Medi-Cal eligibility: work or community engagement.

Removed the provision (former subdivision (i)) that authorized counties to request a Medi-Cal managed care plan to provide information verifying that a beneficiary is exempt or meets work or community engagement requirements when the beneficiary could not be deemed compliant following ex parte review. This narrows the tools available to counties for resolving verification gaps.

Simplified redundant language in the income-based compliance provisions: changed 'MAGI-based household, household budget' to 'MAGI-based household budget' in two places (subdivision (e)(6) and (e)(7)).

Renumbered subdivisions (i) through (q) in the old version to (i) through (p) in the enrolled version, reflecting the deletion of the ex parte review provision.

Removed the word 'either' from the definition of 'applicable individual' (changed from 'and is either any of the following' to 'and is any of the following'), a minor grammatical cleanup.

All amendments to Section 14005.37 were removed from the bill. This eliminates the 6-month redetermination requirement for Medicaid expansion adults, the expanded form delivery mechanisms (telephone, online, electronic means), and related conforming changes to redetermination procedures.

The definition of 'applicable individual' in category (C) was narrowed. Previously it covered any individual aged 19-64 who is not pregnant and not on Medicare. Now it requires the individual to be enrolled under a waiver of the Medi-Cal state plan that provides coverage equivalent to minimum essential coverage, in addition to meeting the age, pregnancy, and Medicare criteria.

The income-based compliance test in subdivision (e)(6) and (7) was changed from using 'MAGI-based household' to 'individual MAGI-based household, household budget.' The list of specific income types (earned income, unemployment benefits, state disability insurance, retirement income, dividends) was removed from the statutory text, leaving the calculation to be defined by federal MAGI-based methods.

A new requirement was added in subdivision (k)(1)(C)(ii): for an applicable individual renewing during a six-month redetermination period who otherwise meets all eligibility criteria, the county must maintain active eligibility pending verification of work or community engagement until at least the last day of the month of the 30-calendar-day cure period.

A new requirement was added in subdivision (k)(1)(E): before denying an application or disenrolling an individual, the county must first determine whether there is any other basis for Medi-Cal eligibility or another insurance affordability program, and must provide written notice and an opportunity for a fair hearing.

The requirement for the department to adopt regulations by July 1, 2028, and to provide semiannual implementation status reports to the Legislature beginning July 1, 2027, was removed from the bill.

Provisions stating that implementation would be subject to an appropriation in the annual Budget Act, that provisions would remain operative only as long as the underlying federal law is operative, and that implementation requires written confirmation from the Director of Health Care Services to the Department of Finance were removed from the digest.

All amendments to Section 14005.37 were removed, including provisions for six-month redetermination cycles for Medicaid expansion adults, ex parte review procedures, prepopulated renewal forms, change-in-circumstances procedures, due process protections, and accessibility requirements. The bill now focuses exclusively on work or community engagement requirements.

The definition of 'applicable individual' was expanded to add a new category: individuals who receive state-funded Medi-Cal coverage and meet the same criteria as Medicaid expansion adults under federal law (Section 1396a(a)(10)(A)(i)(VIII)), in addition to those directly enrolled under that federal provision.

New short-term hardship exemptions were added (subdivision (h)): an individual is deemed compliant if they receive inpatient hospital or similar services and request the exemption, reside in a county with a declared presidential emergency or disaster, reside in a county with unemployment at or above 8 percent or 1.5 times the national rate, or must travel outside their community for extended medical treatment of a serious condition.

The definition of 'educational program' was expanded from two categories (higher education and career/technical education) to four, adding high school and state-approved programs leading to a certificate of high school equivalence for individuals without a diploma.

The definition of 'work program' was revised to explicitly allow inclusion of additional programs that comply with federal regulation or directives, beyond those specifically listed in the federal statute.

A new provision requires that when there is a conflict in reliable data sources that adversely impacts eligibility, the county must request the applicant or beneficiary to confirm information before taking any adverse action on the application or renewal.

The notice of noncompliance process was revised: an applicable individual is now deemed to have received the notice 5 days after the date on the notice, and self-attestation that the individual did not receive a timely notice constitutes good cause for not providing a satisfactory showing.

The fiscal impact provision was changed from requiring implementation only after an appropriation in the annual Budget Act to authorizing the department to defer implementation if changes would result in a fiscal impact requiring an additional appropriation that has not been made.

The effective date for work or community engagement requirements was clarified to 'no sooner than January 1, 2027' (the Assembly version had a corrected date of 'January March 1, 2027').

The effective date for six-month redeterminations of Medicaid expansion adults was moved from January 1, 2027 to March 1, 2027, giving counties an additional two months before the new schedule begins.

A new condition was added stating that implementation of the work or community engagement provisions would be subject to an appropriation in the annual Budget Act, meaning these provisions cannot take effect unless the Legislature appropriates funds for them in a future budget bill.

The definition of 'applicable individual' in Section 14005.69 was narrowed by removing the phrase 'including an individual who receives state-funded Medi-Cal coverage,' which had explicitly included people on state-funded (non-federally funded) Medi-Cal plans within the work requirement.

The definition of 'specified excluded individual' now includes the qualifier 'as determined in accordance with criteria established by federal regulation or directive from the federal Centers for Medicare and Medicaid Services,' tying exclusion determinations to federal CMS guidance rather than leaving them to state interpretation.

A new Section 1 amends WIC Section 14005.37 to require counties to perform Medi-Cal eligibility redeterminations every six months (instead of 12 months) for Medicaid expansion adults, effective no sooner than January 1, 2027, to conform to federal law.

The bill's title and digest changed from 'Medi-Cal: work or community engagement' to 'Medi-Cal: redeterminations and work or community engagement,' reflecting the added redetermination provisions.

The new Section 14005.37 amendment establishes detailed redetermination procedures including: ex parte review before contacting beneficiaries, a 60-day response window for annual/six-month renewal forms, a 30-day window for change-in-circumstances redeterminations, and requirements to use the beneficiary's preferred contact method.

The six-month redetermination requirement excludes individuals described in Section 1396a(xx)(9)(A)(ii)(II) of Title 42 USC and any other individual whose Medicaid eligibility is not specifically required by federal law to be redetermined every six months.

Expanded form delivery and signature mechanisms: counties must accept responses via internet, telephone, mail, in person, or commonly available electronic means, and must accept electronic signatures including telephonically recorded signatures, online application signatures, and handwritten signatures transmitted electronically.

The original Section 1 (work or community engagement) was renumbered as Section 2, and the state mandates provision moved from Section 2 to Section 3. Minor citation formatting changes were made throughout (e.g., '42 U.S.C. Section' to '42 U.S.C. Section Sec.' and 'ex-parte' to 'ex parte').

Two new coauthors were added: Assembly Members Aguiar-Curry and Caloza.