Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a violation of the act by a health care service plan a misdemeanor. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law defines "unreasonable rate increase," for these purposes, to have the same meaning as in the federal Patient Protection and Affordable Care Act, which is that an unreasonable rate increase exists when the federal Centers for Medicare and Medicaid Services makes a determination that a rate increase is excessive, unjustified, or unfairly discriminatory, among other things. This bill would instead define "unreasonable rate increase," for the above-described purposes, to mean a rate increase that the Director of the Department of Managed Health Care or the Insurance Commissioner, as applicable, determines is excessive, unjustified, unfairly discriminatory, or otherwise unreasonable. Existing law requires a health care service plan or health insurer to submit rates to their regulating entity for review and to demonstrate the impact of any changes in the rate of growth of health care costs resulting from health care cost targets. This bill would instead require a health care service plan or health insurer to demonstrate the impact of health care cost targets and to demonstrate whether a health care service plan's or health insurer's annual rate growth exceeds or will exceed the cost target for the rating period. The bill would require, if a health care service plan's or health insurer's rate growth is expected to exceed the cost target for a rating period, the health care service plan or health insurer to include specified information in its rate filing, including, among other things, a detailed list of any proactive steps it is taking, or plans to take, for annual rate growth to meet the cost targets. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. Existing law requires the director or the commissioner, as applicable, in determining if a rate is unreasonable or not justified for purposes of the above-described review, to consider the impact on changes in health care costs as a result of the health care cost targets described above. This bill would delete those provisions and instead require the Department of Managed Health Care and the Department of Insurance to report on if rates, by plan or policy and in aggregate, meet the affordability standard, as defined, for an individual, a couple, and a family of four. The bill would require the report to include the annual change in premiums and cost sharing for the prior 5 years. The bill would, as part of the existing rate submission process, require a health care service plan or health insurer to provide information on premiums, deductibles, cost sharing, and any other factors specified by the department as necessary to complete the reports. 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 no reimbursement is required by this act for a specified reason.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing federal law, the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) , requires group health plans and health insurance issuers that provide both medical and surgical benefits and mental health or substance use disorder benefits to ensure that financial requirements and treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical and surgical benefits. Existing state law requires an individual, small group, or large group health care service plan contract or health insurance policy to provide covered mental health and substance use disorder benefits in compliance with the MHPAEA and specified federal rules, regulations, and guidance. This bill would require the above-described contracts and policies to provide covered mental health and substance use disorder benefits in compliance with specified federal rules, regulations, and guidance as they existed on January 1, 2025. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program. The bill would also require the departments to review provisions of the bill that conflict with or materially differ from federal regulations and collaborate with each other to issue guidance on compliance. 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 no reimbursement is required by this act for a specified reason.
Existing law prohibits a state or local law enforcement agency or officer from knowingly arresting or knowingly participating in the arrest of any person for performing, supporting, or aiding in the performance of a legally protected health care activity, as defined, or for obtaining a legally protected health care activity, if the legally protected health care activity is lawful in this state. Existing law prohibits a state or local public agency from cooperating with or providing information to an individual or agency from another state or a federal law enforcement agency, as specified, regarding a legally protected health care activity. Existing law prohibits specified persons, including a judicial officer, a court employee, or an authorized attorney, among others, from issuing a subpoena in connection with a proceeding in another state regarding an individual performing, supporting, or aiding in the performance of a legally protected health care activity in this state, or an individual obtaining a legally protected health care activity in this state, if the legally protected health care activity is lawful in this state. This bill would make those provisions apply regardless of the patient's location. Existing law authorizes the Governor to surrender, on demand of the executive authority of any other state, any person in this state charged in the other state with committing an act in this state, or in a 3rd state, intentionally resulting in a crime in the state whose executive authority is making the demand. This bill would additionally prohibit a state or local law enforcement