BILL NUMBER: SB 1	AMENDED
	BILL TEXT

	AMENDED IN SENATE  FEBRUARY 12, 2009
	AMENDED IN SENATE  JANUARY 22, 2009

INTRODUCED BY   Senators Steinberg and Alquist
   (Principal coauthors: Assembly Members Chesbro and Jones)

                        DECEMBER 1, 2008

   An act to amend Sections 123870 and 123955 of the Health and
Safety Code, to amend Sections 12693.43, 12693.70, 12693.73,
12693.76, and 12694 of, to add Sections 12693.55.1, 12693.56,
12693.57, 12693.701, and 12693.983 to, and to add Chapter 16.2
(commencing with Section 12694.1) to Part 6.2 of Division 2 of, the
Insurance Code, and to amend Section 14005.23 of, and to add Sections
14005.26, 14011.01, 14011.02, and 14011.61 to, the Welfare and
Institutions Code, relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1, as amended, Steinberg. Health care coverage: children.
   Existing law establishes various public programs to provide health
care coverage to eligible children, including the Medi-Cal program
administered by the State Department of Health Care Services and
county welfare agencies, and the Healthy Families Program
administered by the Managed Risk Medical Insurance Board. Children
through 18 years of age are eligible for health care coverage under
these programs if they meet certain household income and other
criteria including specified citizenship and immigration status
requirements. Under existing law, the applicant's signed statement as
to the value or amount of income is accepted for eligibility
purposes under the Healthy Families Program if documentation cannot
otherwise be provided.
   This bill would expand eligibility for the Medi-Cal program and
the Healthy Families Program by modifying the income requirements
applicable to those programs, and by making coverage available
regardless of citizenship or immigration status, as specified. 
The bill would require a parent or caretaker relative of a child
applying for the Medi-Cal prog   ram to sign a specified
attestation under penalty of perjury regarding the child's
immigration status, as specified, thereby expanding the crime of
perjury and imposing a state-mandated local program.  The bill
would require the Managed Risk Medical Insurance Board, by July 1,
2011, to implement a process for an applicant's self-certification of
income and income deductions for purposes of establishing
eligibility for the Healthy Families Program. The bill would require
the Managed Risk Medical Insurance Board and the State Department of
Health Care Services, by July 1, 2011, to simplify the annual renewal
forms for children enrolled in the Healthy Families Program or the
Medi-Cal program and to establish a process to allow families to
renew their child's coverage by telephone. The bill would require the
Managed Risk Medical Insurance Board and the State Department of
Health Care Services to make specified technological improvements to
the existing eligibility determination and enrollment systems for the
Medi-Cal program and the Healthy Families Program and to develop a
process to transition the enrollment of children from local children'
s health initiatives into those programs.
   The bill would also make various related modifications to the
Medi-Cal program and the Healthy Families Program and would require
the State Department of Health Care Services and the Managed Risk
Medical Insurance Board to maximize federal matching funds for the
Medi-Cal program and the Healthy Families Program. Because the
expansion of, and modifications to, the Medi-Cal program would impose
certain duties on counties relative to administration of that
program, the bill would impose a state-mandated local program.
   Existing law establishes the Healthy Families Presumptive
Eligibility Program, administered by the Managed Risk Medical
Insurance Board, to provide a child who, among other requirements,
has been receiving full-scope Medi-Cal benefits with health care
benefits while the board determines the child's eligibility for the
Healthy Families Program. Existing law also creates a Medi-Cal
presumptive eligibility program to provide a child who, among other
requirements, has been receiving benefits under the Healthy Families
Program with health care benefits until a Medi-Cal eligibility
determination is made.
   This bill would require the Managed Risk Medical Insurance Board
and the State Department of Health Care Services to monitor those
programs to ensure children are timely enrolled in the presumptive
eligibility benefits for which they are eligible.
   Existing law requires the state to administer, to the extent
allowed under federal law, and only if federal financial
participation is available, the Medi-Cal to Healthy Families
Presumptive Eligibility Program to provide a child not receiving
no-cost Medi-Cal benefits or Healthy Families benefits who meets
specified eligibility requirements, including the income requirements
of the Healthy Families Program, with benefits identical to
full-scope benefits under the Medi-Cal program with no share of cost
for the period during which the child has an application pending for
coverage under the Healthy Families Program.
   This bill would establish, to the extent allowed by federal law
and to the extent federal financial participation is available, the
Medi-Cal Presumptive Eligibility Program that would provide a child
not receiving no-cost Medi-Cal benefits or Healthy Families Program
benefits who meets specified eligibility requirements with
presumptive eligibility benefits identical to full-scope benefits
under the Medi-Cal program with no share of cost until the child's
eligibility for the Medi-Cal program is determined, as specified. The
bill would require the county to forward the child's application to
the Healthy Families Program if it finds the child eligible for the
Medi-Cal program with a share of cost. The bill would require this
program to be implemented by July 1, 2011.
   Under existing law, the Robert W. Crown California Children's
Services Act, the State Department of Health Care Services and each
county administer the California Children Services Program (CCS
program) for treatment services for persons under the age of 21 years
diagnosed with severe chronic disease or severe physical
limitations, as specified. Existing law limits eligibility for those
services to persons in families with an annual adjusted gross income
of $40,000 or less.
   This bill would change that eligibility limitation to persons in a
family with an annual, or equivalent monthly income, that is equal
to or less than $40,000, or that meets the income eligibility
requirements for the Healthy Families Program, as specified.
    The bill would also create the Healthy Families Buy-In Program
(buy-in program) and would require the Managed Risk Medical Insurance
Board to implement that program by July 1, 2011. Under the buy-in
program, the coverage provided under the Healthy Families Program
would be available to children whose household income exceeds 300% of
the federal poverty level and who meet other specified criteria. The
bill would specify that coverage under the buy-in program would
include services provided under the CCS program for children eligible
for the CCS program and would deem the child's family financially
eligible for benefits under the CCS program. Because the bill would
thereby expand eligibility for the CCS program, which is administered
by a county's public health or social welfare department, it would
impose a state-mandated local program. The bill would specify the
family contribution required for children enrolled in the buy-in
program.
   Existing law requires the state to reimburse counties for 50% of
the amount required to meet state administrative standards for that
portion of the county caseload under the CCS program that is
ineligible for Medi-Cal, to the extent funds are available in the
state budget.
   This bill would also require the state to reimburse counties for
100% of the amount required to provide CCS program services to
children enrolled in the buy-in program.
   Existing law, the California Special Supplemental Food Program for
Women, Infants, and Children (WIC), authorizes establishment of a
statewide program, administered by the State Department of Public
Health, for providing nutritional food supplements to 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. The program, which implements a
program authorized under existing federal law, provides for the
redemption of nutrition coupons by recipients at any authorized
retail food vendor. Existing law requires the Managed Risk Medical
Insurance Board and the department, in collaboration with WIC program
offices and other designated entities, to design, promulgate, and
implement policies and procedures for an automated enrollment gateway
system to obtain presumptive eligibility for, and to facilitate
application for enrollment in, the Medi-Cal program and the Healthy
Families Program for children applying to the WIC program. Existing
law requires the WIC gateway system to be constructed with the
capacity to be used by entities operating the WIC program.
   This bill would require all WIC local agencies that serve large
numbers of participants and a high proportion of uninsured
participants, as specified, to use the WIC gateway system only to the
extent funding is available, as specified, and would permit all
other local WIC agencies to use the WIC gateway system at their
option.
   Existing law creates the Healthy Families Fund, and provides that
money in the fund is continuously appropriated for purposes of the
Healthy Families Program.
   This bill would provide that the Managed Risk Medical Insurance
Board may implement the provisions of the bill expanding the Healthy
Families Program only to the extent that funds are appropriated for
those purposes in the annual Budget Act or in another statute.

