§ 15877. — 15877. (Added by Stats. 2024, Ch. 40, Sec. 81.)

California § 15877.

• Jurisdiction: California
• Code WIC: Welfare and Institutions Code - WIC
• Div. 9.: DIVISION 9. PUBLIC SOCIAL SERVICES
• Part 3.3.: PART 3.3. Health Care Coverage Assistance
• Ch. 4.: CHAPTER 4. California Major Risk Medical Insurance Program
• Art. 2.: ARTICLE 2. Powers and Duties

Text

(a)
The department shall direct the participating health plans to inform all program subscribers of the December 31, 2024, transition of coverage as follows:
(1)
(A)
On August 1, 2024, the participating health plans shall send an initial notification to all program subscribers. The initial notice will inform subscribers of all of the following:
(i)
That a plan-based enroller shall assist the subscriber in applying to Medi-Cal or through the California Health Benefit Exchange for other health care coverage.
(ii)
That assistance may be available through the California Health Benefit Exchange or
clinic navigators and how to obtain that assistance.
(iii)
Information regarding where and how subscribers can apply to the California Health Benefit Exchange for alternate health care coverage.
(B)
If a participating health plan has plan-based enrollers through the California Health Benefit Exchange, the plan shall direct the plan-based enrollers to assist the subscribers in understanding their coverage options.
(C)
Assistance to subscribers by plans shall provide information on continuity with an existing provider to the extent possible.
(2)
On October 1, 2024, the participating health plans shall send a second notification informing all program subscribers that coverage shall transition on December 31, 2024, for those who are eligible for other
coverage, and the notice shall include all of the information that was included in the initial notification sent on August 1, 2024.
(3)
On December 1, 2024, the participating health plans shall send a third notification informing all program subscribers that coverage shall transition on December 31, 2024, for those who are eligible for other coverage, and the notice shall include all of the information that was included in the initial notification sent on August 1, 2024.
(b)
(1)
Upon request from the California Health Benefit Exchange, the department may disclose information to the Exchange to assist program subscribers to transition into new coverage pursuant to this section.
(2)
The Exchange may disclose information obtained from the department to outreach and marketing vendors under contract
to the Exchange.
(3)
The Exchange shall not disclose information obtained from the department to a certified insurance agent, a certified enrollment counselor, or any other entity without the consent of the applicant, except as provided in paragraph (2).
(4)
Any outreach and marketing conducted pursuant to this section shall include, in a conspicuous and easy-to-access manner, the ability for individuals to decline all future outreach and marketing.
(5)
The Exchange shall take all necessary measures to safeguard the confidentiality of any information obtained from the department and shall at no time use or disclose that information for any purpose other than to market and publicize the availability of health care coverage through the Exchange to individuals whose information the Exchange receives pursuant to
subdivision (c). The Exchange shall at all times only request, use, or disclose the minimum amount of information necessary to accomplish the purposes for which it was obtained.
(6)
A person or entity that receives information from the Exchange pursuant to this section shall take all necessary measures to safeguard the confidentiality of any information obtained from the Exchange and shall at no time use or disclose that information for any purpose other than to market and publicize the availability of health care coverage through the Exchange to individuals, as directed by the Exchange. A person or entity shall at all times only request from the Exchange, use, or disclose the minimum amount of information necessary to accomplish the purposes for which it was received.
(7)
Information received by the Exchange from the department shall both:
(A)
At all times be subject to applicable privacy and information security-related requirements arising under both federal and state law.
(B)
Be destroyed in a manner that maintains confidentiality.
(8)
The Exchange shall ensure that information disclosed to outreach and marketing vendors or any other entity pursuant to this section complies with paragraph (7).
(c)
Sections 1373.65, 1373.95, and 1373.96 of the Health Safety Code shall apply, whether or not the plan is licensed under Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.
(d)
The department shall cease to provide coverage through the program on December 31, 2024, and on that date shall cease to
operate the program except as necessary to comply with subdivision (e).
(e)
The department shall complete payments to, or payment reconciliations with, participating health plans or other contractors, process appeals, and conduct other necessary termination activities.
(f)
Commencing November 1, 2024, and ending when the transition of coverage is complete, the department shall provide monthly updates to the Assembly Committees on Health and Budget and the Senate Committees on Health and Budget and Fiscal Review on the status of the transition of subscribers to other coverage. These updates shall include the number of subscribers who have transitioned and, to the extent available, to where, the number remaining in the program, and any available demographic information of each subscriber.

Legislative History

Added by Stats. 2024, Ch. 40, Sec. 81. (SB 159) Effective June 29, 2024.