Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA) , requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. PPACA defines a "qualified health plan" as a plan that, among other requirements, provides an essential health benefits package. Existing state law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) , provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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. This bill, the California Guaranteed Health Care for All Act, would create the California Guaranteed Health Care for All program, or CalCare, to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. Under the bill, CalCare would be a health care service plan subject to Knox-Keene. The bill, among other things, would provide that CalCare cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Children's Health Insurance Program, Medi-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare Program. The bill would make specified persons eligible to enroll as CalCare members during the implementation period, and would provide for automatic enrollment. The bill would require the board to seek all necessary waivers, approvals, and agreements to allow various existing federal health care payments to be paid to CalCare, which would then assume responsibility for all benefits and services previously paid for with those funds. This bill would create the CalCare Board to govern CalCare, made up of 9 voting members with demonstrated and acknowledged expertise in health care, and appointed as provided, plus the Secretary of California Health and Human Services or their designee as a nonvoting, ex officio member. The bill would provide the board with all the powers and duties necessary to establish CalCare, including determining when individuals may start enrolling into CalCare, employing necessary staff, negotiating pricing for covered pharmaceuticals and medical supplies, establishing a prescription drug formulary, and negotiating and entering into necessary contracts. The bill would require the board, on or before July 1 of an unspecified year, to conduct and deliver a fiscal analysis to determine whether or not CalCare may be implemented and if revenue is more likely than not to pay for program costs, as specified. The bill would establish an Advisory Committee on Long-Term Services and Supports to advise the board on matters of policy related to long-term services and supports. The bill would require the board to convene a CalCare Public Advisory Commission to advise the board on all matters of policy for CalCare, an Advisory Committee on Public Employees' Retirement System Health Benefits to provide recommendations related to public employee retiree health benefits, and a CalCare Health Workforce Working Group to provide the board with input on issues related to health care workforce education, recruitment, and retention. The bill would establish an Office of Health Equity within CalCare and under the direction of the Director of the Department of Health Care Access and Information to ensure health equity under the program and other health programs of the California Health and Human Services Agency and to support the board through specified actions. This bill would provide for the participation of health care providers in CalCare, including the requirements of a participation agreement between a health care provider and the board, provide for payment for health care items and services, and specify program participation standards. The bill would prohibit a participating provider from discriminating against a person by, among other things, reducing or denying a person's benefits under CalCare because of a specified characteristic, status, or condition of the person. This bill would prohibit a participating provider from billing or entering into a private contract with an individual eligible for CalCare benefits regarding a covered benefit, but would authorize contracting for a health care item or service that is not a covered benefit if specified criteria are met. The bill would authorize health care providers to collectively negotiate fee-for-service rates of payment for health care items and services using a 3rd-party representative, as provided. The bill would require the board to annually determine an institutional provider's global budget, to be used to cover operating expenses related to covered health care items and services for that fiscal year, and would authorize payments under the global budget. This bill would state the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for CalCare. The bill would create the CalCare Trust Fund in the State Treasury, as a continuously appropriated fund, consisting of any federal and state moneys received for the purposes of the act. The bill would specify uses for moneys in the CalCare budget, including special projects for which not-for-profit or governmental entities may apply. Because the bill would create a continuously appropriated fund, it would make an appropriation. This bill would prohibit specified provisions of this act from becoming operative until the Secretary of California Health and Human Services gives written notice to the Secretary of the Senate and the Chief Clerk of the Assembly that the CalCare Trust Fund has the revenues to fund the costs of implementing the act. The California Health and Human Services Agency would be required to publish a copy of the notice on its internet website. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law, the Budget Act of 2025, appropriates funds to the department to create a comprehensive hospital value strategy to advance access to high-quality inpatient and outpatient hospital services, financially incentivize appropriate care delivery, and improve health outcomes for Medi-Cal beneficiaries. In developing the comprehensive hospital value strategy described above, this bill would require the department to engage with relevant stakeholders with firsthand experience, including, but not limited to, hospitals, cities, counties, cities and counties, organizations representing these groups, and other affected stakeholders as the department deems necessary. The bill would require the department to ensure that the comprehensive hospital value strategy includes a focus on rural hospitals, critical access hospitals, and public hospitals.