   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 these
statutory provisions.  
   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 with regard to certain mandates no
reimbursement is required by this act for a specified reason. 

   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  (a) The Legislature hereby finds and declares all of
the following:
   (1) Investing in comprehensive health care coverage for children
is cost effective. Children with health care coverage are healthier,
are better able to access needed health care services, and are at
less risk of suffering from preventable illnesses.
   (2) Health care coverage helps children reach their potential in
school. According to a study conducted by the Managed Risk Medical
Insurance Board, children enrolled in the Healthy Families Program
experienced a 63 percent improvement in paying attention in class and
keeping up with school activities.
   (3) Expanding health care coverage to more children is an
essential step to increasing access to preventive, diagnostic, and
therapeutic health care services for children, which, in turn, will
reduce the burden of disease and contribute to a more productive
workforce.
   (4) Although over nine of every 10 children in California have
health care coverage, about 683,000 children in the state are without
health care coverage according to 2007 data from the Center for
Health Policy Research at the University of California at Los
Angeles.
   (5) Of the 683,000 children without coverage, approximately 56
percent are eligible for either the Healthy Families Program or the
Medi-Cal program. It is essential to support local outreach efforts
that find and enroll children into the program for which they are
eligible.
   (6) The goal of providing all uninsured children with health care
coverage through California's two statewide programs is achievable.
However, if the state fails to act now, more children may become
uninsured, resulting in greater costs to the state as children with
developmental disabilities go undiagnosed until older ages after more
effective and inexpensive treatments could have been implemented,
and resulting in more costly emergency room visits and
hospitalizations as children with chronic diseases fail to receive
ongoing treatment.
   (7) In the current economic recession, businesses are struggling,
resulting in some businesses having to reduce their workforce or the
hours of their employees. As a result, many families are losing their
employer-based health insurance due to job loss or reduction in
benefits. Now, more than ever, these families need affordable health
care coverage programs for their children. It is also critical that
these families be informed about public programs for which they and
their children may be eligible.
    (8) Forty-six percent of Medi-Cal beneficiaries in California are
children.
   (9) Local Children's Health Initiatives (CHIs) have provided
health care coverage to over 150,000 children cumulatively since 2001
through locally-operated Healthy Kids programs. Through their
outreach, CHIs have also enrolled hundreds of thousands of eligible
children in Healthy Families and Medi-Cal coverage. With local and
private funding, CHIs currently provide local coverage to 86,000
children who are not currently eligible for state health care
coverage and would otherwise be uninsured. However, financing for
these local health care coverage programs is not sustainable. In
fact, nearly 21,000 children are on waiting lists for these CHIs. A
statewide system is required to provide sustainable funding to ensure
that all children in California have access to health care coverage.
If California does not act quickly to provide a statewide solution
for children's health care coverage, children will lose their access
to care.
   (10) In at least half of the counties in the state, some children
have no access to affordable health care coverage.
   (11) Enrollment barriers, such as multiple reporting periods and
unaffordable premiums, keep children from accessing the health care
that they need and for which they are eligible. Removing those
barriers is essential to ensuring all California children have access
to affordable, comprehensive health care coverage.
   (12) The 111th Congress and the new administration have set health
care reform as a priority. This presents new opportunities as well
as the potential for additional federal funds for California to
finish the job of covering all children. This act is intended to be
congruent with and complementary of all national health care reform
efforts to provide opportunities for health care coverage for
children.
   (b) It is the intent of the Legislature to accomplish all of the
following:
   (1) Provide all uninsured children living in California, from
birth to 18 years of age, access to comprehensive health care
coverage that their families can afford.
   (2) Prevent more children from becoming uninsured by preserving
Healthy Families and Medi-Cal coverage for children currently
enrolled in those programs and keeping the doors to that coverage
open for new enrollees.
   (3) Ensure that currently insured children keep their coverage and
protect children from losing coverage by doing all of the following:

   (A) Eliminating semi-annual reporting requirements and reinstating
12-month continuous eligibility for children in the Medi-Cal
program.
   (B) Keeping family contributions required under the Healthy
Families Program affordable.
   (C) Implementing existing laws that simplify the application and
renewal processes for the Medi-Cal program and the Healthy Families
Program  , including those modified by Chapter 328 of the
Statutes of 2006  .
   (4) Establish, in a timely manner, a statewide system of
transition to prevent children covered by CHIs from losing that
coverage.
   (5) Provide for a smooth transition to a statewide health care
coverage system for all children.
   (6) Build upon the successful outreach and enrollment strategies
of the Healthy Families Program, the Medi-Cal program, and CHIs, and
improve the state insurance programs' operations to enroll all
eligible children, including modernizing and simplifying the
enrollment and renewal processes.
   (7) Support local outreach efforts that find and enroll children
into the programs for which they are eligible, restore funding for
county outreach and enrollment plans, and broaden the outreach
approach of those plans to all California counties.
   (8) Implement a plan for sustainable financing that supports the
statewide programs over the long term.
   (9) Implement this act in a manner that maximizes, and does not
reduce, federal matching funds made available to the state for
children's health care coverage under Titles XIX and XXI of the
Social Security Act, and any other federal funding made available
through federal economic stimulus legislation, health reform
legislation, or any other means.
   (10) Work with California businesses to develop creative solutions
to help businesses do what they can to cover more dependent
children.
   (11) Ensure that all California residents have access to
affordable health care coverage by January 1, 2012.
   (12) Establish a fund to protect existing state health insurance
for children and to assist in funding a phased-in statewide health
care coverage system for all children and link the changes made by
this act to that fund. It is the intent of the Legislature that the
fund include private funds and other federal funds made newly
available to California for the purpose of children's health care.
   (c) It is further the intent of the Legislature to enact
subsequent legislation that would accomplish both of the following:
   (1) Implement new strategies and tools made available through
federal health reform legislation or other means to maximize the
enrollment of eligible children in health care coverage.
   (2) Build on the successful implementation of this act and expand
access to affordable health care coverage for uninsured parents and
adults.
  SEC. 2.  Section 123870 of the Health and Safety Code is amended to
read:
   123870.  (a)  The department shall establish standards of
financial eligibility for treatment services under the California
Children's Services Program (CCS program).
   (1) (A) Financial eligibility for treatment services under this
program shall be limited to persons in a family with an annual
income, or the equivalent monthly income, that is equal to or less
than forty thousand dollars ($40,000) or that meets the income
eligibility requirements for the Healthy Families Program (Part 6.2
(commencing with Section 12639) of Division 2 of the Insurance Code),
as set forth in clause (i) of subparagraph (A) of paragraph (5) of
subdivision (a) of Section 12693.70 of the Insurance Code. However
 ,  the director may authorize treatment services for
persons in families with higher incomes if the estimated cost of care
to the family in one year is expected to exceed 20 percent of the
family's annual or monthly income. When calculating annual or monthly
income under this paragraph, any income deduction that is applicable
to a child under the Medi-Cal program shall be applied in
determining the annual or monthly household income for eligibility
under the CCS program.
   (B) If a person is enrolled in the Healthy Families Program, the
financial documentation required for that program in Section
2699.6600 of Title 10 of the California Code of Regulations may be
used instead of the person's California state income tax return.
   (2) Children enrolled in either the Healthy Families Program or
the Healthy Families Buy-In Program who have a CCS program eligible
medical condition under Section 123830, and whose families do not
meet the financial eligibility requirements of paragraph (1), shall
be deemed financially eligible for CCS program benefits.
   (b) Necessary medical therapy treatment services under the
California Children's Services Program rendered in the public schools
shall be exempt from financial eligibility standards and enrollment
fee requirements for the services when rendered to any handicapped
child whose educational or physical development would be impeded
without the services.
   (c) All counties shall use the uniform standards for financial
eligibility and enrollment fees established by the department. All
enrollment fees shall be used in support of the California Children's
Services Program.
   (d) Annually, every family with a child eligible to receive
services under this article shall pay a fee of twenty dollars ($20),
that shall be in addition to any other program fees for which the
family is liable. This assessment shall not apply to any child who is
eligible for full-scope Medi-Cal benefits without a share of cost,
for children receiving therapy through the California Children's
Services Program as a related service in their individualized
education plans, for children from families having incomes of less
than 100 percent of the federal poverty level, or for children
covered under the Healthy Families Program or the Healthy Families
Buy-In Program.
  SEC. 3.  Section 123955 of the Health and Safety Code is amended to
read:
   123955.  (a)  The state and the counties shall share in the cost
of administration of the California Children's Services Program at
the local level.
   (b)  (1)  The director shall adopt regulations establishing
minimum standards for the administration, staffing, and local
implementation of this article subject to reimbursement by the state.

