Medi-Cal: demonstration project waivers.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides for the Health Care Coverage Initiative, which is a federal waiver demonstration project established to expand health care coverage to low-income uninsured individuals who are not currently eligible for the Medi-Cal program, the Healthy Families Program, or the Access for Infants and Mothers program. Existing law provides for the repeal of the department's authority under the Health Care Coverage Initiative upon the execution of a declaration by the Director of Health Care Services specifying that the demonstration project has been terminated. This bill would, alternatively, authorize the director to continue and administer any extensions, modifications, or continuation of the projects under the Health Care Coverage Initiative approved by the federal Centers for Medicare and Medicaid Services. This bill would, in this regard, only to the extent that federal financial participation is available and only to the extent that federal financial participation is not jeopardized, require the department, on or after November 1, 2010, but no later than March 1, 2011, or 180 days after federal approval of a successor demonstration project, as defined, to authorize local Coverage Expansion and Enrollment Demonstration (CEED) projects, as specified, to provide scheduled health care benefits for uninsured adults 19 to 64, inclusive, years of age with incomes up to 133% of the federal poverty level who are not otherwise eligible for Medi-Cal or Medicare. This bill would require CEED projects to be designed and implemented with the systems and program elements necessary to facilitate the transition of those eligible individuals to the Medi-Cal program, or alternatively, to coverage through the California Health Benefit Exchange, by 2014, pursuant to the provisions of federal and state law, and the terms and conditions of the demonstration project. This bill would also provide that, to the extent federal financial participation is made available under the terms and conditions of the demonstration project, CEED project services may be made available to individuals with incomes between 134% to 200%, inclusive, of the federal poverty level. This bill would require the department to approve any CEED project that, in addition to meeting specified requirements, voluntarily agrees to commit, on an annual basis, to provide the nonfederal share of CEED project expenditures for services to individuals who meet income eligibility standards specified for the CEED project. This bill would provide that no state General Fund moneys shall be used to fund CEED project services, nor to fund any related administrative costs incurred by counties or any other political subdivision of the state. This bill would provide that, subject to the terms and conditions of the demonstration project, if a participating entity elects to fund the nonfederal share of a CEED project, the nonfederal funding and payments to the CEED project shall be provided through one of the specified mechanisms, at the option of the participating entity. This bill would establish the CEED Project Fund in the State Treasury and would require that all moneys in the fund be continuously appropriated to the department for purposes relating to the CEED projects, as specified. It would permit counties, under one of the funding mechanisms, to transfer moneys into the fund for this purpose. This bill would become operative only if Senate Bill 208 of the 2009-10 Regular Session of the Legislature is enacted. This bill would declare that it is to take effect immediately as an urgency statute.