Health.

The bill went from a single-section placeholder (expressing intent to enact Budget Act changes) to a comprehensive omnibus amending or adding over 100 code sections across the Business and Professions Code, Health and Safety Code, Insurance Code, Penal Code, Revenue and Taxation Code, and Welfare and Institutions Code.

Perinatal services pilot project: adds requirement that if qualified, a nonprofit hospital in Lake County be one of the first 3 hospitals selected (previously specified Humboldt and Plumas as first 2). Makes legislative findings for a special statute for Lake County.

California Reproductive Health Equity Program renamed to California Reproductive and TGI Health Equity Program, expanding purposes to include gender-affirming care. Department must begin accepting grant applications by January 1, 2027. Abortion Access Fund moneys authorized for use through the program.

Conforms state Medi-Cal law to federal H.R. 1: requires 6-month eligibility redeterminations for Medicaid expansion adults (ages 19-64, income up to 138% FPL), work or community engagement requirements (minimum 80 hours of work/community service or half-time educational enrollment per month), and reduces retroactive coverage from 3 months to 1 month for expansion adults and 2 months for other beneficiaries.

Individuals without satisfactory immigration status who are eligible for Medi-Cal can now access the fee-for-service delivery system instead of being required to enroll in a managed care plan. They remain eligible for full-scope state-funded benefits subject to service limitations.

Beginning July 1, 2027, new non-MAGI resource limits replace the existing property disregard: $21,000 in nonexempt property for a one-member household, $31,000 for two members, and $1,550 per additional member up to 10 (replacing the prior $130,000/$65,000 disregard structure).

Monthly premium for certain individuals without satisfactory immigration status changed from a fixed $30 to a range of no less than $30 and no greater than $50, with the Governor's 2027-28 May Revision to set the specific level. Effective no sooner than May 14, 2027.

Medical loss ratio remittance funds from Medi-Cal managed care plans (after returning federal share) are now deposited into the General Fund instead of the Medi-Cal Loan Repayment Program Special Fund.

Removes 2026-27 and 2027-28 fiscal years from the legislative statement of intent not to appropriate cost-of-doing-business adjustments for county Medi-Cal eligibility administration, effectively allowing CDB funding for those years.

Establishes the Hospital Fair Pricing Penalties Fund to collect administrative penalties for hospital fair pricing violations (discount payment and charity care policy notices, patient debt sale restrictions).

Behavioral Health Services Act: Beginning 2028-29, counties must spend at least the average annual distributed funds from the preceding 3 years. Prudent reserve maximums recalculated starting 2029-30 and every 3 years thereafter. Non-compliance authorizes corrective action plans, monetary sanctions (deposited to Accountability Fund), or payment withholding.

ADAP Rebate Fund: Authorizes State Department of Public Health to spend up to $134,840,000 in FY 2026-27, $134,490,000 in FY 2027-28, $126,590,000 in FY 2028-29, and $130,090,000 in FY 2029-30 for specified programs, plus up to $50,000,000 for related purposes. Expands allowable uses to include disease intervention, housing support, HIV treatment, and overdose prevention/harm reduction.

Dental service ineligibility for certain immigrants delayed from July 1, 2026 to no sooner than July 1, 2027.

FQHC and RHC per-visit reimbursement condition (requiring federal financial participation eligibility) delayed from July 1, 2026 to July 1, 2027.

CalAIM initiative extended from December 31, 2026 to December 31, 2031, with associated appropriations for federal financial participation and General Fund moneys. Also requires the department to seek federal approval for Employment Supports and BridgeCare (home- and community-based services for near-dual eligibles).

California Health and Human Services Data Exchange Framework compliance delayed to July 1, 2027 (from July 1, 2026) for community clinics, intermittent clinics, and rural health clinics.

For the period July 1, 2026 through June 30, 2027, prohibits granting provisional or preferred provisional enrollment status to Medi-Cal providers as a result of departmental inaction. Applications must remain pending until the department issues a written determination.

Establishes new rules for general acute care hospitals operating skilled nursing distinct parts: requires application and documentation, case-by-case approval, limits hospital to one licensed skilled nursing distinct part with one license number. Creates a new 'composite distinct part' category (2+ noncontiguous components not on the same campus) requiring demonstration of improved access and unmet need.

Home health agencies must have an administrator, director of patient care services, and designees, and submit identifying information by March 31, 2027. New licenses require demonstration of unmet need. Prohibits license transfer and ownership changes within 5 years of initial issuance. Temporary moratorium on new licenses with exceptions for demonstrated unmet need.

Beginning July 1, 2027, physicians and surgeons certified in internal medicine, family medicine, OB/GYN, neurology, neurological surgery, or psychiatry with adult women under 65 in their patient population receive double credit (2 hours per hour, max 8 hours) for continuing education in perimenopause, menopause, and postmenopausal care. Similar provisions for osteopathic physicians and nurse practitioners.

Health care service plan contracts and health insurance policies must include coverage for medically necessary menopausal symptom treatments and a program ensuring access to current menopause information. Utilization review criteria for menopause treatment must be based on current generally accepted standards, with specific criteria required beginning January 1, 2027.

Recasts 'detoxification' as 'withdrawal management' in substance use treatment licensing. Detox-only service licenses expire July 1, 2027, and the department is prohibited from issuing or extending such licenses after that date. ASAM Criteria implementation deadline extended to January 1, 2030.