agency or officer from knowingly arresting or participating in the arrest of any person who the Governor has declined to surrender. Existing law requires any out-of-state subpoena, warrant, wiretap order, pen register trap and trace order, or other legal process to include an affidavit or declaration under penalty of perjury that the discovery request is not in connection with an out-of-state proceeding relating to a legally protected health care activity, except as specified. Existing law prohibits a California corporation that provides electronic communication services or remote computing services to the general public from complying with an out-of-state subpoena, warrant, wiretap order, pen register trap and trace order, other legal process, or request by a law enforcement agent or entity seeking records that would reveal the identity of the customers using those services, data stored by, or on behalf of, the customer, the customer's usage of those services, the recipient or destination of communications sent to or from those customers, or the content of those communications, unless the out-of-state subpoena, warrant, wiretap order, pen register trap and trace order, other legal process, or request from law enforcement includes the affidavit or declaration described above. This bill would extend those provisions to also apply to a California corporation that provides financial services, as defined, to the general public. By expanding the situations in which a declaration under penalty of perjury is required, this bill would expand the scope of the crime of perjury and impose a state-mandated local program. The bill would authorize the Attorney General to commence an action to enforce these provisions, as specified, and would authorize the court to assess a statutory penalty of $10,000 for a first violation, and $15,000 for a 2nd or subsequent violation, against any person or entity found to have intentionally, knowingly, willingly, or recklessly complied with or provided information in response to an inquiry, investigation, subpoena, or summons regarding legally protected health care activity in violation of these provisions. 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 no reimbursement is required by this act for a specified reason.
Existing law generally provides for the regulation of law enforcement agencies and requires specified law enforcement agencies to maintain policies on, among other things, use of force, hate crimes, and gun violence restraining orders. Existing law requires the Commission on Peace Officer Standards and Training to establish and keep updated a field training officer course relating to competencies of the field training program and police training program that addresses how to interact with persons with certain conditions. This bill would make it unlawful for a law enforcement officer to deny, delay, obstruct, or fail to facilitate access to medical evaluation or treatment for an individual under law enforcement control, but who is not in the custody of, or detained by, the Department of Corrections and Rehabilitation, if it is safe and reasonable to provide access to treatment and a medical professional has been requested or is present and is willing to render care to the individual. If access to medical evaluation or treatment is denied or delayed when a medical professional is present and is willing to assist, the bill would require law enforcement to document the basis of the denial within 72 hours of the incident, as specified. The bill would authorize administrative discipline, including suspension or termination, against a law enforcement officer who violates those provisions. By creating a new crime and by increasing the duties on local law enforcement relating to reporting, 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 with regard to certain mandates no reimbursement is required by this act for a specified reason. With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1) Existing law provides for the licensure and regulation of health facilities, clinics, home health agencies, and hospice agencies, as defined, by the State Department of Public Health. Existing law provides for the certification of nurse assistants and home health aides by the department. A violation of these provisions by a licensee is a crime. Existing law authorizes the department to deny an application for, initiate an action to suspend or revoke a certificate for, or deny a training and examination application for a nurse assistant or home health aide under specified circumstances. Existing law requires, with some exceptions, the department to deny a training and examination application and deny, suspend, or revoke a certificate if the applicant or certificate holder has been convicted of a violation of or attempted violation of one or more specified crimes. This bill would instead authorize the department to deny an application for, a certificate for, or a training and examination application for, a nurse assistant or home health aide for various reasons, including if an applicant has been convicted of a crime, as specified, within the preceding 7 years from the date of the application that is directly and adversely related to the qualifications, functions, or duties of a certified nurse assistant or home health aide, regardless of whether the applicant was incarcerated for that crime, as specified, and if the applicant has been subjected to formal discipline by the department or a licensing board in or outside California within the preceding 7 years from the date of the application for professional misconduct that would have been cause for discipline, as specified, and that is directly and adversely related to the qualifications, functions, or duties of a certified nurse assistant or home health aide, as specified. The bill