Medi-Cal: field medicine.

The document was reformatted from the official Chaptered bill format to a web page layout, adding site navigation elements (skip to content, home, accessibility, FAQ, feedback, sitemap, login) and a version history list.

A 'Digest Key' section was added showing Vote: MAJORITY, Appropriation: NO, Fiscal Committee: YES, Local Program: YES, which is metadata from the legislature website rather than new legislative content.

Header changed from 'Assembly Bill No. 543' with legislative passage dates to 'STATE OF CALIFORNIA AUTHENTICATED ELECTRONIC LEGAL MATERIAL' with 'CHAPTER 374' and the Governor's approval date of October 6, 2025.

Page numbering and layout were reformatted from the enrolled bill format (AB 543 page numbers) to the chaptered statute format (Ch. 374 page numbers).

The legislative counsel's digest was reflowed for the new page layout but contains identical content.

The term 'street field medicine' was renamed to 'field medicine' throughout the bill, and the definition was broadened from persons experiencing 'unsheltered homelessness' in 'places not intended for human habitation' to all persons experiencing 'homelessness' using a whole-person approach.

The definition of 'person experiencing homelessness' was changed from a cross-reference to federal regulation (Section 91.5, Title 24 CFR) to a standalone definition: 'a person who lacks a fixed, regular, and adequate nighttime residence.'

The definition of 'experiencing homelessness' in Section 15926(a)(4), which cross-referenced federal regulation Section 91.5 of Title 24 CFR, was removed from the application form provisions.

The 'field medicine provider' definition was broadened from providers serving persons experiencing 'unsheltered homelessness' to those serving persons experiencing 'homelessness' generally, potentially expanding which settings and populations qualify.

Section 14186.4 was removed entirely. This section had required the department to ensure Medi-Cal and CalSAWS mutually share data on the status of applicants or beneficiaries experiencing homelessness, including codes relating to unsheltered status, with an operative date of January 1, 2027.

The provision requiring managed care plans to share a member's homelessness status with the relevant county for inclusion in CalSAWS was removed from Section 14186.3.

The provision allowing a managed care plan to 'establish reasonable requirements governing participation in the plan network' (old subsection (d) of Section 14186.3) was removed, eliminating flexibility for plans to set their own network participation conditions.

References to 'Medi-Cal beneficiary' were changed to 'Medi-Cal member' in most provisions, though 'beneficiary' remains in the fee-for-service reimbursement context.

A new operative date provision was added to the CalSAWS data-sharing section: it becomes effective on January 1, 2027, or on the date the department notifies the Legislature that CalSAWS can perform the necessary automation, whichever is later. This creates a conditional start date that could push implementation past 2027 if the system is not ready.

The CalSAWS data-sharing requirement was restructured from a single paragraph into a standalone section (renumbered from 14186.5 to 14186.4) with five explicit subdivisions covering: data sharing, applicant identification of homelessness status, data availability to the department/CalSAWS/managed care plans, privacy law compliance, and the operative date.

Senator Rubio was added as a coauthor of the bill, indicating Senate sponsorship support for the measure.

The privacy limitation was moved from being embedded in the general description into its own dedicated subdivision (d), making it a standalone requirement that the section be implemented only to the extent not in conflict with applicable federal or state privacy laws.

Typo correction in Section 14186.3(a): the phrase 'through field an in-network, contracted field medicine provider' was corrected to 'through an in-network, contracted field medicine provider,' removing a duplicated word.

Standard enrollment formatting: removal of Senate amendment history dates, addition of Assembly and Senate passage dates (September 10 and September 9, 2025 respectively), conversion to chapter format, addition of Governor receipt line, and removal of 'as amended' from the legislative counsel's digest.

The entire presumptive eligibility program (former Section 14186.3) was deleted. This provision would have allowed enrolled Medi-Cal providers to make presumptive eligibility determinations for people experiencing homelessness, granting them full-scope Medi-Cal coverage without a share of cost while formal eligibility processing was pending.

Street field medicine services are now restricted to 'in-network, contracted' providers only. The previous version allowed beneficiaries to receive services from any contracted street medicine provider regardless of network assignment. The new language requires the provider to be in-network, which could limit access if plans do not contract with enough street field medicine providers.

'Street medicine' is renamed 'street field medicine' and 'street medicine provider' becomes 'field medicine provider' throughout the bill. The definition of 'person experiencing homelessness' is expanded to include a plain-language description ('lacks a fixed, regular, and adequate nighttime residence') in addition to the federal regulation cross-reference.

