2005 California Welfare and Institutions Code Sections 14000-14029 Article 1. General Provisions

14000.  The purpose of this chapter is to afford to qualifying
individuals health care and related remedial or preventive services,
including related social services which are necessary for those
receiving health care under this chapter.
   The intent of the Legislature is to provide, to the extent
practicable, through the provisions of this chapter, for health care
for those aged and other persons, including family persons who lack
sufficient annual income to meet the costs of health care, and whose
other assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future minimum
self-maintenance and security.  It is intended that whenever possible
and feasible:
   (a) The means employed shall allow, to the extent practicable,
eligible persons to secure health care in the same manner employed by
the public generally, and without discrimination or segregation
based purely on their economic disability.  The means employed shall
include an emphasis on efforts to arrange and encourage access to
health care through enrollment in organized, managed care plans of
the type available to the general public.
   (b) The benefits available under this chapter shall not duplicate
those provided under other federal or state laws or under other
contractual or legal entitlements of the person or persons receiving
them.
   (c) In the administration of this chapter and in establishing the
means to be used to provide access to health care to persons eligible
under this chapter, the department shall emphasize and take
advantage of both the efficient organization and ready accessibility
and availability of health care facilities and resources through
enrollment in managed health care plans and new and innovative
fee-for-service managed health care plan approaches to the delivery
of health care services.
14000.03.  (a) The Legislature finds and declares that Section 1396a
(a)(11)(A) of Title 42 of the United States Code provides that
California's state plan for medical assistance under the Medicaid
program must "provide for entering into cooperative arrangements with
the State agencies responsible for administering or supervising the
administration of health services and vocational rehabilitation
services in the State looking toward maximum utilization of such
services in the provision of medical assistance under the plan."
   (b) In furtherance of Section 1396a(a)(11)(A) of Title 42 of the
United States Code and Section 7560 of the Government Code, it is the
intent of the Legislature to maximize the amount of federal and
state funds continually available under agreements identified in
Section 1396a(a)(11)(A) of Title 42 of the United States Code and
entered into by the State Department of Health Services by making
later-appropriated and budgeted funds immediately encumbered and
available for expenditure under agreements by operation of law.
   (c) Notwithstanding any other provision of law, upon additional
funds being appropriated and budgeted for the support of the services
identified within the scope of work of an agreement of the type
identified in Section 1396a (a)(11)(A) of Title 42 of the United
States Code and previously entered into by the State Department of
Health Services, the amount of the encumbrance in such an agreement
shall be amended, by operation of law, to reflect the newly
appropriated and budgeted funds.
   (d) Notwithstanding any other provision of law, once an agreement
of the type identified in Section 1396a (a)(11)(A) of Title 42 of the
United States Code is entered into by the State Department of Health
Services, the agreement shall continue in effect indefinitely and
need not be amended unless the State Department of Health Services
changes the scope of work to be provided under the agreement.
14000.05.  The State Department of Health Services shall consider
the special needs and requirements of rural hospitals in California
that are financially distressed and in danger of closure.  The
department may provide technical assistance and other appropriate
assistance and relief on Medi-Cal program policies, reimbursement
issues, and Medi-Cal operational and procedural problems to
financially distressed rural hospitals, when appropriate, in order to
preserve the availability of health care services in rural
California.
14000.1.  It is the intent of the Legislature that health care
services available under this chapter shall be at least equivalent to
the level provided in 1970-71.
14000.2.  During the time this chapter is effective and
notwithstanding other provisions of the Welfare and Institutions Code
and Health and Safety Code, the board of supervisors of each county
may prescribe rules which authorize the county hospital to integrate
its services with those of other hospitals into a system of community
service which offers free choice of hospitals to those requiring
hospital care.  The intent of this section is to eliminate
discrimination or segregation based on economic disability so that
the county hospital and other hospitals in the community share in
providing services to paying patients and to those who qualify for
care in public medical care programs.  In prescribing rules under
which the county hospital may provide community hospital services
described in this section, the board of supervisors shall provide a
basis under which patients may be attended by their own personal
physicians who are professionally qualified for staff membership in
the county hospital.
   Notwithstanding any other provisions of law or provisions
contained in a county charter, the board of supervisors of any county
may transfer the maintenance, operation and management or ownership
of the county hospital to the University of California or any other
public agency or community nonprofit corporation empowered to operate
a hospital facility upon a finding that the community services
provided by the hospital could be more efficiently, effectively or
economically provided by the transferee than the county.  If such
transfer be made to the University of California or to any other
public agency empowered to operate a hospital facility the transfer
of control or ownership may be made with or without the payment of a
purchase price by the transferee and otherwise upon such terms and
conditions as the parties may mutually agree, but if the transfer be
to a community nonprofit corporation, the board of supervisors shall
comply with all other provisions of law relating to the sale, lease,
or transfer of public property by a county; and provided that in any
event the transaction shall include such terms and conditions as the
board of supervisors find necessary to insure that the transfer will
constitute an ongoing material benefit to the county and its
residents.
   The intent of this section is to permit the implementation of
programs for the consolidation of public hospital services in order
to permit the more effective use of existing hospital facilities and
retard the spiraling costs of medical care.
14000.3.  To the extent permitted by federal law, the director may
enter into contracts with the Secretary of Health, Education, and
Welfare to obtain or provide fiscal intermediary services for all
persons who are receiving benefits under this chapter, who are also
recipients of benefits under Title XVIII of the Social Security Act.
14000.4.  This chapter shall be known and may be cited as the
"Medi-Cal Act."
14000.5.  On a regional pilot project basis, to the extent
authorized by law, the director may enter into contracts with one or
more nonprofit organizations to perform the functions of the
department's Office of the Ombudsman.  These activities may include
outreach, community education and training about health care consumer
rights and responsibilities, including the production and
distribution of consumer-oriented material, individual consumer
assistance, including counseling, advice, assistance, education,
advocacy, and referral as appropriate, establishing and operating a
database to analyze the nature of the inquiries and requests for
assistance, and training of department or county staff.  These
services may be made available to any person who may be eligible for
or is receiving benefits under this chapter.  Funds appropriated in
the annual Budget Act for the support of the Office of the Ombudsman
may be allocated for this purpose.
14001.  Health care as administered under this chapter shall be
considered a component of public social services.
14001.1.  It is the intention of the Legislature, whenever feasible,
that the needs of categorically needy persons for health care and
related remedial or preventive services be met under the provisions
of this chapter.
14001.11.  (a) The department shall implement the federal
requirements described in Section 1396u-5 of Title 42 of the United
States Code.
   (b) In each of the several counties of the state, the eligibility
and enrollment functions required under Section 1396u-5(a)(2) and (3)
of Title 42 of the United States Code, which may include, but are
not limited to, determining eligibility and offering enrollment for
premium and cost sharing subsidies made available under and in
accordance with Section 1395w-114 of Title 42 of the United States
Code, shall be a county function and responsibility, subject to the
direction, authority, and regulations of the department. The
department shall request input from the counties as to the potential
cost of implementing these provisions, and shall consider that input
in developing the budget.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, or make specific this section by
means of all county letters, provider bulletins, or similar
instructions, with input from the counties. Thereafter, the
department may adopt regulations in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of the
Government Code.
   (d) The department shall seek approval of any amendments to the
state plan, necessary to implement this section, for purposes of
federal financial participation under Title XIX of the Social
Security Act (42 U.S.C. Sec. 1396 et seq.). Notwithstanding any other
law and only when all necessary federal approvals have been
obtained, this section, with the exception of the Phased-Down State
Contribution, as described in subparagraphs (A) to (C), inclusive, of
paragraph (1) of subdivision (c) of Section 1396u-5 of Title 42 of
the United States Code, shall be implemented only to the extent
federal financial participation is available.
14002.  For the purposes of this article, the following definitions
shall apply:
   (a) "Community spouse" means the spouse of an institutionalized
spouse.
   (b) "Institutionalized spouse" means any individual to whom all of
the following apply:
   (1) The individual is in a medical institution or nursing facility
or is a person who is receiving institutional or noninstitutional
services from an organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590), and is likely to meet that requirement for at least 30
consecutive days.
   (2) The individual is married to a spouse who is not in a medical
institution or nursing facility, or to a spouse who is not receiving
services from any organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590).
   (3) Except for purposes of Sections 14005.7, 14005.12, 14005.16,
and 14005.17, an individual who is admitted to a medical institution
or nursing facility on or after September 30, 1989, and who applies
for Medi-Cal benefits on or after January 1, 1990, or a Medi-Cal
recipient who is admitted to a medical institution or nursing
facility on or after January 1, 1990.
   (c) "Medical institution" means the same as defined in Section
435.1009 of Title 42 of the Code of Federal Regulations.
   (d) "Nursing facility" has the same meaning as contained in
Section 1250 of the Health and Safety Code.
14002.  Health care granted under the provisions of this chapter is
held subject to the provisions of any law hereafter enacted amending,
repealing, or supplementing in whole or in part the provisions of
this chapter, and subject to the rules and regulations of the
department.  No recipient of health care under this chapter shall
have any claim for compensation or otherwise because his service is
affected in any way by any such amending, repealing, or supplemental
act, or by any such rule or regulation or by any addition, amendment,
or repeal of such rules or regulations.
14003.  The Governor may enter into and execute in behalf of the
state all necessary agreements in connection with this chapter as may
be required by the United States government.
14004.  If any individual in good faith adheres to the teachings of
any bona fide church, sect, denomination, or organization, and in
accordance with its principles depends for healing entirely upon
prayer or spiritual means, no medical examination shall be required
to receive health care authorized by this chapter, but in lieu
thereof the certificate of a practitioner of such bona fide sect,
denomination, or organization approved and authorized by the
department, shall be accepted as to the need of such individual for
service.  No rule or regulation shall be adopted or continued in
force which discriminates against such an individual.
14005.  The health care benefits and services specified in this
chapter, to the extent that such services are neither provided under
any other federal or state law nor provided nor available under other
contractual or legal entitlements of the person, shall be provided
under this chapter to any person who is a resident of this state and
is made eligible by the provisions of this article.  It is the intent
of the Legislature that a provider shall look to such other
contractual or legal entitlements for payment before submitting a
bill for payment under this chapter.
14005.1.  Except for adults receiving aid pursuant to Chapter 2
(commencing with Section 11200) and for whom federal financial
participation would not be obtainable for their medical costs under
Title XIX of the federal Social Security Act, categorically needy
persons are eligible for health care services under Section 14005.
   Eligibility for health care services under Section 14005 shall
continue for four calendar months beginning with the month in which a
family becomes ineligible for benefits under the Aid to Families
with Dependent Children program, if all of the following apply:
   (a) The ineligibility is due wholly or partly to the collection or
increased collection of child or spousal support pursuant to Article
7 (commencing with Section 11475) of Chapter 2.
   (b) The family has received benefits under the Aid to Families
with Dependent Children program in at least three of the six months
immediately preceding the month in which ineligibility begins.
   (c) Ineligibility occurred after October 1, 1984, and before
October 1, 1988.
14005.2.  Unless otherwise specified in this chapter, the
eligibility of a person eligible under the Cuban-Haitian Entrant
Program or the Refugee Resettlement Program for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person, except for those criteria that establish categorical
relatedness, and only as long as federal funds are available.
14005.3.  (a) Notwithstanding any other provision of this chapter,
any person who:          (1) Was once determined to be disabled in
accordance with Section 1614 of Part A of Title XVI of the Social
Security Act (Section 1382c, Title 42, United States Code), and
  (2) Became ineligible for benefits pursuant to Section 1614 of Part
A of Title XVI of the Social Security Act (Section 1382c, Title 42,
United States Code) because the person engaged in substantial gainful
activity, and        (3) Continues to suffer from the physical or
mental impairments which were the basis of the disability
determination required under paragraph (1),  shall be considered to
be disabled, for the purposes of this chapter, even though such
person is engaged in substantial gainful activity. Regardless of
whether such person has excess income pursuant to Sections 14005.12
and 14005.13, such person shall be eligible to receive health care
benefits and services under this chapter if his or her income does
not exceed the maximum income eligibility limits for benefits under
Part A of Title XVI of the Social Security Act.  Any such person
whose income exceeds the maximum income eligibility limits for
benefits under Part A of Title XVI of the Social Security Act shall
be eligible under Sections 14005.4 and 14052 for health care benefits
and services under this chapter, provided, that the income levels
for maintenance in Section 14005.12 for such person shall be the
maximum income eligibility limits for benefits under Part A of Title
XVI of the Social Security Act and provided, that his or her
nonexempt income in excess of that maximum is used to pay his or her
share of costs.
   (b) For purposes of this section, "substantial gainful activity"
means work activity considered to be substantial gainful activity
under applicable federal regulations adopted pursuant to Section 1614
of Part A of Title XVI of the Social Security Act.
   (c) The determination of continued impairments and the need for
health care benefits and services shall be supported by medical
reports when requested.  Such reports shall be provided at the
expense of the department.
14005.4.  Unless otherwise specified in this chapter, the
eligibility of a state-only Medi-Cal person for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person except for those criteria that establish categorical
relatedness.
14005.5.  (a) In determining eligibility pursuant to Section 14005.4
or 14005.7, reparation or restitution payments received by victims
of the Nazi persecution from the Federal Republic of Germany pursuant
to the Federal Law on the Compensation of Victims of the National
Socialist Persecution (Federal Compensation Law), as enacted by that
government on June 29, 1956, shall not be deemed as available income,
nor shall any accumulation of those payments be considered an
available resource, to the extent that the funds are not spent and
are kept identifiable.
   (b) The director shall seek federal waivers from the Secretary of
the United States Department of Health and Human Services, in order
to ensure federal financial participation.  In the event of an
initial determination by the Secretary of the United States
Department of Health and Human Services that any provision of this
section is in conflict with any federal statute or regulation, the
department shall take all available and necessary steps to obtain a
final determination reversing that decision.  In the event that a
final determination is made which finds a conflict with federal law,
the director shall immediately request the Attorney General to seek
judicial review of the determination, and the director shall notify
the appropriate policy and fiscal committees of both houses of the
Legislature of its request.  Notwithstanding the outcome of the
director's efforts to obtain waivers under this subdivision, or a
final judicial decision holding that any provision of this section is
in conflict with federal law, subdivision (a) shall be implemented
on July 1, 1985, or the date upon which waivers are obtained under
this subdivision, whichever is earlier.  Failure to obtain waivers
pursuant to this subdivision shall not affect implementation of
subdivision (a).
14005.6.  (a) The Legislature finds and declares as follows:
   (1) Under federal law, minors living at home with their families
may not be eligible for the SSI and Medicaid programs.
   (2) Under the Federal Budget Reconciliation Act of 1981, however,
states may apply for a Section 1915(c) waiver to allow a person to be
eligible for SSI and Medicaid when medical and social services
provided in the home can be shown to be less costly than services
provided in an institution.
   (3) Whenever possible, medical and social services should be
provided in the least restrictive setting and at the lowest cost to
the programs involved.
   (4) The State Department of Health Services has already
successfully applied for the Section 1915(c) waiver as applied to
certain defined populations of developmentally disabled, elderly, and
medically acute clients.
   (b) The State Director of Health Services shall apply for
additional waivers when appropriate to expand the number and types of
persons who will be eligible for in-home services.
14005.7.  (a) Medically needy persons and medically needy family
persons are entitled to health care services under Section 14005
providing all eligibility criteria established pursuant to this
chapter are met.
   (b) Except as otherwise provided in this chapter or in Title XIX
of the federal Social Security Act, no medically needy family person,
medically needy person or state-only Medi-Cal persons shall be
entitled to receive health care services pursuant to Section 14005
during any month in which his or her share of cost has not been met.
   (c) In the case of a medically needy person, monthly income, as
determined, defined, counted, and valued, in accordance with Title
XIX of the federal Social Security Act, in excess of the amount
required for maintenance established pursuant to Section 14005.12,
exclusive of any amounts considered exempt as income under Chapter 3
(commencing with Section 12000), less amounts paid for Medicare and
other health insurance premiums shall be the share of cost to be met
under Section 14005.9.
   (d) In the case of a medically needy family person or state-only
Medi-Cal person, monthly income, as determined, defined, counted, and
valued, in accordance with Title XIX of the federal Social Security
Act, in excess of the amount required for maintenance established
pursuant to Section 14005.12, exclusive of any amounts considered
exempt as income under Chapter 2 (commencing with Section 11200),
less amounts paid for Medicare and other health insurance premiums
shall be the share of cost to be met under Section 14005.9.
   (e) In determining the income of a medically needy person residing
in a licensed community care facility, income shall be determined,
defined, counted, and valued, in accordance with Title XIX of the
federal Social Security Act, any amount paid to the facility for
residential care and support that exceeds the amount needed for
maintenance shall be deemed unavailable for the purposes of this
chapter.
   (f) (1) For purposes of this section the following definitions
apply:
   (A) "SSI" means the federal Supplemental Security Income program
established under Title XVI of the federal Social Security Act.
   (B) "MNL" means the income standard of the Medi-Cal medically
needy program defined in Section 14005.12.
   (C) Board and care "personal care services" or "PCS" deduction
means the income disregard that is applied to a resident in a
licensed community care facility, in lieu of the board and care
deduction specified in subdivision (e) of Section 14005.7, when the
PCS deduction is greater than the board and care deduction.
   (2) (A) For purposes of this section, the SSI recipient retention
amount is the amount by which the SSI maximum payment amount to an
individual residing in a licensed community care facility exceeds the
maximum amount that the state allows community care facilities to
charge a resident who is an SSI recipient.
   (B) For purposes of this section, the personal and incidental
needs deduction for an individual residing in a licensed community
care facility is either of the following:
   (i) If the deduction specified in subdivision (e) is applicable to
the individual, the amount, not to exceed the amount by which the
SSI recipient retention amount exceeds twenty dollars ($20), nor to
be less than zero, by which the sum of the amount that the individual
pays to his or her licensed community care facility and the SSI
recipient retention amount exceed the sum of the individual's MNL,
the individual's board and care deduction, and twenty dollars ($20).
   (ii) If the deduction specified in paragraph (1) is applicable to
the individual, an amount, not to exceed the amount by which the SSI
recipient retention amount exceeds twenty dollars ($20), nor to be
less than zero, by which the sum of the amount which the individual
pays to his or her community care facility and the SSI recipient
retention amount exceed the sum of the individual's MNL, the
individual's PCS deduction and twenty dollars ($20).
   (3) In determining the countable income of a medically needy
individual residing in a licensed community care facility, the
individual shall have deducted from his or her income the amount
specified in subparagraph (B) of paragraph (2).
   (g) No later than one month after the effective date of
subparagraph (B) of paragraph (2) of subdivision (f), the department
shall submit to the federal medicaid administrator a state plan
amendment seeking approval of the income deduction specified in
subdivision (f), and of federal financial participation for the costs
resulting from that income deduction.
   (h) The deduction prescribed by paragraph (3) of subdivision (f)
shall be applied no later than the first day of the fourth month
after the month in which the department receives approval for the
federal financial participation specified in subdivision (g).  Until
approval for federal financial participation is received by the
department, there shall be no deduction under paragraph (3) of
subdivision (f).
14005.75.  A person who is otherwise eligible for Medi-Cal benefits
under either Section 14005.4 or 14005.7, except for income and
resource eligibility, and who is receiving Medi-Cal services for the
treatment of multiple sclerosis, shall continue to be eligible to
receive benefits only for these services under Medi-Cal, provided
that all other conditions of eligibility for the Medi-Cal program are
met.  These restricted benefits shall continue until such time as
the person is eligible for, and receives, third party coverage for
these treatments.  However, restricted benefits under this section
shall not continue for more than two years.
14005.75.  (a) The Legislature finds and declares all of the
following:
   (1) As a result of federal welfare reform, unprecedented numbers
of welfare recipients will be leaving welfare for work, and will face
time limits on the receipt of aid.
   (2) It is in the interest of the state both to encourage welfare
recipients to seek employment and to ensure the continuity of health
coverage for these recipients as they move from welfare to work.
   (3) California's transitional Medi-Cal program is intended to
encourage welfare recipients to seek employment and to ensure
continuity of health coverage, but various procedural restrictions
limit its effectiveness in achieving those goals.
   (b) It is, therefore, the intent of the Legislature to streamline
the transitional Medi-Cal program in order to maximize its
effectiveness in assisting persons leaving welfare for work.
14005.76.  (a) The department shall provide a Medi-Cal beneficiary
whose Medi-Cal eligibility is established pursuant to Section 1930 of
the federal Social Security Act (42 U.S.C. Sec. 1396u-1) with simple
and clear written notice of the availability of the transitional
Medi-Cal program and the requirements for that program.  This notice
shall be provided at the time that Medi-Cal eligibility is conferred
to the beneficiary and at least once every six months thereafter.
   (b) When a beneficiary loses Medi-Cal eligibility established
pursuant to Section 1930 of the federal Social Security Act (42
U.S.C. Sec. 1396u-1) for failure to meet reporting requirements, the
department shall provide the beneficiary with the notice described in
subdivision (a), and a form with simple and clear instructions on
how to complete and return the form to the county.  The form shall be
used to determine whether the beneficiary is eligible for the
transitional Medi-Cal program.
   (c) The notice and form described in subdivisions (a) and (b)
shall be prepared by the department.  The department shall seek input
on the notice and form from beneficiaries of aid, beneficiary
representatives, and counties.
   (d) The department shall review, and if necessary for simplicity
and clarity, revise the notice required by subdivision (b) of Section
14005.8 and Section 14005.81.  The department shall seek input from
beneficiaries, beneficiary representatives, and counties.
   (e) Notwithstanding any other provision of law, this section shall
become operative nine months after the effective date of this
section.
   (f) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.8.  (a) (1) To the extent required by Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the United
States Code and regulations adopted pursuant thereto, a family who
was receiving aid pursuant to a state plan approved under Part A of
Subchapter IV (commencing with Section 601) of Title 42 of the United
States Code in at least three of the six months immediately
preceding the month in which that family became ineligible for that
assistance due to increased hours of employment, income from
employment, or the loss of earned income disregards, shall remain
eligible for health care services as provided in this chapter during
the immediately succeeding six-month period.
   (2) The department shall terminate extensions of health care
services authorized by paragraph (1) as required under federal law.
   (b) The department shall notify persons eligible under subdivision
(a) of their right to continued health care services for each
six-month period and a description of their reporting requirement,
and the circumstances under which the extension may be terminated.
The notice shall also include a Medi-Cal card or other evidence of
entitlement to those services.
   (c) Notwithstanding any other provision of this section, the
department, in conformance with federal law, shall offer
beneficiaries covered under subdivision (a) the option of remaining
eligible for health care services provided in this chapter for an
additional extension period of six months.  Health services shall be
continued in as automatic a manner as permitted by federal law, and
without any unnecessary paperwork.
   (d) During the initial extension period and any additional
six-month extension period, the department, consistent with federal
law, may, whenever the department determines it to be cost-effective,
elect to pay a family's expenses for premiums, deductibles,
coinsurance, or similar costs for health insurance or other health
coverage offered by an employer of the caretaker relative or by an
employer of the absent parent of the dependent child.  If, during the
additional six-month extension period, the department elects to pay
health premiums and this coverage exists, the beneficiary may be
given the opportunity to express his or her preference between
continuing the Medi-Cal coverage or obtaining health insurance.
   (e) During the additional six-month extension period, the
department may impose a premium for the health insurance or other
health coverage consistent with Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) if the department
determines that the imposition of a premium is cost-effective.
   (f) The department shall adopt emergency regulations in order to
comply with mandatory provisions of Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) for extension of medical
assistance.  These regulations shall become effective immediately
upon filing with the Secretary of State.
   (g) This section shall become operative April 1, 1990.
14005.84.  (a) The department shall develop and conduct a community
outreach and education campaign to assist persons whose Medi-Cal
eligibility is established pursuant to Section 1931 of the federal
Social Security Act (42 U.S.C. Sec. 1396u-1), to learn about the
availability of the transitional Medi-Cal program.
   (b) Any managed care plan, local initiative, or county organized
health system contracting with the department to provide services to
Medi-Cal enrollees shall include in its evidence of coverage and
marketing materials information about the transitional Medi-Cal
program and how to apply for program benefits.
   (c) To implement this section, the department may develop and
execute a contract or may amend any existing or future outreach
campaign contract that it has executed.  Notwithstanding any other
provision of law, any such contract developed and executed, or
amended, as required to implement this section shall be exempt from
the approval of the Director of General Services and from the Public
Contract Code.
   (d) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.85.  (a) Families who, because of marriage or because
separated spouses reunite, lose AFDC eligibility under the chapter
because the family no longer meets the need requirement specified in
Section 11250 or has increased assets or income, or both, shall be
eligible for extended medical benefits as specified under this
article for a period not to exceed 12 months.
   (b) The department shall seek all federal waivers necessary to
implement this section.
   (c) This section shall not be implemented until the director has
executed a declaration, that shall be retained by the director, that
any necessary waivers and federal financial participation have been
obtained.
14005.88.  (a) The department shall contract for an independent
evaluation, to be completed no later than January 1, 2001, in order
to determine the effect of changes made in the transitional Medi-Cal
program by the enactment of Sections 14005.76, 14005.82, 14005.83,
14005.84, 14005.87, 14005.89, and the amendment to Section 14005.85
enacted during the first year of the 1997-98 Regular Session of the
Legislature, on the employment of welfare recipients and the
continuity of their health coverage.
   (b) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.89.  (a) The department shall monitor participation rates for
transitional Medi-Cal and seek input from beneficiaries, beneficiary
representatives, and counties, on a regular basis throughout each
year to consider changes in transitional Medi-Cal procedures as may
be necessary to ensure that participation rates are at levels that
would reasonably be expected, given aid caseload developments.
Before any such changes are made, the department shall seek any
federal waivers, or obtain other federal approval, that may be
necessary to implement the changes.
   (b) The department shall make the participation rate monitoring
data described in subdivision (a) available upon request.
14005.9.  (a) Share of cost shall be determined on a monthly basis.
No person or family shall be required to incur more than one month's
share of cost prior  to being certified as specified in Section
14018.