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, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under the Medi-Cal Dental Provider Handbook, the maximum allowance for a house/extended care facility call under a specified billing code is $20. This bill would require the department to increase the Medi-Cal reimbursement base rate for a house/extended care facility call in order to reflect the reasonable travel costs for purposes of delivering dental services in the patient's private residence or applicable facility instead of the location of the dental provider. The bill would condition implementation of these provisions on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing law establishes procedures for counties in making Medi-Cal eligibility determinations and redeterminations. Existing federal law, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, cost sharing, and retroactive coverage, among other factors, for certain Medicaid populations pursuant to a specified implementation timeline. This bill, the Protect the Promise Act, would require the department, in coordination with counties, to verify Medi-Cal eligibility before enrollment approval whenever reliable data sources are available. The bill, subject to any exceptions under federal law, would prohibit self-attestation alone for Medi-Cal eligibility purposes from being accepted for the eligibility factors of income, residency, identity, household composition, or citizenship or immigration status. The bill would require the department and the county to fully utilize certain data sets and verification systems. The bill would require the department to cross-reference beneficiary data with certain databases, complete a one-time submission of enrollment data to the federal government, and review information from specified federal and state sources. The bill would require the department to maintain a continuous process to identify changes in residency. The bill would require the department to require regular and systematic eligibility redeterminations, as specified. The bill would require the department and the county to identify eligibility errors, correct errors, and recover improper payments. The bill would require the department to establish enforceable accountability mechanisms, including, among others, reports to the Legislature and designation of officials. By creating new duties for counties relating to Medi-Cal eligibility determinations and redeterminations, 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.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including pharmacy services and drugs. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law sets forth a schedule of benefits covered under the Medi-Cal program, including acupuncture, but only to the extent federal matching funds are provided for acupuncture. To the extent federal financial participation is available, this bill would require the Medi-Cal program to cover up to 24 acupuncture visits per beneficiary per calendar year and would state that additional visits per calendar year may be authorized based on medical necessity. This bill would incorporate additional changes to Section 14132 of the Welfare and Institutions Code proposed by AB 350 and SB 944 to be operative only if this bill and either or both AB 350 and SB 944 are enacted and this bill is enacted last. This bill would make certain provisions operative only if both this bill and SB 944 is enacted and takes effect on or before January 1, 2027.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing federal law, Public Law 119-21, enacted on July 4, 2025, sets forth various changes to different health care programs, including certain requirements for Medicaid eligibility with regard to work or community engagement reporting, redeterminations, and cost sharing, among other factors, for certain Medicaid populations pursuant to a specified implementation timeline. Existing law, the federal Patient Protection and Affordable Care Act, imposes a certain assessment on an applicable large employer, as defined, that offers full-time employees and their dependents the opportunity to enroll in minimum essential coverage, and for whom one or more full-time employees have been certified as having enrolled in a qualified health plan for which a premium tax credit or cost-sharing reduction is allowed or paid. This bill would create the Employer Responsibility for Medi-Cal Trust Fund to consist of new taxes and deposits, including employer penalties specified in the Budget Act of 2026. The bill would continuously appropriate moneys in the fund to the department to fund the costs of administering the Medi-Cal program in a manner necessary to prevent loss of or to restore health care coverage, benefits, or access to care following the passage of Public Law 119-21 and subsequent state budget actions. The bill would state that these provisions would become operative only if the Medicaid provisions of Public Law 119-21 are not repealed prior to January 1, 2027. By creating a continuously appropriated fund, the bill would make an appropriation. This bill would declare that it is to take effect immediately as an urgency statute.
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. Under existing law, to the extent that federal financial participation is available, federally qualified health center (FQHC) services and rural health clinic (RHC) services are covered Medi-Cal benefits. Under existing law, FQHCs and RHCs receive a per-visit prospective payment system (PPS) rate for each visit. Existing law provides different methods by which an FQHC or RHC may establish a PPS. This bill would authorize an FQHC or RHC that has multiple PPS rates to elect to consolidate those rates into a single PPS rate to be applied uniformly for all FQHC and RHC services.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing law, subject to implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, requires the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans. Under existing law, target populations include, among others, high utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits, and individuals experiencing homelessness. This bill would recast the definition of ECM, referring to community-based, high-touch coordination and comprehensive care management services, as specified. The bill would delete certain provisions that designate 2022 or 2023 timelines for commencing ECM coverage, depending on whether or not a Medi-Cal managed care plan operates in a county in which the Whole Person Care pilot program or the Health Home Program was implemented. Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports. Under existing law, community supports that the department is authorized to approve include, among others, housing transition navigation services and medically supportive food and nutrition services. This bill would require the department to publish and maintain policy guides and all-plan letters on its internet website that define model coverage standards and policy for each community support, to engage stakeholders, to provide ongoing technical assistance, and to establish a standard timeline and process for regular updates to community supports policy guides, as specified. The bill would require a Medi-Cal managed care plan to adopt community supports policies, and to educate its in-network community support providers, as specified. The bill would require the department to publish certain information on ECM and community supports utilization data on the department's internet website on a quarterly basis, to the extent feasible, until January 1, 2032. The bill would require the department, by March 31, 2029, to provide to the legislative committees specified information in writing necessary to inform legislative consideration of transitioning community supports to benefits that are required to be covered under the Medi-Cal program. The bill would make other technical changes to the ECM and community support provisions.