would authorize an applicant or certificate holder whose application to be a nurse assistant or home health aide was denied or certificate was suspended or revoked on the basis of a criminal conviction to, during a period of 2 years after the department receives the criminal record report, provide the department with evidence of good character and rehabilitation or provide the department with evidence that the criminal conviction is no longer grounds for denial, as specified. The bill would prescribe requirements for the department in requesting or acting on a nursing assistant or home health aide applicant's criminal history information, including if the department decides to deny a training and examination application or certificate. The bill would authorize the department to initiate an action to suspend or revoke a certificate for professional misconduct warranting cause for discipline, as specified. Upon a determination to revoke or suspend a certificate, the bill would prescribe the requirements for the department to notify the certificate holder in writing by certified mail, including providing information about the procedure for the certificate holder to challenge the determination or request reconsideration. By expanding the scope of a crime, this bill would impose a state-mandated local program. (2) Existing law governs the certification of a certified nurse assistant in a licensed skilled nursing or intermediate care facility. Existing law requires renewal of that certification to be conditional upon specified occurrences, including that the certificate holder submitted documentation of completion of 48 hours of in-service training every 2 years, as specified. Existing law requires at least 12 of the 48 hours of in-service training to be completed in each of the 2 years. Existing law requires that 24 of the 48 hours may be obtained through a specified online computer training program. In order to renew an unexpired certificate, existing law requires the certificate holder to, on or before the expiration date, apply for renewal on a form provided by the department and to submit documentation of the required in-service training. Existing law authorizes an expired certificate to be renewed at any time within 2 years of its expiration on the filing of an application for renewal on a form provided by the department and documentation of the required in-service education. This bill would additionally authorize the certificate holder to submit documentation of 48 hours of continuing education every 2 years. The bill would require at least 12 of the 48 hours of continuous education or in-service training to be completed in each of the 2 years. The bill would authorize the 48 continuing education or in-service hours to be obtained through in-person instructions, synchronous online instruction, asynchronous online instruction, or other distance learning formats approved by the department. This bill would require, to renew an unexpired certificate, or authorize, to renew an expired certificate within 2 years after expiration, the certificate holder to submit documentation of the continuing education or in-service training. (3) 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 no reimbursement is required by this act for a specified reason.
Existing law provides that reproductive health care services, gender-affirming health care services, and gender-affirming mental health care services are rights secured by the Constitution and laws of California, and interference with these rights, whether or not under the color of law, is against the public policy of California. Existing law defines "gender-affirming health care services" to mean medically necessary health care that respects the gender identity of the patient, as experienced and defined by the patient, as specified. Existing law provides for various protective measures for persons engaging in legally protected health care activity, including prohibiting a provider of health care, health care service plan, health insurer, or contractor from releasing medical information related to, among other things, an individual seeking or obtaining gender-affirming health care or gender-affirming mental health care, and prohibiting a state or local public agency, or any employee thereof acting in their official capacity, from cooperating with or providing information to an individual or agency from another state or a federal law enforcement agency, as specified, regarding a legally protected health care activity that is lawful in this state and performed in this state. Existing law defines "legally protected health care activity" for those purposes to include, among other things, the exercise and enjoyment, or attempted exercise and enjoyment, by a person of rights to the health care services described above and the provision of those health care services by a person duly licensed under the laws of California. This bill would require a person or entity that is located, headquartered, incorporated, or otherwise conducting business in California and receives, is served with, or is subject to a subpoena, discovery request, or other request for information that is part of a legal process related to a civil, criminal, regulatory, or legislative investigation regarding abortion, as defined, or gender-affirming health care services that are legally protected health care activities secured by the Constitution or laws of California to provide specified notice to the Attorney General at least 7 business days prior to producing records in response to the request unless a shorter response time is required by federal law or other federal obligation, as specified. If a shorter response time is required by federal law or other federal obligation, the bill would require the responding person or entity to provide notice to the