Medi-Cal: redetermination: developmental disability.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services (department) to contract with regional centers to provide services and supports to individuals with developmental disabilities, or consumers, as defined, and their families. Existing law requires an individual to disclose to a regional center during an assessment whether he or she is eligible to receive health benefits, including under Medi-Cal. Existing law requires the department to maintain the confidentiality of information and records obtained in the course of providing intake, assessment, and services, as specified. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services (DHCS) and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law generally requires a county to redetermine a Medi-Cal beneficiary's eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiary's circumstances that may affect his or her eligibility for Medi-Cal benefits. This bill would instead require a consumer of services provided by a regional center to disclose during the initial intake whether he or she is enrolled in the Medi-Cal program. The bill would authorize the department to disclose to the county or DHCS information for the purposes of enabling the county or DHCS to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries. This bill would require a county to perform the annual eligibility redetermination of a regional center consumer with information that the county acquired during the last 36 months that is relevant to the beneficiary's Medi-Cal eligibility, and would authorize continued eligibility, until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits, as specified. The bill would require the department to make available to the counties and DHCS, on a regular basis to be determined by DHCS, a list identifying consumers receiving services at regional centers. The bill would require the implementation of these provisions only if and to the extent that federal financial participation is available and any necessary federal approvals or waivers have been obtained. Because the bill would require counties to perform additional duties regarding Medi-Cal eligibility determinations related to department consumers, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.