   (b) For persons in long-term care, any income exempted under
Sections 14005.4  and 14005.7 shall be considered in the
share-of-cost determination to the extent required by federal law or
regulations.
   (c) Once the beneficiary has incurred expenses for Medicare and
other health insurance deductibles or coinsurance charges and
necessary medical and remedial services that are not subject to
payment by a third party and which equal or exceed his or her share
of cost, the individual is entitled to receive health care services
pursuant to Section 14005 if all other applicable conditions of
eligibility under this chapter are met.
14005.10.  For purposes of facilitating arrangements for health care
through prepaid health plans, the department may set standards for
determining monthly income, for purposes of eligibility, on the
person's average pattern of income and earnings, subject to
subsequent adjustment if actual experience deviates substantially
from the amount determined by such method.
14005.11.  (a) To the extent required by federal law for qualified
Medicare beneficiaries, the department shall pay the premiums,
deductibles, and coinsurance for elderly and disabled persons
entitled to benefits under Title XVIII of the federal Social Security
Act, whose income does not exceed the federal poverty level and
whose resources do not exceed 200 percent of the Supplemental
Security Income program standard.
   (b) The department shall, in addition to subdivision (a), pay
applicable additional premiums, deductibles, and coinsurance for drug
coverage extended to qualified Medicare beneficiaries.
   (c) The deductible payments required by subdivision (b) may be
covered by providing the same drug coverage as offered to
categorically needy recipients, as defined in Section 14050.1.
14005.12.  (a) For the purposes of Sections 14005.4 and 14005.7, the
department shall establish the income levels for maintenance need at
the lowest levels that reasonably permit medically needy persons to
meet their basic needs for food, clothing, and shelter, and for which
federal financial participation will still be provided under Title
XIX of the federal Social Security Act.  It is the intent of the
Legislature that the income levels for maintenance need for medically
needy aged, blind, and disabled adults, in particular, shall be
based upon amounts that adequately reflect their needs.
   (1) Subject to paragraph (2), reductions in the maximum aid
payment levels set forth in subdivision (a) of Section 11450 in the
1991-92 fiscal year, and thereafter, shall not result in a reduction
in the income levels for maintenance under this section.
   (2) (A) The department shall seek any necessary federal
authorization for maintaining the income levels for maintenance at
the levels in effect June 30, 1991.
   (B) If federal authorization is not obtained, medically needy
persons shall not be required to pay the difference between the share
of cost as determined based on the payment levels in effect on June
30, 1991, under Section 11450, and the share of cost as determined
based on the payment levels in effect on July 1, 1991, and
thereafter.
   (3) Any medically needy person who was eligible for benefits under
this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families with
Dependent Children program as set forth in Section 11452.018 made in
the 1995-96 Regular Session of the Legislature shall not be
responsible for paying his or her share of cost if all of the
following apply:
   (A) He or she had eligibility as categorically needy terminated by
the reductions in the minimum basic standards of adequate care.
   (B) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.
   (C) He or she is not eligible to receive benefits without a share
of cost as a medically needy person pursuant to paragraph (1) or (2).
   (b) In the case of a single individual, the amount of the income
level for maintenance per month shall be 80 percent of the highest
amount that would ordinarily be paid to a family of two persons,
without any income or resources, under subdivision (a) of Section
11450, multiplied by the federal financial participation rate.
   (c) In the case of a family of two adults, the income level for
maintenance per month shall be the highest amount that would
ordinarily be paid to a family of three persons without income or
resources under subdivision (a) of Section 11450, multiplied by the
federal financial participation rate.
   (d) For the purposes of Sections 14005.4 and 14005.7, for a person
in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from an
organization with a frail elderly demonstration project waiver
pursuant to Chapter 8.75 (commencing with Section 14590), the amount
considered as required for maintenance per month shall be computed in
accordance with, and for those purposes required by, Title XIX of
the federal Social Security Act, and regulations adopted pursuant
thereto.  Those amounts shall be computed pursuant to regulations
which include providing for the following purposes:
   (1) Personal and incidental needs in the amount of not less than
thirty-five dollars ($35) per month while a patient.  The department
may, by regulation, increase this amount as necessitated by
increasing costs of personal and incidental needs.  A long-term
health care facility shall not charge an individual for the laundry
services or periodic hair care specified in Section 14110.4.
   (2) The upkeep and maintenance of the home.
   (3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.
   (4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent children,
dependent parents, or dependent siblings of either spouse, provided
the individuals are residing with the community spouse.
   (5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396r-5(d)(1)(B)).
   (6) The family allowance for each family member residing with the
community spouse shall be computed in accordance with the formula
established in Section 1924(d)(1)(C) of Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).
   (e) For the purposes of Sections 14005.4 and 14005.7, with regard
to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be computed
pursuant to regulations adopted by the department which provide for
the support and care of his or her spouse, minor children, or any
disabled relative for whose support he or she has contributed
regularly.
   (f) The income levels for maintenance per month, except as
specified in subdivisions (b) to (d), inclusive, shall be equal to
the highest amounts that would ordinarily be paid to a family of the
same size without any income or resources under subdivision (a) of
Section 11450, multiplied by the federal financial participation
rate.
   (g) The "federal financial participation rate," as used in this
section, shall mean 1331/3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396
(b)), or its successor provisions.
   (h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.
   (i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for each
household in accordance with subdivisions (b) to (h), inclusive.
The total of these levels shall be the level for the single
eligibility unit.
   (j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.
14005.13.  (a) Notwithstanding Section 14005.12, when an individual
residing in a long-term care facility would incur a share of cost for
services under this chapter due to income which exceeds that allowed
for the incidental and personal needs of the individual, a specified
portion of the individual's earned income from therapeutic wages
shall be exempt.  Therapeutic wages are wages earned by the
individual under all of the following conditions:
   (1) A physician who does not have a financial interest in the
long-term care facility in which the individual resides, and who is
in charge of the individual's case prescribes work as therapy for the
individual.
   (2) The individual must be employed within the same long-term care
facility where he or she resides.
   (3) The individual's employment does not displace any existing
employees.
   (4) The individual has resided in a long-term care facility for a
continuous period commencing at least five years prior to the date of
the addition of this section as originally adopted during the
1983-84 Regular Session.
   (b) The amount of earned income from therapeutic wages which shall
be exempt shall be the lesser of 70 percent of the gross therapeutic
wages or 70 percent of the maintenance level for a
noninstitutionalized person or family of corresponding size as
described in subdivision (b), (c), or (e) of Section 14005.12.
   (c) The provisions of this section shall be given retroactive
effect for the period commencing June 1, 1983.
   (d) This section shall not become operative unless and until the
necessary waivers are obtained from the United States Department of
Health and Human Services.
   (e) The director shall adopt regulations implementing this section
as emergency regulations in accordance with Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code.  For the purposes of the Administrative Procedure
Act, the adoption of the regulations shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare.  Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code, emergency regulations adopted by
the department in order to implement this section shall not be
subject to the review and approval of the Office of Administrative
Law.  These regulations shall become effective immediately upon
filing with the Secretary of State.
14005.14.  (a) In addition to the income exemptions specified in
subdivision (a) of Section 14005.7, an income exemption shall be
allowed each month for the amount actually paid toward the cost of
in-home supportive services needed as determined under standards and
procedures established by the Director of Social Services, by a
person who is eligible for Medi-Cal in accordance with Section 14005.
  3 or 14005.7.  For the purpose of this section, "in-home supportive
services" means those services that are available to recipients of
the In-Home Supportive Services Program as defined by the Director of
Social Services in regulations adopted pursuant to Article 7
(commencing with Section 12300) of Chapter 3 of Part 3 of Division 9.
   (b) The income exemption provided by this section for those
persons eligible for Medi-Cal in accordance with Section 14005.7
shall be restricted to those persons who, without in-home supportive
services, would require 24-hour-a-day care in a health facility, as
defined in Section 1250 of the Health and Safety Code, or a community
care facility, as defined under Section 1502 of the Health and
Safety Code.
   (c) The State Department of Health Services shall seek all federal
waivers necessary to allow for federal financial participation.  The
income exemption authorized by subdivision (b) shall remain in
effect during the time period that the federal waivers are pending.
If the necessary federal waivers cannot be obtained, the income
exemption authorized by subdivision (b) shall continue to be
implemented by the department.
14005.15.  Notwithstanding the provisions of Section 14005, Medi-Cal
beneficiaries shall obtain family planning services through the
Medi-Cal program to the extent they are available through such
program.
14005.16.  (a) In determining the eligibility of a married
individual pursuant to Section 14005.4 or 14005.7, who resides in a
nursing facility, and who is in a Medi-Cal family budget unit
separate from that of his or her spouse, the community property
interest of the noninstitutionalized spouse in the income of the
married individual shall not be considered income available to that
individual.
   (b) For purposes of this section, there shall be a presumption,
rebuttable by either spouse, that each spouse has a community
property interest in one-half of the total monthly income of both
spouses.
   (c) (1) This section shall not become operative unless Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
laws in determining eligibility or the federal government authorizes
the state to apply community property laws in that determination.
   (2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or the receipt of federal approval, as specified in paragraph (1).
14005.17.  (a) In determining the eligibility of an
institutionalized spouse pursuant to Section 14005.4 or 14005.7, who
resides in a medical institution or nursing facility, and who is in a
Medi-Cal family budget unit separate from that of his or her spouse,
the community property interest of either spouse in the income of
the other spouse shall not be considered when determining eligibility
for Medi-Cal benefits.
   (b) In the case of an institutionalized spouse, income shall be
determined in accordance with subsections (b) and (d) of Section 1924
of the federal Social Security Act and regulations adopted pursuant
thereto.
   (c) (1) This section shall remain operative only until Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
law in determining eligibility under this chapter, or the federal
government authorizes the consideration of state community property
in that determination.
   (2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or receipt of federal authorization as specified in paragraph (1).
14005.18.  A woman is eligible, to the extent required by federal
law, as though she were pregnant, for all pregnancy-related and
postpartum services for a 60-day period beginning on the last day of
pregnancy.
   For purposes of this section, "postpartum services" means those
services provided after childbirth, child delivery, or miscarriage.
14005.19.  The receipt of respite care, as defined in Section 1418.1
of the Health and Safety Code, shall not affect the eligibility of
any individual with respect to benefits under this chapter, except as
subject to the limitations of subdivision (b) of Section 14124.7.
14005.20.  (a) The State Department of Health Services shall adopt
the option made available under Section 13603 of the federal Omnibus
Budget Reconciliation Act of 1993 (Public Law 103-66) to pay
allowable tuberculosis related services for persons infected with
tuberculosis.
   (b) The income and resources of these persons may not exceed the
maximum amount for a disabled person as described in Section 1902(a)
(10)(A)(i) of Title XIX of the federal Social Security Act (42 U.S.C.
Sec.  1396a(a)(10)(A)(i)).
14005.20.  (a) The State Department of Health Services shall adopt
the option made available under Section 13603 of the federal Omnibus
Budget Reconciliation Act of 1993 (Public Law 103-66) to pay
allowable tuberculosis related services for persons infected with
tuberculosis.
   (b) The income and resources of these persons may not exceed the
maximum amount for a disabled person as described in Section 1902(a)
(10)(A)(i) of Title XIX of the federal Social Security Act (42 U.S.C.
Sec.  1396a(a)(10)(A) (i)).
14005.21.  (a) Any medically needy aged, blind, or disabled person
who was categorically needy under this chapter on the basis of
eligibility under Chapter 3 (commencing with Section 12000) or
Subchapter 16 (commencing with Section 1381) of Chapter 7 of Title 42
of the United States Code for the month of August 1993, and was
discontinued as of September 1, 1993, and who, but for the addition
of Section 12200.015, would be eligible to receive benefits without a
share of cost in September 1993 under this chapter, shall remain
eligible to receive benefits without a share of cost under this
chapter as if that person were categorically needy as long as he or
she meets other applicable requirements.
   (b) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy or
medically needy under subdivision (a) for the month of August 1994,
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the addition of Section 12200.017, and
if he or she, but for Section 12200.017, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
   (c) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivision (a) or (b), for the calendar
month immediately preceding the date that the reductions in maximum
aid payments for the state supplementary program established in
Chapter 3 (commencing with Section 12000) of Part 3 of Division 9
made in the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
   (d) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivisions (a), (b), or (c) for the
calendar month immediately preceding the date that the reductions in
maximum aid payments for the state supplementary program established
in Chapter 3 (commencing with Section 12000) made in the 1996 portion
of the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for these reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
   (e) The department shall implement this section regardless of the
availability of federal financial participation for the share of cost
paid from state funds pursuant to subdivisions (a), (b), (c), and
(d).
14005.23.  To the extent federal financial participation is
available, the department shall, when determining eligibility for
children under Section 1396a(l)(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(l)(1)(D) of Title 42 of the United States Code.
14005.24.  The department shall instruct counties, by means of an
all county letter or similar instruction, as to the process that is
to be used to ensure that each child, physical custody of whom has
been voluntarily surrendered pursuant to Section 1255.7 of the Health
and Safety Code, shall be determined eligible for benefits under
this chapter for, at a minimum, a period of time commencing on the
date physical custody is surrendered and ending on the earliest of
the following dates:
   (a) The last day of the month following the month in which the
child was voluntarily surrendered under Section 1255.7 of the Health
and Safety Code.
   (b) The date the child is reclaimed under Section 1255.7 of the
Health and Safety Code.
   (c) The date the child ceases to reside in California.
14005.25.  (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger.  A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
   (1) The end of a 12-month period following the eligibility
determination.
   (2) The date the individual exceeds the age of 19 years.
   (b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
14005.28.  (a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall exercise its option under Section 1902(a)(10)(A)(XV)
of the federal Social Security Act (42 U.S.C. Sec.  1396a(a)(10)(A)
(XV)) to extend Medi-Cal benefits to independent foster care
adolescents, as defined in Section 1905(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396d(v)(1)).
   (b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, and if the
state plan amendment described in subdivision (a) is approved by the
federal Health Care Financing Administration, the department may
implement subdivision (a) without taking any regulatory action and by
means of all-county letters or similar instructions.  Thereafter,
the department shall adopt regulations 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.
   (c) The department shall implement subdivision (a) on October 1,
2000, but only if, and to the extent that, the department has
obtained all necessary federal approvals.
14005.29.  To the extent that federal matching funds are available,
disabled persons who are otherwise eligible for benefits under this
chapter, except for income due to employment, shall continue to be
eligible to receive benefits for conditions excluded from coverage by
a private insurer, provided those persons' incomes do not exceed 200
percent of the income level for maintenance established pursuant to
Section 14005.12.
14005.30.  (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) made available to and exercised by the
state.
   (2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
   (3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u-1(b)(2)
(C) of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012.  The department
shall implement this paragraph only if, and to the extent that the
State Child Health Insurance Program waiver described in Section
12693.755 of the Insurance Code extending Healthy Families Program
eligibility to parents and certain other adults is approved and
implemented.
   (b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to expand eligibility for Medi-Cal under subdivision (a) by
establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).
   (c) To the extent federal financial participation is available,
the department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1) and the amount
equal to 100 percent of the federal poverty level applicable to the
size of the family.  A recipient shall be entitled to the same
disregard, but only to the extent it is more beneficial than, and is
substituted for, the earned income disregard available to recipients.
   (d) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec. 401
and following) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the federal
poverty level requires the department to modify the income disregard
pursuant to subdivision (c) and in which new income limits for the
program established by this section are adopted by the department.
   (e) Subdivision (b) shall be applied retroactively to January 1,
1998.
   (f) 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, without taking regulatory action,
subdivisions (a) and (b) of this section by means of an all county
letter or similar instruction.  Thereafter, the department shall
adopt regulations 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.  Beginning six months after the effective date
of this section, the department shall provide a status report to the
Legislature on a semiannual basis until regulations have been
adopted.
14005.31.  (a) (1) Subject to paragraph (2), for any person whose
eligibility for benefits under Section 14005.30 has been determined
with a concurrent determination of eligibility for cash aid under
Chapter 2 (commencing with Section 11200), loss of eligibility or
termination of cash aid under Chapter 2 (commencing with Section
11200) shall not result in a loss of eligibility or termination of
benefits under Section 14005.30 absent the existence of a factor that
would result in loss of eligibility for benefits under Section
14005.30 for a person whose eligibility under Section 14005.30 was
determined without a concurrent determination of eligibility for
benefits under Chapter 2 (commencing with Section 11200).
   (2) Notwithstanding paragraph (1), a person whose eligibility
would otherwise be terminated pursuant to that paragraph shall not
have his or her eligibility terminated until the transfer procedures
set forth in Section 14005.32 or the redetermination procedures set
forth in Section 14005.37 and all due process requirements have been
met.
   (b) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties, to inform Medi-Cal beneficiaries whose
eligibility for cash aid under Chapter 2 (commencing with Section
11200) has ended, but whose eligibility for benefits under Section
14005.30 continues pursuant to subdivision (a), that their benefits
will continue.  To the extent feasible, the notice shall be sent out
at the same time as the notice of discontinuation of cash aid, and
shall include all of the following:
   (1) A statement that Medi-Cal benefits will continue even though
cash aid under the CalWORKs program has been terminated.
   (2) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (3) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but shall be required to submit a semiannual status report
and annual reaffirmation forms.  The notice shall remind individuals
whose cash aid ended under the CalWORKs program as a result of not
submitting a status report that he or she should review his or her
circumstances to determine if changes have occurred that should be
reported to the Medi-Cal eligibility worker.
   (4) A statement describing the responsibility of the Medi-Cal
beneficiary to report to the county, within 10 days, significant
changes that may affect eligibility.
   (5) A telephone number to call for more information.
   (6) A statement that the Medi-Cal beneficiary's eligibility worker
will not change, or, if the case has been reassigned, the new worker'
s name, address, and telephone number, and the hours during which the
county's eligibility workers can be contacted.
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
14005.32.  (a) (1) If the county has evidence clearly demonstrating
that a beneficiary is not eligible for benefits under this chapter
pursuant to Section 14005.30, but is eligible for benefits under this
chapter pursuant to other provisions of law, the county shall
transfer the individual to the corresponding Medi-Cal program.
Eligibility under Section 14005.30 shall continue until the transfer
is complete.
   (2) The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall prepare a simple, clear, consumer-friendly notice to
be used by the counties, to inform beneficiaries that their Medi-Cal
benefits have been transferred pursuant to paragraph (1) and to
inform them about the program to which they have been transferred.
To the extent feasible, the notice shall be issued with the notice of
discontinuance from cash aid, and shall include all of the
following:
   (A) A statement that Medi-Cal benefits will continue under another
program, even though aid under Chapter 2 (commencing with Section
11200) has been terminated.
   (B) The name of the program under which benefits will continue,
and an explanation of that program.
   (C) A statement that continued receipt of Medi-Cal benefits will
not be counted against any time limits in existence for receipt of
cash aid under the CalWORKs program.
   (D) A statement that the Medi-Cal beneficiary does not need to
fill out monthly status reports in order to remain eligible for
Medi-Cal, but shall be required to submit a semiannual status report
and annual reaffirmation forms. In addition, if the person or persons
to whom the notice is directed has been found eligible for
transitional Medi-Cal as described in Section 14005.8, 14005.81, or
14005.85, the statement shall explain the reporting requirements and
duration of benefits under those programs, and shall further explain
that, at the end of the duration of these benefits, a
redetermination, as provided for in Section 14005.37 shall be
conducted to determine whether benefits are available under any other
provision of law.
   (E) A statement describing the beneficiary's responsibility to
report to the county, within 10 days, significant changes that may
affect eligibility or share of cost.
   (F) A telephone number to call for more information.
   (G) A statement that the beneficiary's eligibility worker will not
change, or, if the case has been reassigned, the new worker's name,
address, and telephone number, and the hours during which the county'
s Medi-Cal eligibility workers can be contacted.
   (b) No later than September 1, 2001, the department shall submit a
federal waiver application seeking authority to eliminate the
reporting requirements imposed by transitional medicaid under Section
1925 of the federal Social Security Act (Title 42 U.S.C. Sec.
1396r-6).
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
14005.33.  (a) If a Medi-Cal beneficiary's Medi-Cal eligibility
worker is changed, notice shall be sent to the beneficiary within 10
days of the change.  This notice shall include the worker's name,
address, and telephone number, and the beneficiary's Medi-Cal case
number, and hours during which the county's Medi-Cal eligibility
workers may be contacted by the beneficiary.
   (b) This section shall be implemented on or before July 1, 2001.
14005.34.  (a) For an individual whose cash aid was terminated
pursuant to Chapter 2 (commencing with Section 11200), but whose
Medi-Cal eligibility was continued either pursuant to subdivision (a)
of Section 14005.31 or pursuant to a transfer of eligibility under
Section 14005.32, the Medi-Cal beneficiary's annual reaffirmation
date under Section 14012 shall be no earlier than 12 months from the
date on which the most recent annual CalWORKs cash aid eligibility
determination was conducted, or, if no such determination was
conducted, 12 months from the date cash aid was granted.
   (b) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
14005.35.  The department, in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers, shall study the feasibility of adopting a mechanism
whereby, to the extent federal financial participation is available,
a Medi-Cal managed care plan shall be notified whenever the
eligibility of a Medi-Cal beneficiary enrolled in that plan is being
redetermined, including notice of the date upon which any forms must
be submitted to the county by the beneficiary.
14005.36.  (a) The county shall undertake outreach efforts to
beneficiaries receiving benefits under this chapter, in order to
maintain the most up-to-date home addresses, telephone numbers, and
other necessary contact information, and to encourage and assist with
timely submission of the annual reaffirmation form, and, when
applicable, transitional Medi-Cal program reporting forms and to
facilitate the Medi-Cal redetermination process when one is required
as provided in Section 14005.37.  In implementing this subdivision, a
county may collaborate with community-based organizations, provided
that confidentiality is protected.
   (b) The department shall encourage and facilitate efforts by
managed care plans to report updated beneficiary contact information
to counties.
   (c) The department and each county shall incorporate, in a timely
manner, updated contact information received from managed care plans
pursuant to subdivision (b) into the beneficiary's Medi-Cal case file
and into all systems used to inform plans of their beneficiaries'
enrollee status.  Updated Medi-Cal beneficiary contact information
shall be limited to the beneficiary's telephone number, change of
address information, and change of name.  The county may attempt to
verify that the information it receives from the plan is accurate
before updating the beneficiary's case file.  The department shall
develop a consent form that may be used by the counties to record the
beneficiary's consent to use the information received from a managed
care plan to update the beneficiary's file.
   (d) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
14005.37.  (a) Except as provided in Section 14005.39, whenever a
county receives information about changes in a beneficiary's
circumstances that may affect eligibility for Medi-Cal benefits, the
county shall promptly redetermine eligibility.  The procedures for
redetermining Medi-Cal eligibility described in this section shall
apply to all Medi-Cal beneficiaries.
   (b)  Loss of eligibility for cash aid under that program shall not
result in a redetermination under this section unless the reason for
the loss of eligibility is one that would result in the need for a
redetermination for a person whose eligibility for Medi-Cal under
Section 14005.30 was determined without a concurrent determination of
eligibility for cash aid under the CalWORKs program.
   (c) A loss of contact, as evidenced by the return of mail marked
in such a way as to indicate that it could not be delivered to the
intended recipient or that there was no forwarding address, shall
require a prompt redetermination according to the procedures set
forth in this section.
   (d) Except as otherwise provided in this section, Medi-Cal
eligibility shall continue during the redetermination process
described in this section. A Medi-Cal beneficiary's eligibility shall
not be terminated under this section until the county makes a
specific determination based on facts clearly demonstrating that the
beneficiary is no longer eligible for Medi-Cal under any basis and
due process rights guaranteed under this division have been met.
   (e) For purposes of acquiring information necessary to conduct the
eligibility determinations described in subdivisions (a) to (d),
inclusive, a county shall make every reasonable effort to gather
information available to the county that is relevant to the
beneficiary's Medi-Cal eligibility prior to contacting the
beneficiary.  Sources for these efforts shall include, but are not
limited to, Medi-Cal, CalWORKs, and Food Stamp Program case files of
the beneficiary or of any of his or her immediate family members,
which are open or were closed within the last 45 days, and wherever
feasible, other sources of relevant information reasonably available
to the counties.
   (f) If a county cannot obtain information necessary to redetermine
eligibility pursuant to subdivision (e), the county shall attempt to
reach the beneficiary by telephone in order to obtain this
information, either directly or in collaboration with community-based
organizations so long as confidentiality is protected.
   (g) If a county's efforts pursuant to subdivisions (e) and (f) to
obtain the information necessary to redetermine eligibility have
failed, the county shall send to the beneficiary a form, which shall
highlight the information needed to complete the eligibility
determination.  The county shall not request information or
documentation that has been previously provided by the beneficiary,
that is not absolutely necessary to complete the eligibility
determination, or that is not subject to change.  The form shall be
accompanied by a simple, clear, consumer-friendly cover letter, which
shall explain why the form is necessary, the fact that it is not
necessary to be receiving CalWORKs benefits to be receiving Medi-Cal
benefits, the fact that receipt of Medi-Cal benefits does not count
toward any time limits imposed by the CalWORKs program, the various
bases for Medi-Cal eligibility, including disability, and the fact
that even persons who are employed can receive Medi-Cal benefits.
The cover letter shall include a telephone number to call in order to
obtain more information.  The form and the cover letter shall be
developed by the department in consultation with the counties and
representatives of consumers, managed care plans, and Medi-Cal
providers.  A Medi-Cal beneficiary shall have no less than 20 days
from the date the form is mailed pursuant to this subdivision to
respond.  Except as provided in subdivision (h), failure to respond
prior to the end of this 20-day period shall not impact his or her
Medi-Cal eligibility.
   (h) If the purpose for a redetermination under this section is a
loss of contact with the Medi-Cal beneficiary, as evidenced by the
return of mail marked in such a way as to indicate that it could not
be delivered to the intended recipient or that there was no
forwarding address, a return of the form described in subdivision (g)
marked as undeliverable shall result in an immediate notice of
action terminating Medi-Cal eligibility.
   (i) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), a beneficiary does
not submit the completed form to the county, the county shall send
the beneficiary a written notice of action stating that his or her
eligibility shall be terminated 10 days from the date of the notice
and the reasons for that determination, unless the beneficiary
submits a completed form prior to the end of the 10-day period.