Attorney General no later than contemporaneously with producing the responsive records. The bill would exempt a person or entity from the notice requirement if the subpoena, discovery request, or other request for information meets certain requirements, including that it is accompanied by an attestation verifying that the use or disclosure of the requested information meets certain requirements, including that the requested information is related to an investigation or proceeding regarding activity that is unlawful under California civil or criminal law, and it identifies the California law under which the activity is unlawful. The bill would prohibit a person or entity receiving, served with, or subject to a subpoena, discovery request, or other request for information described above who is not subject to the above-described exemption from producing the responsive records until at least 7 business days after providing notice to the Attorney General unless a shorter response time is required by federal law or other federal obligation, as specified. If a shorter response time is required by federal law or other federal obligation, the bill would require the responding person or entity to make best efforts to deliver the responsive records on the date on which the person or entity is required to respond to the subpoena, discovery request, or other request for information. The bill would authorize the Attorney General to make reasonable attempts to notify the individual who provided, sought, received, facilitated, or otherwise engaged in the abortion or gender-affirming health care service pertaining to the subpoena, discovery request, or other request for information. The bill would entitle a person or entity subject to these provisions to rely on the representations made in an attestation described above. The bill would authorize the Attorney General to intervene in any civil action instituted by a person or entity to protect against compliance with or providing information in response to the subpoena, discovery request, or other request for information. The bill would authorize the Attorney General to commence certain actions, including a civil action against any person or entity that attaches a false attestation described above, and would make the attachment of a false attestation by a person or entity punishable by a civil penalty of $15,000, as specified. The bill would require any action brought by the Attorney General to be commenced within 6 years of the date on which the Attorney General received the notice of the subpoena, discovery request, or other request for information at issue, and would require the court to award court costs and attorney's fees to the Attorney General in any civil action in which the court imposes any penalty authorized by the bill's provisions.
(1) Existing law establishes various grant and loan programs for research, including, among others, the California Institute for Regenerative Medicine, California Firefighter Cancer Prevention and Research Program, and the Public Interest Research, Development, and Demonstration Program. This bill would establish the California Foundation for Science and Health Research within the Government Operations Agency. The bill would require the Secretary of Government Operations to oversee the process of appointing the director of the foundation, and would authorize the Secretary of Government Operations to delegate the task of hiring and determining the salaries, bonuses, and benefits of additional personnel to the director, as specified. The bill would require the director and personnel of the foundation to be responsible for implementing the strategic objectives of the California Foundation for Science and Health Research Council, as described below, administering grants, loans, and contracts awarded by the council, and all other duties as deemed necessary for the operation of the foundation. This bill would create the California Foundation for Science and Health Research and Innovation Acceleration Fund and require the moneys in the fund to be used by the foundation to award grants and make loans to, and enter into contracts with, public or private research companies, universities, academic medical centers, institutes, and organizations for scientific research and development and for certain economic sectors, as specified, in specific areas of research, including, but not limited to, biomedical, behavioral health, and climate research. The bill would also create the California Foundation for Science and Health Research and Innovation Acceleration Benefit Fund, to consist solely of private donations. The bill would make the moneys in the benefit fund available for the same purposes as the California Foundation for Science and Health Research and Innovation Acceleration Fund. This bill would require that, prior to the first grant from the foundation and no later than one year from the date the bill takes effect, the council develop various provisions and requirements to facilitate the foundation's goals of affordability and equitable access. The foundation shall impose various requirements on the grantees, loan recipients, and contractors, as specified, including, among other things, developing strategies to promote equitable access to the subject invention in various specified communities and making the data resulting from the bond-funded research available to the broader scientific community, except in cases involving national security interests. The council shall also establish standards requiring that all grants, awards, and contracts be subject to intellectual property agreements that balance the opportunity for the State of California to benefit from the inventions, technologies, patents, royalties, and licenses that result from research funded by certain public and private grants, as