2009 California Insurance Code - Section 12693.98-12694 :: Chapter 16.1. Healthy Families Bridge Benefits Program ...

12693.98.  (a) (1) The Medi-Cal-to-Healthy Families Bridge Benefits
Program is hereby established to provide any child who meets the
criteria set forth in subdivision (b) with a one calendar-month
period of health care benefits in order to provide the child with an
opportunity to apply for the Healthy Families Program established
under Chapter 16 (commencing with Section 12693).
   (2) The Medi-Cal-to-Healthy Families Bridge Benefits Program shall
be administered by the board and the State Department of Health Care
Services.
   (b) (1) Any child who meets all of the following requirements
shall be eligible for one calendar month of Healthy Families benefits
funded by Title XXI of the Social Security Act, known as the State
Children's Health Insurance Program:
   (A) He or she has been receiving, but is no longer eligible for,
full-scope Medi-Cal benefits without a share of cost.
   (B) He or she is eligible for full-scope Medi-Cal benefits with a
share of cost.
   (C) He or she is under 19 years of age at the time he or she is no
longer eligible for full-scope Medi-Cal benefits without a share of
cost.
   (D) He or she has family income at or below 200 percent of the
federal poverty level.
   (E) He or she is not otherwise excluded under the definition of
"targeted low-income child" under subsections (b)(1)(B)(ii), (b)(1)
(C), and (b)(2) of Section 2110 of the Social Security Act (42 U.S.C.
Secs. 1397jj(b)(1)(B)(ii), 1397jj(b)(1)(C), and 1397jj(b)(2)).
   (2) The one calendar month of benefits under this chapter shall
begin on the first day of the month following the last day of the
receipt of benefits without a share of cost.
   (c) The income methodology for determining a child's family
income, as required by paragraph (1) of subdivision (b) shall be the
same methodology used in determining a child's eligibility for the
full scope of Medi-Cal benefits.
   (d) The one calendar-month period of Healthy Families benefits
provided under this chapter shall be identical to the scope of
benefits that the child was receiving under the Medi-Cal program
without a share of cost.
   (e) The one calendar-month period of Healthy Families benefits
provided under this chapter shall only be made available through a
Medi-Cal provider or under a Medi-Cal managed care arrangement or
contract.
   (f) Except as provided in subdivision (j), nothing in this section
shall be construed to provide Healthy Families benefits for more
than a one calendar-month period under any circumstances, including
the failure to apply for benefits under the Healthy Families Program
or the failure to be made aware of the availability of the Healthy
Families Program, unless the circumstances described in subdivision
(b) reoccur.
   (g) (1) This section shall become operative on the first day of
the second month following the effective date of this section,
subject to paragraph (2).
   (2) Under no circumstances shall this section become operative
until, and shall be implemented only to the extent that, all
necessary federal approvals, including approval of any amendments to
the State Child Health Plan have been sought and obtained and federal
financial participation under the federal State Children's Health
Insurance Program, as set forth in Title XXI of the Social Security
Act, has been approved.
   (h) This section shall become inoperative if an unappealable court
decision or judgment determines that any of the following apply:
   (1) The provisions of this section are unconstitutional under the
United States Constitution or the California Constitution.
   (2) The provisions of this section do not comply with the State
Children's Health Insurance Program, as set forth in Title XXI of the
Social Security Act.
   (3) The provisions of this section require that the health care
benefits provided pursuant to this section are required to be
furnished for more than two calendar months.
   (i) If the State Child Health Insurance Program waiver described
in Section 12693.755 is approved, and at the time the waiver is
implemented, the benefits described in this section shall also be
available to persons who meet the eligibility requirements of the
program and are parents of, or, as defined by the board, adults
responsible for, children enrolled to receive coverage under this
part or enrolled to receive full-scope Medi-Cal services with no
share of cost.
   (j) The one month of benefits provided in this section shall be
increased to two months commencing on implementation of the waiver
referred to in Section 12693.755.
   (k) This section shall cease to be implemented on the date that
the Director of Health Care Services executes a declaration stating
that implementation of the Healthy Families Presumptive Eligibility
Program established pursuant to Section 12693.98a has commenced, and
as of that date is repealed.