   (j) If, within 20 days of the date of mailing of a form to the
Medi-Cal beneficiary pursuant to subdivision (g), the  beneficiary
submits an incomplete form, the county shall attempt to contact the
beneficiary by telephone and in writing to request the necessary
information.  If the beneficiary does not supply the necessary
information to the county within 10 days from the date the county
contacts the beneficiary in regard to the incomplete form, a 10-day
notice of termination of Medi-Cal eligibility shall be sent.
   (k) If, within 30 days of termination of a Medi-Cal beneficiary's
eligibility pursuant to subdivision (h), (i), or (j), the beneficiary
submits to the county a completed form, eligibility shall be
determined as though the form was submitted in a timely manner and if
a beneficiary is found eligible, the termination under subdivision
(h), (I), or (j) shall be rescinded.
   (l) If the information reasonably available to the county pursuant
to the redetermination procedures of subdivisions (d), (e), (g), and
(m) does not indicate a basis of eligibility, Medi-Cal benefits may
be terminated so long as due process requirements have otherwise been
met.
   (m) The department shall, with the counties and representatives of
consumers, including those with disabilities, and Medi-Cal
providers, develop a timeframe for redetermination of Medi-Cal
eligibility based upon disability, including ex parte review, the
redetermination form described in subdivision (g), timeframes for
responding to county or state requests for additional information,
and the forms and procedures to be used.  The forms and procedures
shall be as consumer-friendly as possible for people with
disabilities.  The timeframe shall provide a reasonable and adequate
opportunity for the Medi-Cal beneficiary to obtain and submit medical
records and other information needed to establish eligibility for
Medi-Cal based upon disability.
   (n) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (o) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
14005.38.  To the extent feasible, the department shall use the
redetermination form required by subdivision (g) of Section 14005.37
as the annual reaffirmation form.
14005.39.  (a) If a county has facts clearly demonstrating that a
Medi-Cal beneficiary cannot be eligible for Medi-Cal due to an event,
such as death or change of state residency, Medi-Cal benefits shall
be terminated without a redetermination under Section 14005.37.
   (b) Whenever Medi-Cal eligibility is terminated without a
redetermination, as provided in subdivision (a), the Medi-Cal
eligibility worker shall document that fact or event causing the
eligibility termination in the beneficiary's file, along with a
written certification that a full redetermination could not result in
a finding of Medi-Cal eligibility. Following this written
certification, a notice of action specifying the basis for
termination of Medi-Cal eligibility shall be sent to the beneficiary.
   (c) This section shall be implemented on or before July 1, 2001,
but only to the extent that federal financial participation under
Title XIX of the federal Social Security Act (Title 42 U.S.C. Sec.
1396 and following) is available.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
Comprehensive implementing instructions shall be issued to the
counties no later than March 1, 2001.
14005.40.  (a) To the extent federal financial participation is
available, the department shall exercise its option under Section
1902(a)(10)(A)(ii)(X) of the federal Social Security Act (42 U.S.C.
Sec.  1396a(a)(10)(A)(ii)(X), to implement a program for aged and
disabled persons as described in Section 1902(m) of the federal
Social Security Act (42 U.S.C.  Sec. 1396a(m)(1)).
   (b) To the extent federal financial participation is available,
the blind shall be included within the definition of disabled for the
purposes of the program established in this section.
   (c) An individual shall satisfy the financial eligibility
requirement of this program if both of the following conditions are
met:
   (1) Countable income, as determined in accordance with Section
1902(m) of the federal Social Security Act (42 U.S.C. Sec. 1396a(m)),
does not exceed an income standard equal to 100 percent of the
applicable federal poverty level, plus two hundred thirty dollars
($230) for an individual or, in the case of a couple, three hundred
ten dollars ($310), provided that the income standard so determined
shall not be less than the SSI/SSP payment level for a disabled
individual or, in the case of a couple, the SSI/SSP payment level for
a disabled couple.
   (2) Countable resources, as determined in accordance with Section
1902(m) of the federal Social Security Act (42 U.S.C. Sec. 1396a(m)),
do not exceed the maximum levels established in that section.
   (d) The financial eligibility requirements provided in
subdivisions (c) may be adjusted upwards to reflect the cost of
living in California, contingent upon appropriation in the annual
Budget Act.
   (e) 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, and without taking regulatory
action.  Thereafter, the department shall adopt regulations 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.
   (f) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec. 401
et seq.) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the federal
poverty level requires the department to modify the income standard
described in subdivision (c).
   (g) (1) For purposes of this section the following definitions
apply:
   (A) "SSI" means the federal Supplemental Security Income program
established under Title XVI of the federal Social Security Act.
   (B) "Income standard" means the applicable income standard
including the augmentations specified in paragraph (1) of subdivision
(c).
   (C) The board and care "personal care services" or "PCS" deduction
refers to an income disregard that is applied to a resident in a
licensed community care facility in lieu of the board and care
deduction (equal to the amount by which the basic board and care rate
exceeds the income standard in subparagraph (B), of paragraph (1) of
subdivision (g)) when the PCS deduction is greater than the board
and care deduction.
   (2) (A) For purposes of this section, the SSI recipient retention
amount is the amount by which the SSI maximum payment amount to an
individual residing in a licensed community care facility exceeds the
maximum amount that the state allows community care facilities to
charge a resident who is an SSI recipient.
   (B) For the purposes of this section, the personal and incidental
needs deduction for an individual residing in a licensed community
care facility is either of the following:
   (i) If the board and care deduction is applicable to the
individual, the amount, not to exceed the amount by which the SSI
recipient retention amount exceeds twenty dollars ($20), nor to be
less than zero, by which the sum of the amount which the individual
pays to his or her licensed community care facility and the SSI
recipient retention amount exceed the sum of the individual's income
standard, the individual's board and care deduction, and twenty
dollars ($20).
   (ii) If the PCS deduction specified in paragraph (1) of
subdivision (g) is applicable to the individual, an amount, not to
exceed the amount by which the SSI recipient retention amount exceeds
twenty dollars ($20), nor to be less than zero, by which the sum of
the amount which the individual pays to his or her community care
facility and the SSI recipient retention amount exceed the sum of the
individual's income standard, the individual's PCS deduction and
twenty dollars ($20).
   (3) In determining the countable income under this section of an
individual residing in a licensed community care facility, the
individual shall have deducted from his or her income the amount
specified in subparagraph (B) of paragraph (2).
   (h) No later than one month after the effective date of
subdivision (g), the department shall submit to the federal medicaid
administrator a state plan amendment seeking approval of the income
deduction specified in paragraph (3) of subdivision (g), and of
federal financial participation for the costs resulting from that
income deduction.
   (i) The deduction prescribed by paragraph (3) of subdivision (g)
shall be applied no later than the first day of the fourth month
after the month in which the department receives approval for the
federal financial participation specified in subdivision (h).  Until
approval for federal financial participation is received, there shall
be no deduction under paragraph (3) of subdivision (g).
14005.41.  (a) Notwithstanding any other provision of law, the
department shall deem to have met the income documentation
requirements for participation in the Medi-Cal program, without a
share of cost, any child who is less than six years of age and who
has been determined to be eligible for free meals through a federally
funded program using the National School Lunch Program application
provided for pursuant to Chapter 13 (commencing with Section 1751) of
Title 42 of the United States Code.
   (b) Notwithstanding any other provision of law, with regard to any
child who is enrolled in and attending public school in the State of
California, the department shall accept documentation of enrollment
for free meals under the National School Lunch Program as sufficient
documentation of California residency for that child for the purposes
of the Medi-Cal program.
   (c) (1) (A) Notwithstanding any other provision of law, each
county shall participate in a statewide pilot project to determine
Medi-Cal program eligibility for any child under six years of age and
currently enrolled in school in the State of California who is
eligible for free meals under the National School Lunch Program upon
receipt of proof of participation in the National School Lunch
Program and a signed Medi-Cal application, which may be the
supplemented application, described in subdivision (i).  Counties
shall notify the parent or guardian of the results of the eligibility
determination.
   (B) Notwithstanding any other provision of law, each county shall
participate in a statewide pilot project to use the procedure
described in this subdivision to determine Medi-Cal eligibility
without a share of cost, and, if eligible, shall enroll in the
Medi-Cal program, any child six years of age or older currently
enrolled in school in the State of California who is eligible for
free meals under the National School Lunch Program, upon receipt of
proof of participation in the National School Lunch Program and a
signed Medi-Cal application, which may be the supplemented
application, described in subdivision (i).  If the county determines
from the supplemented application described in subdivision (i) that
the child meets the eligibility requirements for participation in the
Medi-Cal program, the county shall notify the parent or guardian
that the child has been found eligible for the Medi-Cal program.  If
the county is unable to determine from the information on the
application as described in subdivision (i) whether the child is
eligible, the county shall contact the family to seek any additional
information regarding income, household composition, or deductions
that the department, in consultation with the county welfare
departments, may determine to be necessary to complete the Medi-Cal
application.  If the county determines that the child does not meet
the income eligibility requirements for participation in the
full-scope no-cost Medi-Cal program, the county shall notify the
parent or guardian of the determination and shall forward the school
lunch application and any supplemental forms as described in
subdivision (i) to the Healthy Families Program.  If an applicant is
determined to be ineligible for the full-scope no-cost Medi-Cal
program and for the Healthy Families Program, the school lunch
application and any supplemental forms as described in subdivision
(i) shall be forwarded to a county- or local-sponsored health
insurance program, as applicable, if the parent or guardian has
provided consent.  For purposes of this section, a county- or
local-sponsored health insurance program includes a county agency, a
local initiative, a county-organized health system, or other local
entity that provides health care coverage to children who do not
qualify for the full-scope no-cost Medi-Cal program or for the
Healthy Families Program.
   (2) Each county shall ask the parent or guardian of each child
identified in subparagraph (A) of paragraph (1) and the parent or
guardian of each child whom the county determines to meet the income
eligibility requirements for participation in the Medi-Cal program
under subparagraph (B) of paragraph (1) to provide additional
documentation as required by current law necessary for retention of
eligibility in the Medi-Cal program.  If a parent or guardian does
not provide the documentation required for retention of full-scope
Medi-Cal program eligibility, the county shall continue the child's
enrollment in the Medi-Cal program, but only for the limited scope of
Medi-Cal program benefits as described in Section 14007.5.  If
applicable, the county shall also forward the school lunch
application and any supplemental forms as described in subdivision
(i), for applicants who are determined to be ineligible for the
full-scope no-cost Medi-Cal program and for the Healthy Families
Program, to a county- or local-sponsored health insurance program if
the parent or guardian has provided consent.
   (d) Nothing in this section shall be construed as preventing the
department from verifying eligibility through the Income Eligibility
Verification System match mandated by Section 1137 of the federal
Social Security Act (42 U.S.C. Sec. 1320b-7) or from requesting
additional information or documentation required by federal law.
   (e) Each county shall include its cost of implementing this
section in its annual Medi-Cal administrative budget requests
submitted to the department.
   (f) For purposes of this section, the Medi-Cal program application
date shall be the date on which the school lunch application
information is received by the local agency determining eligibility
under the Medi-Cal program.
   (g) (1) This section shall be implemented only if, and to the
extent that, federal financial participation is available for the
services provided and only for the period of time the free National
School Lunch Program utilizes a gross income standard at or below 133
percent of the federal poverty level.  This section shall be
implemented in a manner consistent with any federal approval.
   (2) Notwithstanding paragraph (1), if the department determines
that one or more state plan amendments are necessary to ensure full
federal financial participation in the provisions of this section,
the department shall prepare and submit requests for the state plan
amendments to the federal government, after which this section shall
not be implemented until the department receives approval of all
necessary state plan amendments.
   (h) (1) Notwithstanding subdivision (g), not later than March 1,
2003, the department, in consultation with the State Department of
Education and representatives of the school districts, county
superintendents of schools, 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 Section 49557.2 of the
Education Code and this section.
   (2) The policies and procedures required to be developed and
distributed pursuant to subdivision (a) shall include, at a minimum,
both of the following:
   (A) Processes for the school districts, county superintendents of
schools, and local agencies that administer the Medi-Cal program to
use in forwarding and processing free school lunch application
information pursuant to Section 49557.2 of the Education Code, and in
following up with the applicants to obtain any necessary
documentation required by federal law.
   (B) Instructions for implementing the eligibility provisions of
this chapter.
   (3) The policies and procedures required to be developed pursuant
to subdivision (a) shall specify all of the following:
   (A) The information on the school lunch application may be used to
initiate a Medi-Cal program application only when the applicant has
provided his or her consent pursuant to Section 49557.2 of the
Education Code.
   (B) The date of the Medi-Cal program application shall be the date
on which the school lunch application was received by the local
agency that determines eligibility under the Medi-Cal program.
   (C) The county, in determining eligibility for the Medi-Cal
program, shall request additional documentation only as required by
federal law, and shall enroll any child whose parent or guardian does
not provide the necessary documentation for full-scope benefits
under the Medi-Cal program in the Medi-Cal program with limited scope
benefits, as described in Section 14007.5.
   (i) To the extent federal financial participation is available,
and to the extent administratively feasible, the department shall
utilize the free National School Lunch Program application developed
under Section 49557.2 of the Education Code, if supplemented as
needed by simplified forms and disclosures, including Medi-Cal rights
and responsibility notices and privacy notices, as a Medi-Cal
application for children described in this section.
   (j) 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 regulatory action.
Thereafter, the department shall adopt regulations 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.
   (k) The department shall review the effectiveness of the statewide
pilot project and make recommendations regarding appropriate ways to
expand the use of the approaches contained in this section.
   (l) In order to expedite health coverage for children who have
been determined eligible for free meals under the National School
Lunch Program, the department, at its discretion, may choose to
implement this section in whole or in part by exercising the option
described in Section 1396r-1a of Title 42 of the United States Code
to allow information provided on the National School Lunch Program
application referred to, and supplemented as described, in paragraph
(1) of subdivision (a) of Section 49557.2 of the Education Code to
serve as a basis for a preliminary eligibility determination by a
qualified entity designated by the department.
   (m) County- and local-sponsored health program agencies are
authorized to use the supplemental application described in
subdivision (i) and received pursuant to subdivision (c) to make an
eligibility determination for those respective programs, and shall
request additional information only as needed to complete the
eligibility process.
   (n) A county may, at its option, and with the consent of the
parent or guardian as provided in paragraph (3) of subdivision (a) of
Section 49557.2 of the Education Code, notify the school of the
names and contact information of children who are in jeopardy of
losing accelerated Medi-Cal coverage because a child's parent or
guardian has not provided required followup information to the
county.  This notice shall be limited to the names and contact
information, and shall not specify what information is missing.  This
shall be done for the sole purpose of enabling the school, at its
option, to conduct outreach activities to encourage or assist those
parents or guardians to complete and submit the required followup
information.
14006.  (a) This section applies to medically needy persons,
medically needy family persons, and state-only Medi-Cal persons.
   (b) For the purposes of this section, the term "principal
residence" means the home, including a multiple-dwelling unit, in
which the individual resides or  formerly resided.  The home will
continue to be considered the principal residence if any of the
following is applicable:
   (1) During any absence, the individual intends to return to the
home.
   (2) The individual lives in a nursing facility or a medical
institution and intends to return home.
   (3) The individual's spouse or a dependent relative of the
individual continues to reside in the home during the individual's
absence.
   (4) The individual does not have the right, authority, power, or
legal capacity to liquidate the property, but a bona fide effort is
being made to attain the right, authority, power, or legal capacity
to liquidate the property.
   (5) The property cannot readily be converted to cash but a bona
fide effort is being made to sell the property, in which case the
state shall, subject to notice and an opportunity for a hearing, have
a lien against the property, to the extent permitted by federal law,
for the cost of medical services.
   The lien shall be recorded, and from the date of recording, shall
have the force, effect, and priority of a judgment lien.
   (6) If it is a multiple-dwelling unit, one unit of which is
occupied by the applicant or recipient, any unit not occupied by the
applicant or recipient is producing income for the individual or
family reasonably consistent with its value.
   (7) It is inhabited by any sibling or child of the recipient who
has continuously resided in the property since at least one year
prior to the date the owner entered a nursing facility, or in a
medical institution.
   For purposes of this subdivision, "bona fide effort" means that
the property shall be listed with a licensed real estate broker at
the value determined to be the fair market value by a qualified real
estate appraiser and the applicant or recipient provides evidence
that a continuous effort is being made to sell the property, offers
at fair market value are accepted, and all offers are reported.
   (c) For purposes of determining eligibility under this part,
resources shall be determined, defined, counted, and valued in
accordance with the federal law governing resources under Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.).
Resources exempt under Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.) shall not be considered in determining
eligibility.  A community spouse may retain nonexempt resources to
the maximum extent permitted under Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.).  Medically needy
individuals and families may retain nonexempt resources to the extent
permitted under Title XIX of the federal Social Security Act (42
U.S.C. Sec. 1396 et seq.).  In addition, the principal residence as
defined in subdivision (b) shall be exempt.
   (d) The director, to meet the requirements of the federal Social
Security Act and to ensure the highest percentage of federal
financial participation in the program provided by this chapter, may
decrease or increase the amounts set forth  herein.
   (e) (1) If the holdings are in the form of real property, the
value shall be the assessed value, determined under the most recent
county property tax assessment, less the unpaid amount of any
encumbrance of record.
   (2) If the real property other than the home is not producing
income reasonably consistent with its value, the applicant or
recipient shall be allowed reasonable time to begin producing such
income from the property.  If the property cannot produce reasonable
income or be sold based on the market value, the applicant or
recipient shall be allowed to submit evidence from a qualified real
estate appraiser which indicates the value for which the property can
be adequately utilized or sold.  If the applicant or recipient
provides evidence that the only method of adequately utilizing the
property is sale, and the property has not been sold at market value
during a reasonable period of time, the property shall be considered
to be adequately utilized provided it is listed with a licensed real
estate broker at the value determined to be the fair market value by
a qualified real estate appraiser and the applicant or recipient
provides evidence that a bona fide and continuous effort is being
made to sell the property.
   (3) If federal requirements permit a person to whom this
subdivision applies to own an automobile of greater value than is
permitted in determining eligibility for aid under Chapter 3
(commencing with Section 12000), the department shall adopt
regulations authorizing that higher allowance.
   (f) Any mortgage or note secured by a deed of trust shall be
deemed real property if its value does not exceed six thousand
dollars ($6,000) and it is obtained by the applicant or recipient, or
in combination with his or her spouse, through the sale of such real
property.
   (g) If the holdings consist of money on deposit, the value shall
be the actual amount thereof.  If the holdings are in any other form
of personal property or  investment, except life insurance, the value
shall be the conversion value as of the date of application or the
anniversary date of such application.  If the holdings are in the
form of life insurance, the value shall be the cash value as  of the
policy anniversary nearest the date of such application.
   (h) The value of property holdings shall be determined as of the
date of application and, if the person is found eligible, this
determination shall establish  the amount of such holdings to be
considered during the ensuing 12 months except a new determination to
govern during the succeeding 12 months shall be made on the first
anniversary date of the application or such alternate date as may be
established following the acquisition of additional holdings as
provided in the following paragraph and on each succeeding
anniversary date thereafter.
   (i) If any person shall by gift, inheritance, or other manner,
acquire additional holdings during any such interval, other than from
his or her own earnings, he or she shall immediately report such
acquisition, and the anniversary date shall become the date of such
acquisition.
   (j) If any provision of this section does not comply with federal
requirements, the provision shall become inoperative to the extent
that it is not in compliance with federal requirements pursuant to
Section 11003.
14006.1.  (a) The State Director of Health Services shall adopt
emergency regulations pursuant to Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code to implement subdivision (b) of Section 14006.  The adoption of
the regulations shall be deemed to be an emergency and necessary for
the immediate preservation of the public peace, health or safety.
Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code, emergency
regulations adopted by the Department of Health Services in order to
implement subdivision (b) of Section 14006 shall not be subject to
the review and approval of the Office of Administrative Law.  These
regulations shall become effective immediately upon filing with the
Secretary of State.
   (b) Any provision of Section 14006 that is in conflict with any
federal statute or regulation shall be inapplicable to the extent of
this conflict, but the provision and the remainder of the provisions
shall be unaffected to the extent that no conflict exists.
14006.2.  (a) In determining the eligibility of a married
individual, pursuant to Section 14005.4 or 14005.7, who, in
accordance with Title XIX of the federal Social Security Act (42
U.S.C. Sec. 1396 et seq.) and regulations adopted pursuant thereto,
is considered to be living separately from his or her spouse, the
individual shall be considered to have made a transfer of resources
for full and adequate consideration under Section 14006 or 14015 by
reason of either of the following:
   (1) Having entered into a written agreement with his or her spouse
dividing their nonexempt community property into equal shares of
separate property.  Property so agreed to be separate property shall
be considered by the department to be the separate property of the
spouse who, pursuant to the agreement, is the owner of the property.
Only in cases in which separate property owned by one spouse is
actually made available to the other spouse, may the department count
the separate property in the eligibility determination of the
nonowner spouse.
   (2) Having transferred to his or her spouse all of his or her
interest in a home, whether the transfer was made before or after the
individual became a resident in a nursing facility in accordance
with and to the extent permitted by Title XIX of the federal Social
Security Act and regulations promulgated pursuant thereto.
   (b) The department shall furnish to all Medi-Cal applicants a
clear and simple statement in writing advising them that (1) in the
case of an individual who is an inpatient in a nursing facility, if
the individual or the individual's conservator transferred to the
individual's spouse all of the interest in a home, the individual
shall not be considered ineligible for Medi-Cal by reason of the
transfer; and that (2) if the individual and the individual's spouse
execute a written interspousal agreement which divides and transmutes
nonexempt community property into equal shares of separate property,
the separate property of the individual's spouse shall not be
considered available to the individual and need not be spent by the
spouse for the individual's care in a nursing facility or other
medical institution.  The statement provided for in this subdivision
shall also be furnished to each individual admitted to a nursing
facility, along with, but separately from, the statement required
under Section 72527 of Title 22 of the California Code of
Regulations.
   (c) In order to qualify for Medi-Cal benefits pursuant to Section
14005.4 or 14005.7, a married individual who resides in a nursing
facility, and who is in a Medi-Cal budget unit separate from that of
his or her spouse, shall be required to expend his or her other
resources for his or her own benefit, so that the amount which
remains does not exceed the limit established pursuant to subdivision
  (c) of Section 14006.  In the event that the married individual
expends his or her resources for expenses associated with or for
improvements to property, those expenditures shall be considered to
be for his or her own benefit only to the extent that the
expenditures are proportionate to the ownership interest the
individual has in the property.  For purposes of this section, the
term "his or her other resources" shall be limited to the following:
   (1) All of his or her separate property that would not have been
exempt under applicable Medi-Cal laws and regulations at the time
when he or she entered a nursing facility, or at the date of
execution of the agreement referred to in this section, whichever is
earlier.  For purposes of this paragraph, the mere change of
residence from one facility to another shall not be deemed to be a
new entry.
   (2) One-half of all the community property, or the proceeds from
the sale or exchange of that property, that would not have been
exempt at the time described in paragraph (1).
   (d) For purposes of subdivision (c), in the absence of an
agreement such as that referred to in subdivision (a), there shall be
a presumption, rebuttable by either spouse, that all property owned
by either spouse was community property.
   (e) The statement furnished pursuant to subdivision (b) shall
advise all persons entering a long-term care facility, and all
Medi-Cal applicants that only their half of the community property
shall be taken into account in determining their eligibility for
Medi-Cal, whether or not they execute the written interspousal
agreement referred to in the statement.
   (f) This section shall not apply to an institutionalized spouse.
   (g) This section shall apply to the full extent to an
institutionalized spouse if Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.) is amended to authorize the
consideration of state community property law in determining
eligibility under this chapter, or the federal government authorizes
the state to apply community property laws in making that
determination.
   (h) (1) Subdivision (f) shall become inoperative if the federal
government amends Title XIX of the federal Social Security Act (42
U.S.C. Sec.  1396 et seq.) to allow state community property laws to
be considered for Medi-Cal eligibility purposes, or the federal
government authorizes the state to apply community property laws in
making that determination.
   (2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or receipt of federal authorization as specified in paragraph (1).
14006.3.  The department, at the time of application or the
assessment pursuant to Section 14006.6, and any nursing facility
enrolled as a provider in the Medi-Cal program, prior to admitting
any person, shall provide a clear and simple statement, in writing,
in a form and language specified by the department, to that person,
and that person's spouse, legal representative, or agent, if any,
that explains the resource and income requirements of the Medi-Cal
program including, but not limited to, certain exempt resources,
certain protections against spousal impoverishment, and certain
circumstances under which an interest in a home may be transferred
without affecting Medi-Cal eligibility.
14006.4.  (a) The statement required by Sections 14006.2 and 14006.3
shall be in the following form:
      "NOTICE REGARDING STANDARDS FOR MEDI-CAL ELIGIBILITY
   If you or your spouse is in or is entering  a nursing facility,
read this important message!
   You or your spouse do not have to use all your resources, such as
savings, before Medi-Cal might help pay for all or some of the costs
of a nursing facility.
   You should be aware of the following to take advantage of these
provisions of the law:
      UNMARRIED RESIDENT
   An unmarried resident is financially eligible for Medi-Cal
benefits if he or she has less than (insert amount of individual's
resource allowance) in available resources.  A home is an exempt
resource and is not considered against the resource limit, as long as
the resident states on the Medi-Cal application that he or she
intends to return home.  Clothes, household furnishings, irrevocable
burial plans, burial plots, and an automobile are examples of other
exempt resources.
   If an unmarried resident is financially eligible for Medi-Cal
reimbursement, he or she is allowed to keep from his or her monthly
income a personal allowance of (insert amount of personal needs
allowance) plus the amount of health insurance premiums paid monthly.
  The remainder of the monthly income is paid to the nursing facility
as a monthly deductible called the "Medi-Cal share of cost."