(1) Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing to license and regulate the practice of nursing. Existing law requires an applicant for licensure as a registered nurse to comply with specified education and other requirements. This bill would also require an applicant for licensure as a registered nurse to undergo a fingerprint-based state and national criminal history background check, would require the board to submit to the Department of Justice (department) fingerprint images and related information for applicants, and would require the department to provide a state- and federal-level response, as specified. (2) Existing law requires the department to maintain state summary criminal history information, as defined, and to furnish this information to various state and local government officers and officials, as well as other prescribed entities, including, among others, a city, county, city and county, or district, if needed in the course of their duties. Existing law authorizes the Attorney General to furnish state summary criminal history information and, if authorized, federal-level criminal history information, upon a showing of a compelling need, to specified entities, including, among others, peace officers of the United States, other states, or territories or possessions of the United States. Existing law makes it a misdemeanor to furnish criminal history information to a person who is not authorized by law to receive it. This bill would instead make those provisions applicable to a city, county, city and county, or governmental district. The bill would also authorize the Attorney General to provide that information to peace officers of tribes in other states under the same conditions. The bill would prescribe a procedure by which a city, county, city and county, or governmental district submit fingerprint images and related information to the department. The bill would make a release of information by the department under these provisions subject to specified federal regulations. By expanding access to criminal history information, this bill would expand a crime and therefore impose a state-mandated local program. (3) Existing law requires employees, prospective employees, volunteers, contractors, and subcontractors of a criminal justice agency to undergo a fingerprint-based state and national criminal history background check. Existing law requires the department to provide a state- and federal-level response, as specified. This bill would make that provision, with regard to a volunteer, contractor, or subcontractor, only applicable to a volunteer, contractor, or subcontractor who either provides services for the administration of criminal justice or has direct or remote access to the criminal justice agency's systems or unescorted access to a criminal justice agency's facilities. (4) Existing law requires employees of entities that have contracts with a private school or heritage school and provide services, including schoolsite administrative or grounds, landscape maintenance, and instruction, to provide their fingerprints to the department, as specified. Existing law requires employees of an entity that contracts with a local educational agency to complete a criminal background check, as specified. Under existing law, a county, city, city and county, or special district is required to have specified prospective employees or volunteers complete a background check that inquires as to whether the applicant has been convicted of certain offenses. Existing law also requires the submission of fingerprints to the department for certifying a massage professional, licensing a professional fiduciary, registering a tax preparer, confirming the appointment of a humane officer, working for a bank or its affiliates, and licensing an escrow agent, as specified. Existing law requires the department to ascertain whether the individual whose fingerprints were submitted has been arrested or convicted of a crime and notify the employer if the person has been convicted of specified felonies. Existing law authorizes the department to notify specified entities of pending criminal proceedings. This bill would instead require those background checks to be submitted pursuant to the provisions above and would make conforming changes. (5) Existing law authorizes a human resource agency, as defined, or a nonprofit corporation or other organization specified by the Attorney General that employs or uses the services of volunteers in positions in which the volunteer or employee has supervisory or disciplinary power over a child or children to request from the department records of all convictions or any arrest pending adjudication involving specified offenses of a person who applies for a license, employment, or volunteer position in which they would have supervisory or disciplinary power over a minor or any person under their care. This bill would revise and recast those provisions to instead allow a qualified entity, as defined, to require a covered individual, as defined, to undergo a fingerprint-based state and national criminal history background check and would authorize a qualified entity to get a subsequent arrest notification pursuant to the provisions above. By expanding access to criminal history information, this bill would expand a crime and therefore impose a state-mandated local program. The bill would make any statutory requirement for an entity to conduct a federal criminal history information check for licensing, certification, or employment purposes inapplicable until the Federal Bureau of Investigation authorizes the entity to conduct a federal criminal history information check, as specified. If the Federal Bureau of Investigation authorizes an entity to conduct a federal criminal history information check, the bill would require the entity to require an applicant, licensee, certified individual, or employee who did not previously undergo a federal criminal history information check to resubmit their fingerprints for that purpose. (6) Existing law requires an application used to determine the eligibility to own a firearm to include 2 copies of the applicant's fingerprints. This bill would instead require an applicant for a certificate of eligibility and a dangerous weapons license or permit issued by the department, including, among other weapons, an assault weapon or short-barreled shotgun, to submit to the department fingerprint images and related information for purposes of conducting a state and national criminal history background check, as specified, and for the purpose of determining if the applicant is prohibited by state or federal law from possessing, receiving, owning, or purchasing a firearm. The bill would require the department to retain the fingerprint impressions for subsequent arrest notification, as specified. (7) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 