   (2)  The standards shall allow necessary flexibility in the
administration of county programs, taking into account the
variability of county needs and resources, and shall be developed and
revised jointly with state and county representatives.
   (c)  The director shall establish minimum standards for
administration, staffing and local operation of the program subject
to reimbursement by the state.
   (d)  Until July 1, 1992, reimbursable administrative costs, to be
paid by the state to counties, shall not exceed 4.1 percent of the
gross total expenditures for diagnosis, treatment and therapy by
counties as specified in Section 123940.
   (e)  Beginning July 1, 1992, this subdivision shall apply with
respect to all of the following:
   (1)  (A) Counties shall be reimbursed by the state for 50 percent
of the amount required to meet state administrative standards for
that portion of the county caseload under this article that is
ineligible for Medi-Cal to the extent funds are available in the
state budget for the California Children's Services Program.
   (B) Commencing January 1, 2010, counties shall be reimbursed by
the state for 100 percent of the amount required to meet state
administrative standards for that portion of the county caseload
under this article that provides services to children enrolled in the
Healthy Families Buy-In Program.
   (2)  On or before September 15 of each year, each county program
implementing this article shall submit an application for the
subsequent fiscal year that provides information as required by the
state to determine if the county administrative staff and budget meet
state standards.
   (3)  The state shall determine the maximum amount of state funds
available for each county from state funds appropriated for CCS
county administration. If the amount appropriated for any fiscal year
in the Budget Act for county administration under this article
differs from the amounts approved by the department, each county
shall submit a revised application in a form and at the time
specified by the department.
   (f)  The department and counties shall maximize the use of federal
funds for administration of the programs implemented pursuant to
this article, including using state and county funds to match funds
claimable under Title 19 of the Social Security Act.
  SEC. 4.  Section 12693.43 of the Insurance Code is amended to read:

