(a)To be eligible to participate in the program, a person shall meet all of the requirements in either paragraph (1) or (2):
(1)
(A)Be pregnant or in the postpartum period as specified in Section 15840 and a resident of the state. A person who is a member of a federally recognized California Indian tribe is a resident of the state for these purposes.
(B)Have a household income that is above 208 percent of the official federal poverty level but does not exceed 317 percent of the official federal poverty level.
(C)Agree to the payment of the complete subscriber contribution. A federally recognized California Indian
tribal government may make the subscriber contributions on behalf of a member of the tribe only if a contribution on behalf of members of federally recognized California
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(a)
To be eligible to participate in the program, a person shall meet all of the requirements in either paragraph (1) or (2):
(1)
(A)
Be pregnant or in the postpartum period as specified in Section 15840 and a resident of the state. A person who is a member of a federally recognized California Indian tribe is a resident of the state for these purposes.
(B)
Have a household income that is above 208 percent of the official federal poverty level but does not exceed 317 percent of the official federal poverty level.
(C)
Agree to the payment of the complete subscriber contribution. A federally recognized California Indian
tribal government may make the subscriber contributions on behalf of a member of the tribe only if a contribution on behalf of members of federally recognized California Indian tribes does not limit or preclude federal financial participation under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.). If a federally recognized California Indian tribal government makes a contribution on behalf of a member of the tribe, the tribal government shall ensure that the subscriber is made aware of all the health care delivery options available in the county where the member resides.
(2)
(A)
Be a child under two years of age who is delivered by a mother enrolled in the program under this chapter. Except as stated in this section, these infants shall be automatically enrolled in the program.
(B)
For the applicable month, not be enrolled in
employer-sponsored health care coverage, or have been enrolled in that health care coverage in the prior three months or enrolled in full-scope Medi-Cal without a share of cost. Exceptions may be identified in regulations or other guidance and shall, at minimum, include all exceptions applicable to the Healthy Families Program on and after March 23, 2010.
(C)
Be subject to subscriber contributions as determined by the department.
(3)
For infants identified in paragraph (2), all of the following shall apply:
(A)
Enrollment in the program shall cover the first 12 months of the infant’s life unless the infant is determined eligible for Medi-Cal benefits under Section 14005.26. An infant shall be screened for eligibility under Section 14005.26 immediately after the infant is born. If the infant is eligible under Section
14005.26, the infant shall be automatically enrolled in the Medi-Cal program on that basis.
(B)
(i)
At the end of the 12 months, the infant shall remain continuously eligible for the Medi-Cal program until they are five years of age. A redetermination of Medi-Cal eligibility shall not be conducted before the child reaches five years of age, except as specified in Section 14005.255. This clause shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available. The department shall seek any necessary federal approvals to implement this clause.
(ii)
Effective January 1, 2014, when determining eligibility for benefits under the program, income shall be determined, counted, and valued in accordance with the requirements of Section 1397bb(b)(1)(B) of Title 42 of the United States Code as added by
the federal Patient Protection and Affordable Care Act (Public Law 111-148) and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments.
(C)
At the end of their first and second year in the program, and subsequent years, up to five years of age, the child shall be screened for eligibility for the Medi-Cal program.
(4)
If at any time the director determines that the eligibility criteria established under this chapter for the program may jeopardize the state’s ability to receive federal financial participation under the federal Patient Protection and Affordable Care Act (Public Law 111-148), any amendment or extension of that act, or any similar federal legislation affecting federal financial participation, the director may alter the eligibility criteria to the extent necessary for the state to receive that
federal financial participation.
(5)
(A)
Effective July 1, 2024, or the effective date for implementation of the Children’s Presumptive Eligibility Program portal pursuant to Section 14011.7, whichever is later, all qualified Medi-Cal providers participating in presumptive eligibility programs shall use the electronic Newborn Hospital Gateway process, as described in Section 14148.04, to report the birth of an infant eligible under this chapter who is born in their facilities, including hospitals, birthing centers, or other birthing settings, within 72 hours after the birth, or one business day after discharge, whichever is sooner.
(B)
The inclusion of infants eligible under this chapter in the Newborn Hospital Gateway process shall commence on July 1, 2024, or on the effective date for implementation of the Children’s Presumptive Eligibility Program portal
pursuant to Section 14011.7, whichever is later.
(b)
(1)
Implementation of this section is contingent on all of the following conditions:
(A)
All necessary federal approvals have been obtained by the department pursuant to subdivision (d).
(B)
The Legislature has appropriated funding to implement this section after a determination that ongoing General Fund resources are available to support the ongoing implementation of this section in the 2024–25 fiscal year and subsequent fiscal years.
(C)
The department has determined that systems have been programmed to implement this section.
(2)
The department shall issue a declaration certifying the date that all conditions in
paragraph (1) have been met. The department shall post the declaration on its internet website and provide a copy of the declaration to the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel.
(c)
Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, through all-county letters or similar instructions, without taking any further regulatory action.
(d)
This section shall be implemented only to the extent that any necessary federal approvals are obtained, and federal financial participation is available and not otherwise jeopardized.
(e)
(1)
If the voters approve the addition of Chapter
7.5 (commencing with Section 14199.100) to Part 3 of this division at the November 5, 2024, statewide general election, this section shall become operative on January 1, 2025, or the date certified by the department pursuant to paragraph (2) of subdivision (b), whichever is later.
(2)
If the voters do not approve the addition of Chapter 7.5 (commencing with Section 14199.100) to Part 3 of this division at the November 5, 2024, statewide general election, this section shall be repealed as of January 1, 2025.