California AB 543

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 sets forth various provisions for Medi-Cal coverage of community health worker services, enhanced care management, and community supports, subject to any necessary federal approvals. Under existing law, these benefits are designed to, respectively, provide a link between health and social services and the community; address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries, including individuals experiencing homelessness; and provide housing transition navigation services, among other supports. This bill would set forth provisions regarding field medicine, as defined, under the Medi-Cal program for persons experiencing homelessness, as defined. The bill would state the intent of the Legislature that the field medicine-related provisions coexist with, and not duplicate, other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports. The bill would authorize a Medi-Cal managed care plan to elect to offer Medi-Cal covered services through a field medicine provider, as defined. Under the bill, a managed care plan that elects to do so would be required to allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member's in-network assignment, as specified. The bill would also require the managed care plan to allow an in-network, contracted field medicine provider enrolled in Medi-Cal to directly refer a member who is experiencing homelessness for covered services within the appropriate network, as specified. The bill would require a managed care plan to have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member's plan or independent practice association, and the member's primary care provider for purposes of care coordination and to prevent the duplication of services. The bill would require a managed care plan to provide a method for a Medi-Cal member to inform the managed care plan online, in person, or via telephone that the member is experiencing homelessness. The bill would require the department to inform a managed care plan if a member has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application. In the case of a Medi-Cal beneficiary who is experiencing homelessness and who receives services within the fee-for-service delivery system, the bill would require the department to reimburse a field medicine provider enrolled in Medi-Cal for providing Medi-Cal covered services. The bill would condition implementation of the above-described provisions on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would require, on or before January 1, 2027, that the standard application form for insurance affordability programs include an optional question for an applicant to identify whether they are experiencing homelessness. The bill would make conforming changes to related provisions under existing law regarding the application process. The bill would also remove obsolete references within related provisions. To the extent that the bill would create new duties for counties with regard to data sharing under Medi-Cal, 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.