   12693.43.  (a) Applicants applying to the purchasing pool shall
agree to pay family contributions, unless the applicant has a family
contribution sponsor. Family contribution amounts consist of the
following two components:
   (1) The flat fees described in subdivision (b) or (d).
   (2) Any amounts that are charged to the program by participating
health, dental, and vision plans selected by the applicant that
exceed the cost to the program of the highest cost family value
package in a given geographic area.
   (b) In each geographic area, the board shall designate one or more
family value packages for which the required total family
contribution is:
   (1) Seven dollars ($7) per child with a maximum required
contribution of fourteen dollars ($14) per month per family for
applicants with annual household incomes up to and including 150
percent of the federal poverty level.
   (2) Nine dollars ($9) per child with a maximum required
contribution of twenty-seven dollars ($27) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (5) of subdivision (a) of Section
12693.70. Commencing the first day of the fifth month following the
enactment of the 2008-09 Budget Act, the family contribution pursuant
to this paragraph shall be twelve dollars ($12) per child with a
maximum required contribution of thirty-six dollars ($36) per month
per family.
   (3) (A) On and after July 1, 2005, fifteen dollars ($15) per child
with a maximum required contribution of forty-five dollars ($45) per
month per family for applicants with annual household income to
which subparagraph (B) of paragraph (5) of subdivision (a) of Section
12693.70 is applicable. Notwithstanding any other provision of law,
if an application with an effective date prior to July 1, 2005, was
based on annual household income to which subparagraph (B) of
paragraph (5) of subdivision (a) of Section 12693.70 is applicable,
then this subparagraph shall be applicable to the applicant on July
1, 2005, unless subparagraph (B) of paragraph (5) of subdivision (a)
of Section 12693.70 is no longer applicable to the relevant family
income. The program shall provide prior notice to any applicant for
currently enrolled subscribers whose premium will increase on July 1,
2005, pursuant to this subparagraph and, prior to the date the
premium increase takes effect, shall provide that applicant with an
opportunity to demonstrate that subparagraph (B) of paragraph (5) of
subdivision (a) of Section 12693.70 is no longer applicable to the
relevant family income.
   (B) Commencing the first day of the fifth month following the
enactment of the 2008-09 Budget Act, the family contribution pursuant
to this paragraph shall be seventeen dollars ($17) per child with a
maximum required contribution of fifty-one dollars ($51) per month
per family.
   (4) Applicants on behalf of children with an annual or monthly
household income to which subparagraph (C) of paragraph (5) of
subdivision (a) of Section 12693.70 is applicable shall be required
to make family contributions at 150 percent of the contributions
required for children who are enrolled in the program whose annual or
monthly household incomes are greater than 200 percent but less than
or equal to 250 percent of the federal poverty level.
   (c) Combinations of health, dental, and vision plans that are more
expensive to the program than the highest cost family value package
may be offered to and selected by applicants. However, the cost to
the program of those combinations that exceeds the price to the
program of the highest cost family value package shall be paid by the
applicant as part of the family contribution.
   (d) The board shall provide a family contribution discount to
those applicants who select the health plan in a geographic area that
has been designated as the Community Provider Plan. The discount
shall reduce the portion of the family contribution described in
subdivision (b) to the following:
   (1) A family contribution of four dollars ($4) per child with a
maximum required contribution of eight dollars ($8) per month per
family for applicants with annual household incomes up to and
including 150 percent of the federal poverty level.
   (2) Six dollars ($6) per child with a maximum required
contribution of eighteen dollars ($18) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (5) of subdivision (a) of Section
12693.70. Commencing the first day of the fifth month following the
enactment of the 2008-09 Budget Act, the family contribution pursuant
to this paragraph shall be nine dollars ($9) per child with a
maximum required contribution of twenty-seven dollars ($27) per month
per family.
   (3) (A) On and after July 1, 2005, twelve dollars ($12) per child
with a maximum required contribution of thirty-six dollars ($36) per
month per family for applicants with annual household income to which
subparagraph (B) of paragraph (5) of subdivision (a) of Section
12693.70 is applicable. Notwithstanding any other provision of law,
if an application with an effective date prior to July 1, 2005, was
based on annual household income to which subparagraph (B) of
paragraph (5) of subdivision (a) of Section 12693.70 is applicable,
then this subparagraph shall be applicable to the applicant on July
1, 2005, unless subparagraph (B) of paragraph (5) of subdivision (a)
of Section 12693.70 is no longer applicable to the relevant family
income. The program shall provide prior notice to any applicant for
currently enrolled subscribers whose premium will increase on July 1,
2005, pursuant to this subparagraph and, prior to the date the
premium increase takes effect, shall provide that applicant with an
opportunity to demonstrate that subparagraph (B) of paragraph (5) of
subdivision (a) of Section 12693.70 is no longer applicable to the
relevant family income.
   (B) Commencing the first day of the fifth month following the
enactment of the 2008-09 Budget Act, the family contribution pursuant
to this paragraph shall be fourteen dollars ($14) per child with a
maximum required contribution of forty-two dollars ($42) per month
per family.
   (4) The premium discounts available to children enrolled in the
program whose families have annual or monthly household incomes
greater than 200 percent of the federal poverty level but less than
or equal to 250 percent of the federal poverty level shall be
available on the same terms to children enrolled in the program whose
families' annual or monthly household incomes are greater than 250
percent of the federal poverty level but less than or equal to 300
percent of the federal poverty level.
   (e) Applicants, but not family contribution sponsors, who pay
three months of required family contributions in advance shall
receive the fourth consecutive month of coverage with no family
contribution required.
   (f) Applicants, but not family contribution sponsors, who pay the
required family contributions by an approved means of electronic fund
transfer shall receive a 25-percent discount from the required
family contributions.
   (g) It is the intent of the Legislature that the family
contribution amounts described in this section comply with the
premium cost sharing limits contained in Section 2103 of Title XXI of
the Social Security Act. If the amounts described in subdivision (a)
are not approved by the federal government, the board may adjust
these amounts to the extent required to achieve approval of the state
plan.
   (h) The adoption and one readoption of regulations to implement
paragraph (3) of subdivision (b) and paragraph (3) of subdivision (d)
shall be deemed to be an emergency and necessary for the immediate
preservation of public peace, health, and safety, or general welfare
for purposes of Sections 11346.1 and 11349.6 of the Government Code,
and the board is hereby exempted from the requirement that it
describe specific facts showing the need for immediate action and
from review by the Office of Administrative Law. For purposes of
subdivision (e) of Section 11346.1 of the Government Code, the
120-day period, as applicable to the effective period of an emergency
regulatory action and submission of specified materials to the
Office of Administrative Law, is hereby extended to 180 days.
   (i) The board may adopt, and may only one-time readopt,
regulations to implement the changes to this section that are
effective the first day of the fifth month following the enactment of
the 2008-09 Budget Act. The adoption and one-time readoption of a
regulation authorized by this section is deemed to address an
emergency, for purposes of Sections 11346.1 and 11349.6 of the
Government Code, and the board is hereby exempted for this purpose
from the requirements of subdivision (b) of Section 11346.1 of the
Government Code.
  SEC. 5.  Section 12693.55.1 is added to the Insurance Code, to
read:
   12693.55.1.  The board and the State Department of Health Care
Services shall maximize federal matching funds available under the
program and the Medi-Cal program and shall implement strategies that
coordinate and integrate other programs that provide health care
coverage for children to maximize federal matching funds, such as
matching funds available for emergency or pregnancy-related benefits
under the Medi-Cal program for all eligible children.
  SEC. 6.  Section 12693.56 is added to the Insurance Code, to read:
   12693.56.  (a) Every person administering or providing benefits
under the program shall perform his or her duties in such a manner as
to secure for every subscriber the amount of assistance to which the
subscriber is entitled, without attempting to elicit any information
that is not required to carry out the provisions of the law
applicable to the program.
   (b) All types of information, whether written or oral, concerning
an applicant, subscriber, or household member of the subscriber or
applicant, made or kept by any public officer or agency in connection
with the administration of any provision of this part shall be
confidential and shall not be open to examination other than for
purposes directly connected with the administration of the program or
the Medi-Cal program.
   (c) Except as provided in this section and to the extent permitted
by federal law or regulation, all information concerning an
applicant, subscriber, or a household member of the subscriber or
applicant to be safeguarded as provided in subdivision (b) includes,
but is not limited to, names and addresses, medical services
provided, social and economic conditions or circumstances, agency
evaluation of personal information, and medical data, including
diagnosis and past history of disease or disability.
   (d) For purposes of this section, "purposes directly connected
with the administration of the program or the Medi-Cal program"
include, but are not limited to, all activities and responsibilities
that the board or the State Department of Health Care Services and
their agents, officers, trustees, employees, consultants, and
contractors undergo in order to conduct operations of the program and
the Medi-Cal program.
   (e) Nothing in this section shall be construed to prohibit the
disclosure of information about the applicant, subscriber, or
household member of the subscriber or applicant if the person to whom
the information pertains or the parent or adult with legal custody
of that person provides express written authorization for the
disclosure.
   (f) Nothing in this section shall prohibit the disclosure of
protected health information as provided in Section 164.512 of Title
45 of the Code of Federal Regulations.
   (g) Nothing in this section shall preclude the board from
soliciting voluntary participation by applicants and subscribers in
communicating with the board, or with any other party, concerning
their needs as well as the needs of others who are not adequately
covered by existing private and public health care delivery systems
or concerning the means of ensuring the availability of adequate
health care services. The board shall inform applicants and
subscribers that their participation is voluntary and shall inform
them of the uses for which the information is intended.
  SEC. 7.  Section 12693.57 is added to the Insurance Code, to read:
   12693.57.  (a) Upon implementation of subdivision (a) of Section
14005.26 of the Welfare and Institutions Code and paragraph (1) of
subdivision (a) of Section 12693.701, the board and the State
Department of Health Care Services, in consultation with
stakeholders, shall develop a process for the transition of eligible
children from local children's health initiatives to the Medi-Cal
program and to the Healthy Families Program, ensuring that all
eligible children are transferred without a disruption in coverage.
The                                            involved stakeholders
shall include, but shall not be limited to, local children's health
initiative program officials, children's advocates, consumer
advocates, legislative staff, counties, and others as appropriate.
   (b) The process developed pursuant to subdivision (a) shall
include the provision of training on the transfer of children and
their coverage for local  and county  eligibility workers,
Certified Application Assistors, and other local children's health
initiative organizations assisting this population.
   (c) The transition described in subdivision (a) shall only occur
after the board has implemented the confidentiality and privacy
standards pursuant to Section 12693.56 and the board and department
have implemented the other functions necessary to operate the
eligibility expansion pursuant to Sections 12693.43, 12693.70,
12693.701, and 12693.76, and Sections 14005.23 and 14005.26 of the
Welfare and Institutions Code.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the board
and department may issue regulations, all-county letters, or similar
instructions, as necessary pursuant to the Administrative Procedure
Act, to implement this section. The adoption and readoption of
regulations pursuant to this section shall be deemed to be an
emergency and necessary for the immediate preservation of public
peace, health and safety, or general welfare.
  SEC. 8.  Section 12693.70 of the Insurance Code is amended to read:

   12693.70.  To be eligible to participate in the program, an
applicant shall meet all of the following requirements:
   (a) Be an applicant applying on behalf of an eligible child, which
means a child who is all of the following:
   (1) Less than 19 years of age. An application may be made on
behalf of a child not yet born up to three months prior to the
expected date of delivery. Coverage shall begin as soon as
administratively feasible, as determined by the board, after the
board receives notification of the birth. However, no child less than
12 months of age shall be eligible for coverage until 90 days after
the enactment of the Budget Act of 1999.
   (2) Not eligible for no-cost full-scope Medi-Cal or Medicare
coverage at the time of application.
   (3) In compliance with Sections 12693.71 and 12693.72.
   (4) A resident of the State of California pursuant to Section 244
of the Government Code; or, if not a resident pursuant to Section 244
of the Government Code, is physically present in California and
entered the state with a job commitment or to seek employment,
whether or not employed at the time of application to or after
acceptance in, the program.
   (5) (A) In either of the following:
   (i) In a family with an annual or monthly household income equal
to or less than 200 percent of the federal poverty level.
   (ii) When implemented by the board, subject to subdivision (b) of
Section 12693.765 and pursuant to this section, a child under the age
of two years who was delivered by a mother enrolled in the Access
for Infants and Mothers Program as described in Part 6.3 (commencing
with Section 12695). Commencing July 1, 2007, eligibility under this
subparagraph shall not include infants during any time they are
enrolled in employer-sponsored health insurance or are subject to an
exclusion pursuant to Section 12693.71 or 12693.72, or are enrolled
in the full scope of benefits under the Medi-Cal program at no share
of cost. For purposes of this clause, any infant born to a woman
whose enrollment in the Access for Infants and Mothers Program begins
after June 30, 2004, shall be automatically enrolled in the Healthy
Families Program, except during any time on or after July 1, 2007,
that the infant is enrolled in employer-sponsored health insurance or
is subject to an exclusion pursuant to Section 12693.71 or 12693.72,
or is enrolled in the full scope of benefits under the Medi-Cal
program at no share of cost. Except as otherwise specified in this
section, this enrollment shall cover the first 12 months of the
infant's life. At the end of the 12 months, as a condition of
continued eligibility, the applicant shall provide income
information. The infant shall be disenrolled if the gross annual
household income exceeds the income eligibility standard that was in
effect in the Access for Infants and Mothers Program at the time the
infant's mother became eligible, or following the two-month period
established in Section 12693.981 if the infant is eligible for
Medi-Cal with no share of cost. At the end of the second year,
infants shall again be screened for program eligibility pursuant to
this section, with income eligibility evaluated pursuant to clause
(i), subparagraphs (B) and (C), and paragraph (2) of subdivision (a).

   (B) All income over 200 percent of the federal poverty level but
less than or equal to 250 percent of the federal poverty level shall
be disregarded in calculating annual or monthly household income.
   (C) All income over 250 percent of the federal poverty level but
less than or equal to 300 percent of the federal poverty level shall
be disregarded in calculating annual or monthly household income.
   (D) In a family with an annual or monthly household income greater
than 300 percent of the federal poverty level, any income deduction
that is applicable to a child under Medi-Cal shall be applied in
determining the annual or monthly household income. If the income
deductions reduce the annual or monthly household income to 300
percent or less of the federal poverty level, subparagraph (C) shall
be applied.
   (b) The applicant shall agree to remain in the program for six
months, unless other coverage is obtained and proof of the coverage
is provided to the program.
   (c) An applicant shall enroll all of the applicant's eligible
children in the program.
   (d) In filing documentation to meet program eligibility
requirements, if the applicant's income documentation cannot be
provided, as defined in regulations promulgated by the board, the
applicant's signed statement as to the value or amount of income
shall be deemed to constitute verification.
   (e) An applicant shall pay in full any family contributions owed
in arrears for any health, dental, or vision coverage provided by the
program within the prior 12 months.
   (f) By January 2008, the board, in consultation with stakeholders,
shall implement processes by which applicants for subscribers may
certify income at the time of annual eligibility review, including
rules concerning which applicants shall be permitted to certify
income and the circumstances in which supplemental information or
documentation may be required. The board may terminate using these
processes not sooner than 90 days after providing notification to the
Chair of the Joint Legislative Budget Committee. This notification
shall articulate the specific reasons for the termination and shall
include all relevant data elements that are applicable to document
the reasons for the termination. Upon the request of the Chair of the
Joint Legislative Budget Committee, the board shall promptly provide
any additional clarifying information regarding implementation of
the processes required by this subdivision.
   (g) By July 1, 2011, the board, in consultation with stakeholders,
including, but not limited to, consumer advocates, shall do all of
the following:
   (1) Implement a process by which applicants self-certify income
and income deductions at the time of initial application. The board
shall request documentation and verify that information only to the
extent required under federal law.
   (2) Simplify the annual renewal forms for children enrolled in the
program, including forms prepopulated with all of the family's
eligibility information and a simple check-off list for families to
identify whether each eligibility information item remains correct.
The renewal form shall request families to provide and certify with
their signature any changes to the prepopulated eligibility
information form.
   (3) Establish a process to allow families to renew their child's
coverage by telephone.
  SEC. 9.  Section 12693.701 is added to the Insurance Code, to read:

   12693.701.  (a) (1) On and after January 1, 2010, children under
19 years of age who meet the state residency requirements of the
Medi-Cal program or the Healthy Families Program shall be eligible
for health care coverage in accordance with subdivision (b) if they
satisfy either of the following criteria:
   (A) Live in families with countable household income at or below
300 percent of the federal poverty level.
   (B) Meet the income requirements of Section 14005.7 of the Welfare
and Institutions Code or the income and resource requirements of
Section 14005.30 of the Welfare and Institutions Code.
   (2) The eligibility under paragraph (1) includes for both programs
all children for whom federal financial participation under Title
XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.),
or under Title XXI of the federal Social Security Act (42 U.S.C.
Sec. 1397aa et seq.) is not available because of their immigration
status or date of entry into the United States, but does not include
children who are ineligible for funds under those titles for other
reasons.
   (b) Children described in subdivision (a) in families whose
household income would make them ineligible for the Medi-Cal program
with no share of cost or for Medicare, and who are in compliance with
Sections 12693.71 and 12693.72, shall be eligible for the Healthy
Families Program and shall also be eligible for the Medi-Cal program
with a share of cost in accordance with Section 14005.7 of the
Welfare and Institutions Code. The remaining children described in
subdivision (a) shall be eligible for the Medi-Cal program with no
share of cost.
   (c) Nothing in this section shall be construed to authorize the
denial or reduction of medical assistance under the Medi-Cal program
(Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of
the Welfare and Institutions Code) or the Healthy Families Program
to a person who, without the application of this section, would
qualify for that assistance or to relieve the Medi-Cal program of the
obligation to determine eligibility on all other available grounds.
  SEC. 10.  Section 12693.73 of the Insurance Code is amended to
read:
   12693.73.  Notwithstanding any other provision of law, children
excluded from coverage under Title XXI of the Social Security Act are
not eligible for coverage under the program, except as specified in
clause (ii) of subparagraph (A) of paragraph (5) of subdivision (a)
of Section 12693.70, Section 12693.701, and Section 12693.76.
  SEC. 11.  Section 12693.76 of the Insurance Code is amended to
read:
   12693.76.  (a) Notwithstanding any other provision of law, a child
shall not be determined ineligible solely on the basis of his or her
immigration status or date of entry into the United States.
   (b) Notwithstanding any other provision of law, subdivision (a)
may only be implemented to the extent provided in the annual Budget
Act.
   (c) Notwithstanding any other provision of law, an uninsured
parent or responsible adult who is a qualified alien, as defined in
Section 1641 of Title 8 of the United States Code, shall not be
determined to be ineligible solely on the basis of his or her date of
entry into the United States.
   (d) Notwithstanding any other provision of law, subdivision (c)
may only be implemented to the extent of funding provided in the
annual Budget Act.
  SEC. 12.  Section 12693.983 is added to the Insurance Code, to
read:
   12693.983.  (a) On and after January 1, 2010, the board and the
State Department of Health Care Services shall monitor the Healthy
Families Presumptive Eligibility Program established under Section
12693.98a and the program of presumptive eligibility (Healthy
Families to Medi-Cal Presumptive Eligibility Program) established
under Section 14011.65b of the Welfare and Institutions Code in order
to ensure that all children are enrolled in a timely manner in the
presumptive eligibility benefits for which they are eligible.
   (b) The monitoring responsibilities required by this section shall
consist of the following activities:
   (1) The board and the department shall collect and make publicly
available on their respective Internet Web sites, the following data
on a quarterly basis:
   (A) The number of children enrolled in the Healthy Families
Presumptive Eligibility Program and the number of children enrolled
in the Healthy Families to Medi-Cal Presumptive Eligibility Program.
   (B) The length of time these children were enrolled in each
program.
   (C) The status of the children enrolled in each program, including
a status report for each child enrolled more than one month in the
Healthy Families Presumptive Eligibility Program and more than two
months in the Healthy Families to Medi-Cal Presumptive Eligibility
Program.
   (2) The board and the department shall record all attempts to
assist the child to enroll in ongoing health benefits programs and
shall record the final disposition of the child's application for
continuing health care coverage.
   (c) The department shall work with the board, counties, and client
advocates to document and identify barriers to timely eligibility
determination and discontinuance of accelerated benefits for children
and to implement methods to overcome those barriers. The department,
in consultation with the board, counties, and client advocates,
shall provide written recommendations to the Secretary of California
Health and Human Services on how to ensure timely eligibility
determinations for children enrolled in accelerated enrollment and
presumptive eligibility programs and shall work with stakeholders and
consumer advocates to implement those recommendations.
  SEC. 13.  Section 12694 of the Insurance Code is amended to read:
   12694.  (a) The board and the department, in collaboration with
program offices for the California Special Supplemental Food Program
for Women, Infants, and Children (WIC or the WIC program), local WIC
agencies, counties in their capacity of making Medi-Cal eligibility
determinations, advocates, information technology specialists, and
other stakeholders, shall design, promulgate, and implement policies
and procedures for an automated enrollment gateway system developed
by the department and the board that performs, but is not limited to
performing, the following functions:
   (1) To the extent that federal financial participation is
available, allowing children applying to the WIC program to submit a
simple electronic application to simultaneously obtain presumptive
eligibility for the Medi-Cal program and the Healthy Families Program
under Title XIX (42 U.S.C. Sec. 1396 et seq.) and Title XXI (42
U.S.C. Sec. 1397aa et seq.) of the Social Security Act and apply for
enrollment into the Medi-Cal program or the Healthy Families Program
with the consent of their parent or guardian.
   (2) Modify the existing WIC enrollment system to obtain the
minimum required data for enrollment in the Medi-Cal program and the
Healthy Families Program in order to provide an electronic
transactional platform that is connected to the simple electronic
application referenced in paragraph (1) and allowing for an interface
between that application, the Medi-Cal Eligibility Data System
(MEDS), and the Medi-Cal program or the Healthy Families Program, as
relevant.
   (3) Providing an automated real-time connection with MEDS for the
purpose of checking an applicant's enrollment status.
   (4) Allowing for the electronic transfer of information to the
Medi-Cal program or the Healthy Families Program, as relevant, for
the purpose of making the final eligibility determination.
   (5) Checking, as relevant, available government databases for the
purpose of electronically receiving information that is necessary to
allow the Medi-Cal program or the Healthy Families Program to
complete the eligibility determination. The department and the
Managed Risk Medical Insurance Board shall comply with all applicable
privacy and confidentiality provisions under federal and state law.
   (b) The automated enrollment gateway system shall be constructed
with the capacity to be used by entities operating the WIC program.
Those WIC local agencies that serve a large number of participants
and those that serve a high proportion of uninsured participants, at
levels designated by the entities provided for in subdivision (a),
shall be required to use the automated enrollment gateway system to
the extent funding provided in subdivision (k) is sufficient to
accomplish the tasks of participation. All other WIC local agencies
may use the WIC gateway system at their option.
   (c) The WIC application process shall be modified to provide an
electronic application described in subdivision (a), which shall
contain the information necessary to apply for the automated
enrollment gateway system, supplemented by information required to
apply for enrollment into the Medi-Cal program or the Healthy
Families Program.
   (d) Benefits for applicants opting to simultaneously obtain
presumptive eligibility for enrollment under this section shall
continue until a final eligibility determination is made for the
Medi-Cal program or the Healthy Families Program pursuant to Section
14011.8 of the Welfare and Institutions Code.
   (e) Operation of the automated enrollment gateway system for the
WIC program shall occur within a timely and appropriate period as
determined by the department and the board, in consultation with the
stakeholders as provided in subdivision (a) subject to a specific
appropriation being provided for that purpose in the Budget Act or in
subsequent legislation. The automated enrollment gateway system
shall comply with all applicable confidentiality and privacy
protection in federal and state law and regulation.
   (f) The WIC program shall collect income and residency information
necessary for the Medi-Cal program and the Healthy Families Program
documentation requirements for applications submitted through the
automated enrollment gateway system. To the extent allowed by the
federal government, the Medi-Cal and Healthy Families programs shall
rely on income information obtained by WIC and upon the income
verification process performed by WIC. The Medi-Cal and Healthy
Families programs shall collect and verify citizenship and
immigration information as required under those programs.
   (g) Consistent with the provisions of this section, the Medi-Cal
and Healthy Families programs may collect additional information
needed to verify eligibility in those programs.
   (h) Counties shall accept and process for a Medi-Cal eligibility
determination applications provided by the WIC gateway system and
ensure timely processing of these applications and a timely
eligibility determination and ending of presumptive eligibility.
   (i) The presumptive eligibility benefits provided under this
section shall be identical to the benefits provided to children who
receive full-scope Medi-Cal benefits without a share of cost, and
shall only be made available through a Medi-Cal provider.
   (j) The confidentiality and privacy protections set forth in
Sections 10850 and 14100.2 of the Welfare and Institutions Code and
all other confidentiality and privacy protections in federal and
state law and regulation shall apply to all children and families
using the automated enrollment gateway system as described in this
section.
   (k) The state shall promote and offer support to the WIC program
for the use of the simple electronic application and the automated
enrollment gateway system. Participation in the automated enrollment
gateway system shall be required only to the extent that sufficient
financial assistance is made available to support the additional
training, staff time, administration, and other expenditures required
by a WIC local agency to use the gateway. This financial assistance
can be made available by public and private entities.
   (l) The board shall seek approval of any amendments to the state
plan necessary to implement this section, in accordance with Title
XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security
Act.
   (m) The department shall seek approval of any amendments to the
state plan necessary to implement this section, in accordance with
Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social
Security Act. Notwithstanding any other provision of law, only when
all necessary federal approvals have been obtained shall this section
be implemented.
  SEC. 14.  Chapter 16.2 (commencing with Section 12694.1) is added
to Part 6.2 of Division 2 of the Insurance Code, to read:
      CHAPTER 16.2.  HEALTHY FAMILIES BUY-IN PROGRAM