      MARRIED RESIDENT
   If one spouse lives in a nursing facility, and the other spouse
does not live in a nursing facility, the Medi-Cal program will pay
some or all of the nursing facility costs as long as the couple
together does not have more than (insert amount of Community Spouse
Resource Allowance plus individual's resource allowance) in available
assets.  The couple's home will not be counted against this (insert
amount of Community Spouse Resource Allowance plus individual's
resource allowance), as long as one spouse or a dependent relative,
or both, lives in the home, or the spouse in the nursing facility
states on the Medi-Cal application that he or she intends to return
to the couple's home to live.
   If a spouse is eligible for Medi-Cal payment of nursing facility
costs, the spouse living at home is allowed to keep a monthly income
of at least his or her individual monthly income or (insert amount of
Minimum Monthly Maintenance Needs Allowance), whichever is greater.
Of the couple's remaining monthly income, the spouse in the nursing
facility is allowed to keep a personal allowance of (insert amount of
personal needs allowance) plus the amount of health insurance
premiums paid monthly.  The remaining money, if any, generally must
be paid to the nursing facility as the Medi-Cal share of cost.  The
Medi-Cal program will pay remaining nursing facility costs.
   Under certain circumstances, an at-home spouse can obtain an order
from an administrative law judge that will allow the at-home spouse
to retain additional resources or income.  Such an order can allow
the couple to retain more than (insert amount of Community Spouse
Resource Allowance plus individual's resource allowance) in available
resources, if the income that could be generated by the retained
resources would not cause the total monthly income available to the
at-home spouse to exceed (insert amount of Monthly Maintenance Needs
Allowance).  Such an order also can allow the at-home spouse to
retain more than (insert amount of Monthly Maintenance Needs
Allowance) in monthly income, if the extra income is necessary "due
to exceptional circumstances resulting in significant financial
duress."
   An at-home spouse also may obtain a court order to increase the
amount of income and resources that he or she is allowed to retain,
or to transfer property from the spouse in the nursing facility to
the at-home spouse.  You should contact a knowledgeable attorney for
further information regarding court orders.
   The paragraphs above do not apply if both spouses live in a
nursing facility and neither previously has been granted Medi-Cal
eligibility.  In this situation, the spouses may be able to hasten
Medi-Cal eligibility by entering into an agreement that divides their
community property.  The advice of a knowledgeable attorney should
be obtained prior to the signing of this type of agreement.
   Note:  For married couples, the resource limit ((insert amount of
Community Spouse Resource Allowance plus individual's resource
allowance) in (insert current year)) and income limit ((insert amount
of Minimum Monthly Maintenance Needs Allowance) in (insert current
year)) generally increase a slight amount on January 1 of every year.
      TRANSFER OF HOME FOR BOTH A MARRIED AND AN UNMARRIED RESIDENT
   A transfer of a property interest in a resident's home will not
cause ineligibility for Medi-Cal reimbursement if either of the
following conditions is met:
   (a) At the time of transfer, the recipient of the property
interest states in writing that the resident would have been allowed
to return to the home at the time of the transfer, if the resident's
medical condition allowed him or her to leave the nursing facility.
This provision shall only apply if the home has been considered an
exempt resource because of the resident's intent to return home.
   (b) The home is transferred to one of the following individuals:
   (1) The resident's spouse.
   (2) The resident's minor or disabled child.
   (3) A sibling of the resident who has an equity interest in the
home, and who resided in the resident's home for at least one year
immediately before the resident began living in institutions.
   (4) A son or daughter of the resident who resided in the resident'
s home at least two years before the resident began living in
institutions, and who provided care to the resident that permitted
the resident to remain at home longer.
   This is only a brief description of the Medi-Cal eligibility
rules, for more detailed information, you should call your county
welfare department.  You will probably want to consult with the local
branch of the state long-term care ombudsman, an attorney, or a
legal services program for seniors in your area.
   I have read the above notice and have received a copy.  Dated:
______                               Signature: _________"
   (b) The statement required by subdivision (a) shall be printed in
at least 10-point type, shall be clearly separate from any other
document or writing, and shall be signed by the person to be admitted
and that person's spouse, and legal representative, if any.
   (c) Any nursing facility that willfully fails to comply with this
section shall be subject to a class "B" citation, as defined by
Section 1424 of the Health and Safety Code.
   (d) The department may revise this statement as necessary to
maintain its consistency with state and federal law.
14006.5.  The department shall include training regarding the
treatment of separate and community income and resources in
determining eligibility for Medi-Cal benefits, as part of the ongoing
training offered to county welfare departments.
14006.6.  (a) To the extent required by Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et seq.) and regulations
adopted pursuant thereto, upon the request of either an
institutionalized spouse or a community spouse, and upon receipt of
relevant documentation of resources, the department shall promptly
assess and document the total value of the couple's resources to the
extent either the institutionalized spouse or the community spouse
has an ownership interest.  Upon completion of the assessment and
documentation, the department shall provide a copy of such assessment
and documentation to each spouse and shall retain a copy of the
assessment.
   (b) If the assessment is not part of an application for Medi-Cal,
the department may, as a condition of providing the assessment,
require payment of a fee not to exceed the reasonable expenses of
providing and documenting the assessment.
   (c) For purposes of completing the assessment, resources shall be
determined, defined, counted, and valued in accordance with
subdivision (c) of Section 14006.
   (d) At the time of providing the copy of the assessment to the
couple, the department shall include a notice indicating that either
spouse will have a right to a fair hearing to the extent required by
federal law.
   (e) (1) This section shall remain operative only until Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
law in determining eligibility under this chapter, or the federal
government authorizes the state to apply community property laws in
making that determination.
   (2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or the receipt of federal authorization to apply community property
law, as specified in paragraph (1).
14006.7.  (a) At the time of application for Medi-Cal benefits, the
department shall provide to any applicant who is aged, blind, or
disabled, other than an individual applying for, or receiving, aid
under Chapter 2 (commencing with Section 11200), Article 5
(commencing with Section 12200) of Chapter 3, or Article 7
(commencing with Section 12300) of Chapter 3, and to the applicant's
spouse, legal representative, or agent, if any, a clear and simple
statement, in writing, in a form and language specified by the
department, that explains the circumstances under which an interest
in a home may be transferred for less than fair market value without
affecting Medi-Cal eligibility.
   (b) The statement required by subdivision (a) shall be in the
following form:
      "NOTICE REGARDING TRANSFER OF A HOME FOR BOTH A MARRIED AND AN
UNMARRIED APPLICANT/BENEFICIARY
   A transfer of property interest for less than fair market value in
a Medi-Cal beneficiary's home will not cause ineligibility for
Medi-Cal benefits if at the time of the transfer, the home would have
been considered an exempt resource.
   This is only a brief description of the Medi-Cal eligibility
rules.  For more detailed information, you should call your county
welfare department.  You will probably want to consult with an
attorney, your local legal services program for seniors, or the local
branch of the long-term care ombudsman program.
   I have read the above notice and have received a copy.  Dated:
______     Signature: _________"
   (c) The statement required by subdivision (a) shall be printed in
at least 12-point type, shall be clearly separate from any other
document or writing, and may be signed by the applicant, the
applicant's spouse, legal representative, or agent, if any.  Failure
to sign this form shall not result in ineligibility for medical
assistance.
   (d) The department may revise this statement as necessary to
maintain its consistency with state and federal law.
   (e) In the case of an applicant applying for Medi-Cal
reimbursement for nursing facility care, the statements required
under Sections 14006.2 and 14006.3 shall apply, and the statement
required by subdivision (a) shall not be provided.
14007.  No period of residence in this state shall be required as a
condition of eligibility under this chapter, but an individual who
does not reside in this state shall not be eligible.
14007.1.  (a) The department shall adopt regulations for use by the
county welfare department in determining whether an applicant is a
resident of this state and of the county subject to the requirements
of federal law.  The regulations shall require that state residency
is not established unless the applicant does both of the following.
   (1) The applicant produces one of the following:
   (A) A recent California rent or mortgage receipt or utility bill
in the applicant's name.
   (B) A current California motor vehicle driver's license or
California Identification Card issued by the California Department of
Motor Vehicles in the applicant's name.
   (C) A current California motor vehicle registration in the
applicant's name.
   (D) A document showing that the applicant is employed in this
state.
   (E) A document showing that the applicant has registered with a
public or private employment service in this state.
   (F) Evidence that the applicant has enrolled his or her children
in a school in this state.
   (G) Evidence that the applicant is receiving public assistance in
this state.
   (H) Evidence of registration to vote in this state.
   (2) The applicant declares, under penalty of perjury, that all of
the following apply:
   (A) The applicant does not own or lease a principal residence
outside this state.
   (B) The applicant is not receiving public assistance outside this
state.  As used in this subdivision, "public assistance" does not
include unemployment insurance benefits.
   (b) A denial of a determination of residency may be appealed in
the same manner as any other denial of eligibility.  The
Administrative Law Judge shall receive any proof of residency offered
by the applicant and may inquire into any facts relevant to the
question of residency.  A determination of residency shall not be
granted unless a preponderance of the credible evidence supports the
applicant's intent to remain indefinitely in this state.
14007.4.  Any children under the jurisdiction of the county welfare
department, who are dependent children in relative placement, foster
home placement, or group home placement, and any child in custody
pending the filing of a petition for placement, who are receiving or
are eligible to receive services from the county welfare department,
shall be deemed to have met the residence requirements for services
under this chapter, and no further verification of residence shall be
required.
   This section shall be implemented only to the extent that full
federal financial participation is made available.
14007.45.  (a) To the extent federal financial participation is
available, the department shall exercise the option provided in
Section 1920A of the federal Social Security Act (42 U.S.C. Sec.
1396r-1a) to the extent necessary to implement a program for
accelerated eligibility for children who are in the process of
entering the foster care system.
   (b) The department shall designate county foster care workers,
public health nurses, or other staff who are involved in the children'
s removal from the home as a qualified entity capable of making an
eligibility determination under Section 1920A of the federal Social
Security Act (42 U.S.C. Sec.  1396r-1a).
   (c) The qualified entity shall have access to the Medi-Cal
Eligibility Data System to determine whether the child for whom the
petition of dependency was filed is eligible for Medi-Cal.  If the
child is not currently eligible for Medi-Cal, the qualified entity
shall have the authority to enter the child's information into the
Medi-Cal Eligibility Data System to ensure timely issuance of either
a Medi-Cal card or Medi-Cal Benefits Identification Card thereby
ensuring immediate proof of or access to proof of Medi-Cal
eligibility.
   (d) The department shall seek any state plan amendments necessary
to implement this section.  Once federal approval of all necessary
state plan amendments is received, implementation shall begin on the
first day of the month that follows the full calendar month after the
month federal approval is received.
   (e) In the event that the state plan amendment necessary to
implement this section is disapproved by the federal government, the
department shall instruct counties on all available procedures for
expediting eligibility applications for children described in
subdivision (a) and for immediately issuing sufficient proof of
eligibility to ensure that eligibility of children entering the
foster care system can be immediately confirmed by providers.
   (f) If the federal waiver described in Section 12693.755 of the
Insurance Code for covering parents under the State Children's Health
Insurance Program is approved, and if the option under Section 1920A
of the federal Social Security Act (42 U.S.C. Sec. 1396r-1a) is
exercised to extend accelerated eligibility to all children as part
of implementation of that waiver, and if the state plan amendment for
implementation of this section is disapproved, then the department
shall have discretion to determine whether and under what
circumstances foster care workers who complete the application form
described in subdivision (e) shall submit that form to the qualified
entity for accelerated eligibility rather than to the county Medi-Cal
eligibility worker.
   (g) This section shall be implemented only if and to the extent
that federal financial participation is available.
   (h) 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, without taking any regulatory action,
this section by means of all-county letters or similar instructions.
Thereafter, the department shall adopt regulations 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.
14007.5.  (a) Aliens shall be eligible for Medi-Cal, whether
federally funded or state-funded, only to the same extent as
permitted under federal law and regulations for receipt of federal
financial participation under Title XIX of the federal Social
Security Act, except as otherwise provided in this section and
Section 14007.7.
   (b) In accordance with Section 1903(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396b(v)(1)), an alien shall only be
eligible for the full scope of Medi-Cal benefits, if the alien has
been lawfully admitted for permanent residence, or is otherwise
permanently residing in the United States under color of law.
   For purposes of this section, aliens "permanently residing in the
United States under color of law" shall be interpreted to include all
aliens residing in the United States with the knowledge and
permission of the United States Immigration and Naturalization
Service and whose departure the United States Immigration and
Naturalization Service does not contemplate enforcing and with
respect to whom federal financial participation is available under
Title XIX of the federal Social Security Act.
   (c) Any alien whose immigration status has been adjusted either to
lawful temporary resident or lawful permanent resident in accordance
with the provisions of Section 210, 210A, or 245A of the federal
Immigration and Nationality Act, and who meets all other eligibility
requirements, shall be eligible only for care and services under
Medi-Cal for which the alien is not disqualified pursuant to those
sections of the federal act.
   (d) Any alien who is otherwise eligible for Medi-Cal services, but
who does not meet the requirements under subdivision (b) or (c),
shall only be eligible for care and services that are necessary for
the treatment of an emergency medical condition and medical care
directly related to the emergency, as defined in federal law.  For
purposes of this section, the term "emergency medical condition"
means a medical condition manifesting itself by acute symptoms of
sufficient severity, including severe pain, such that the absence of
immediate medical attention could reasonably be expected to result in
any of the following:
   (1) Placing the patient's health in serious jeopardy.
   (2) Serious impairment to bodily functions.
   (3) Serious dysfunction to any bodily organ or part.  It is the
intent of this section to entitle eligible individuals to inpatient
and outpatient services that are necessary for the treatment of  the
emergency medical condition in the same manner as administered  by
the department through regulations and provisions of federal law.
   (e) Pursuant to Section 14001.2, each county department shall
require that each applicant for, or beneficiary of, Medi-Cal,
including a child, shall provide his or her social security number
account number, or numbers, if he or she has more than one social
security number.
   (f) (1) In order to be eligible for benefits under subdivision (b)
or (c), an alien applicant or beneficiary shall present alien
registration documentation or other proof of satisfactory immigration
status from the United States Immigration and Naturalization
Service.
   (2) Any alien who meets all other program requirements but who
lacks documentation of alien registration or other proof of
satisfactory immigration status shall be provided a reasonable
opportunity to submit the evidence.  For purposes of this paragraph,
"reasonable opportunity" means 30 days or the time it actually takes
the county to process the Medi-Cal application, whichever is longer.
   (3) During the reasonable opportunity period under paragraph (2),
the county department shall process the applicant's application for
medical assistance in a manner that conforms to its normal processing
procedures and timeframes.
   (g) (1) The county department shall grant only the Medi-Cal
benefits set forth in subdivision (d) of this section or in Section
14007.7 to any individual who, after 30 calendar days or the time it
actually takes the county to process the Medi-Cal application,
whichever is longer, has failed to submit documents constituting
reasonable evidence indicating a satisfactory immigration status for
Medi-Cal purposes, or who is reported by the United States
Immigration and Naturalization Service to lack a satisfactory
immigration status for Medi-Cal purposes.
   (2) If an alien has been receiving Medi-Cal benefits based on
eligibility established prior to the effective date of this section
and that individual, upon redetermination of eligibility for
benefits, fails to submit documents constituting reasonable evidence
indicating  a satisfactory immigration status for Medi-Cal purposes,
the county department shall discontinue the Medi-Cal benefits, except
for the care and services set forth in subdivision (d) of this
section or in Section 14007.7.  The county department shall provide
adequate notice to the individual of any adverse action and shall
accord the individual an opportunity for a fair hearing if he or she
requests one.
   (h) To the extent permitted by federal law and regulations, an
alien applying for services under subdivisions (b) and (c) shall be
granted eligibility for the scope of services to which he or she
would otherwise be entitled if, at the time the county department
makes the determination about his or her eligibility, the alien meets
either of the following requirements:
   (1) He or she has  not had a reasonable opportunity to submit
documents constituting reasonable evidence indicating satisfactory
immigration status.
   (2) He or she has provided documents constituting reasonable
evidence indicating a satisfactory immigration status, but the county
department has not received timely verification of the alien's
immigration status from the United States Immigration and
Naturalization Service.
   (3) The verification process shall protect the privacy of all
participants.  An alien's immigration status shall be subject to
verification by the United States Immigration and Naturalization
Service, to the extent required for receipt of federal financial
participation in the Medi-Cal program.
   (i) If an alien  does not declare status as a lawful permanent
resident or alien permanently residing under color of law, or as an
alien legalized under Section 210, 210A, or 245A of the federal
Immigration and Nationality Act (P.L. 82-414), Medi-Cal coverage
under subdivision (d) of this section or in Section 14007.7 shall be
provided to the individual if he or she is otherwise eligible.
   (j) If an alien subject to this section is not fluent in English,
the county department shall provide an understandable explanation of
the requirements of this section in a language in which the alien is
fluent.
   (k) Aliens who were receiving long-term care or renal dialysis
services (1) on the day prior to the effective date of the amendment
to paragraph (1) of subdivision (f) of Section 1 of Chapter 1441 of
the Statutes of 1988 at the 1991-92 Regular Session of the
Legislature and (2) under the authority of paragraph (1) of
subdivision (f) of Section 1 of Chapter 1441 of the Statutes of 1988
as it read on June 30, 1992, shall continue to receive these
services.  The authority for continuation of long-term care or renal
dialysis services in this subdivision shall not apply to any person
whose long-term care or renal dialysis services end for any reason
after the effective date of the amendment described in this
subdivision.
14007.6.  (a) A recipient who maintains a residence outside of this
state for a period of at least two months shall not be eligible for
services under this chapter where the county has made inquiry of the
recipient pursuant to Section 11100, and where the recipient has not
responded to this inquiry by clearly showing that he or she has (1)
not established residence elsewhere; and (2) been prevented by
illness or other good cause from returning to this state.
   (b) If a recipient whose services are terminated pursuant to
subdivision (a) reapplies for services, services shall be restored
provided all other eligibility criteria are met if this individual
can prove both of the following:
   (1) His or her permanent residence is in this state.
   (2) That residence has not been established in any other state
which can be considered to be of a permanent nature.
14007.65.  (a) Aliens who were receiving long-term care services
under the authority of subdivision (f) of Section 1 of Chapter 1441
of the Statutes of 1988 on the day prior to the effective date of
this section shall continue to receive those long-term care services.
   (b) On or after the effective date of this section, any alien
applicant who is not lawfully present in the United States, who is
otherwise eligible for Medi-Cal services, but who does not meet the
requirements under subdivision (b) or (c) of Section 14007.5, would
be eligible to receive federally reimbursable long-term care services
pursuant to the medicaid program provided for pursuant to Title 19
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.),
shall be eligible to receive long-term care services to the extent
that funding is made available for this purpose in the annual Budget
Act.  In no event shall expenditures for this program exceed the
amount necessary to serve 110 percent of the 1999-2000 estimated
eligible population without further authorization by the Legislature.
14007.7.  Any alien who is otherwise eligible for Medi-Cal services,
but who does not meet the requirements under subdivision (b) or (c)
of Section 14007.5, shall be eligible for medically necessary
pregnancy-related services.
14007.705.  (a) Through its courts and statutes, and under its
Constitution, California protects a woman's right to reproductive
privacy. California reaffirms these protections and specifically its
Supreme Court decision in People v. Belous (1969) 71 Cal.2d 954,
966-68.
   (b) The State Department of Health Services and the Managed Risk
Medical Insurance Board may accept or use moneys under Title XXI of
the federal Social Security Act (known as the State Children's Health
Insurance Program or S-CHIP), as interpreted in Section 457.10 of
Title 42 of the Code of Federal Regulations, to fund services for
women pursuant to Section 14007.7 (Medi-Cal) and Part 6.3 (commencing
with Section 12695) (Access for Infants and Mothers (AIM)) of
Division 2 of the Insurance Code only when, during the period of
coverage, the woman is the beneficiary. The scope of services covered
under Medi-Cal and AIM, as defined in statutes, regulations, and
state plans, is not altered by this section or the state plan
amendment submitted pursuant to this section.
   (c) California's S-CHIP plan and any amendments submitted and
implemented pursuant to this section shall be consistent with
subdivisions (a) and (b).
   (d) This section is a declaration of existing law.
14007.71.  (a) The department shall adopt the option made available
under Section 1396a(a)(10)(A)(ii)(XVIII) of Title 42 of the United
States Code, to provide medical assistance during the period in which
an individual described in subdivision (c) of Section 104162 of the
Health and Safety Code requires treatment for breast or cervical
cancer.  In addition, to assist in the delivery of timely and
continuing breast cancer and cervical cancer treatment, a state
benefits identification card shall be issued by the department within
four working days of the date in which the individual submits
application information that demonstrates to the provider, as
described in subdivision (c) of Section 104162 of the Health and
Safety Code, that the individual meets the federal criteria described
in Section 1902a(aa) of the federal Social Security Act (Section
1396a(aa) of Title 42 of the United States Code).
   (b) Notwithstanding any other provision of law, an individual who
is a qualified alien as defined in Section 1641 of Title 8 of the
United States Code shall not be determined ineligible for services
under this section solely on the basis of the individual's date of
entry into the United States.
   (c) The department shall file all necessary state plan amendments
to implement the requirements of this section.
   (d) 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, and Article 1.3 (commencing
with Section 104150) and Article 1.5 (commencing with Section 104160)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety
Code, by means of an all-county letter or similar instruction,
without taking any further regulatory action.  Thereafter, the
department shall adopt regulations 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.
   (e) Notwithstanding any other provision of law, the department
shall make eligibility determinations and redeterminations necessary
for applicants and beneficiaries to obtain services pursuant to this
section as provided under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.).
   (f) Except for those individuals described in subdivision (b) and
notwithstanding any other provision of law, this section shall be
implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Section
1396a, et seq.), is available.
   (g) The department shall implement this section on January 1,
2002, if a state plan amendment adopting the option described in
subdivision (a), has been approved by the federal Centers for
Medicare and Medicaid Services, or at the time state plan amendment
is approved, if a later date.
14007.9.  (a) The department shall adopt the option made available
under Section 1902(a)(10)(A)(ii)(XIII) of the federal Social Security
Act (42 U.S.C. Sec. 1396a(a)(10)(A)(ii)(XIII).  In order to be
eligible for benefits under this section, an individual shall be
required to meet all of the following requirements:
   (1) His or her net countable income is less than 250 percent of
the federal poverty level for one person or, if the deeming of
spousal income applies to the individual, his or her net countable
income is less than 250 percent of the federal poverty level for two
persons.
   (2) He or she is disabled under Title II of the Social Security
Act (Subch. 2 (commencing with Sec. 401), Ch. 7, Title 42 U.S.C.),
Title XVI of the Social Security Act (Subch. 16 (commencing with Sec.
1381), Ch. 7, Title 42, U.S.C.), or Section 1902(v) of the Social
Security Act (42 U.S.C. Sec.  1396a(v)).  An individual shall be
determined to be eligible under this section without regard to his or
her ability to engage in, or actual engagement in, substantial
gainful activity, as defined in Section 223(d)(4) of the Social
Security Act (42 U.S.C. Sec. 423(d)(4)).
   (3) Except as otherwise provided in this section, his or her net
nonexempt resources, which shall be determined in accordance with the
methodology used under Title XVI of the federal Social Security Act
(42 U.S.C.  Sec. 1381 et seq.), are not in excess of the limits
provided for under those provisions.
   (b) (1) Countable income shall be determined under Section 1612 of
the Social Security Act (42 U.S.C. Sec. 1382a), except that the
individual's disability income, including all federal and state
disability benefits and private disability insurance, shall be
exempted.  Resources excluded under Section 1613 of the Social
Security Act (42 U.S.C. Sec. 1382b) shall be disregarded.
   (2) Resources in the form of employer or individual retirement
arrangements authorized under the Internal Revenue Code shall be
exempted as authorized by Section 1902(r) of the Social Security Act
(42 U.S.C. Sec.  1396a(r)).
   (c) Medi-Cal benefits provided under this chapter pursuant to this
section shall be available in the same amount, duration, and scope
as those benefits are available for persons who are eligible for
Medi-Cal benefits as categorically needy persons and as specified in
Section 14007.5.
   (d) Individuals eligible for Medi-Cal benefits under this section
shall be subject to the payment of premiums determined under this
subdivision.  The department shall establish sliding-scale premiums
that are based on countable income, with a minimum premium of twenty
dollars ($20) per month and a maximum premium of two hundred fifty
dollars ($250) per month, and shall, by regulations, annually adjust
the premiums.  Prior to adjustment of any premiums pursuant to this
subdivision, the department shall submit a report of proposed premium
adjustments to the appropriate committees of the Legislature as part
of the annual budget act process.
   (e) The department shall adopt regulations specifying the process
for discontinuance of eligibility under this section for nonpayment
of premiums for more than two months by a beneficiary.
   (f) In order to implement the collection of premiums under this
section, the department may develop and execute a contract with a
public or private entity to collect premiums, or may amend any
existing or future premium-collection contract that it has executed.
Notwithstanding any other provision of law, any contract developed
and executed or amended pursuant to this subdivision is exempt from
the approval of the Director of General Services and from the Public
Contract Code.
   (g) Notwithstanding the rulemaking provisions of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the department shall implement, without taking
any regulatory action, this section by means of an all-county letter
or similar instruction.  Thereafter, the department shall adopt
regulations 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.
   (h) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation is available pursuant
to Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.).
   (i) Subject to subdivision (h), this section shall be implemented
commencing April 1, 2000.
   (j) This section shall become inoperative on September 1, 2008,
and as of January 1, 2009, is repealed, unless a later enacted
statute that is enacted on or before January 1, 2009, extends or
deletes the dates on which it becomes inoperative and is repealed.
14007.95.  The department shall report to the Governor and the
Legislature any information the department gathers from the
California Health Improvement Project, or from any other public or
private sources, that may explain the low participation rates in the
optional program provided pursuant to Section 14007.9 and any
recommendations from the department on actions the state may take to
increase participation by eligible persons in a manner that is cost
effective for the state and beneficial for the participants.
14008.  (a) No relative, other than the spouse, shall be held to be
financially responsible for the cost of health care received by an
adult eligible under this chapter, except as provided in subdivisions
(b) and (c).