specified. This bill would create the California Foundation for Science and Health Research Council, as specified, which shall be vested with full power, authority, and jurisdiction over the foundation. The bill would require the council to, among other things, develop the strategic objectives and priorities of the foundation and provide the opportunity for public comment on the foundation's priorities, as specified, determine the research projects that will be funded by the California Foundation for Science and Health Research and Innovation Acceleration Fund, develop objectives and opportunities that offer support to early career researchers, and adopt certain regulations and standards, as specified. The bill would also require the council to consider how the foundation's research priorities relate to or support various economic and industry considerations, as specified. The bill would provide that a majority of the members of the council constitutes a quorum for the transaction of any business, for the performance of any duty, or for the exercise of any power of the council, except as otherwise provided. The bill would authorize the council to establish one or more scientific peer review panels consisting of experts in specified fields of research for the purposes of reviewing and prioritizing proposals on the basis of the scientific merit of the proposal, the potential benefit to the health and well-being of the population, natural resources, and environment of the state, and the demonstrated background, training, and expertise of the researchers and investigators to conduct the proposed work. This bill would require all research and development funded by the California Foundation for Science and Health Research and Innovation Acceleration Fund to be conducted under established standards of open scientific exchange, peer review, and public oversight. The bill would require the funds and contracts to be awarded on the basis of the research priorities established for the foundation by the council and the scientific merit of the proposed research, as determined by an open, competitive, scientific peer review process that ensures objectivity, consistency, and high quality. This bill would enact the California Science and Health Research Bond Act, which, if approved by the voters, would authorize the issuance of bonds in the amount of $7,500,000,000, pursuant to the State General Obligation Bond Law, to finance grants and loans to fund research and operate and maintain facilities for research. The bill would provide for the submission of the bond act to the voters at the March 7, 2028, statewide primary election. (2) Existing law establishes prohibitions and penalties with respect to ethical obligations and conflicts of interest for public officials, including a prohibition on engaging in activities that are incompatible with their official duties and a prohibition on being financially interested in a contract made by them in their official capacity or the board of which they are a part. This bill would authorize a council member to participate in a decision to approve or award a grant, loan, or contract for the purpose of research into a disease in which the member or their immediate family member has a personal interest, as specified. The bill would provide that service with specified educational institutions and organizations is not incompatible with a council member's duties. The bill would provide that the prohibition on being financially interested in a contract, as specified, does not apply if the council member recuses themself from a decision to award or approve a grant, loan, or contract that would otherwise be subject to the prohibition. The bill would provide that council members are subject to certain disclosure requirements relating to personal investments and potential conflicts of interest, as specified. (3) Existing law, the Bagley-Keene Open Meeting Act, requires that all meetings of a state body be open and public and all persons be permitted to attend any meeting of a state body, with specified exceptions for authorized closed sessions. This bill would require the Bagley-Keene Open Meeting Act to apply to all meetings of the council and scientific peer review panels, except as specified for when the council or scientific peer review panels meet to consider or discuss specified matters in closed sessions, including matters involving information relating to patients or medical or scientific research subjects, the disclosure of which would constitute an unwarranted invasion of personal privacy. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. (4) This bill would declare that it is to take effect immediately as an urgency statute.
Existing law defines "sexual orientation change efforts" as practices by mental health providers that seek to change an individual's sexual orientation, as specified. Existing law prohibits a mental health provider, as defined, from engaging in sexual orientation change efforts with a patient under 18 years of age, and provides that such efforts attempted by a mental health provider are considered unprofessional conduct and must subject the mental health provider to discipline by that provider's licensing entity. This bill would define "sexual orientation or gender identity change efforts" as any practices of a licensed mental health provider that seek, during the provision of mental health services, to direct a patient toward a predetermined sexual orientation or gender identity, as specified, and would apply the prohibitions described above to such efforts. The bill would exclude specified practices, including age-appropriate interventions to address unlawful conduct or unsafe practices that do not seek to direct the patient toward a particular sexual orientation or gender identity, from this definition.