   12694.1.  By July 1, 2011, the board shall implement the Healthy
Families Buy-In Program that shall be referred to as the buy-in
program for purposes of this chapter.
   12694.2.  A child under 19 years of age is eligible for the buy-in
program if he or she meets all of the following criteria:
   (a) Lives in a family whose monthly or annual income exceeds 300
percent of the federal poverty level.
   (b) Is not eligible for full-scope Medi-Cal benefits without a
share of cost or the Healthy Families Program.
   (c) Has been without health care coverage for, at minimum, a
period of six consecutive months immediately preceding the date of
application for the buy-in program. Compliance with this criteria
shall be determined by the board using the same verification
procedures that it uses to verify compliance with Sections 12693.71
and 12693.72.
   12694.4.  The coverage for children in the buy-in program shall be
identical to the coverage for children enrolled in the Healthy
Families Program and shall include health, dental, and vision
benefits provided solely by a participating health, dental, or vision
care plan. Coverage shall also include the services provided
pursuant to the California Children's Services Program (Article 5
(commencing with Section 123800) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code) for a child who has been found
eligible for that program.
   12694.5.  (a) The family of a child enrolled in the buy-in program
shall pay the board a monthly contribution amount that 
include   includes  both of the following:
   (1) The full cost of coverage for health, dental, and vision
benefits for a child under the Healthy Families Program.
   (2) The per capita actuarial value, including medical, case
management, and administrative costs, of providing the California
Children's Services Program to a child enrolled in the buy-in
program, as calculated annually by the board in consultation with the
California Children's Services Program and the State Department of
Health Care Services.
   (b) The family of a child enrolled in the buy-in program shall
receive the same discounts from their contributions under this
section as provided to applicants pursuant to paragraph (4) of
subdivision (d) of, and subdivisions (e) and (f) of, Section 12693.43
and shall be subject to the payment procedures set forth in Section
2699.6813 of Title 10 of the California Code of Regulations.
   12694.6.  (a) A county that determines a child ineligible for the
Medi-Cal program or for the Healthy Families Program shall inform the
applicant of the option of enrolling the child in the buy-in program
and, with the applicant's approval, shall transmit the application
to the board.
   (b) If the board determines a child is ineligible for the Healthy
Families Program or the Medi-Cal program, it shall inform the
applicant of the option of enrolling the child in the buy-in program
and, with the applicant's approval, shall consider the application
for the child's eligibility for the buy-in program.
   12694.7.  (a) The board, in conjunction with the State Department
of Health Care Services and the California Children's Services
Program, shall study the impact of the inclusion of the California
Children's Services Program in the buy-in program on all of the
following:
   (1) The enrollment of eligible children in the buy-in program.
   (2) The California Children's Services Program.
   (3) Buy-in program costs.
   (4) Access to California Children's Services Program services for
eligible buy-in participants.
   (b) The board shall provide a report to the Legislature of the
study conducted pursuant to this section, including, but not limited
to, recommendations on how to improve access to California Children's
Services Program services for children eligible for the buy-in
program.
  SEC. 15.  Section 14005.23 of the Welfare and Institutions Code is
amended to read:
   14005.23.  (a) To the extent federal financial participation is
available, the department shall, when determining eligibility for
children under Section 1396a()(1)(D) of Title 42 of the United States
Code, designate a birth date by which all children who have not
attained the age of 19 years will meet the age requirement of Section
1396a()(1)(D) of Title 42 of the United States Code.
   (b) On and after January 1, 2010, the department shall apply the
less restrictive income deduction described in Section 1396a(r) of
Title 42 of the United States Code when determining eligibility for
the children identified in Section 14005.26. The amount of this
deduction shall be the difference between 133 percent and 100 percent
of the federal poverty level applicable to the size of the family.
  SEC. 16.  Section 14005.26 is added to the Welfare and Institutions
Code, to read:
   14005.26.  (a) On and after January 1, 2010, children, including
children for whom federal financial participation is not available
under Title XIX of the federal Social Security Act (42 U.S.C. Sec.
1396 et seq.) for full-scope coverage, who meet the household income
and age requirements in Section 14005.23 shall be eligible to enroll
in the Medi-Cal program.  The parent or caretaker relative of the
child shall sign, under penalty of perjury, an attestation that
indicates whether the child is described in any of the categories
enumerated on the attestation for which federal financial
participation for full-scope coverage is available. 
   (b) When determining the eligibility of children described in
subdivision (a), the department shall apply the less restrictive
income disregard described in Section 1396a(r) of Title 42 of the
United States Code. The income disregard shall be equal to the
difference between the income standard and the amount equal to 133
percent of the federal poverty level applicable to the size of the
family.
                                        (c) Nothing in this section
shall be construed to authorize the denial, discontinuance, or
reduction of medical assistance under the Medi-Cal program or the
Healthy Families Program (Part 6.2 (commencing with Section 12693) of
Division 2 of the Insurance Code) to a person who qualifies for the
Medi-Cal program or for the Healthy Families Program, or who, without
the application of this section, would qualify for either program,
or to relieve the Medi-Cal program or the Healthy Families Program of
the obligation to determine eligibility on all other available
grounds. 
   (d) In implementing this section, the department shall consult
with stakeholders, including, but not limited to, consumer advocates
and counties. 
  SEC. 17.  Section 14011.01 is added to the Welfare and Institutions
Code, to read:
   14011.01.  By July 1, 2011, the department, in consultation with
stakeholders, including, but not limited to, consumer advocates,
shall do both of the following:
   (a) Simplify the annual renewal forms for children enrolled in the
Medi-Cal program, including forms prepopulated with all of the
family's eligibility information and a simple check-off list for
families to identify whether each eligibility information item
remains correct. The renewal form shall request families to provide
and certify with their signature any changes to the prepopulated
eligibility information form.
   (b) Establish a process to allow families to renew their child's
coverage by telephone.
  SEC. 18.  Section 14011.02 is added to the Welfare and Institutions
Code, to read:
   14011.02.  (a) The department, in coordination with the Managed
Risk Medical Insurance Board, counties, stakeholders, including, but
not limited to, consumer advocates, shall make technological
improvements to the existing eligibility determination and enrollment
systems for the Medi-Cal program, such as the Medi-Cal Eligibility
Data System (MEDS), the Statewide Automated Welfare System, and the
Healthy Families Program based on the guidelines set forth in
subdivisions (b), (c), and (d) in order to better integrate the
enrollment processes for those programs.
   (b) The improvements shall allow families to be screened for, and
with their consent to apply to, multiple programs from more than one
location.
   (c) The improvements shall include, but not be limited to,
accomplishment of all of the following objectives:
   (1) Promote accessible enrollment opportunities through public
service programs that are widely used by families, including schools
and other public access points, while incorporating mechanisms to
minimize duplicate applications and to identify whether a child is
currently enrolled in the Medi-Cal program, the Healthy Families
Program, or other coverage before processing a new application.
   (2) Eliminate all duplicative requests and requirements for
applications and other information and require the Managed Risk
Medical Insurance Board, the department, and the counties to use the
procedures in subdivisions (e) to (g), inclusive, of Section 14005.37
for all applications to minimize the burdens on families.
   (3) Support electronic and digital signature approaches to reduce
the burden of the applicant appearing in person and to allow the
applicant to submit any application without appearing in person,
wherever possible.
   (4) Eliminate all documentation requirements, other than those
required by federal law, and verify necessary information through
other available databases and through the use of the procedures
established in subdivisions (e) to (g), inclusive, of Section
14005.37.
   (5) Promote data integrity by expanding access to and improving
MEDS search and file clearance functionality.
   (6) Include the ability to obtain birth and other state maintained
verification documents electronically.
   (7) Support electronic exchange of information with the Statewide
Automated Welfare System.
   (8) Guarantee privacy protections and secure information exchange.