   (b)  Except as provided in Section 14010, no relative, other than
the parent or parents of a child under the age of 18 years, or a
child over the age of 18 years if a parent claims the child as a
dependent in order to receive a tax credit or deduction for purposes
of state or federal income taxation, shall be held to be financially
responsible for the cost of health care or related services received
by such child, otherwise eligible under this chapter.
   (c) To the extent permitted by federal law, the parent or parents
shall have such financial responsibility for any child 18 years of
age or older but under the age of 21 years who is living in the home
of the parent or parents.
14008.6.  (a) As a condition of eligibility for medical services
provided under this chapter or Chapter 8 (commencing with Section
14200), each applicant or beneficiary shall do all of the following:
   (1) Assign to the state any rights to medical support and to
payments for medical care from a third party that an individual may
have on his or her own behalf or on behalf of any other family member
for whom that individual has the legal authority to assign those
rights, and is applying for or receiving medical services.  Receipt
of medical services under this chapter or Chapter 8 (commencing with
Section 14200) shall operate as an assignment by operation of law.
If those rights are assigned pursuant to this subdivision, the
assignee may become an assignee of record by the local child support
agency or other public official filing with the court clerk an
affidavit showing that an assignment has been made or that there has
been an assignment by operation of law.  This procedure does not
limit any other means by which the assignee may become an assignee of
record.
   (2) Cooperate, as defined by subdivision (b) of Section 11477,
with the local child support agency in establishing the paternity of
a child born out of wedlock with respect to whom medical services are
requested or claimed, and for whom that individual can legally
assign the rights described in paragraph (1), and in obtaining any
medical support, as provided in Section 17400 of the Family Code, and
payments, as described in paragraph (1), due any person for whom
medical services are requested or obtained.
   (3) Cooperate with the state in identifying and providing
information to assist the state in pursuing any third party who may
be liable to pay for care and services available under the Medi-Cal
program.
   (b) The local child support agency shall verify that the applicant
or recipient refused to offer reasonable cooperation prior to
determining that the applicant or recipient is ineligible.  The
granting of medical services shall not be delayed or denied if the
applicant is otherwise eligible, if the applicant completes the
necessary forms and agrees to cooperate with the district attorney in
securing medical support and determining paternity, where
applicable.
   (c) An applicant or beneficiary shall be considered to be
cooperating with the local child support agency and shall be eligible
for medical services, if otherwise eligible, if the applicant or
beneficiary cooperates to the best of his or her ability or has good
cause for refusal to cooperate with the requirements in paragraphs
(2) and (3) of subdivision (a), as defined by Section 11477.04.  The
county welfare department shall make the determination of whether
good cause for refusal to cooperate exists.
   (d) The county welfare department and the local child support
agency shall ensure that all applicants for or beneficiaries of
medical services under this chapter or Chapter 8 (commencing with
Section 14200) are properly notified of the conditions imposed by
this section.
14008.7.  If the applicant or beneficiary does not cooperate in the
manner described in subdivisions (b) and (c) of Section 14008.6 to
establish paternity and medical support orders against the
noncustodial parents of each of the children for whom Medi-Cal
services are requested or received, without good cause, as described
in Section 11477.04, the applicant or beneficiary shall be ineligible
for aid under this chapter or Chapter 8 (commencing with Section
14200).  An applicant's or beneficiary's refusal to cooperate shall
not effect the eligibility of the child or children.  If otherwise
eligible, the child or children may be granted Medi-Cal or continue
to receive Medi-Cal.
14008.85.  (a) To the extent federal financial participation is
available, a parent who is the principal wage earner shall be
considered an unemployed parent for purposes of establishing
eligibility based upon deprivation of a child where any of the
following applies:
   (1) The parent works less than 100 hours per month as determined
pursuant to the rules of the Aid to Families with Dependent Children
program as it existed on July 16, 1996, including the rule allowing a
temporary excess of hours due to intermittent work.
   (2) The total net nonexempt earned income for the family is not
more than 100 percent of the federal poverty level as most recently
calculated by the federal government.  The department may adopt
additional deductions to be taken from a family's income.
   (3) The parent is considered unemployed under the terms of an
existing federal waiver of the 100-hour rule for recipients under the
program established by Section 1931(b) of the federal Social
Security Act (42 U.S.C.  Sec. 1396u-1).
   (b) 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 an all county
letter or similar instruction without taking regulatory action.
Thereafter, the department shall adopt regulations 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.
   (c) This section shall become operative March 1, 2000.
14009.  (a) Any applicant for, or beneficiary of Medi-Cal, or person
acting on behalf of an applicant or beneficiary shall be informed as
to the provisions of eligibility and, in writing, of his or her
responsibility for reporting facts material to a correct
determination of eligibility and share of cost.
   (b) Any applicant for, or beneficiary of Medi-Cal, or person
acting on behalf of an applicant or beneficiary shall be responsible
for reporting accurately and completely within his or her competence
those facts required of him or her pursuant to subdivision (a) and to
report promptly any changes in those facts.
   (c) If, because of a failure to report facts in accordance with
subdivision (b), the beneficiary received health care to which he or
she was not entitled, he or she shall be liable to repay any
overpayment.  The amount of overpayment shall be based on the amount
of excess income or resources and computed in accordance with
overpayment regulations promulgated by the director.
   (d) No liability for overpayment shall result from circumstances
where there is a failure on the part of an applicant or beneficiary
to perform an act constituting a condition of eligibility, if the
failure is caused by an error made by the department or a county
welfare department, or where the beneficiary reported facts in
accordance with subdivision (b) but a county welfare department
failed to act on those facts.
   (e) When the department determines that an overpayment has
occurred, the department shall seek to recover the full amount of the
overpayment by appropriate action under state law against the income
or resources of the beneficiary or the income and resources of any
person who is financially responsible for the cost of his or her
health care pursuant to Section 14008.
   (f) The department shall advise the beneficiary of the
overpayment, the amount he or she is liable to repay, and of his or
her entitlement to a hearing on the propriety of the action pursuant
to Chapter 7 (commencing with Section 10950) of Part 2.
   (g) No civil or criminal action may be commenced against any
person based on alleged unlawful application for or receipt of health
care services, where the case record of the person has been
destroyed after the expiration of the retention period provided
pursuant to Section 10851.
14009.5.  (a) Notwithstanding any other provision of this chapter,
the department shall claim against the estate of the decedent, or
against any recipient of the property of that decedent by
distribution or survival an amount equal to the payments for the
health care services received or the value of the property received
by any recipient from the decedent by distribution or survival,
whichever is less.
   (b) The department may not claim in any of the following
circumstances:
   (1) The decedent was under 55 when services were received, except
in the case of an individual who had been an inpatient in a nursing
facility.
   (2) Where there is any of the following:
   (A) A surviving spouse during his or her lifetime. However, upon
the death of a surviving spouse, the department shall make a claim
against the estate of the surviving spouse, or against any recipient
of property from the surviving spouse obtained by distribution or
survival, for either the amount paid for the medical assistance given
to the decedent or the value of any of the decedent's property
received by the surviving spouse through distribution or survival,
whichever is less.  Any statute of limitations that purports to limit
the ability to recover for medical assistance granted under this
chapter shall not apply to any claim made for reimbursement.
   (B) A surviving child who is under age 21.
   (C) A surviving child who is blind or permanently and totally
disabled, within the meaning of Section 1614 of the federal Social
Security Act (42 U.S.C.A. Sec. 1382c).
   (3) Any exemption described in paragraph (2) that restricts the
department from filing a claim against a decedent's property shall
apply only to the proportionate share of the decedent's estate or
property that passes to those recipients, by survival or
distribution, who qualify for an exemption under paragraph (2).
   (c) (1) The department shall waive its claim, in whole or in part,
if it determines that enforcement of the claim would result in
substantial hardship to other dependents, heirs, or survivors of the
individual against whose estate the claim exists.
   (2) The department shall notify individuals of the waiver
provision and the opportunity for a hearing to establish that a
waiver should be granted.
   (d) The following definitions shall govern the construction of
this section:
   (1) "Decedent" means a beneficiary who has received health care
under this chapter or Chapter 8 (commencing with Section 14200) and
who has died leaving property to others either through distribution
or survival.
   (2) "Dependents" includes, but is not limited to, immediate family
or blood relatives of the decedent.
14010.  (a) Notwithstanding any other provision of law, the parent
or parents of a person under 21 years of age shall not be held
financially responsible, nor shall financial contribution be
requested or required of such parent or parents for health care or
related services to which the person may consent under any express
provision of law, including, but not limited to, Sections 6924, 6925,
6926, 6927, 6928, and 6929 of the Family Code, and including, but
not limited to, maternity home care, social service counseling, and
other services related to pregnancy of the person which are provided
by a licensed maternity home.
   Federal financial participation in providing such services shall
not be claimed to the extent that the exemption from financial
responsibility provided by this section is inconsistent with federal
law.
   (b) Notwithstanding the provisions of subdivision (a), the parent
or parents of a person under 21 years of age, who is living in the
home of the parent or parents, shall be held financially responsible
for health care or related services to which the person under 21
years of age may consent pursuant to paragraph (1) of subdivision (e)
of Section 7050 of the Family Code, but excluding health care and or
related services to which a person may consent under Sections 6924,
6925, 6926, 6927, 6928, and 6929 of the Family Code.
14011.  (a) Each applicant who is not a recipient of aid under the
provisions of Chapter 2 (commencing with Section 11200) or Chapter 3
(commencing with Section 12000) shall be required to file an
affirmation setting forth such facts about his annual income and
other resources and qualifications for eligibility as may be required
by the department.  Such statements shall be on forms prescribed by
the department.
   (b) To the extent permitted by federal law, eligibility for
medical assistance for such applicants shall not be granted until the
applicant or designated representative provides independent
documentation verifying statements of gross income by type and
source; income amounts withheld for taxes, health care benefits
available through employment, retirement, military service, work
related injuries or settlements from prior injuries, employee
retirement contributions, and other employee benefit contributions,
deductible expenses for maintenance or improvement of
income-producing property and status and value of property owned,
other than property exempt under Section 14006.  The director may
prescribe those items of exempt property which the director deems
should be verified as to status and value in order to reasonably
assure a correct designation of those items as exempt.
   (c) The verification requirements of subdivision (b) apply to
income, income deductions and property both of applicants for medical
assistance (other than applicants for public assistance) and to
persons whose income, income deductions, expenses or property
holdings must be considered in determining the applicant's
eligibility and share of cost.
   (d) A determination of eligibility and share of cost may be
extended beyond otherwise prescribed time frames if, in the county
department's judgment, and subject to standards of the director, the
applicant or designated representative has good cause for failure to
provide the required verification and continues to make a good faith
effort to provide such verification.
   (e) To the extent permitted by federal law, in addition to the
other verification requirements of this section, a county department
may require verification of any other applicant statements, or
conduct a full and complete investigation of the statements, whenever
a verification or investigation is warranted in the judgment of the
county department.
   (f) If documentation is unavailable, as defined in regulations
promulgated by the department, the applicant's signed statement as to
the value or amount shall be deemed to constitute verification.
14011.1.  (a) The department shall, not later than July 1, 1998,
create and implement a simplified application package for the
following Medi-Cal applicants, as described under Section 1902(l)(3)
of the federal Social Security Act (42 U.S.C. Sec. 1396a(l)(3)):
   (1) Children.
   (2) Pregnant women and infants.
   (b) In developing the application package described in this
section, the department shall seek input from the Managed Risk
Medical Insurance Board and persons with expertise, including
beneficiary representatives, counties, and beneficiaries.
   (c) The department shall permit an applicant to whom subdivision
(a) applies to apply for benefits by mailing in the simplified
application package.  The package shall include, but not be limited
to, the following items, as they now exist or may be changed from
time to time:
   (1) An application for cash aid, food stamps, and Medi-Cal.
   (2) A statement of citizenship, alienage, and immigration status.
   (3) A statement of facts.
   (4) Important information for persons requesting Medi-Cal.
   (5) The Child Health and Disability Prevention Program brochure.
   (d) The department shall not require an applicant who submits a
simplified application pursuant to subdivision (c) to complete a
face-to-face interview, except for good cause, a suspicion of fraud,
or to complete the application process.  Every application package
shall contain a notification of the applicant's right to complete a
face-to-face interview.
   (e) The department shall implement this section only to the extent
that its provisions are not violative of the requirements of federal
law, and only to the extent that federal financial participation is
not jeopardized.
14011.15.  (a) The department shall, not later than July 1, 2000,
create and implement a simplified application package for children,
families, and adults applying for Medi-Cal benefits.  This simplified
application package shall include a simplified supplemental resource
form.
   (b) In developing the application package described in subdivision
(a), the department shall seek input from persons with expertise,
including beneficiary representatives, counties, and beneficiaries.
   (c) The department shall allow an applicant to apply for benefits
by mailing in the simplified application package.
   (d) The simplified application package shall utilize at a minimum,
all of the following documentation standards:
   (1) Proof of income shall be documented by the most recent paystub
or a copy of the last year's federal income tax return.
   (2) Self-declaration of pregnancy.
   (3) A simplified supplemental resource form, if applicable.
   (e) The department shall not require an applicant who submits a
simplified application pursuant to this section to complete a
face-to-face interview, except for good cause, a suspicion of fraud,
or in order to complete the application process.  A county shall
conduct random monitoring of the mail-in application process to
ensure appropriate enrollment.  Every application package shall
contain a notification of the applicant's right to complete a
face-to-face interview.
   (f) The department shall implement this section only to the extent
that its provisions are not in violation of the requirements of
federal law, and only to the extent that federal financial
participation is available.
   (g) 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 regulatory action.
Thereafter, the department shall adopt regulations 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.
14011.16.  (a) Commencing August 1, 2003, the department shall
implement a requirement for beneficiaries to file semiannual status
reports as part of the department's procedures to ensure that
beneficiaries make timely and accurate reports of any change in
circumstance that may affect their eligibility.  The department shall
develop a simplified form to be used for this purpose.  The
department shall explore the feasibility of using a form that allows
a beneficiary who has not had any changes to so indicate by checking
a box and signing and returning the form.
   (b) Beneficiaries who have been granted continuous eligibility
under Section 14005.25 shall not be required to submit semiannual
status reports.  To the extent federal financial participation is
available, all children under 19 years of age shall be exempt from
the requirement to submit semiannual status reports.
   (c) Beneficiaries whose eligibility is based on a determination of
disability or on their status as aged or blind shall be exempt from
the semiannual status report requirement described in subdivision
(a).  The department may exempt other groups from the semiannual
status report requirement as necessary for simplicity of
administration.
   (d) When a beneficiary has completed, signed, and filed a
semiannual status report that indicated a change in circumstance,
eligibility shall be redetermined.
   (e) 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 regulatory action.
Thereafter, the department shall adopt regulations 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.
   (f) This section shall be implemented only if and to the extent
federal financial participation is available.
14011.2.  (a) The department shall require that each applicant for
or beneficiary of Medi-Cal, including a child, who is not a recipient
of aid under the provisions of Chapter 2 (commencing with Section
11200) or Chapter 3 (commencing with Section 12000) shall provide his
or her social security account number, or numbers, if he or she has
more than one such number.
   (b) The requirement for a social security account number shall be
a condition of eligibility only for the applicant who is seeking or
the beneficiary who is receiving (1) full-scope medical benefits or
(2), pursuant to Section 14007.5, restricted medical benefits
(emergency and pregnancy-related services only), and, in either case,
who declares, as required in subdivision (d), that he or she is a
citizen or national of the United States, and, if he or she is not a
citizen or national of the United States, that he or she has
satisfactory immigration status.
   (c) The requirement for a social security account number shall not
be a condition of eligibility for the applicant who is seeking or
the beneficiary who is receiving, pursuant to Section 14007.5,
restricted medical benefits (emergency and pregnancy-related services
only), and who has not made the declaration, as required in
subdivision (d), that he or she is not a citizen or national of the
United States, and, if he or she is not a citizen or national of the
United States, that he or she does not have satisfactory immigration
status.
   (d) Every applicant or beneficiary or, in the case of a child, by
the child's caretaker relative or legal guardian on his or her behalf
shall declare, under penalty of perjury, that he or she is, or is
not any of the following:
   (1) A citizen of the United States.
   (2) A national of the United States.
   (3) An alien who has satisfactory immigration status.
14011.2.  To the extent federal financial participation is
available, the department shall take all steps necessary to comply
with the terms and conditions of the State Child Health Insurance
Program waiver described in Section 12693.755 of the Insurance Code
extending eligibility under the Healthy Families Program to parents
and certain other adults.  The department shall seek any state plan
amendments or other waivers under Title XIX of the Social Security
Act (42 U.S.C. Sec. 1396 et seq.) necessary to implement this
section.
14011.3.  (a) To the same extent as required by federal law, an
alien whose entry into the United States has been sponsored by an
individual who, or organization that, executed an affidavit of
support or similar agreement with respect to the alien shall be
ineligible for the Medi-Cal program for a period of five years after
the alien's entry into the United States unless the sponsoring person
dies or the sponsoring organization ceases to exist.
   (b) Subdivision (a) shall not apply with respect to any alien who
is:
   (1) Admitted to the United States as a result of the application,
prior to April 1, 1980, of Section 1153(a)(7) of Title 8 of the
United States Code.
   (2) Admitted to the United States as a result of the application,
after March 31, 1980, of Section 1157(c) of Title 8 of the United
States Code.
   (3) Paroled into the United States under Section 1182(d)(5) of
Title 8 of the United States Code.
   (4) Granted political asylum by the United States Attorney General
under Section 1158 of Title 8 of the United States Code.
   (5) A Cuban or Haitian entrant, as defined in Section 501(e) of
the Refugee Education Assistance Act of 1980 (Public Law 96-422).
   (c) This section shall become operative on the effective date of
federal law that prohibits providing Medi-Cal assistance to sponsored
aliens, as defined in subdivision (a), and shall remain operative
only as long as federal law remains in effect.  The director shall
determine the operative dates of this section pursuant to this
subdivision and shall execute a declaration, that shall be retained
by the director, that sets forth the operative date or termination
date.
14011.4.  The department shall, subject to the requirements of
federal law, and not later than six months after the effective date
of this section, develop a simple referral form to be used as proof
of birth, in order to initiate Medi-Cal enrollment and the
establishment of benefits for newborns who are eligible for one year
of automatic continuous Medi-Cal eligible benefits pursuant to
Section 1902(e)(4) of the federal Social Security Act (42 U.S.C. Sec.
1396a(e)(4)).  In developing the referral form, the department shall
seek input from beneficiary representatives and health care
providers serving pregnant women receiving, or eligible for, Medi-Cal
benefits.  The infant's parent or guardian, or, with the knowledge
and written consent of the infant's parent or guardian, a health care
provider or other hospital worker, may submit the referral form by
mail or facsimile.  Upon receipt of the form, the department shall,
subject to the requirements of federal law, assign a Medi-Cal number
to the newborn and issue a Medi-Cal card.
14011.5.  The department shall be responsible for establishing the
necessary systems for the identification, review and approval,
disbursement, and reimbursement systems for those health services
provided to the medically indigent population eligible for federal
reimbursement under the Refugee/Cuban Haitian Entrant Program.
14011.6.  (a) To the extent federal financial participation is
available, the department shall exercise the option provided in
Section 1920a of the federal Social Security Act (42 U.S.C. Sec.
1396r-1a) to implement a program for accelerated enrollment of
children.
   (b) The department shall designate the single point of entry, as
defined in subdivision (c), as the qualified entity for determining
eligibility under this section.
   (c) For purposes of this section, "single point of entry" means
the centralized processing entity that accepts and screens
applications for benefits under the Medi-Cal Program for the purpose
of forwarding them to the appropriate counties.
   (d) The department shall implement this section only if, and to
the extent that, federal financial participation is available.
   (e) The department shall seek federal approval of any state plan
amendments necessary to implement this section.  When federal
approval of the state plan amendment or amendments is received, the
department shall commence implementation of this section on the first
day of the second month following the month in which federal
approval of the state plan amendment or amendments is received, or on
July 1, 2002, whichever is later.
   (f) Notwithstanding any other provision of law, the department
shall implement this section only if, and to the extent that, the
federal State Children's Health Insurance Program waiver described in
Section 12693.755 of the Insurance Code is approved by the federal
government.
   (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all-county letters.  Thereafter, the
department shall adopt regulations 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.
   (h) Upon the receipt of an application for a child who has
coverage pursuant to the accelerated enrollment program, a county
shall determine whether the child is eligible for Medi-Cal benefits.
If the county determines that the child does not meet the
eligibility requirements for participation in the Medi-Cal program,
the county shall report this finding to the Medical Eligibility Data
System so that accelerated enrollment coverage benefits are
discontinued.  The information to be reported shall consist of the
minimum data elements necessary to discontinue that coverage for the
child.  This subdivision shall become operative on July 1, 2002, or
the date that the program for accelerated enrollment coverage for
children takes effect, whichever is later.
14011.65.  (a) To the extent allowed under federal law and only if
federal financial participation is available under Title XXI of the
Social Security Act (42 U.S.C. Sec. 1397aa et seq.), the state shall
administer the Medi-Cal to Healthy Families Accelerated Enrollment
program, to provide any child who meets the criteria set forth in
subdivision (b) with temporary health benefits for the period
described in paragraph (2) of subdivision (b), as established under
Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code.
   (b) (1) Any child who meets all of the following requirements,
shall be eligible for temporary health benefits under this section:
   (A) The child, or his or her parent or guardian, submits an
application for the Medi-Cal program directly to the county.
   (B) The child's income, as determined on the basis of the
application described in subparagraph (A), is within the income
limits established by the Healthy Families Program.
   (C) The child is under 19 years of age at the time of the
application.
   (D) The county determines, on the basis of the application
described in subparagraph (A), that the child is eligible for
full-scope Medi-Cal with a share of cost.
   (E) The child is not receiving Medi-Cal benefits at the time that
the application is submitted.
   (F) The child, or his or her parent or guardian, gives, or has
given consent for the application to be shared with the Healthy
Families Program for purposes of determining the child's Healthy
Families Program eligibility.
   (2) The period of accelerated eligibility provided for under this
section begins on the first day of the month that the county finds
that the child meets all of the criteria described in paragraph (1)
and concludes on the last day of the month that the child either is
fully enrolled in, or has been determined ineligible for, the Healthy
Families Program.
   (3) For any child who meets the requirements for temporary health
benefits under this section, the county shall forward to the Healthy
Families Program sufficient information from the child's application
to determine eligibility for the Healthy Families Program. To the
extent possible, submission of that information to the Healthy
Families Program shall be accomplished using an electronic process
developed for use in the Medi-Cal-to-Healthy Families Bridge Benefits
Program. The department shall give the Healthy Families Program a
daily electronic file of all children provided temporary health
benefits pursuant to this section.
   (4) The temporary health 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.
   (c) The department, in consultation with the Managed Risk Medical
Insurance Board and 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.
   (d) 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 may 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.
   (e) 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 Social Security Act.
Notwithstanding any other provision of law, only when all necessary
federal approvals have been obtained shall this section be
implemented.
   (f) Under no circumstances shall this section be implemented
unless the state has sought and obtained approval of any amendments
to its state plan, as described in Section 12693.50 of the Insurance
Code, necessary to implement this section and obtain funding under
Title XXI of the Social Security Act(42 U.S.C. Sec. 1397aa et seq.)
for the provision of benefits provided under this section.
Notwithstanding any other provision of law, and only when all
necessary federal approvals have been obtained by the state, this
section shall be implemented only to the extent federal financial
participation under Title XXI of the Social Security Act(42 U.S.C.
Sec. 1397aa et seq.) is available to fund benefits provided under
this section.
   (g) The department shall commence implementation of this section
on the first day of the third month following the month in which
federal approval of the state plan amendment or amendments described
in subdivision (f), and subdivision (b) of Section 12693.50 of the
Insurance Code is received, or on August 1, 2006, whichever is later.
14011.7.  (a) To the extent allowed under federal law and only if
federal financial participation is available, the department shall
exercise the option provided in Section 1396r-1a of Title 42 of the
United States Code and the Managed Risk Medical Insurance Board shall
exercise the option provided in Section 1397gg(e)(1)(D) of Title 42
of the United States Code to implement a program for preenrollment of
children into the Medi-Cal program or the Healthy Families Program.
Upon the exercise of both of the federal options described in this
subdivision, the department shall implement and administer a program
of preenrollment of children into the Medi-Cal program or the Healthy
Families Program.
   (b) (1) Before July 1, 2003, the department shall develop an
electronic application to serve as the application for preenrollment
into the Medi-Cal program or the Healthy Families Program and to also
serve as an application for the Child Health and Disability
Prevention (CHDP) program, to the extent allowed under federal law.
   (2) The department may, at its option, also use the electronic
application developed pursuant to paragraph (1), as a means to enroll
newborns into the Medi-Cal program as is authorized under Section
1396a(e)(4) of Title 42 of the United States Code.
   (c) (1) The department may designate, as necessary, those CHDP
program providers described in paragraphs (1) to (5), inclusive, of
subdivision (g) of Section 124030 of the Health and Safety Code as
qualified entities who are authorized to determine eligibility for
the CHDP program and for preenrollment into either the Medi-Cal
program or the Healthy Families Program as authorized under this
section.
   (2) The CHDP provider shall assist the parent or guardian of the
child seeking eligibility for the CHDP program and for preenrollment
into the Medi-Cal program or the Healthy Families Program in
completing the electronic application.
   (d) The electronic application developed pursuant to subdivision
(b) may only be filed through the CHDP program when the child is in
need of CHDP program services in accordance with the periodicity
schedule used by the CHDP program.
   (e) (1) The electronic application developed pursuant to
subdivision (b) shall request all information necessary for a CHDP
provider to make an immediate determination as to whether a child
meets the eligibility requirements for CHDP and for preenrollment
into either the Medi-Cal program or the Healthy Families Program
pursuant to the federal options described in Section 1396r-1a or
1397gg(e)(1)(D) of Title 42 of the United States Code.
