (Sec. 361.a):

• Provide focused leadership and expertise on innovative models for Medicare beneficiaries in California, including Medicare-only beneficiaries, and individuals dually eligible for the Medicare and Medi-Cal programs;

• Support new and existing models and strategies to benefit Medicare-only beneficiaries in California, in collaboration with local, state, and federal partners and other stakeholders;

• Consider and develop strategies for Medicare and Medi-Cal enrollment, benefits, health care delivery systems, and data sharing and reporting, to improve health outcomes, quality, equity, and cost-effectiveness; and

• Develop innovative approaches to integrated models of care and coordinated access to long-term services and supports for Medicare-only beneficiaries and dually eligible beneficiaries.

• Establishes an individual is eligible, to the extent required by federal law, as though the individual was pregnant, for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy (Sec. 362.a).

Full Bill Text