California AB 2161

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 generally requires, commencing in 2027, Medicaid beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, to demonstrate community engagement as a condition of Medicaid eligibility. Existing state law sets forth various provisions to conform to that federal requirement. Existing law requires, no sooner than January 1, 2027, as specified, an applicable individual to demonstrate work or community engagement. Existing law sets forth the mechanisms for an applicable individual to comply with that requirement on a monthly basis, including, among others, a minimum of 80 hours of work, community service, or participation in a work program, or a minimum of half-time enrollment in an educational program. This bill would make changes to the definitions of "applicable individual," "work program," and "educational program," and to some of the compliance mechanisms regarding monthly income, for purposes of the above-described provisions. When there is a conflict in reliable data sources that adversely impacts the eligibility of an applicant or beneficiary, the bill would require the county to request the applicant or beneficiary to confirm information before taking any adverse action on the application or renewal. Existing law requires a county, if it is unable to verify that an applicable individual either has met the requirement to demonstrate work or community engagement or was deemed to have demonstrated work or community engagement, to provide the individual with a notice of noncompliance, as specified, and to continue to provide the individual with Medi-Cal services during a 30-calendar-day period if the individual is enrolled in the Medi-Cal program. This bill would require the county to notify applicable individuals enrolled in the Medi-Cal program of the requirement to demonstrate work or community engagement based on certain delivery formats. For an applicable individual renewing their Medi-Cal enrollment during a 6-month redetermination period and who otherwise meets all other eligibility criteria, the bill would require the county to maintain active eligibility pending verification of work or community engagement until at least the last day of the month of the 30-calendar-day period. Under the bill, an applicable individual would be deemed to have received the notice of noncompliance 5 days after the date on the notice. Under the bill, self-attestation that the individual did not receive a timely notice would constitute good cause for not providing a satisfactory showing within the 30-calendar-day period. If no satisfactory showing is made after the 30-calendar-day period, the bill would require the department to consider all other bases of eligibility for medical assistance under the Medi-Cal state plan prior to denying coverage at application or determining that an individual is ineligible. The bill would authorize the department to defer implementation of any of the above-described changes if the change would result in a fiscal impact that would require an additional appropriation and that additional appropriation has not been made, as specified. By creating new duties for counties relating to Medi-Cal eligibility determinations with regard to work or community engagement, 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.