   (2) (A) If the electronic application indicates that the child is
seeking eligibility for either no cost full-scope Medi-Cal benefits
or enrollment in the Healthy Families Program, the department shall
mail to the child's parent or guardian a followup application for
Medi-Cal program eligibility or enrollment in the Healthy Families
Program.  The parent or guardian of the child shall be advised to
complete and submit to the appropriate entity the followup
application.
   (B) The followup application, at a minimum, shall include all
notices and forms necessary for both a Medi-Cal program and a Healthy
Families Program eligibility determination under state and federal
law, including, but not limited to, any information and documentation
that is required for the joint application package described in
Section 14011.1.
   (C) The date of application for the Medi-Cal program or the
Healthy Families Program is the date the completed followup
application is submitted with the appropriate entity by the parent or
guardian.
   (3) Upon making a determination pursuant to paragraph (1) that a
child is eligible, the CHDP provider shall inform the child's parent
or guardian of both of the following:
   (A) That the child has been determined to be eligible for services
under the CHDP program and, if applicable, eligible for
preenrollment into either the Medi-Cal program or the Healthy
Families Program.
   (B) That if the child has been determined to be eligible for
preenrollment into either the Medi-Cal program or the Healthy
Families Program, the period of preenrollment eligibility will end on
the last day of the month following the month in which the
determination of preenrollment eligibility is made, unless the parent
or guardian completes and returns to the appropriate entity the
followup application described in paragraph (2) on or before that
date.
   (4) If the followup application described in paragraph (2) is
submitted on or before the last day of the month following the month
in which a determination is made that the child is eligible for
preenrollment into either the Medi-Cal program or the Healthy
Families Program, the period of preenrollment eligibility shall
continue until the completion of the determination process for the
applicable program or programs.
   (f) The scope and delivery of benefits provided to a child who is
preenrolled for the Healthy Families Program pursuant to this section
shall be identical to the scope and delivery of benefits received by
a child who is preenrolled for the Medi-Cal program pursuant to this
section.
   (g) The department and the Managed Risk Medical Insurance Board
shall seek approval of any amendments to the state plan, necessary to
implement this section, for purposes of funding under Title XIX (42
U.S.C. 1396 et seq.) and Title XXI (42 U.S.C. 1397aa et seq.) of the
Social Security Act.  Notwithstanding any other provision of law and
only when all necessary federal approvals have been obtained, this
section shall be implemented only to the extent federal financial
participation is available.
   (h) Upon the implementation of this section, this section shall
control in the event of a conflict with any provision of Article 6
(commencing with Section 124025) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code governing the Child Health and
Disability Prevention program.
   (i) To implement this section, the department may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program's fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that
appropriately claims federal financial reimbursement.  Contracts,
including the Medi-Cal fiscal intermediary contract for the Child
Health and Disability Prevention Program, including any contract
amendment, any system change pursuant to a change order, and any
project or systems development notice shall be exempt from Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code, Chapter 7 (commencing with Section 11700) of Part 1 of Division
3 of Title 2 of the Government Code, Section 19130 of the Government
Code, and any policies, procedures, or regulations authorized by
these laws.
   (j) 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.
   (k) Notwithstanding subdivision (g), in no event shall this
section be implemented before April 1, 2003.
14011.8.  (a) Benefits provided to an individual pursuant to a
preliminary determination as described in Section 1396r-1, 1396r-1a,
or 1396r-1b of Title 42 of the United States Code shall end, without
the necessity for any further review or determination by the
department, on or before the last day of the month following the
month in which the preliminary determination was made, unless an
application for medical assistance under the state plan is filed on
or before that date.
   (b) If an application for medical assistance is filed on or before
the last day of the month following the month in which the
preliminary determination was made, preliminary benefits shall
continue until the regular eligibility determination based on the
application has been completed.  The application shall be treated in
all respects as an initial application for benefits and the following
shall apply:
   (1) In the case of an applicant who is found eligible for medical
assistance, benefits shall be granted in an amount and under those
conditions, including imposition of a share of cost, as have been
found applicable pursuant to the regular eligibility determination.
   (2) In the case of all other applicants, provision of preliminary
benefits shall end on the day that the regular eligibility
determination is made.
   (c) Notwithstanding any other provision of law, medical assistance
pursuant to a preliminary determination as described in Section
1396r-1, 1396r-1a, or 1396r-1b of Title 42 of the United States Code
shall be provided only if and to the extent federal financial
participation is available.
14011.9.  (a) On or before October 1, 2002, the department shall
issue instructions to counties via an all-county letter or similar
instructions to establish an automated system for tracking the status
of applications received by county welfare departments from the
centralized processing entity that accepts and screens applications
for benefits under the Medi-Cal program for the purpose of forwarding
these applications to the appropriate counties.  Except for
reporting denials of applications on behalf of children enrolled in
accelerated Medi-Cal coverage pursuant to subdivision (g) of Section
14011.6, the department shall not institute a process to require
county welfare departments to routinely manually report to the
Medi-Cal Eligibility Data System (MEDS) regarding the status of
applications for Medi-Cal coverage prior to the development of an
interface between that county's automated eligibility determination
system and the MEDS system for the purposes of implementing this
section.  It is the intent of the Legislature that the Health Human
Services Data Center and the counties complete the automation changes
necessary to implement the automated tracking system on or before
July 1, 2003.
   (b) This section shall be implemented only to the extent that
federal financial participation is not jeopardized.
   (c) Nothing in this section shall be construed as prohibiting the
department from requiring a county to report on the status of an
individual application or to manually generate a report on a
statistically valid sampling of applications pursuant to federally
required monitoring activities.
14012.  Reaffirmation shall be filed annually and may be required at
other times in accordance with general standards established by the
department.
14013.  The department shall establish a system for investigation of
a sufficient sample of applications and affirmations as shall be
deemed necessary to assure the validity of such applications.
14014.  (a) Any person receiving health care for which he or she was
not eligible on the basis of false declarations as to his or her
eligibility or any person making false declarations as to eligibility
on behalf of any other person receiving health care for which that
other person was not eligible shall be liable for repayment and shall
be guilty of a misdemeanor or felony depending on the amount paid on
his or her behalf for which he or she was not eligible, as specified
in Section 487 of the Penal Code.
   (b) (1) Any person who willfully and knowingly counsels or
encourages any individual to make false statements or otherwise
causes false statements to be made on an application, in order to
receive health care services to which the applicant is not entitled,
shall be liable to the Medi-Cal program for damages incurred for the
cost of services rendered to the applicant.
   (2) Paragraph (1) shall be implemented to the extent permitted by
federal law and to the extent that implementation of paragraph (1)
does not affect the availability of federal financial participation.
14015.  (a) The providing of health care under this chapter shall
not impose any limitation or restriction upon the person's right to
sell, exchange or change the form of property holdings nor shall the
care provided constitute any encumbrance on the holdings.  However,
the transfer or gift of assets, including income and resources, for
less than fair market value shall, to the extent and under the
circumstances set forth in Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.) result in a period of ineligibility
for aid.
   (b) Pursuant to Section 1917 (c)(2)(C)(ii) of the federal Social
Security Act (42 U.S.C. Sec. 1396p(c)(2)(C)(ii)), a satisfactory
showing that assets transferred exclusively for a purpose other than
to qualify for medical assistance shall not result in ineligibility
for Medi-Cal and shall include, but not be limited to, the following:
   (1) The property that would have been considered exempt for
purposes of establishing eligibility pursuant to federal or state
laws at the time of transfer.
   (2) Property with a net market value that, when the property is
transferred, if included in the property reserve, would not result in
ineligibility.
   (3) Property for which adequate consideration is received.
   (4) Property upon which foreclosure or repossession was imminent
at the time of transfer, provided there is no evidence of collusion.
   (5) Assets transferred in return for an enforceable contract for
life care that does not include complete medical care.
   (6) Assets transferred without adequate consideration, provided
that the applicant or beneficiary provides convincing evidence to
overcome the presumption that the transfer was for the purpose of
establishing eligibility or reducing the share of cost.
   (c) In administering this section, it shall be presumed that
property transferred by the applicant or beneficiary prior to the
look back period established by the department preceding the date of
initial application was not transferred to establish eligibility or
reduce the share of cost.  This property shall not be considered in
determining eligibility.
   (d) Any item of durable medical equipment which is purchased for a
recipient pursuant to this chapter exclusively with Medi-Cal program
funds shall be returned to the department when the department
determines that the item is no longer medically necessary for the
recipient.  Items of durable medical equipment shall include, but are
not limited to, wheelchairs and special hospital beds.
14016.  (a) The county in which the person resides, except as
specified in subdivision (d), shall determine the eligibility of each
person pursuant to Sections 14005.1, 14005.4, and 14005.7 and
Article 4.4 (commencing with Section 14140), except that the
department may contract with the federal Social Security
Administration for the determination of Medi-Cal eligibility of
persons eligible under Title XVI of the Social Security Act.  Upon
termination of such assistance, the county shall determine whether
the person remains eligible for Medi-Cal coverage under one of these
sections.
   (b) The department shall institute an eligibility quality control
program, to verify the eligibility determination of a sample of
persons in each county granted Medi-Cal eligibility  under Section
14005.4, 14005.7, or 14005.8 or Article 4.  4 (commencing with
Section 14140).
   (c) A review period shall be defined as one year and shall
coincide with the federal fiscal year.  The department shall draw a
random sample of cases for each period.  The random sample shall be
drawn to ensure a minimum number of cases reviewed in each county in
each review period according to the following:
   (1) All cases shall be sampled in any county with less than 50
Medi-Cal cases.
   (2) Fifty cases in any county with greater than 0.01 percent and
less than or equal to .50 percent of the Medi-Cal cases.
   (3) Seventy-five cases in any county with greater than .50 percent
and less than or equal to 1 percent of the Medi-Cal cases.
   (4) One hundred cases in any county with greater than 1 percent
and less than or equal to 3 percent of the Medi-Cal cases.
   (5) One hundred twenty-five cases in any county with greater than
3 percent and less than or equal to 10 percent of the Medi-Cal cases.
   (6) Six hundred fifty cases in any county with greater than 10
percent of the Medi-Cal cases.
   (d) When family members maintain separate residences, but
eligibility is determined as a single unit because of the provisions
of Section 14008, the county in which the parent or parents reside
shall determine the eligibility for the entire unit.
   (e) In administering the provisions of law and regulations related
to eligibility determination the director shall impose such fiscal
penalties as provided by this  section to assure adequate county
administrative performance.
   (f) The director shall hold counties financially liable for
payments made on behalf of ineligible persons or persons with an
incorrect share of cost.  When a sample case is found to include an
ineligible person or a person with an understated share of cost,
written notification shall be sent to the county department which
describes the error and requests a written response within two weeks.
  The county shall indicate whether it agrees or disagrees with the
findings.  If the county disagrees, the department shall reevaluate
the error findings, taking into consideration any additional facts
contained in the county's response.  The department shall again
notify the county of the department's findings.  If the county
continues to disagree with the error findings, the county may appeal
to the Chief of the Medi-Cal Policy Division, requesting that the
department review the case and render a final decision.  The director
may reduce or waive the fiscal liability of a county if the
department is unable to meet the minimum sample required, as defined
in subdivision (c), or if an individual county experienced a natural
disaster, job actions, or other occurrences which impacted the
findings in an individual county as  determined by the director.
   (g) The department shall utilize the methodology detailed in this
subdivision to establish counties' fiscal penalties.  The department
shall determine each county's case error rate for each review period
by dividing the number of completed case reviews in that county found
in error by the number of case reviews in that county.  State caused
errors shall be determined by the department and shall not be
included in this calculation.  Case error rates shall be arrayed from
highest to lowest.  From this array, the department shall determine
the percentage of counties liable as follows:
   (1) The 60 percent of counties with the highest case error rates
shall be liable if the state's dollar error rate exceeds the federal
standard by 0.01 percent to 1 percent.
   (2) The 70 percent of counties with the highest case error rates
shall be liable if the state's dollar error rate exceeds the federal
standard by greater than 1 percent and less than or equal to 2
percent.
   (3) The 80 percent of counties with the highest case error rates
shall be liable if the state's dollar error rate exceeds the federal
standard by greater than 2 percent and less than or equal to 3
percent.
   (4) The 90 percent of counties with the highest case error rates
shall be liable if the state's dollar error rate exceeds the federal
standard by greater than 3 percent and less than or equal to 4
percent.
   (5) All counties shall be liable if the state's dollar error rate
exceeds the federal standard by greater than 4 percent.
   As used herein, "the state's dollar error rate" means the Medicaid
dollar error rate reported to the department by the United States
Department of Health and Human Services, less any portion of this
error rate attributable to state caused errors.  The term "federal
standard" means the Medicaid dollar error rate standard to which the
state is held accountable.
   For each county determined liable, the department shall calculate
a penalty multiple which shall be the product of a liable county's
case error rate multiplied by the liable county's percentage of
statewide Medi-Cal cases.  Each county's fiscal penalty shall be the
product of a county's penalty multiple divided by the sum of all
penalty multiples, multiplied times the penalty bank.  The penalty
bank includes only quality control federal fiscal sanctions, federal
withholds, federal disallowances, and any associated General Fund
expenditures, minus the value of any state assumed errors and the
General Fund share of the value of client caused errors.  The case
error rate and penalty multiple shall be adjusted by excluding client
errors for the purpose of determining the associated General Fund
expenditures.
   If, after the department has assessed penalties to counties, the
federal government reduces or eliminates any quality control federal
fiscal sanction, federal withhold or federal disallowance, the
department shall reduce or eliminate the corresponding fiscal penalty
assessment including any associated General Fund expenditures to
liable counties.
   (h) When a county welfare department contravenes state eligibility
processing regulations and written instructions in a way that
produces increased program benefits or administrative expenses but
doesn't result in an increase in the eligibility dollar error rate,
the director shall recoup from that county the additional
administrative or program benefit costs above those which would have
been incurred had that county not contravened the established state
eligibility  processing regulations and written instructions.  This
section shall not be construed to interfere with the rights of
counties to out-station eligibility staff.
   Notwithstanding the number of counties determined liable for
fiscal penalties under this section, individual county corrective
action plans as prescribed by the department shall be required from
all counties which exceed a 15 percent case error rate.
   (i) Any penalties imposed under this system shall be collected
through direct repayment from liable counties rather than through any
reduction in funds otherwise due to counties.
14016.1.  If a patient at a health facility operated by the county
either directly or through contract is received in a comatose
condition or suffering from amnesia and dies before he is able to
cooperate in providing information necessary to a determination of
Medi-Cal eligibility, the patient shall be presumed eligible.
However, such presumption may be rebutted by the department.  All
costs incurred in providing care to such patient under such
presumption shall be reimbursable to the extent permitted by federal
statutes and regulations.  If such a patient subsequently is
determined ineligible, the department shall make reasonable efforts
to recover the costs of care incurred during the period of
presumptive eligibility and shall have the right to seek restitution
in a civil action.
14016.2.  If a person who is incapable of acting on his own behalf
and who would otherwise be eligible is discontinued from Medi-Cal
eligibility because the guardian or authorized representative of the
person fails or refuses to provide information needed to determine
eligibility, then anyone with knowledge of the person's need for
Medi-Cal coverage may apply for retroactive eligibility for any of
the three preceding months on behalf of the person. If the necessary
information becomes available within three months of the application
the county department shall act on the application to determine the
person's eligibility for the retroactive period.
   The provisions of this section shall become inoperative to the
extent that they are found to conflict with federal requirements
governing federal reimbursements of state Medicaid costs.
14016.3.  The department shall provide technical assistance to
counties in order to maximize the identification of private health
care coverage as defined by Section 10020.  A county agency shall
receive reimbursement for the administrative costs for properly
completing a form which identifies such private health care coverage
only in those cases where the agency does not receive such
reimbursement from the department or the State Department of Social
Services.  The administrative costs for properly completing the form
shall be determined by the department.
14016.4.  The department may enter into an agreement with a county
to have the county detect and recover the value of any Medi-Cal
benefits which have been improperly received or obtained by any
person.  Counties shall receive an incentive amount not to exceed 30
percent of the amount remaining after reasonable county costs of the
recovery have been deducted from the amount recovered.  As the single
state agency for state plan purposes, the department is responsible
for and has authority to impose procedural requirements necessary for
federal compliance.
   The administrative costs for the implementation of this section
shall be controlled by the department.  The department shall
establish and maintain a plan whereby costs for counties'
administration of beneficiary collections will be effectively
controlled.  The plan shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere.
14016.5.  (a) At the time of determining or redetermining the
eligibility of a Medi-Cal program or Aid to Families with Dependent
Children (AFDC) program applicant or beneficiary who resides in an
area served by a managed health care plan or pilot program in which
beneficiaries may enroll, each applicant or beneficiary shall
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.
The county shall ensure that each beneficiary or applicant attends
this presentation.
   (b) The health care options presentation described in subdivision
(a) shall include all of the following elements:
   (1) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship in the fee-for-service sector.
   (2) Each beneficiary or eligible applicant shall be provided with
the name, address, telephone number, and specialty, if any, of each
primary care provider, and each clinic participating in each prepaid
managed health care plan, pilot project, or fee-for-service case
management provider option. This information shall be provided under
geographic area designations, in alphabetical order by the name of
the primary care provider and clinic. The name, address, and
telephone number of each specialist participating in each prepaid
managed health care plan, pilot project, or fee-for-service case
management provider option shall be made available by contacting
either the health care options contractor or the prepaid managed
health care plan, pilot project, or fee-for-service case management
provider.
   (3) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship in a managed care option, if his or her treating
provider is a primary care provider or clinic contracting with any of
the prepaid managed health care plans, pilot projects, or
fee-for-service case management provider options available, has
available capacity, and agrees to continue to treat that beneficiary
or applicant.
   (4) In areas specified by the director, each beneficiary or
eligible applicant shall be informed that if he or she fails to make
a choice, or does not certify that he or she has an established
relationship with a primary care provider or clinic, he or she shall
be assigned to, and enrolled in, a prepaid managed health care plan,
pilot project, or fee-for-service case management provider.
   (c) No later than 30 days following the date a Medi-Cal or AFDC
beneficiary or applicant is determined eligible, the beneficiary or
applicant shall indicate his or her choice in writing, as a condition
of coverage for Medi-Cal benefits, of either of the following health
care options:
   (1) To obtain benefits by receiving a Medi-Cal card, which may be
used to obtain services from individual providers, that the
beneficiary would locate, who choose to provide services to Medi-Cal
beneficiaries.
   The department may require each beneficiary or eligible applicant,
as a condition for electing this option, to sign a statement
certifying that he or she has an established patient-provider
relationship, or in the case of a dependent, the parent or guardian
shall make that certification. This certification shall not require
the acknowledgment or guarantee of acceptance, by any indicated
Medi-Cal provider or health facility, of any beneficiary making a
certification under this section.
   (2) (A) To obtain benefits by enrolling in a prepaid managed
health care plan, pilot program, or fee-for-service case management
provider that has agreed to make Medi-Cal services readily available
to enrolled Medi-Cal beneficiaries.
   (B) At the time the beneficiary or eligible applicant selects a
prepaid managed health care plan, pilot project, or fee-for-service
case management provider, the department shall, when applicable,
encourage the beneficiary or eligible applicant to also indicate, in
writing, his or her choice of primary care provider or clinic
contracting with the selected prepaid managed health care plan, pilot
project, or fee-for-service case management provider.
   (d) (1) In areas specified by the director, a Medi-Cal or AFDC
beneficiary or eligible applicant who does not make a choice, or who
does not certify that he or she has an established relationship with
a primary care provider or clinic, shall be assigned to and enrolled
in an appropriate Medi-Cal managed care plan, pilot project, or
fee-for-service case management provider providing service within the
area in which the beneficiary resides.
   (2) If it is not possible to enroll the beneficiary under a
Medi-Cal managed care plan, pilot project, or a fee-for-service case
management provider because of a lack of capacity or availability of
participating contractors, the beneficiary shall be provided with a
Medi-Cal card and informed about fee-for-service primary care
providers who do all of the following:
   (A) The providers agree to accept Medi-Cal patients.
   (B) The providers provide information about the provider's
willingness to accept Medi-Cal patients as described in Section
14016.6.
   (C) The providers provide services within the area in which the
beneficiary resides.
   (e) If a beneficiary or eligible applicant does not choose a
primary care provider or clinic, or does not select any primary care
provider who is available, the managed health care plan, pilot
project, or fee-for-service case management provider that was
selected by or assigned to the beneficiary shall ensure that the
beneficiary selects a primary care provider or clinic within 30 days
after enrollment or is assigned to a primary care provider within 40
days after enrollment.
   (f) (1) The managed care plan shall have a valid Medi-Cal
contract, adequate capacity, and appropriate staffing to provide
health care services to the beneficiary.
   (2) The department shall establish standards for all of the
following:
   (A) The maximum distances a beneficiary is required to travel to
obtain primary care services from the managed care plan,
fee-for-service case management provider, or pilot project in which
the beneficiary is enrolled.
   (B) The conditions under which a primary care service site shall
be accessible by public transportation.
   (C) The conditions under which a managed care plan,
fee-for-service case management provider, or pilot project shall
provide nonmedical transportation to a primary care service site.
   (3) In developing the standards required by paragraph (2), the
department shall take into account, on a geographic basis, the means
of transportation used and distances typically traveled by Medi-Cal
beneficiaries to obtain fee-for-service primary care services and the
experience of managed care plans in delivering services to Medi-Cal
enrollees. The department shall also consider the provider's ability
to render culturally and linguistically appropriate services.
   (g) To the extent possible, the arrangements for carrying out
subdivision (d) shall provide for the equitable distribution of
Medi-Cal beneficiaries among participating managed care plans,
fee-for-service case management providers, and pilot projects.
   (h) If, under the provisions of subdivision (d), a Medi-Cal
beneficiary or applicant does not make a choice or does not certify
that he or she has an established relationship with a primary care
provider or clinic, the person may, at the option of the department,
be provided with a Medi-Cal card or be assigned to and enrolled in a
managed care plan providing service within the area in which the
beneficiary resides.
   (i) Any Medi-Cal or AFDC beneficiary who is dissatisfied with the
provider or managed care plan, pilot project, or fee-for-service case
management provider shall be allowed to select or be assigned to
another provider or managed care plan, pilot project, or
fee-for-service case management provider.
   (j) The department or its contractor shall notify a managed care
plan, pilot project, or fee-for-service case management provider when
it has been selected by or assigned to a beneficiary. The managed
care plan, pilot project, or fee-for-service case management provider
that has been selected by, or assigned to, a beneficiary, shall
notify the primary care provider or clinic that it has been selected
or assigned. The managed care plan, pilot project, or fee-for-service
case management provider shall also notify the beneficiary of the
managed care plan, pilot project, or fee-for-service case management
provider or clinic selected or assigned.
   (k) (1) The department shall ensure that Medi-Cal beneficiaries
eligible under Title XVI of the Social Security Act are provided with
information about options available regarding methods of receiving
Medi-Cal benefits as described in subdivision (c).
   (2) (A) The director may waive the requirements of subdivisions
(c) and (d) until a means is established to directly provide the
presentation described in subdivision (a) to beneficiaries who are
eligible for the federal Supplemental Security Income for the Aged,
Blind, and Disabled Program (Subchapter 16 (commencing with Section
1381) of Chapter 7 of Title 42 of the United States Code).
   (B) The director may elect not to apply the requirements of
subdivisions (c) and (d) to beneficiaries whose eligibility under the
Supplemental Security Income program is established before January
1, 1994.
   (l) In areas where there is no prepaid managed health care plan or
pilot program that has contracted with the department to provide
services to Medi-Cal beneficiaries, and where no other enrollment
requirements have been established by the department, no explicit
choice need be made, and the beneficiary or eligible applicant shall
receive a Medi-Cal card.
   (m) The following definitions contained in this subdivision shall
control the construction of this section, unless the context requires
otherwise:
   (1) "Applicant," "beneficiary," and "eligible applicant," in the
case of a family group, mean any person with legal authority to make
a choice on behalf of dependent family members.
   (2) "Fee-for-service case management provider" means a provider
enrolled and certified to participate in the Medi-Cal fee-for-service
case management program the department may elect to develop in
selected areas of the state with the assistance of and in cooperation
with California physician providers and other interested provider
groups.
   (3) "Managed health care plan" and "managed care plan" mean a
person or entity operating under a Medi-Cal contract with the
department under this chapter or Chapter 8 (commencing with Section
14200) to provide, or arrange for, health care services for Medi-Cal
beneficiaries as an alternative to the Medi-Cal fee-for-service
program that has a contractual responsibility to manage health care
provided to Medi-Cal beneficiaries covered by the contract.
   (n) (1) Whenever a county welfare department notifies a public
assistance recipient or Medi-Cal beneficiary that the recipient or
beneficiary is losing Medi-Cal eligibility, the county shall include,
in the notice to the recipient or beneficiary, notification that the
loss of eligibility shall also result in the recipient's or
beneficiary's disenrollment from Medi-Cal managed health care or
dental plans, if enrolled.
   (2) (A) Whenever the department or the county welfare department
processes a change in a public assistance recipient's or Medi-Cal
beneficiary's residence or aid code that will result in the recipient'
s or beneficiary's disenrollment from the managed health care or
dental plan in which he or she is currently enrolled, a written
notice shall be given to the recipient or beneficiary.
   (B) This paragraph shall become operative and the department shall
commence sending the notices required under this paragraph on or
before the expiration of 12 months after the effective date of this
section.
   (o) This section shall be implemented in a manner consistent with
any federal waiver required to be obtained by the department in order
to implement this section.
14016.51.  Upon the availability of federal funding, the department
shall modify the Medi-Cal program mail-in application form, and other
appropriate materials, and the single point-of-entry application
form, to allow applicants in counties served by managed care plans to
contact the enrollment contractor by using the Health Care Options
toll-free telephone number to request and receive enrollment
materials before a Medi-Cal eligibility determination has been made.
14016.55.  (a) It is the intent of the Legislature that Medi-Cal
beneficiaries who are required to enroll in a Medi-Cal managed care
health plan make an informed choice that is not the result of
confusion, lack of information, or understanding of the choices
available to them.
   (b) It is the intent of the Legislature that the department strive
to increase the level of choice of Medi-Cal beneficiaries required
to enroll in a Medi-Cal managed care health plan and that default
rates be no greater than 20 percent in any participating county.