requires the State Department of Health Care Services to screen all providers and designate each provider as "limited," "moderate," or "high" categorical risk. For all providers designated as a "high" categorical risk, existing law requires the State Department of Health Care Services, or its designee, to conduct a criminal background check and require specified individuals to submit a set of fingerprints within 30 days of the State Department of Health Care Services's request in a manner specified by the State Department of Health Care Services. This bill would instead add the State Department of Public Health in place of the State Department of Health Care Services's authority to have a designee for these purposes. The bill would require, as an alternative to the State Department of Health Care Services, the State Department of Public Health to prescribe the manner by which a person submits their fingerprints. (8) Existing law requires the State Department of Health Care Services to require that specified applicants, providers, and individuals submit fingerprint images and related information for purposes of a state and federal criminal background check and prescribes a procedure for the State Department of Health Care Services and the department to follow for these purposes. This bill would also add the State Department of Public Health to this requirement and procedure as an alternative to the State Department of Health Care Services and would instead require the information be submitted for specified individuals who are subject to a state and national criminal history background checks. The bill would define "applicant" and "provider" for these purposes. (9) Existing law requires the State Department of Social Services to license and regulate community care facilities, residential care facilities for persons with chronic, life-threatening illness, residential care facilities for the elderly, and childcare centers. Existing law requires the department to obtain a criminal record for all applicants for licenses for these facilities and services and specified other employees and officers of these facilities, including, among others, adults responsible for the administration or direct supervision of staff, a staff person, volunteer, or employee who has contact with clients, and, if the applicant is a firm, partnership, association, or corporation, the chief executive officer or other person serving in a like capacity. This bill would expand the list of individuals to include, among others, an administrator, supervisor, manager, or director of the facility, or an individual acting in those roles, an adult responsible for the operation of the facility, and a person with a 10% or greater financial interest in the applicant. The bill would clarify that a staff person, volunteer, or employee who has direct contact with clients includes adults and minors. The bill would also include limited liability companies in the list of applicant types to which these provisions apply. By expanding access to criminal history information, this bill would expand a crime and therefore impose a state-mandated local program. (10) Existing law authorizes specified governmental entities to require employees, prospective employees, volunteers, contractors, and subcontractors to undergo fingerprint-based state and national criminal history background checks. Existing law establishes the Business and Consumer Services Agency, the California Housing and Homelessness Agency, and the Housing Development and Finance Committee. Existing law sets forth the general responsibilities and roles of the California Housing Finance Agency, the California Housing and Homelessness Agency, the Department of Housing and Community Development, and the Housing Development and Finance Committee in carrying out state housing policies and programs. This bill would authorize the Housing Development and Finance Committee to require an employee, prospective employee, volunteer, contractor, or subcontractor to undergo a fingerprint-based state and national criminal history background check, as specified. The bill would require the department to provide a state- and federal-level response. By expanding access to criminal history information, this bill would expand a crime and therefore impose a state-mandated local program. (11) Existing law, the Yacht and Ship Brokers Act, prohibits a person from, among other things, acting as a broker or salesperson for the purchase or sale of a yacht without a license. The act authorizes the issuance of a temporary license to a salesperson under specified conditions. The act requires an applicant for a broker or salesperson license to undergo a fingerprint-based state and national criminal history background check. This bill would authorize a temporary license to be issued to a broker. The bill would also authorize the Deputy Director of Boating and Waterways to extend the term of a temporary license or issue a new temporary license to provide an applicant for a broker or salesperson license time to comply with the criminal history background requirement, as specified. (12) This bill would incorporate additional changes to Section 44237 of the Education Code proposed by SB 685 to be operative only if this bill and SB 685 are enacted and this bill is enacted last. (13) This bill would incorporate additional changes to Section 11105 of the Penal Code proposed by AB 2001 to be operative only if this bill and AB 2001 are enacted and this bill is enacted last. (14) 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 no reimbursement is required by this act for a specified reason. (15) This bill would declare that it is to take effect immediately as an urgency statute.
Existing law, the Medi-Cal Act, 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. Under existing law, early and periodic screening, diagnostic, and treatment (EPSDT) services, including private duty nursing services, are covered under Medi-Cal for an individual under 21 years of age in accordance with certain federal provisions. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions. This bill would require the department to measure and assess whether private duty nursing services provided as part of the EPSDT benefit are in compliance with federal Medicaid requirements, as specified. The bill would require the assessment to include a comparison of the hours of EPSDT private duty nursing services authorized by the Medi-Cal program to the hours actually provided to eligible beneficiary children and a determination of whether the reimbursement rates for those services are sufficient to ensure that all authorized hours are able to be provided. The bill would require the department to prepare and submit a report to the Legislature on the findings of the assessment by no later than March 1, 2027.
