Health.

(1) Until January 1, 2022, existing law establishes the Council on Health Care Delivery Systems to develop a plan that includes options for advancing progress toward achieving a health care delivery system in California that provides coverage and access through a unified financing system for all Californians. Existing law, on or before October 1, 2021, requires the council to submit to the Legislature and Governor a plan with options that include a timeline of the benchmarks and steps necessary to implement health care delivery system changes. Existing law authorizes the California Health and Human Services Agency to provide staff support to implement these requirements. Until January 1, 2022, this bill would instead establish the Healthy California for All Commission for purposes of developing a plan that includes options for advancing progress toward achieving a health care delivery system in California that provides coverage and access through a unified financing system, including, but not limited to, a single-payer financing system, for all Californians. The bill would require the commission, by July 1, 2020, to submit a report to the Legislature and the Governor with, among other things, an analysis of California's existing health care delivery system and options to transition to a unified financing system, including a single-payer financing system. The bill would also require the commission, by February 1, 2021, to submit a report to the Legislature and the Governor that includes options for key design considerations for a unified financing system, including a single-payer financing system. The bill would require those reports to be posted on the California Health and Human Services Agency's internet website. (2) Under existing law, an individual is eligible for Medi-Cal benefits, to the extent required by federal law, as though the individual was pregnant, for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy. This bill would, subject to an appropriation in the annual Budget Act, extend Medi-Cal eligibility for a pregnant individual who is receiving health care coverage under the Medi-Cal program, or another specified program, and who has been diagnosed with a maternal mental health condition, for a period of one year following the last day of the individual's pregnancy if the individual complies with certain requirements. The bill would define "maternal mental health condition" for purposes of the bill. The bill would suspend implementation of these provisions on December 31, 2021, unless specified circumstances apply. (3) The federal Medicaid program prohibits payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law. Existing law requires that individuals under 19 years of age enrolled in restricted-scope Medi-Cal at the time the Director of Health Care Services makes a determination that systems have been programmed for implementation of these provisions be enrolled in the full scope of Medi-Cal benefits, if otherwise eligible. Existing law requires the department to maximize federal financial participation in implementing the provisions. This bill would extend eligibility for full-scope Medi-Cal benefits to individuals 19 to 25 years of age, inclusive, and who are otherwise eligible for those benefits but for their immigration status. This bill would additionally require the department to claim federal financial participation to the extent that the department determines it is available, and to the extent that federal financial participation is not available, would require the department to use state funds. Because counties are required to make eligibility determinations and this bill would expand Medicaid eligibility, the bill would impose a state-mandated local program. (4) Existing law also requires the State Department of Health Care Services to exercise its option under federal law to implement a program for aged and disabled persons, as described. Existing law requires an individual under these provisions to satisfy certain financial eligibility requirements, including, among other things, that the individual's countable income does not exceed an income standard equal to 100% of the applicable federal poverty level, plus an income disregard of $230 for an individual, or $310 in the case of a couple, except that the income standard determined shall not be less than the SSI/SSP payment level for a disabled individual or couple, as applicable. Existing law requires the department to implement this program by means of all-county letters or similar instructions without taking regulatory action and thereafter requires the department to adopt regulations. This bill would instead require, upon receipt of federal approval, all countable income over 100% of the federal poverty level, up to 138% of the federal poverty level, to be disregarded, after taking all other disregards, deductions, and exclusions into account for those persons eligible under the program for aged and disabled persons. The bill would require that provision to be implemented after the Director of Health Care Services determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of that provision, but no sooner than January 1, 2020. The bill would require the department to implement, interpret, or make specific the above-described program for aged and disabled persons by means of all-county letters, plan or provider bulletins, or similar instructions until regulations are adopted, and would require the department to adopt regulations by July 1, 2023. The bill would require the department to provide a status report on a semiannual basis to the Legislature until regulations are adopted. The bill would require the implementation of the program only if and to the extent that any necessary federal approvals have been obtained. Because counties are required to make Medi-Cal eligibility determinations, and this bill would expand Medi-Cal eligibility by increasing the income disregard amounts and would increase the responsibility of counties in determining Medi-Cal eligibility, the bill would impose a state-mandated local program. (5) Existing federal law establishes the Program of All-Inclusive Care for the Elderly (PACE) , which provides specified services for older individuals, and authorizes states to implement the PACE program as a Medicaid state option. Existing law authorizes the State Department of Health Care Services to enter into contracts with public or private organizations for implementation of the PACE program and to enter into separate contracts with PACE organizations. Existing law requires the State Department of Health Care Services to develop and pay capitation rates to contracted PACE organizations using actuarial methods and in accordance with criteria specific to those organizations, based on, among other things, a standardized rate methodology across managed care plan models for comparable populations. Existing law requires the department to pay a capitation rate within the actuarially sound rate range during the first 2 years in which a new PACE organization enters a previously unserved area. This bill would require the department's rate methodology to be consistent with actuarial rate development principles and to provide for all reasonable, appropriate, and attainable costs for each PACE organization within a region. During the first 2 years in which a new PACE organization enters a previously unserved area, the bill would require the department to pay a capitation rate within the actuarially sound rate range to reflect the lower enrollment and higher operating costs associated with a new PACE organization. (6) Existing law redirects specified 1991 health realignment funds to pay an increased county contribution toward the cost of CalWORKs grants, a county contribution toward the costs of the CalWORKs single allocation, or both. Existing law specifies the formula to be used in determining the amount of funds that are required to be redirected, which varies depending on the method a county uses to provide indigent health care services. Existing law requires, for counties that provide indigent health care services via the County Medical Services Program (CMSP) , 60% of 1991 health realignment funds be redirected to the Family Support Subaccount. This bill would instead require, for counties that participate in CMSP, the amount identified on a specified schedule that would have otherwise been payable to the CMSP, and the amount that would have otherwise been allocated to the governing board of the CMSP, be redirected until the Department of Finance determines that the total reserves of the CMSP are projected to fall below an amount totaling 2 fiscal years of total expenditures, and, after the Department of Finance makes that determination, the bill would reinstate the existing formula for determining the amount of 1991 health realignment funds that are redirected to the Family Support Subaccount. By increasing county payments to the Family Support Subaccount of the continuously appropriated Local Revenue Fund, this bill would make an appropriation. (7) 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. (8) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.