   (c) In any county in which conversion to managed care plan
enrollment has taken place and where the default rate, as defined in
subdivision (e), is 20 percent or higher in two consecutive months
occurring after conversion upon the effective date of this section,
the department shall conduct a one-time survey of beneficiaries aimed
at determining the reasons why beneficiaries fail to enroll into a
managed care plan when required to do so by the department or its
health care options contractor.
   (d) The department shall submit the results of the survey to the
appropriate legislative policy and budget committees within six
months of completion, and implement a plan of correction intended to
reduce the rate of beneficiary default.  The plan of correction may
include, but not be limited to, culturally appropriate outreach and
education activities, including the use of community based
organization.
   (e) For purposes of this section, "default rate" refers to the
rate of Medi-Cal beneficiaries defaulting into managed care health
plan enrollment by virtue of their failure to make an election, as
provided for in Section 14016.5.
14016.6.  The State Department of Health Services shall develop a
program to implement Section 14016.5 and to provide information and
assistance to enable Medi-Cal beneficiaries to understand and
successfully use the services of the Medi-Cal managed care plans in
which they enroll.  The program shall include, but not be limited to,
the following components:
   (a) (1) Development of a method to inform beneficiaries and
applicants of all of the following:
   (A) Their choices for receiving Medi-Cal benefits including the
use of fee-for-service sector managed health care plans, or pilot
programs.
   (B) The availability of staff and information resources to
Medi-Cal managed health care plan enrollees described in subdivision
(f).
   (2) (A) Marketing and informational materials including printed
materials, films, and exhibits, to be provided to Medi-Cal
beneficiaries and applicants when choosing methods of receiving
health care benefits.
   (B) The department shall not be responsible for the costs of
developing material required by subparagraph (A).
   (C) (i) The department may prescribe the format and edit the
informational materials for factual accuracy, objectivity and
comprehensibility .
   (ii) The department shall use the edited materials in informing
beneficiaries and applicants of their choices for receiving Medi-Cal
benefits.
   (b) Provision of information that is necessary to implement this
program in a manner that fairly and objectively explains to
beneficiaries and applicants their choices for methods of receiving
Medi-Cal benefits, including information prepared by the department
emphasizing the benefits and limitations to beneficiaries of
enrolling in managed health  care plans and pilot projects as opposed
to the fee-for-service system.
   (c) Provision of information about providers who will provide
services to Medi-Cal beneficiaries.  This may be information about
provider referral services of a local provider professional
organization.  The information shall be made available to Medi-Cal
beneficiaries and applicants at the same time the beneficiary or
applicant is being informed of the options available for receiving
care.
   (d) Training of specialized county employees to carry out the
program.
   (e) Monitoring the implementation of the program in those county
welfare offices where choices are made available in order to assure
that beneficiaries and applicants may make a well-informed choice,
without duress.
   (f) Staff and information resources dedicated to directly assist
Medi-Cal managed health care plan enrollees to understand how to
effectively use the services of, and resolve problems or complaints
involving, their managed health care plans.
   (g) The responsibilities outlined in this section shall, at the
option of the department, be carried out by a specially trained
county or state employee or by an independent contractor paid by the
department.  If a county sponsored prepaid health plan or pilot
program is offered, the responsibilities outlined in this section
shall be carried out either by a specially trained state employee or
by an independent contractor paid by the department.
   (h) The department shall adopt any regulations as are necessary to
ensure that the informing of beneficiaries of their health care
options is a part of the eligibility determination process.
14016.7.  (a) Managed care contracts entered into by the department
under the act adding this section shall include all of the following:
   (1) Contractor requirements concerning eligibility and coverage
verification.
   (2) Utilization controls.
   (3) Claims processing.
   (b) The contract requirements shall include all of the following:
   (1) Standards for prompt response to provider requests for
information.
   (2) Twenty-four hour response to emergency service authorization
requests.
   (3) Use of commonly accepted billing forms.
14016.8.  (a) The Legislature finds and declares that the right of
every patient to receive basic information necessary to give full and
informed consent is a fundamental tenet of good public health policy
and has long been the established law of this state.  Some hospitals
and other providers do not provide a full range of reproductive
health services and may prohibit or otherwise not provide
sterilization, infertility treatments, abortion, or contraceptive
services, including emergency contraception.  It is the intent of the
Legislature that every patient be given full and complete
information about the health care services available to allow
patients to make well informed health care decisions.
   (b) On or before July 1, 2001, the department shall:
   (1) Ensure that all Medi-Cal beneficiaries receive the following
statement by the methods described in paragraphs (2) to (6),
inclusive:
   "Some hospitals and other providers do not provide one or more of
the following services that may be covered under your plan contract
and that you or your family member might need:  family planning;
contraceptive services, including emergency contraception;
sterilization, including tubal ligation at the time of labor and
delivery; infertility treatments; or abortion.  You should obtain
more information before you enroll.  Call your prospective doctor or
clinic, or call the Medi-Cal managed care plan at (insert the plan's
membership services number or other appropriate number that
individuals can call for information) to ensure that you can obtain
the health care services that you  need."
   (2) Require that each Medi-Cal managed care plan provide the
statement described in paragraph (1), in at least 12-point boldface
type at the beginning of each provider directory.
   (3) Require that each Medi-Cal managed care plan place the
statement described in paragraph (1) in a prominent location on any
provider directory posted on the plan's website, if any, and include
this statement in a conspicuous place in the plan's evidence of
coverage and disclosure forms, if any.
   (4) Require that the statement described in paragraph (1) be
included in the health care option activities described in Sections
14016.5, 14087.305, subdivision (e) of Section 14089, and paragraph
(2) of subdivision (f) of Section 14408.
   (5) Require each county organized health system to provide to
Medi-Cal beneficiaries the statement described in paragraph (1).
This statement shall be provided in writing in at least 12-point
boldface type prior to enrollment, prior to selection of a primary
care provider, and  on an annual basis.
   (6) Ensure that the statement described in paragraph (1) is
provided to any other Medi-Cal managed care beneficiary who would not
receive the statement under the provisions of paragraphs (2) to (5),
inclusive.  This statement shall be provided in writing in at least
12-point boldface type prior to enrollment, prior to selection of a
primary care provider, and  on an annual basis.
   (c) The requirement to provide the statement described in
paragraph (1) of subdivision (b) shall apply to Medi-Cal managed care
programs, including, but not limited to, the following programs:
   (1) In areas where the department is contracting with persons or
entities that are contracting with, or governed, owned, or operated
by, either a county board of supervisors or a county special
commission, or a county health authority, operating under Article 2.8
(commencing with Section 14087.5) or Article 7 (commencing with
Section 14490) of Chapter 8, or Chapter 3 (commencing with Section
101675) of Part 4 of Division 101 of the Health and Safety Code.
   (2) In areas specified by the director for expansion of the
Medi-Cal managed care program under Section 14087.3, including where
the department is contracting with prepaid health plans, including
prepaid health plans that are contracting with, governed, owned, or
operated by a county board of supervisors, a county special
commission or county health authority authorized by Sections 14018.7,
14087.31, 14087.316, 14087.35, 14087.36, 14087.38, and 14087.9605.
   (3) Where the department has entered into contracts with prepaid
health plans or primary care case management providers pursuant to
Article 2.9 (commencing with Section 14088) and Chapter 8 (commencing
with Section 14200).
   (4) Where the department or the California Medical Assistance
Commission has entered into contracts with any persons or entities
pursuant to Section 14087.47, Article 2.91 (commencing with Section
14089), or Article 2.97 (commencing with Section 14093).
   (d) A Medi-Cal managed care plan shall not be required to provide
the statement described in paragraph (1) of subdivision (b) in a
service area in which none of the hospitals, health facilities,
clinics, medical groups, or independent practice associations with
which it contracts limit or restrict any of the reproductive services
described in the statement.
   (e) This section shall not apply to specialized health care
service plans.
14016.9.  Where determined to be cost effective, the department
shall utilize the earnings clearance system to verify the eligibility
of persons who have applied for or are receiving benefits pursuant
to Sections 14005.4 and 14005.7.
14016.10.  The department shall implement the federal requirement
under Section 4603 of the Omnibus Budget Reconciliation Act of 1990
(P.L.  101 -508) which provides for the continuity of Medi-Cal
coverage during pregnancy and the post partum period for pregnant
women who were certified as Medi-Cal eligible.
14017.  On a regional pilot project basis, the department may issue
an identification card to a person eligible for Medi-Cal program
benefits under Section 14005.1, 14005.4, or 14005.7 who is certified,
but is not in possession of a valid California driver's license or
identification card issued by the Department of Motor Vehicles.  The
identification card shall contain his or her picture, social security
number, identifying characteristics, and signature.  This provision
shall not apply to:
   (a) Persons age 12 and under.
   (b) Recipients of aid under Title XVI of the Social Security Act.
   (c) Persons in long-term institutional status.
14017.1.  The Joint Legislative Audit Committee shall conduct an
audit of one or more county eligibility departments.
14017.5.  The department shall not issue identification cards to
Medi-Cal recipients on a statewide basis until (1) a pilot project
has been completed which indicates that the General Fund savings from
reduced unauthorized use of Medi-Cal cards more than offsets the
costs of issuing the identification cards, and (2) the Legislature
has specifically appropriated the funds necessary to issue
identification cards to Medi-Cal beneficiaries.
   If identification cards are issued by the department on a pilot
project or statewide basis, the department shall notify providers
that current Medi-Cal beneficiaries have been issued identification
cards in accordance with Section 14017.  At that time, it shall be
the responsibility of the provider prior to rendering nonemergency
Medi-Cal reimbursable services to persons presenting themselves as
Medi-Cal beneficiaries to verify the person's identity by matching
the name and signature on their identification card issued by the
department or their valid California driver's license or California
identification card issued by the Department of Motor Vehicles,
against a signature executed at the time of service and further by
visually verifying their likeness to the photograph on the
identification card or driver's license.  If the provider complies in
good faith, he or she shall not be held responsible by having
payments withheld by the state.
14017.6.  For the purposes of this chapter, all references to "the
Medi-Cal card," identified in Section 14017.8, shall be deemed to
also be a reference to the benefits identification card, identified
in Section 14017.7.
14017.7.  (a) In addition to the issuance of Medi-Cal cards,
pursuant to Section 14017.8, the department may issue a benefits
identification card for the purpose of identifying an individual who
has been determined eligible for health care benefits under this
chapter or health care benefits under another health care program
administered by the department, or both.
   (b) In no event shall a benefits identification card be issued to
an individual described in subdivision (a) unless appropriate and
adequate safeguards have been implemented to ensure all of the
following:
   (1) If the individual has been determined eligible for health care
benefits under another health care program administered by the
department, that health care program pays for any and all health care
benefits delivered to the individual by that health care program.
   (2) State funds appropriated to or federal medicaid financial
participation claimed by the Medi-Cal program shall only be used for
the delivery of health care benefits authorized pursuant to this
chapter.
   (c) The individual described in subdivision (a) may present the
benefits identification card to obtain health care benefits for which
that individual has been determined eligible under this chapter, or
health care benefits under another health care program administered
by the department, or both.
   (d) Where applicable, all laws, regulations, restrictions,
conditions, and terms of participation regarding the possession,
billing, and use of Medi-Cal cards shall also apply to a benefits
identification card.
   (e) For the purposes of this section, "benefits" includes
medically necessary services, goods, supplies, or merchandise.
14017.8.  Each person eligible under Section 14005.1 and each person
eligible under Section 14005.4 or 14005.7 who is certified eligible
shall be provided, by the department, with a Medi-Cal card certifying
his or her status, identification number, expiration date and his or
her entitlements, insofar as these do not require specific prior
authorization.  The department shall determine the form of the
Medi-Cal card.  The cards shall be for a term as determined by the
department and, unless canceled for cause, shall entitle individuals
to care and service as indicated.  Cause for cancellation shall exist
when the person dies, loses state residence, is found to be
ineligible, or has been issued a new Medi-Cal card.
14018.  The Medi-Cal card shall be authorization for payment for
health care services rendered, during and subsequent to the month of
application of a person eligible under Section 14005.1, or a person
eligible under Section 14005.4 or 14005.7 who is certified by the
department.
   The Medi-Cal card shall be signed and dated in the space provided
on the card by the beneficiary upon receipt of the card and prior to
presentation of the card for any service.  This provision shall not
apply to:
   (a) Persons 17 years of age and under.
   (b) Persons in long-term care.
14018.1.  The department shall prospectively notify a Medi-Cal
managed care plan of the date of the regularly scheduled annual
redetermination of a Medi-Cal beneficiary in a disabled aid category,
who is enrolled in that plan and where eligibility redetermination
is the responsibility of the department. Nothing in this section
shall provide a beneficiary with additional Medi-Cal coverage due to
the department's failure to provide this notice.
14018.2.  (a) Reimbursement shall not be denied to any qualified
health care provider for care rendered to an eligible Medi-Cal
beneficiary for the sole reason that a proof of eligibility label
does not accompany the bill.
   Proof of eligibility labels may, however, continue to be used as
such and shall be made available to an eligible Medi-Cal beneficiary
through the local office which has determined the person's
eligibility or through the department.  The  provider may submit
machine-reproduced copies of the beneficiary Medi-Cal card for
billing purposes as long as the copy is made from the original
unaltered Medi-Cal card under circumstances controlled by the
provider, for example, on the premises of the provider with copying
equipment controlled by the provider.
   (b) It shall remain the responsibility of a Medi-Cal beneficiary
to provide information and evidence of Medi-Cal eligibility,
restrictions on the eligibility, and non-Medi-Cal health coverage, to
that person's health care providers, if this information is
requested by those providers prior to rendering services to that
beneficiary.
   (c) It shall be the responsibility of the provider prior to
rendering Medi-Cal reimbursable services to persons presenting
themselves as Medi-Cal beneficiaries to make a good faith effort to
verify the person's identity, if the person is not known to the
provider, by matching the name and signature on his or her Medi-Cal
card against the signature on a valid California driver's license, or
California identification card issued by the Department of Motor
Vehicles, or another type of picture identification card or other
credible document of identification.  When the provider verifies the
beneficiary's identity with a signed Medi-Cal card and one of the
documents described above, the state will deem this to be a good
faith effort.  If the provider does not make a good faith effort of
reasonable identification prior to rendering Medi-Cal reimbursable
services and renders services to a presenting person who is
ineligible for those Medi-Cal services, payment for those services
may later be disallowed.
   This provision shall not apply to:
   (1) Persons 17 years of age and under.
   (2) Persons in long-term care.
   (3) Persons receiving emergency services.
   (d) Notwithstanding subdivision (b) of this section, county
welfare departments may provide Medi-Cal eligibility information to
other governmental agencies and their designated agents as necessary
for proper administration of the Medi-Cal program.
14018.4.  (a) Reimbursement shall not be denied to any hospital,
licensed primary care clinic, or long-term health care facility as
defined in Section 1326 of the Health and Safety Code for care
rendered to an eligible Medi-Cal beneficiary for the sole reason that
a proof of eligibility label does not accompany the bill, so long as
the claim includes other appropriate documentation of eligibility.
   (b) The director shall require county welfare departments to
issue, upon the request of a hospital, licensed primary care clinic,
or long-term health care facility as defined in Section 1326 of the
Health and Safety Code providing care to an eligible Medi-Cal
beneficiary, replacement Medi-Cal proof of eligibility labels or
other appropriate documentation of eligibility to the requester, if
all of the following conditions are met:
   (1) The hospital, licensed primary care clinic, or long-term
health care facility as defined in Section 1326 of the Health and
Safety Code attempted to obtain a label from the beneficiary at the
time the service was provided.
   (2) The hospital, licensed primary care clinic, or long-term
health care facility as defined in Section 1326 of the Health and
Safety Code made a subsequent attempt to obtain a label or other
appropriate documentation from the beneficiary.
   (c) Notwithstanding subdivision (a), the director shall require
that the replacement proof of eligibility label or other appropriate
documentation of eligibility provided pursuant to subdivision (b)
accompany the bill of the hospital, the licensed primary care clinic,
or the long-term health care facility as defined in Section 1326 of
the Health and Safety Code.
   (d) This section shall remain in effect only until both the
Secretary of the Senate and the Chief Clerk of the Assembly have
received certification by registered mail from the Director of Health
Services, that the automated eligibility verification system
required by Section 14042 is operative for all counties and has been
demonstrated to be accurate for each county at the 97-percent level
as required by Section 14042 and as of that date is repealed.
14018.5.  Notwithstanding any other provision of law, Section 3275
of the Civil Code does not apply to Medi-Cal reimbursement or prior
authorization.
14018.7.  (a) Notwithstanding any other provision of law, neither a
member of the governing body of the commission nor a member of any
advisory panel to the governing body shall be deemed to be interested
in a contract entered into by the commission within the meaning of
Article 4 (commencing with Section 1090) of Chapter 1 of Division 4
of Title 1 of the Government Code if all of the following apply:
   (1) The board of supervisors or the governing body appointed the
individual to represent the interests of physicians, health care
practitioners, hospitals, pharmacies, or other health care
organizations.
   (2) The contract authorizes the individual or the organization the
individual represents to provide services under the local
initiative.
   (3) The contract contains substantially the same terms and
conditions as contracts entered into with other individuals or
organizations that the individual was appointed to represent.
   (4) The individual does not influence or attempt to influence any
advisory panel, the governing body, or any member of the governing
body to enter into the contract.
   (5) The individual discloses the interest to the governing body
and the advisory panel, if applicable, and abstains from voting on
the contract.
   (6) The governing body and the advisory panel, if applicable,
notes the disclosure and abstention in its official records and
authorizes the contract in good faith by a vote of its membership
sufficient for that purpose without counting the vote of the
individual.
   (b) (1) For purposes of this section, "commission" means a
nonprofit corporation established in Kern County to operate the local
health plan and other health care programs owned by, or operated in,
Kern County.
   (2) The commission shall be considered a public entity for
purposes of Division 3.6 (commencing with Section 810) of Title 1 of
the Government Code.
   (c) For purposes of this section, "governing body" means the board
of directors of the nonprofit corporation established in Kern
County, and "board of supervisors" means the Kern County Board of
Supervisors.
   (d) The commission may enter into agreements under Chapter 5
(commencing with Section 6500) of Division 7 of Title 1 of the
Government Code.
14019.  Notwithstanding the provisions of Section 14018, except as
provided in Sections 14019.1 and 14019.6, a Medi-Cal card shall be
authorization for payment for health care services rendered, under
conditions prescribed by the director and to the extent required by
federal law, during any of the three months immediately prior to the
month in which application was made, and for which such person would
have otherwise been eligible.
14019.3.  (a) A beneficiary or any person on behalf of a beneficiary
who has paid for medically necessary health care services, otherwise
covered by the Medi-Cal program, received by the beneficiary shall
be entitled to a return from a provider or directly from the
department of any part of the payment that meets all of the
following:
   (1) Was rendered during the 90-day period prior to application
for, his or her Medi-Cal card, or after application for but prior to
the issuance of, his or her Medi-Cal card, for which the card
authorizes payment under Section 14018 or 14019, or was charged to
the beneficiary as excess copayment during the period after issuance
of his or her Medi-Cal card.
   (2) Is not payable by a third party under contractual or other
legal entitlement.
   (3) Was not used to satisfy his or her paid or obligated liability
for health care services or to establish eligibility.
   (b) To the extent permitted by federal law, whether or not a
facility actually evicts a beneficiary, a beneficiary who may validly
be evicted pursuant to Section 1439.7 of the Health and Safety Code,
and who has received and paid for health care services otherwise
covered by the Medi-Cal program shall not be entitled to the return
from a provider of any part of the payment for which service was
rendered during any period prior to the date upon which knowledge is
acquired by a provider of the application of a beneficiary for
Medi-Cal or the date of application for Medi-Cal, whichever is later.
   (c) Upon presentation of the Medi-Cal card or other proof of
eligibility, a provider shall submit a Medi-Cal claim for
reimbursement, subject to the rules and regulations of the Medi-Cal
program.
   (d) Notwithstanding subdivision (c), payment received from the
state in accordance with Medi-Cal fee structures shall constitute
payment in full, except that a provider, after making a full refund
to the department of any Medi-Cal payments received for services, may
recover all provider fees to the extent that any other contractual
entitlement, including, but not limited to, a private group or
indemnification insurance program, is obligated to pay the charges
for the care provided a beneficiary.
   (e) A provider shall return any and all payments made by a
beneficiary, or any person on behalf of a beneficiary, other than a
third party obligated to pay charges by reason of a beneficiary's
other contractual or legal entitlement for Medi-Cal program covered
services upon receipt of Medi-Cal payment.
   (f) To the extent permitted by federal law, the department shall
waive overpayments made to a pharmacy provider that would otherwise
be reimbursable to the department for prescription drugs returned to
a pharmacy provider from a nursing facility upon discontinuation of
the drug therapy or death of a beneficiary.
   (g) The department shall ensure payment to a beneficiary from a
provider.  A provider shall be notified in writing by the department
when a beneficiary has submitted a claim to the department for
reimbursement of services provided during the periods specified in
paragraph (1) of subdivision (a).  If a provider is not currently
enrolled in the Medi-Cal program, the department shall assist in that
enrollment.  Enrollment in the Medi-Cal program may be made
retroactive to the date the service was rendered.
   (h) If a provider fails or refuses to reimburse a beneficiary for
services provided during the periods specified in paragraph (1) of
subdivision (a), within 90 days of receipt by the department of a
written request by a beneficiary or a representative of a
beneficiary, the department may take enforcement action that may
include, but shall not be limited to, any or all of the following:
   (1) Withholding of future provider payments.
   (2) Suspension of a provider from participation in the Medi-Cal
program.
   (3) Recoupment of funds from a provider.
   (i) If a provider fails or refuses to reimburse a beneficiary
within 90 days after receipt by the department of a written request
from a beneficiary or a representative of a beneficiary, the
department shall directly reimburse a beneficiary for medically
necessary health care expenses incurred during the periods specified
in paragraph (1) of subdivision (a).  The department shall reimburse
a beneficiary only to the extent that federal financial participation
is available and only when the claim meets all of the following
criteria:
   (1) The service was a covered benefit under the Medi-Cal program.
   (2) The provider was an enrolled Medi-Cal provider at the time the
service was rendered.
   (3) The service was ordered by a health care provider, within the
scope of his or her practice.
   (4) The beneficiary is eligible for reimbursement, as specified in
subdivision (a).
   (5) The reimbursement shall be the amount paid by the beneficiary,
not to exceed the rate established for that service under the
Medi-Cal program.
   (j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of the Government Code, this section may be
implemented with a provider bulletin or similar notification, without
any further regulatory action.
14019.4.  (a) Any provider of health care services who obtains a
label or copy from the Medi-Cal card or other proof of eligibility
pursuant to this chapter shall not seek reimbursement nor attempt to
obtain payment for the cost of those covered health care services
from the eligible applicant or recipient, or any person other than
the department  or a third-party payor who provides a contractual or
legal entitlement to health care services.
   (b) Whenever a service or set of services rendered to a Medi-Cal
beneficiary results in the submission of a claim in excess of five
hundred dollars ($500), and the beneficiary has given the provider
proof of eligibility to receive the service or services, the provider
shall issue the beneficiary a receipt to document that appropriate
proof of eligibility has been provided.  The form and content of
those receipts shall be determined by the provider but shall be
sufficient to comply with the intent of this subdivision.  Nursing
facilities and all categories of intermediate care facilities for the
developmentally disabled are exempt from the requirements of this
subdivision.
14019.5.  Nothing in this chapter shall be construed as imposing any
control over the management of any medical or health care facility,
except that each such facility shall be required to comply with
reasonable standards for certification to participate in the program
provided by this chapter.
14019.6.  Notwithstanding any other provision of law, no person,
whose property reserve exceeds the property limit, may establish
eligibility for any of the three months immediately prior to the
month in which application was made, by spenddown of such excess
property.
14019.7.  (a) Notwithstanding Section 14019.4 and if permitted by
federal law, a relative of a skilled nursing facility resident who is
a beneficiary under this chapter may pay an additional amount to the
facility to enable the resident to obtain requested noncovered
services, such as a private room, telephone, or television, or for
bed hold days that exceed a period paid for under the state plan.
   (b) The additional charge for requested noncovered services shall
not exceed the amount charged to private pay residents.  The
additional charge for bed hold days shall not exceed the rate paid
for by the Medi-Cal program for a covered bed hold day.  The
additional charge for a private room shall not exceed the difference
between the private pay rate for a semiprivate room and a private
room.
   (c) Prior to accepting supplemental payment for holding a bed for
a resident in a facility, a facility shall disclose to the relative
the resident's right under federal law to be readmitted without
charge upon the first availability of a bed in a semiprivate room in
that facility, other state and federal laws regarding bed hold
rights, the average number of bed vacancies at that facility for the
past month, and the current number of bed vacancies.  Written
information regarding bed vacancies shall be provided to the relative
at the first available opportunity.
   (d) The ability of a resident's relative to pay an additional
amount for noncovered services shall not be a condition of admission.
14020.  All sections of this chapter shall remain in operation
during such times as grants-in-aid are provided or made available to
the state on the basis of a state plan approved by the federal
government for medical assistance pursuant to provisions of the
Federal Social Security Act, as amended.
14021.  Notwithstanding any other provision of this chapter, health
care shall include the following mental health services:
   (a) Mental health services provided by a county or a city.
   (b) Mental health services provided in a Short-Doyle community
mental health service or in a community mental health center
organized under the Federal Community Mental Health Centers Act of
1963.  No amount shall be paid for that portion of the total costs of
care and services in a federally funded community mental health
center which may be compensated by the United States government under
the Community Mental Health Centers Act of 1963.  No amount shall be
paid to a Short-Doyle community mental health service or a federally
funded community mental health center unless the Short-Doyle
community mental health service or the federally funded community
mental health center participates in a county or city mental health
performance contract pursuant to Section 5650.
   (c) Outpatient drug abuse services under the jurisdiction of the
State Department of Alcohol and Drug Programs provided by a county
provider certified under this chapter or a private provider certified
under this chapter which has an approved contract with the county or
with the State Department of Alcohol and Drug Programs to provide
covered drug abuse services.