12693.98a.  (a) (1) The Healthy Families Presumptive Eligibility
Program is hereby established to provide any child who meets the
criteria set forth in subdivision (b) with presumptive eligibility
benefits until the board has determined the child's eligibility for
the Healthy Families Program.
   (2) The Healthy Families Presumptive Eligibility Program shall be
administered by the board.
   (b) (1) Any child who meets both of the following requirements
shall be eligible for presumptive eligibility benefits under the
Healthy Families Presumptive Eligibility Program:
   (A) He or she has been receiving, but is no longer eligible for,
full-scope Medi-Cal benefits without a share of cost, or he or she is
eligible for full-scope Medi-Cal benefits with a share of cost.
   (B) He or she otherwise appears to meet the income eligibility
criteria for the Healthy Families Program.
   (2) The presumptive eligibility benefits under this section shall
begin on the first day of the month following the last day of the
receipt of Medi-Cal benefits without a share of cost. Presumptive
eligibility benefits under this section shall terminate at the end of
the month in which a child's effective date in the Healthy Families
Program begins or the end of the month in which the board determines
that the child is not eligible for the Healthy Families Program. If
the board determines that the child is eligible for the Healthy
Families Program, the board shall enroll the child in the Healthy
Families Program without an interruption in coverage. If the board
determines that the child is ineligible for the Healthy Families
Program, the board shall terminate the child's benefits under the
Healthy Families Presumptive Eligibility Program.
   (c) The income methodology for determining a child's family income
for the purposes of the Healthy Families Presumptive Eligibility
Program, as required by paragraph (1) of subdivision (b), shall be
the same methodology used in determining a child's eligibility for
the full scope of Medi-Cal benefits.
   (d) The scope of presumptive eligibility benefits provided under
the Healthy Families Presumptive Eligibility Program shall be
identical to the scope of benefits that the child was receiving under
the Medi-Cal program without a share of cost.
   (e) The presumptive eligibility benefits provided under this
section shall only be made available through a Medi-Cal provider or
under a Medi-Cal managed care arrangement or contract.
   (f) When an application is forwarded by the county to the Healthy
Families Program, the county shall send the application to the
Healthy Families Program via an electronic application format defined
by the department, provided that the department has implemented the
automated interfaces necessary to accomplish electronic submission of
applications from the county to the Healthy Families Program without
requiring duplicative data entry by the county. The transmission of
the electronic application to the Healthy Families Program shall
occur within the timeframes designated by the department.
   (g) To the extent necessary, the department and the board may
exchange a child's case file solely for the purpose of determining
the child's eligibility for the Medi-Cal program or the Healthy
Families Program, without requiring the family's consent, to the
extent allowed by federal law. Any information, including the child's
case file, shall be kept confidential by the department and the
board pursuant to state and federal law, and it shall be used only
for the determination or continuation of eligibility.
   (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 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.
   (i) This section shall be implemented when the state has sought
and obtained approval of any amendments to its state plan necessary
to implement the changes to this section, pursuant to this act, and
has obtained funding under Title XXI of the Social Security Act (42
U.S.C. Sec. 1397aa et seq.) for the provision of benefits under this
section. Until the changes to this section, made by this act, are
implemented, the Medi-Cal to Healthy Families Bridge Program
established pursuant to Section 12693.98 shall remain in effect.
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.
   (j) Upon implementation of the Healthy Families Presumptive
Eligibility Program pursuant to this section, the Director of Health
Care Services shall execute a declaration, which shall be retained by
the director, stating that implementation of the section has
commenced.

12693.981.  (a) (1) The Healthy Families-to-Medi-Cal Bridge Benefits
Program is hereby established to provide any person enrolled for
coverage under this part who meets the criteria set forth in
subdivision (b) with a two calendar-month period of health care
benefits in order to provide the person with an opportunity to apply
for Medi-Cal.
   (2) The Healthy Families-to-Medi-Cal Bridge Benefits Program shall
be administered by the board.
   (b) (1) Any person who meets all of the following requirements
shall be eligible for two additional calendar months of Healthy
Families benefits:
   (A) He or she has been receiving, but is no longer eligible for,
benefits under the program.
   (B) He or she appears to be income eligible for full-scope
Medi-Cal benefits without a share of cost.
   (2) The two additional calendar months of benefits under this
chapter shall begin on the first day of the month following the last
day of the person's eligibility for benefits under the program.
   (c) The two-calendar-month period of Healthy Families benefits
provided under this chapter shall be identical to the scope of
benefits that the person was receiving under the program.
   (d) Nothing in this section shall be construed to provide Healthy
Families benefits for more than a two calendar-month period under any
circumstances, including the failure to apply for benefits under the
Medi-Cal program or the failure to be made aware of the availability
of the Medi-Cal program unless the circumstances described in
subdivision (b) reoccur.
   (e) This section shall become inoperative if an unappealable court
decision or judgment determines that any of the following apply:
   (1) The provisions of this section are unconstitutional under the
United States Constitution or the California Constitution.
   (2) The provisions of this section do not comply with the State
Children's Health Insurance Program, as set forth in Title XXI of the
federal Social Security Act.
   (3) The provisions of this section require that the health care
benefits provided pursuant to this section are required to be
furnished for more than two calendar months.
   (f) The board shall cease to provide the benefits described in
this section to any additional individuals on the date that the State
Department of Health Care Services implements the presumptive
eligibility program established pursuant to Section 14011.65b of the
Welfare and Institutions Code and the Director of Health Care
Services executes a declaration pursuant to subdivision (d) of that
section stating that the program of presumptive eligibility has
commenced. The board shall consult and coordinate with the State
Department of Health Care Services in implementing presumptive
eligibility under Section 14011.65b of the Welfare and Institutions
Code for these individuals.
   (g) This section shall be repealed six months after the board
ceases to provide benefits to additional individuals pursuant to this
section.