The care coordination communication requirement between the field medicine provider, the plan or IPA, and the primary care provider now explicitly includes 'to prevent the duplication of services' as an additional purpose beyond care coordination.

Terminology throughout managed care plan sections changes from 'Medi-Cal beneficiary' to 'Medi-Cal member,' aligning with standard managed care language. The requirement for plans to provide a way for beneficiaries to report homelessness status changes from providing 'the ability' to providing 'a method.'

The state mandate reimbursement language is narrowed to cover only data sharing duties for counties, removing the reference to presumptive eligibility determinations since that provision was deleted.

Presumptive eligibility determinations can now only be made by enrolled Medi-Cal providers acting in the capacity of a street medicine provider (previously any enrolled Medi-Cal provider, including health facilities and clinics). The provider must also notify the department in writing before making determinations, unless already disqualified.

The presumptive eligibility program now applies to persons experiencing homelessness 'who appear to be otherwise eligible for full-scope Medi-Cal benefits coverage without a share of cost,' adding an explicit eligibility qualifier that was not in the prior version.

Managed care plans contracting with street medicine providers must have appropriate mechanisms, procedures, or protocols to ensure timely communication between the street medicine provider, the beneficiary's plan or IPA, and the beneficiary's assigned primary care provider for care coordination.

If a managed care plan is informed by a beneficiary that they are experiencing homelessness, the plan must share that information with the relevant county for inclusion in CalSAWS.

Implementation of the presumptive eligibility program must include securing federal approvals, programming necessary systems, creating a simplified application form, and providing information to providers who wish to participate.

The federal approval condition was changed from 'this article shall be implemented only to the extent' federal approvals are obtained to 'each section of this article shall be implemented only to the extent' federal approvals are obtained, allowing individual sections to be implemented independently rather than requiring all-or-nothing approval.

A new deadline requires that on or before January 1, 2027, the standard application form for insurance affordability programs include an optional question for applicants to identify whether they are experiencing homelessness.

The core mechanism changed from a mandatory requirement that managed care plans allow homeless beneficiaries to seek services from any participating Medi-Cal provider off-premises (with reimbursement regardless of network assignment) to an elective framework where a managed care plan 'may elect to offer' Medi-Cal covered services through a street medicine provider. This is the most significant policy change in the amendment.

Assembly Member Haney was added as a coauthor of the bill.

References to street medicine providers in sections 14186.4(b) and (c) were changed from simply 'a street medicine provider' to 'a contracted street medicine provider,' adding a requirement that the provider must have a contract with the managed care plan.

The definition of 'premises' (a site located at an address listed on the provider's license or in the provider master file) was removed from Section 14186, consistent with the shift away from the off-premises access framework.

Fee-for-service reimbursement language was narrowed. The Assembly version required the department to reimburse 'an enrolled Medi-Cal provider' for off-premises services; the Senate version limits this to 'a street medicine provider enrolled in the Medi-Cal program.'

Section 14186.4(b)(1)(A): Changed 'regardless of primary care provider (PCP) or independent practice association (IPA) assignment' to 'regardless of network assignment such as PCP or IPA assignment,' broadening the reimbursement guarantee beyond just PCP/IPA to all network assignments.

Section 14186.4(b)(1)(B)(i): Expanded the list of services that enrolled providers may refer homeless beneficiaries for, adding 'medications, durable medical equipment, transportation, or other medically necessary covered services' alongside the existing specialist and diagnostic services. Also added that referrals must be 'within the appropriate network of the Medi-Cal managed care plan.'

Section 14186.4(b)(1)(B)(ii): New provision requiring Medi-Cal managed care plans to create referral and authorization mechanisms to facilitate referrals for homeless beneficiaries. Adds that referrals or authorizations made by an enrolled provider shall not be declined solely based on delegation (including network-assigned PCPs or IPAs), even if the referring provider is not a member of the delegated network while the beneficiary is.

Section 15926(c)(1): Changed 'at the time of application' to 'at the time of application or redetermination,' allowing persons to identify as experiencing homelessness during renewal/redetermination, not only at initial application.

MRMIB (Medi-Cal Risk Management and Information Bureau) was removed from three coordination and oversight provisions in Section 15926: the streamlining of eligibility rules (subdivision j), the stakeholder suggestion process (subdivision l), and the privacy/confidentiality design requirements (subdivision m).

Minor typo fix in findings section: 'consult service' corrected to 'consultation service.'