   (d) Inpatient hospital services in an institution for mental
diseases to persons of all ages, provided that the institution for
mental diseases is certified as a psychiatric hospital under Title
XVIII of the federal Social Security Act and regulations issued
thereunder.
   Notwithstanding Section 14157, no money in the State Health Care
Deposit Fund shall be expended for the purposes of this section
unless the Legislature specifically appropriates money for the
purposes of this section.
   The amendment of this subdivision enacted at the 1972 Regular
Session of the Legislature does not constitute a change in, but is
declaratory of, the preexisting law.
   (e) (1) Other diagnostic, screening, preventive, or remedial
rehabilitative services for the maximum restoration of an individual
to the best possible functional level.
   (2) Paragraph (1) includes any medical or remedial services
provided in a facility, home, or other setting, that are recommended
by a physician or other licensed practitioner of the healing arts
within the scope of his or her practice under state law.
14021.3.  The department shall amend the  state plan for medical
assistance under Medicaid pursuant to Section 1915(g) of Title 19 of
the Social Security Act, as amended by Public Law 99-272 (42 U.S.C.
Sec. 1396n(g)), to add case management services as a covered benefit
under the Short-Doyle/Medi-Cal program, and shall submit the plan for
federal approval by  December 31, 1988, or, if the plan has not been
submitted by that date, shall submit a letter to the Legislature by
that date explaining the circumstances delaying the plan's
submission.
   Upon federal approval for federal financial assistance, the
department, in consultation with the State Department of Mental
Health, shall define case management services, shall establish the
standards under which case management services qualify as a
Short-Doyle/Medi-Cal reimbursable service, and shall develop an
appropriate rate of reimbursement, subject  to utilization controls.
   It is the intent of the Legislature that at least 50 percent of
the total state dollars that are offset as a result of the federal
funds received for case management services be redirected to services
for those persons identified in Section 14132.44 and that the
remainder of these funds be redirected to services under the
jurisdiction of the Health and Welfare Agency for persons other than
those persons identified in Section 14132.44.
14021.3.  The department shall amend the state plan for medical
assistance under Medicaid pursuant to Section 1915(g) of Title 19 of
the Social Security Act, as amended by Public Law 99-272 (42 U.S.C.
Section 1396n(g)), to add case management services as a benefit under
the Short-Doyle Medi-Cal program for persons served by the State
Department of Mental Health and Short-Doyle mental health programs.
14021.35.  (a) The State Department of Alcohol and Drug Programs
shall prepare amendments to the medicaid state plan in order to
obtain federal financial participation for Drug-Medi-Cal Program
provisions contained in subdivision (b) of Section 11758.46 of the
Health and Safety Code.  The department shall review the recommended
state plan amendments prepared by the State Department of Alcohol and
Drug Programs.  If the department determines that the recommended
state plan amendments satisfy federal requirements for federal
financial participation, the department shall submit an amendment to
the medicaid state plan for medical assistance under Section 1915(g)
of the federal Social Security Act (Title 42 U.S.C. Sec. 1396n(g)),
to implement Drug-Medi-Cal Program provisions contained in
subdivision (b) of Section 11758.46 of the Health and Safety Code.
   (b) Upon federal approval for federal financial assistance, the
department, in consultation with the State Department of Alcohol and
Drug Programs, shall define the new services, as needed, shall
establish the standards under which those services qualify as
Drug-Medi-Cal reimbursable services, and shall develop appropriate
rates of reimbursement for those services, subject to utilization
controls.
14021.4.  (a) The State Department of Mental Health shall prepare by
January 15, 1991, amendments to California's plan for federal
Medi-Cal grants for medical assistance programs, pursuant to
Subchapter XIX (commencing with Section 1396) of Title 42 of the
United States Code, to accomplish the following objectives:
   (1) Expansion of the location and type of therapeutic services
offered to the mentally ill under Medi-Cal by the category of "other
diagnostic, screening, preventative, and rehabilitative services"
which is available to states under the Social Security Act (42 U.S.C.
Sec. 1396d(a)(13); 42 C.F.R.  440.130).
   (2) Expansion of federal financial participation in the costs of
community mental health services provided by local Short-Doyle
community mental health programs or under contract to local
Short-Doyle community mental health programs.
   (3) Expansion of the location where reimbursable Short-Doyle
Medi-Cal mental health services can be provided, including home,
school, and community based sites.
   (4) Expansion of federal financial participation for services
which meet the rehabilitation needs of severely mentally ill
consumers, including, but not limited to, medication management,
functional rehabilitation assessments of clients, and rehabilitative
services which include remedial services directed at restoration to
the highest possible functional level for persons with psychiatric
disabilities and maximum reduction of symptoms of mental illness.
   (5) Improvement of fiscal systems and accountability structures
for Short-Doyle Medi-Cal and Short-Doyle costs and rates, with the
goal of achieving federal fiscal requirements.
   (b) This Short-Doyle Medi-Cal state plan revision shall be
completed with review and comments by the California Conference of
Local Mental Health Directors and other appropriate groups.  The
addition of the rehabilitative option shall be limited to Short-Doyle
providers certified to provide Medi-Cal under this option.
   (c) The State Department of Health Services shall review the state
plan revision for medicaid services as recommended by the State
Department of Mental Health.  If the state plan amendment satisfies
published federal requirements for these amendments and if the State
Department of Health Services has approved and submitted to the
Health Care Financing Administration a plan of correction for audit
issues identified for the Short-Doyle Medi-Cal program, then the
department shall promptly pursue federal adoption of the state plan
revision.  If the State Department of Health Services does not
recommend adoption of the revision, it shall report on the financial
and programmatic implications of the proposal and the reasons for the
rejection to the Joint Legislative Budget Committee by July 1, 1991.
   (d) The state and local funds required to match federal financial
participation shall include, but not be limited to, Short-Doyle and
county matching funds.  Additional General Fund moneys for this
purpose shall be subject to appropriation in the annual Budget Act.
   (e) It is the intent of the Legislature that the rehabilitation
option of the state medicaid plan be implemented to expand and
provide flexibility to treatment services and to increase the federal
participation without increasing the costs to the General Fund.
   (f) It is the intent of the Legislature that addition of the
rehabilitation option as a Short-Doyle Medi-Cal benefit shall become
operative only after the Health Care Financing Administration has
reviewed and approved the state plan revision submitted by the State
Department of Health Services, a plan of correction approved by the
department for audit issues identified for the Short-Doyle Medi-Cal
program has been submitted, and the requirements of this section have
been fully satisfied.
   (g) If the Medi-Cal state plan revision required by this section
is approved by the State Department of Health Services, and submitted
for federal approval, the State Department of Mental Health shall
review and revise the quality assurance standards and guidelines
required by Article 5 (commencing with Section 4070) of Chapter 2 of
Division 4 to meet the necessary standards to assure that quality
services are delivered to the eligible population.  This review shall
include, but not be limited to, appropriate use of mental health
professionals, including psychiatrists, in the treatment and
rehabilitation of clients under this model. The existing quality
assurance standards and guidelines shall remain in effect until the
adoption of the new quality assurance standards and guidelines.
   (h) Consistent with services offered to persons who are mentally
ill under the Medi-Cal program, as required by this section, it is
the intent of the Legislature for the State Department of Mental
Health, working collaboratively with the department, to include care
and treatment of persons with mental disorders who are eligible for
the Medi-Cal program in facilities with a bed capacity of 16 beds or
less.
14021.5.  (a) Notwithstanding any other provision of law, rates for
reimbursing Short-Doyle mental health and drug services allowable
under the Medi-Cal program and rendered to Medi-Cal beneficiaries
under the Short-Doyle program shall continue to be based on the upper
limits allowable under federal law and regulations for services
provided prior to July 1, 1980, on the lower of reasonable cost and
customary charges for services provided July 1, 1980, through June
30, 1982, and on the lowest of reasonable cost, customary charges,
and rates paid by the Short-Doyle program for services provided July
1, 1982, through June 30, 1984.
   (b) The Legislature hereby states and declares that this section
does not constitute a change in, but is declaratory of, existing law
and that rates for reimbursing Short-Doyle mental health and drug
services to Medi-Cal beneficiaries under the Short-Doyle program in
previous fiscal years were based upon the lower of reasonable costs
or customary charges.
   (c) The State Department of Health Services, after consulting with
the State Department of Mental Health and the State Department of
Alcohol and Drug Programs, in regard to their respective programs,
shall promulgate emergency regulations relating to claims submission
and establishing rates and a ratesetting methodology for determining
reimbursement of Short-Doyle mental health and drug services
allowable under the Medi-Cal program and rendered to Medi-Cal
beneficiaries under the State Department of Mental Health and the
State Department of Alcohol and Drug Programs' programs respectively.
   The methodology and rates shall reflect the most recently
completed cost reports and shall be effective commencing July 1,
1984.
   (d) Notwithstanding any other provision of law, rates for
reimbursing Short-Doyle mental health services allowable under the
Medi-Cal program and rendered to Medi-Cal beneficiaries under the
programs administered by the State Department of Mental Health shall
be effective from July 1 through June 30 of the fiscal year in which
these rates are established.
   (e) Notwithstanding any other provision of law, rates for
reimbursing drug services allowable under the Medi-Cal program and
rendered to Medi-Cal beneficiaries under the programs administered by
the State Department of Alcohol and Drug Programs shall be effective
from July 1 through June 30 of the fiscal year in which these rates
are established.
14021.6.  (a) For the fiscal years prior to fiscal year 2004-05, and
subject to the requirements of federal law, the maximum allowable
rates for the Medi-Cal Drug Treatment Program shall be determined by
computing the median rate from available cost data by modality from
the fiscal year that is two years prior to the year for which the
rate is being established.
   (b) (1) For the fiscal year 2007-08, and subsequent fiscal years,
and subject to the requirements of federal law, the maximum allowable
rates for the Medi-Cal Drug Treatment Program shall be determined by
computing the median rate from the most recently completed cost
reports, by specific service codes that are consistent with the
federal Health Insurance Portability and Accountability Act of 1996
(42 U.S.C. Sec. 300gg).
   (2) For the fiscal years 2005-06 and 2006-07, if the State
Department of Health Services and the Department of Alcohol and Drug
Programs determine that reasonably reliable and complete cost report
data are available, the methodology specified in this subdivision
shall be applied to either or both of those years.  If reasonably
reliable and complete cost report data are not available, the State
Department of Health Services and the Department of Alcohol and Drug
Programs shall establish rates for either or both of those years
based upon the usual, customary, and reasonable charge for the
services to be provided, as these two departments may determine in
their discretion.  This subdivision is not intended to modify
subdivision (k) of Section 11758.46 of the Health and Safety Code,
that requires certain providers to submit performance reports.
   (c) Notwithstanding subdivision (a), for the 1996-97 fiscal year,
the rates for nonperinatal outpatient methadone maintenance services
shall be set at the rate established for the 1995-96 fiscal year.
   (d) Notwithstanding subdivision (a), the maximum allowable rate
for group outpatient drug free services shall be set on a per person
basis.  A group shall consist of a minimum of four and a maximum of
10 individuals, at least one of which shall be a Medi-Cal eligible
beneficiary.
   (e) The department shall develop individual and group rates for
extensive counseling for outpatient drug free treatment, based on a
50-minute individual or a 90-minute group hour, not to exceed the
total rate established for subdivision (d).
   (f) The department may adopt regulations as necessary to implement
subdivisions (a), (b), and (c), or to implement cost containment
procedures.  These regulations may be adopted as emergency
regulations in accordance with Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
The adoption of these emergency regulations shall be deemed an
emergency necessary for the immediate preservation of the public
peace, health and safety, or general welfare.
14021.7.  (a) The department shall amend the state plan for medical
assistance under the Medicaid program pursuant to subdivision (g) of
Section 1396n of Title 42 of the United States Code, to add targeted
case management services for those pregnant and parenting adolescents
and their children, targeted by the department, in those localities
served on January 1, 1991, by the Adolescent Family Life Program
(Article 1 (commencing with Section 124175) of Chapter 4 of Part 2 of
Division 106 of the Health and Safety Code), as a covered benefit
under the Medi-Cal program.  The department shall submit the amended
plan for federal approval by April 1, 1991.
   (b) For purposes of this section, the term "targeted case
management services" shall be defined as those services provided to
pregnant and parenting adolescents pursuant to Article 1 (commencing
with Section 124175) of Chapter 4 of Part 2 of Division 106 of the
Health and Safety Code.
   (c) Upon federal approval for federal financial assistance, the
department shall establish the standards under which targeted case
management services qualify as a Medi-Cal reimbursable service,
subject to the availability of funding through the budget process,
and shall develop an appropriate rate of reimbursement, subject to
utilization controls.
14021.8.  The department may not utilize any information regarding
whether a beneficiary's psychiatric inpatient admission was made on a
voluntary or involuntary basis for the purpose of determining
eligibility for Medi-Cal claim reimbursement.
14022.  (a) This section shall be known as the "Medi-Cal Conflict of
Interest Law."
   It is the intent of the Legislature that provisions be made for
disclosure of the interests of providers of service in the services,
facilities and organizations to which they refer Medi-Cal recipients
so that it is possible to determine the extent to which conflicts of
interests may exist because of such referrals.
   (b) As used in this section, the term "referral" means (1) the
referral of a recipient by a provider of service to any other
provider of service; (2) the placement of a recipient by a provider
of service in any facility; or (3) the obtaining, requesting,
ordering or prescribing of services or supplies by a provider of
service on behalf of a recipient from any other provider of service.
   As used in this section, the term "immediate family" includes the
spouse and children of the provider of service, the parents of the
provider of service and his spouse, and the spouses of the children
of the provider of service.
   (c) No payment under this chapter shall be made to a provider of
service or to any facility or organization in which he or his
immediate family has a significant beneficial interest, for services
rendered in connection with any referral of a recipient, unless there
is on file with the director and the Advisory Health Council a
statement of the nature and extent of such interest.
   This section shall become operative only upon the date of which
Section 1902(a)(4)(C) of the federal Social Security Act, as added by
Public Law 95-559 is repealed, held invalid by a court of appeal, or
otherwise made inoperative.
14022.1.  Any nursing facility or any category of intermediate care
facility for the developmentally disabled participating in the
Medi-Cal program shall supply to the department full and complete
information as to the identity (a) of each person having, directly or
indirectly, an ownership interest of 10 percent or more in the
facility, or, who is owner, in whole or part, of any mortgage, deed
of trust, note, or other obligation secured, in whole or part, by the
facility, or any of the property or assets of the facility, (b) in
case a facility is organized as a corporation, of each officer and
director of the corporation, and (c) in case a facility is organized
as a partnership, of each partner; and shall promptly report any
changes which would affect the current accuracy of the information so
required to be supplied.
14022.3.  Long-term health care facilities shall reveal to
applicants for admission, or their designated representatives, orally
and in writing and prior to admission, whether the facility
participates in the Medi-Cal program, and the circumstances under
which the law permits a Medi-Cal recipient to be transferred
involuntarily.
14022.4.  (a) Any nursing facility or any category of intermediate
care facility for the developmentally disabled currently certified to
participate in the Medi-Cal program may not voluntarily withdraw
from the program unless all of the following conditions are met:
   (1) The facility shall file with the department a notice of intent
to withdraw from the Medi-Cal program.
   (2) Except for patients to be transferred or discharged only for
medical reasons, or for patients' welfare or that of other patients,
or for nonpayment for his or her stay, the facility shall not
subsequently evict any Medi-Cal recipient or private pay patient
residing in the facility at the time the notice of intent to withdraw
from the Medi-Cal program is filed.
   (3) Patients admitted to the facility on or after the date of the
notice of intent to withdraw from the Medi-Cal program shall be
advised orally and in writing of both the following:
   (A) That the facility intends to withdraw from the Medi-Cal
program.
   (B) That notwithstanding Section 14124.7, the facility is not
required to keep a new resident who converts from private pay to
Medi-Cal.
   (b) Subdivision (a) shall not apply to facilities that have filed,
prior to May 1, 1987, a notice of intent to withdraw from the
Medi-Cal program.
   (c) The department shall notify the appropriate substate ombudsmen
monthly as to which facilities have filed a notice of intent to
withdraw from the Medi-Cal program.  This information shall also be
made available to the public and noted in facility files available in
each district office.
   (d) The facility may formally withdraw from the Medi-Cal program
when all patients residing in the facility at the time the facility
filed the notice of intent to withdraw from the Medi-Cal program no
longer reside in the facility.
   (e) If a facility that has withdrawn as a Medi-Cal provider
pursuant to this section subsequently reapplies to the department to
become a Medi-Cal provider, the department shall require as a
condition of becoming a Medi-Cal provider that the facility enter
into a five-year Medi-Cal provider contract with the department.
   (f) (1) This section shall be inoperative in the event federal law
or federal or state appellate judicial decisions prohibit
implementation or invalidate any part of this section.
   (2) In the event of any occurrence which renders this section
inoperative pursuant to paragraph (1), the department shall within 30
days, report that information to the Legislature.
   (g) (1) This section does not apply to any facility which ceases
operations entirely.
   (2) For purposes of this subdivision, "ceases operations entirely"
means not being in operation for a period of not less than 12
months.
14022.5.  (a) It is the intent of the Legislature to recognize the
challenges and unique dental treatment needs of the developmentally
disabled population that cannot be addressed within the current
structure of benefits, frequency of allowable procedures, and
treatment authorization procedures for assistance programs relating
to dental benefits.
   (b) The department shall work in cooperation with the State
Department of Developmental Services, and in consultation with the
California Dental Association, to provide existing data directly to
the fiscal and policy committees of the Legislature specified in
subdivision (c), by April 1, 2003, describing the characteristics of
dental services received by Medi-Cal beneficiaries who are eligible
to receive dental services under the Lanterman Developmental
Disability Services Act (Division 4.5 (commencing with Section
4500)), who can be easily identified, including, but not limited to,
the frequency of utilization of dental procedures and services, and
types of dental procedures and services.
   (c) The committees to whom the data shall be provided include all
of the following:
   (1) The Senate Committee on Health and Human Services.
   (2) The Senate Budget Subcommittee Number 3 on Health, Human
Services, Labor, and Veterans Affairs.
   (3) The Assembly Committee on Health.
   (4) The Assembly Committee on Human Services.
   (5) The Assembly Budget Subcommittee Number 1 on Health and Human
Services.
   (d) It is the intent of the Legislature that the information
described in subdivision (b) will be used to identify possible
program modifications that are more appropriate to serve the
population described in subdivision (b), and that are more efficient
and more effective in serving this population, while remaining
cost-neutral.
14023.  (a) Any applicant for coverage under this chapter who at the
time of application has any other contractual or legal entitlement
to any health care service defined in Section 14053, and who
willfully fails at that time to disclose the fact of such other
entitlement, or falsely represents that he or she does not have such
other entitlement, is guilty of a misdemeanor.
   (b) Any person eligible under this chapter who, subsequent to the
date of application for such assistance or coverage under this
chapter, acquires any other contractual or legal entitlement to any
health care service defined in Section 14053, and willfully fails or
refuses to give notice thereof to his county welfare department
within 10 days of such acquisition, is guilty of a misdemeanor.
   (c) Any person eligible under this chapter who has any other
contractual or legal entitlement to any health care service defined
in Section 14053, and who knowing that he or she must use such
entitlement first, obtains any such service under Medi-Cal without
first having utilized and exhausted his or her other contractual or
legal entitlement thereto or therefor, is guilty of a misdemeanor.
   (d) Any applicant shall by virtue of becoming eligible under this
chapter have irrevocably assigned the benefits of any contractual or
legal entitlement for health care to the State Director of Health
Services to the extent that the services were paid for under this
chapter.
14023.7.  Any provider of service seeking payment for health care
services for a person eligible for these services under this chapter
shall first seek to obtain payment from any private or public health
insurance coverage to which the person is entitled, where the
provider is aware of this coverage and to the extent the coverage
extends to these services, prior to submitting a claim to the
department for the payment of any unpaid balance for these services.
In the event that a claim submitted to a private or public health
insurer has not been paid within 90 days of billing by the provider,
a claim may be submitted to the department.
14024.  When health care services are provided to a person under
this chapter who at the time the service is provided has any other
contractual or legal entitlement to such services, the director shall
have the right to recover from the person, corporation, or
partnership who owes such entitlement, the amount which would have
been paid to the person entitled thereto, or to a third party in his
behalf, or the value of the service actually provided, if the person
entitled thereto was entitled to services.  The Attorney General may,
to recover under this section, institute and prosecute legal
proceedings against the person, corporation, or partnership owing
such entitlement in the appropriate court in the name of the
director.
   To the extent permitted by federal law and subject to the director'
s prior right to recover upon any contractual or legal entitlement or
other third-party liability for the cost incurred in rendering care,
the provider of services shall remain entitled to recover remaining
unpaid charges to the extent that any third party is obligated to pay
the charges by reason of the beneficiary's other contractual
entitlement.  Any claim shall not be permitted to the extent that the
claim would reduce the director's right to recover pursuant to
Section 14124.78.
   The provider of services shall be required to notify the
department of any potential contractual or legal entitlement or other
third-party liability within 60 days of discovery.  A provider who
has obtained proof of Medi-Cal eligibility and who makes a claim for
payment by any third party shall disclose in the claim that the
patient is a Medi-Cal beneficiary.
14025.  (a) Any person who buys or sells a Medi-Cal card, Medi-Cal
label, or Medi-Cal beneficiary identification number is guilty of a
public offense punishable by imprisonment in the county jail for not
more than one year, or in the state prison, or by a fine not
exceeding five thousand dollars ($5,000), or by both the fine and
imprisonment.
   (b) Any person who barters for the purpose of resale or commercial
exchange a Medi-Cal card, Medi-Cal label, or Medi-Cal beneficiary
identification number is guilty of a public offense punishable by
imprisonment in the county jail for not more than one year, or in the
state prison, or by a fine not exceeding five thousand dollars
($5,000), or by both the fine and imprisonment.
   (c) This section shall not apply to any peace officer or  any
other person working under the peace officer's immediate direction,
supervision, or instruction while investigating Medi-Cal fraud or
other related crimes in the performance of his or her official
duties.
14026.  (a) It is a misdemeanor for a Medi-Cal beneficiary to
furnish, give, or lend his Medi-Cal card or labels to any person
other than a provider of service as required under Medi-Cal
regulations.
   (b) It is a misdemeanor for any person to  use a Medi-Cal card
other than the one which was issued to him or her to obtain health
care services.  This subdivision shall not apply to the use of a
Medi-Cal card of a family member by another family member if the
person using the card is, in fact, eligible under this chapter.
   (c) This section shall not apply to any peace officer while
investigating Medi-Cal fraud or other crimes in performance of his
official duties or to any person working under the peace officer's
immediate direction, supervision, or instruction when such peace
officer has been issued a Medi-Cal card pursuant to Section 14026.5.
14026.5.  (a) The State Director of Health Services may issue
Medi-Cal cards to Medi-Cal fraud investigators for the purpose of
conducting investigations of Medi-Cal fraud, or a violation of the
Medical Practice Act as set forth in Chapter 5 (commencing with
Section 2000) of Division 2 of the Business and Professions Code upon
written request to the State Director of Health Services, or his or
her designee, from the head of the requesting agency stating the
purpose of the investigation.  The request shall be based upon a
specific complaint or information alleging Medi-Cal fraud.  The
request shall be based upon a specific complaint or information from
an outside agency pursuant to its standard procedure for referring
cases to another agency where there is suspicion of Medi-Cal fraud.
   (b) (1) Upon a complaint by any individual alleging information
creating a reasonable suspicion that any person is engaging in
Medi-Cal fraud, the State Director of Health Services shall issue
Medi-Cal cards for the purpose of conducting investigations of
Medi-Cal fraud, or a violation of the Medical Practice Act as set
forth in Chapter 5 (commencing with Section 2000) of Division 2 of
the Business and Professions Code, upon an order of a magistrate
issued upon a showing of reasonable suspicion that the person being
investigated has committed or is committing Medi-Cal fraud or a
violation of the Medical Practice Act as set forth in Chapter 5
(commencing with Section 2000) of Division 2 of the Business and
Professions Code.
   (2) For purposes of this section, "reasonable suspicion" means
that a peace officer subjectively entertains such a suspicion and
that it is objectively reasonable for him or her to do so.  The facts
shall be those that would cause any reasonable peace officer in a
like position drawing when appropriate on his or her training and
experience, to suspect the same criminal activity and the same
involvement by the person in question.  A showing of reasonable
suspicion may be made either by written statement under penalty of
perjury or by oral statement taken under oath, recorded and
transcribed.
   (c) Nothing in this section shall be construed to mean that it is
the exclusive method for conducting investigations for Medi-Cal fraud
or for violations of the Medical Practice Act as set forth in
Chapter 5 (commencing with Section 2000) of Division 2 of the
Business and Professions Code.
   (d) The State Department of Health Services shall report to the
Legislature every six months commencing June 1, 1981, on the
utilization of Medi-Cal cards issued pursuant to this section.  The
report shall include, among other matters, a description of the types
of criminal investigations conducted pursuant thereto.
14027.  (a) The department may designate participating county health
service agencies as health care service providers of home nursing
services, subject to appropriate statutory licensing and
certification requirements.
   (b) Any county designated as a health care provider of home
nursing services pursuant to subdivision (a) shall act as a fiscal
intermediary for the provision of home nursing services and pass
through to the licensed individuals rendering those nursing services,
in total, all Medi-Cal reimbursements received for those nursing
services.
   (c) The Medi-Cal reimbursement rate applicable to nursing services
reimbursed through a designated county health service agency shall
be the current Medi-Cal rate applicable to those services.
   (d) For purposes of this section, "designated provider of home
nursing services" means any participating county health services
agency designated as a provider of home nursing services pursuant to
subdivision (a).
14029.  Whenever a request for services authorized pursuant to
subdivision (s), (t), or (v) of Section 14132 is made to the
department for a child who is being case-managed by the California
Children's Services program, any decision to transfer the child to
the home setting shall be made only in consultation with the
California Children's Services program case manager for the child.