12693.982.  For purposes of this chapter, "Medi-Cal" means the state
health care program established pursuant to Chapter 14 (commencing
with Section 14000) of Part 3 of Division 9 of the Welfare and
Institutions Code.

12694.  (a) The board and the department, in collaboration with
program offices for the California Special Supplemental Food Program
for Women, Infants, and Children (WIC or the WIC program), local WIC
agencies, counties in their capacity of making Medi-Cal eligibility
determinations, advocates, information technology specialists, and
other stakeholders, shall design, promulgate, and implement policies
and procedures for an automated enrollment gateway system developed
by the department and the board that performs, but is not limited to
performing, the following functions:
   (1) To the extent that federal financial participation is
available, allowing children applying to the WIC program to submit a
simple electronic application to simultaneously obtain presumptive
eligibility for Medi-Cal and Healthy Families 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 and apply for enrollment into the Medi-Cal
program or the Healthy Families Program with the consent of their
parent or guardian.
   (2) Modify the existing WIC enrollment system to obtain the
minimum required data for enrollment in Medi-Cal and Healthy Families
in order to provide an electronic transactional platform that is
connected to the simple electronic application referenced in
paragraph (1) and allowing for an interface between that application,
the Medi-Cal Eligibility Data System (MEDS), and the Medi-Cal
program or the Healthy Families Program, as relevant.
   (3) Providing an automated real-time connection with MEDS for the
purpose of checking an applicant's enrollment status.
   (4) Allowing for the electronic transfer of information to the
Medi-Cal program or the Healthy Families Program, as relevant, for
the purpose of making the final eligibility determination.
   (5) Checking, as relevant, available government databases for the
purpose of electronically receiving information that is necessary to
allow the Medi-Cal program or the Healthy Families Program to
complete the eligibility determination. The department and the
Managed Risk Medical Insurance Board shall comply with all applicable
privacy and confidentiality provisions under federal and state law.
   (b) The automated enrollment gateway system shall be constructed
with the capacity to be used by entities operating the WIC program.
   (c) The WIC application process shall be modified to provide an
electronic application described in subdivision (a), which shall
contain the information necessary to apply for the automated
enrollment gateway system, supplemented by information required to
apply for enrollment into the Medi-Cal program or the Healthy
Families Program.
   (d) Benefits for applicants opting to simultaneously obtain
presumptive eligibility for enrollment under this section shall
continue until a final eligibility determination is made for the
Medi-Cal program or the Healthy Families Program pursuant to Section
14011.8 of the Welfare and Institutions Code.
   (e) Operation of the automated enrollment gateway system for the
WIC program shall occur within a timely and appropriate period as
determined by the department and the board, in consultation with the
stakeholders as provided in subdivision (a) subject to a specific
appropriation being provided for that purpose in the Budget Act or in
subsequent legislation. The automated enrollment gateway system
shall comply with all applicable confidentiality and privacy
protection in federal and state law and regulation.
   (f) The WIC program shall collect income and residency information
necessary for the Medi-Cal program and the Healthy Families Program
documentation requirements for applications submitted through the
automated enrollment gateway system. To the extent allowed by the
federal government, the Medi-Cal and Healthy Families programs shall
rely on income information obtained by WIC and upon the income
verification process performed by WIC. The Medi-Cal and Healthy
Families programs shall collect and verify citizenship and
immigration information as required under those programs.
   (g) Consistent with the provisions of this section, the Medi-Cal
and Healthy Families programs may collect additional information
needed to verify eligibility in those programs.
   (h) Counties shall accept and process for a Medi-Cal eligibility
determination applications provided by the WIC gateway system and
ensure timely processing of these applications and a timely
eligibility determination and ending of presumptive eligibility.
   (i) The presumptive eligibility benefits provided under this
section shall be identical to the benefits provided to children who
receive full-scope Medi-Cal benefits without a share of cost, and
shall only be made available through a Medi-Cal provider.
   (j) The confidentiality and privacy protections set forth in
Sections 10850 and 14100.2 of the Welfare and Institutions Code and
all other confidentiality and privacy protections in federal and
state law and regulation shall apply to all children and families
using the automated enrollment gateway system as described in this
section.
   (k) The state shall promote and offer support to the WIC program
for the use of the simple electronic application and the automated
enrollment gateway system.
   (l) The board shall seek approval of any amendments to the state
plan necessary to implement this section, in accordance with Title
XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security
Act.
   (m) The department shall seek approval of any amendments to the
state plan necessary to implement this section, in accordance with
Title XIX (42 U.S.C. 1396 et seq.) of the federal Social Security
Act. Notwithstanding any other provision of law, only when all
necessary federal approvals have been obtained shall this section be
implemented.