§ 14011.7. — 14011.7. (Amended by Stats. 2023, Ch. 42, Sec. 111.)

California § 14011.7.

• Jurisdiction: California
• Code WIC: Welfare and Institutions Code - WIC
• Div. 9.: DIVISION 9. PUBLIC SOCIAL SERVICES
• Part 3.: PART 3. AID AND MEDICAL ASSISTANCE
• Ch. 7.: CHAPTER 7. Basic Health Care
• Art. 1.: ARTICLE 1. General Provisions

Text

(a)
To the extent allowed under federal law and only if federal financial participation is available, the department shall exercise the option provided in Section 1396r-1a of Title 42 of the United States Code and the option provided in Section 1397gg(e)(1)(D) of Title 42 of the United States Code to implement a program for preenrollment of children into the Medi-Cal program. Upon the exercise of both of the federal options described in this subdivision, the department shall implement the Children’s Presumptive Eligibility Program for the preenrollment of children into the Medi-Cal program.
(b)
(1)
Before July 1, 2003, the department shall develop an electronic application to serve as the application for the Children’s Presumptive
Eligibility Program, to the extent allowed under federal law.
(2)
The department may, at its option, also use the electronic application developed pursuant to paragraph (1), as a means to enroll newborns into the Medi-Cal program as is authorized under Section 1396a(e)(4) of Title 42 of the United States Code. Providers may submit newborn enrollments through the electronic application on behalf of patients without a patient’s signature.
(c)
(1)
The department may designate, as necessary, Medi-Cal providers as qualified entities who are authorized to determine eligibility for preenrollment into the Medi-Cal program as authorized under this section.
(2)
The provider shall assist the parent
or guardian of the child seeking eligibility for preenrollment into the Medi-Cal program in completing the electronic application.
(d)
The electronic application developed pursuant to subdivision (b) may only be filed when the child is in need of Medi-Cal.
(e)
(1)
The electronic application developed pursuant to subdivision (b) shall request all information necessary for a provider to make an immediate determination as to whether a child meets the eligibility requirements for preenrollment into the Medi-Cal program pursuant to the federal options described in Section 1396r-1a or 1397gg(e)(1)(D) of Title 42 of the United States Code.
(2)
(A)
If the electronic application indicates that the child is seeking eligibility for no cost full-scope Medi-Cal benefits, the department
shall mail to the child’s parent or guardian a followup application for Medi-Cal program eligibility. The parent or guardian of the child shall be advised to complete and submit to the appropriate entity the followup application.
(B)
The followup application, at a minimum, shall include all notices and forms necessary for the Medi-Cal program eligibility determination under state and federal law, including, but not limited to, any information and documentation that is required for the joint application package described in Section 14011.1.
(C)
The date of application for the Medi-Cal program is the date the completed followup application is submitted with the appropriate entity by the parent or guardian.
(3)
Upon making a determination pursuant to paragraph (1) that a child is eligible, the
provider shall inform the child’s parent or guardian of both of the following:
(A)
That the child has been determined to be eligible for preenrollment into the Medi-Cal program.
(B)
That if the child has been determined to be eligible for preenrollment into the Medi-Cal program, the period of preenrollment eligibility will end on the last day of the month following the month in which the determination of preenrollment eligibility is made, unless the parent or guardian completes and returns to the appropriate entity the followup application described in paragraph (2) on or before that date.
(4)
If the followup application described in paragraph (2) is submitted on or before the last day of the month following the month in which a determination is made that the child is eligible for preenrollment into
the Medi-Cal program, the period of preenrollment eligibility shall continue until the completion of the determination process for the applicable program or programs.
(f)
The department shall seek approval of any amendments to the state plan, necessary to implement this section, for purposes of funding under Title XIX (42 U.S.C. 1396 et seq.) and Title XXI (42 U.S.C. 1397aa et seq.) of the Social Security Act. Notwithstanding any other provision of law and only when all necessary federal approvals have been obtained, this section shall be implemented only to the extent federal financial participation is available.
(g)
To implement this section, the department may contract with public or private entities, or utilize existing health care service provider enrollment and payment mechanisms, including the Medi-Cal program’s fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that appropriately claims federal financial reimbursement. Contracts, including the Medi-Cal fiscal intermediary contracts and contract amendments, any system change pursuant to a change order, and any project or systems development notice shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, Section 19130 of the Government Code, and any policies, procedures, or regulations authorized by these laws.
(h)
Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of all-county letters or similar instructions, without taking any further
regulatory action. Thereafter, the department shall adopt regulations, as necessary, to implement this section in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.

Legislative History

Amended by Stats. 2023, Ch. 42, Sec. 111. (AB 118) Effective July 10, 2023.