   (d) To improve the integration and efficiency of technological
systems used by the state to operate the Medi-Cal program and the
Healthy Families Program, the department shall take the following
actions:
   (1) Establish reusable service-based interfaces to allow multiple
existing enrollment systems to exchange data electronically.
   (2) Support the electronic submission of verification documents
that are also available for exchange and reuse by multiple existing
enrollment systems.
   (3) Develop a plan and timeline for the implementation of
technology that provides an infrastructure to allow legacy systems,
new enrollment systems, and other systems to access common system
functions, features, and rules through a central repository of shared
services.
   (e) The technological improvements required by this section shall
be implemented by  July 1, 2011   January 1,
2013  .
  SEC. 19.  Section 14011.61 is added to the Welfare and Institutions
Code, to read:
   14011.61.  (a) To the extent allowed under Title XIX of the
federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) and Title
XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa et
seq.), and to the extent federal financial participation is available
under Title XXI of the federal Social Security Act, the department
shall administer the Medi-Cal Presumptive Eligibility Program to
provide a child who meets the criteria set forth in subdivision (d)
with presumptive eligibility benefits for the period described in
this section.
   (b) The department shall designate all 58 counties as qualified
entities for determining eligibility under this section.
   (c) A county shall perform an initial screen of every application
for the Medi-Cal program or the Healthy Families Program that is
filed with that county. The initial screen shall be completed within
 48 hours   four business days  from the
time of  submission   receipt  of the
application for the Medi-Cal program or the Healthy Families Program.

   (d) On the basis of the initial screen performed by the county, a
child who meets all of the following requirements shall be eligible
for presumptive eligibility benefits under this section:
   (1) The child, or his or her parent or guardian, submits an
application for the Medi-Cal program or the Healthy Families Program
with the county.
   (2) The child's income, as screened by the county on the basis of
the application described in paragraph (1), appears to be within the
income levels necessary to establish eligibility for the Medi-Cal
program with no share of cost.
   (3) The child is under 19 years of age at the time of the
application.
   (4) The child is not receiving no-cost Medi-Cal benefits or
benefits under the Healthy Families Program at the time that the
application is submitted.
   (e) When the county performs the initial screen and determines
that the child meets the criteria described in subdivision (d), the
county shall immediately establish presumptive eligibility for the
Medi-Cal program for that child. The presumptive eligibility benefits
provided under this section shall be identical to the benefits
provided to children who receive full-scope Medi-Cal benefits with no
share of cost and shall only be made available through a Medi-Cal
program provider.
   (f) Once presumptive eligibility has been established, the county
shall continue to determine a child's eligibility for the Medi-Cal
program on the basis of the application submitted to it.
   (g) The period of presumptive eligibility provided for under this
section begins on the first day of the month that the application is
filed.
   (h) If the county determines that the child is eligible for the
Medi-Cal program without a share of cost, the county shall enroll the
child in the Medi-Cal program without an interruption in coverage.
If the county determines that the child is eligible for the Medi-Cal
program with a share of cost, the county shall enroll the child in
the Medi-Cal program and forward the application to the Managed Risk
Medical Insurance Board for an evaluation of the child's eligibility
for the Healthy Families Program. To ensure continuity of coverage,
the presumptive eligibility benefits under this section shall
terminate on the last day of the month that precedes the month in
which the child begins receiving benefits under the Medi-Cal program.

   (i) If the county determines that the child is ineligible for the
Medi-Cal program with or without a share of cost, the county shall
terminate the child's presumptive eligibility benefits under this
section in accordance with due process requirements.
   (j) The Managed Risk Medical Insurance Board and the department,
in consultation with counties, consumer advocates, and other
stakeholders, shall develop a notice to inform families of the
transfer of a case between the Medi-Cal program and the Healthy
Families Program and from presumptive eligibility benefits to
benefits under one of those programs, to minimize the confusion for
the family, to clarify that coverage is continued during the
transfer, and to provide the family with contact information advising
the family where to ask questions about continuity of coverage and
access to care.
   (k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of all-county
letters or similar instructions, without taking any further
regulatory action. Thereafter, the department shall adopt
regulations, as necessary, to implement this section in accordance
with the requirements of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code.
   (l) The department, in consultation with representatives of the
local agencies that administer the Medi-Cal program, consumer
advocates, and other stakeholders, shall develop and distribute the
policies and procedures, including any all-county letters, necessary
to implement this section.
   (m) Nothing in this section shall be construed to authorize the
denial of medical assistance under the Medi-Cal program to a child
who, without the application of this section, would qualify for that
assistance or to excuse the Medi-Cal program or the Healthy Families
Program of the obligation to determine eligibility on all other
available grounds.
   (n) The department shall implement this section by July 1, 2011.
  SEC. 20.  It is the intent of the Legislature to enact legislation
that would require the State Department of Health Care Services to
coordinate with the Employment Development Department to inform
recently unemployed workers about potential eligibility for the
Medi-Cal program, the Healthy Families Program, or other public
health care coverage programs.
  SEC. 21.  It is the intent of the Legislature to enact legislation
that would, on or before July 1, 2011, restore funding for the county
outreach and enrollment plans pursuant to Section 14067.3 of the
Welfare and Institutions Code and that would broaden the outreach
approach of those plans to all California counties.
  SEC. 22.  It is the intent of the Legislature to enact legislation
providing parents with an easier way to pay premiums, including
family contributions under the Healthy Families Program, with pretax
dollars or through their paychecks.
  SEC. 23.  Notwithstanding any other provision of law, the Managed
Risk Medical Insurance Board may implement the provisions of this act
expanding the Healthy Families Program only to the extent that funds
are appropriated for those purposes in the annual Budget Act or in
another statute. 
  SEC. 24.    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. 
   SEC. 24.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution for certain costs that may be incurred by a local agency
or school district because, in that regard, this act creates a new
crime or infraction, eliminates a crime or infraction, or changes the
penalty for a crime or infraction, within the meaning of Section
17556 of the Government Code, or changes the definition of a crime
within the meaning of Section 6 of Article XIII B of the California
Constitution.  
   However, if the Commission on State Mandates determines that this
act contains other 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.