Existing law establishes the California Reproductive and TGI Health Equity Program within the Department of Health Care Access and Information for the purpose of ensuring abortion, contraception, and gender-affirming care are affordable for and accessible to all patients, regardless of their ability to pay, and to provide financial support for safety net providers of these services to offset the costs of providing uncompensated care to patients with low incomes who would otherwise lack access to care. Existing law authorizes a Medi-Cal enrolled provider to apply for a grant, and a continuation award after the initial grant, if they agree to provide abortion, contraception, and gender-affirming care services in accordance with specified requirements, including that the services are provided at no cost or a reduced cost to individuals with a household income at or below 400% of the federal poverty level who are uninsured or have health care coverage that does not include both abortion and contraception or does not include gender-affirming care and are not otherwise eligible to receive both abortion and contraception care at no cost through the Medi-Cal and Family PACT programs or receive gender-affirming care at no cost through the Medi-Cal program. This bill would additionally authorize a Medi-Cal enrolled provider to apply for a grant or a continuation of a grant if they provide the above-described services to patients who are veterans, as defined, who are uninsured or have health care coverage that does not include both abortion and contraception and are not otherwise eligible to receive both abortion and contraception care at no cost through the Medi-Cal and Family PACT programs. The bill would make other conforming changes and would make related findings and declarations. Existing law establishes the Department of Veterans Affairs and vests the department with specified duties related to veterans in the state, including the development of a transition program to assist veterans in successfully transitioning from military to civilian life by providing information related to, among other things, health care programs and services. This bill would require the Department of Veterans Affairs to publish a link to the State Department of Public Health's abortion information internet website on the women veterans resources page of its internet website.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing federal law generally requires, commencing in 2027, Medicaid beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, to demonstrate community engagement as a condition of Medicaid eligibility. Existing state law sets forth various provisions to conform to that federal requirement. Existing law requires, no sooner than January 1, 2027, as specified, an applicable individual to demonstrate work or community engagement. Existing law sets forth the mechanisms for an applicable individual to comply with that requirement on a monthly basis, including, among others, a minimum of 80 hours of work, community service, or participation in a work program, or a minimum of half-time enrollment in an educational program. This bill would make changes to the definitions of "applicable individual," "work program," and "educational program," and to some of the compliance mechanisms regarding monthly income, for purposes of the above-described provisions. When there is a conflict in reliable data sources that adversely impacts the eligibility of an applicant or beneficiary, the bill would require the county to request the applicant or beneficiary to confirm information before taking any adverse action on the application or renewal. Existing law requires a county, if it is unable to verify that an applicable individual either has met the requirement to demonstrate work or community engagement or was deemed to have demonstrated work or community engagement, to provide the individual with a notice of noncompliance, as specified, and to continue to provide the individual with Medi-Cal services during a 30-calendar-day period if the individual is enrolled in the Medi-Cal program. This bill would require the county to notify applicable individuals enrolled in the Medi-Cal program of the requirement to demonstrate work or community engagement based on certain delivery formats. For an applicable individual renewing their Medi-Cal enrollment during a 6-month redetermination period and who otherwise meets all other eligibility criteria, the bill would require the county to maintain active eligibility pending verification of work or community engagement until at least the last day of the month of the 30-calendar-day period. Under the bill, an applicable individual would be deemed to have received the notice of noncompliance 5 days after the date on the notice. Under the bill, self-attestation that the individual did not receive a timely notice would constitute good cause for not providing a satisfactory showing within the 30-calendar-day period. If no satisfactory showing is made after the 30-calendar-day period, the bill would require the department to consider all other bases of eligibility for medical assistance under the Medi-Cal state plan prior to denying coverage at application or determining that an individual is ineligible. The bill would authorize the department to defer implementation of any of the above-described changes if the change would result in a fiscal impact that would require an additional appropriation and that additional appropriation has not been made, as specified. By creating new duties for counties relating to Medi-Cal eligibility determinations with regard to work or community engagement, 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.
