Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services 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 establishes the Medi-Cal Access Program, which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is within specified thresholds of the federal poverty level, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified. Existing federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid program. Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) , which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk. Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified. This bill would delete the above-described provisions relating to the automated enrollment gateway system and would instead require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, operational no later than January 1, 2020, allowing children applying to the WIC Program to obtain express lane eligibility for, and to facilitate application for enrollment in, the Medi-Cal program, and allowing pregnant women applying to the WIC Program to obtain presumptive eligibility for the Medi-Cal program or the Medi-Cal Access Program, to the extent federal financial participation is available. The bill would also require the system to perform specified functions relating to the eligibility of those persons under the programs. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition the implementation of the provisions on the department obtaining all necessary federal approvals. Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, this 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.