Part 3.5HEALTH CARE COVERAGE INITIATIVE

Section § 15900

Explanation

This section states that about 21% of nonelderly people in California do not have health insurance, and many of these uninsured individuals are low-income. There is $180 million in federal funds available to support a Health Care Coverage Initiative aimed at expanding health coverage for these uninsured individuals, as part of a larger Medicaid project in California. The health care safety net is vital for providing important services to low-income populations, and local governments are in a good position to create health service plans tailored to their communities' needs.

The Legislature finds and declares the following:
(a)CA Welfare and Institutions Code § 15900(a) Approximately 21 percent of nonelderly Californians lack health insurance coverage. Many are low-income individuals who are not eligible for existing public health coverage programs.
(b)CA Welfare and Institutions Code § 15900(b) One hundred eighty million dollars ($180,000,000) in federal funds will be available for three years to reimburse for public expenditures made under a Health Care Coverage Initiative for uninsured individuals. These funds are to be provided pursuant to the Special Terms and Conditions of California’s Section 1115 Medicaid demonstration project waiver number 11-W-00193/9 relating to hospital financing and health coverage expansion.
(c)CA Welfare and Institutions Code § 15900(c) California’s health care safety net system plays an essential role in delivering critical health services to low-income individuals.
(d)CA Welfare and Institutions Code § 15900(d) Local governments have the unique ability to design health service delivery models that meet the needs of their diverse populations and build on local infrastructures.
uninsured Californians low-income health coverage federal funds reimbursement health care safety net Medicaid demonstration project health service delivery models local government health services Section 1115 waiver hospital financing health coverage expansion California health initiative public expenditures Medicaid project waiver health service infrastructure diverse health needs
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15901

Explanation

This section establishes the Health Care Coverage Initiative, which aims to increase access to health care for low-income uninsured people in California.

The initiative operates under a specific Medicaid waiver that began on September 1, 2005, and will only move forward if federal funding is available.

(a)CA Welfare and Institutions Code § 15901(a) There is hereby established the Health Care Coverage Initiative to expand health care coverage to low-income uninsured individuals in California.
(b)CA Welfare and Institutions Code § 15901(b) The Health Care Coverage Initiative shall operate pursuant to the Special Terms and Conditions of California’s Section 1115 Medicaid demonstration project waiver number 11-W-00193/9 relating to hospital financing and health coverage expansion that became effective September 1, 2005. The initiative shall be implemented only to the extent that federal financial participation is available.
Health Care Coverage Initiative low-income uninsured health care access Medicaid waiver Section 1115 hospital financing health coverage expansion federal financial participation California Medicaid uninsured individuals demonstration project
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15902

Explanation

This section talks about the Health Care Coverage Initiative, which helps low-income people who don't already qualify for certain government health programs, like Medi-Cal. Money for the initiative is specifically used to offer health coverage to these uninsured individuals. Importantly, expanding this coverage shouldn't reduce access to healthcare for other uninsured people, such as those using county or community clinics. Moreover, while services are provided to those who sign up, this law doesn't create an automatic right to healthcare coverage. Additionally, no general state funds are to be used for this initiative or its related administrative costs in counties.

(a)CA Welfare and Institutions Code § 15902(a) Persons eligible to be served by the Health Care Coverage Initiative are low-income uninsured individuals who are not currently eligible for the Medi-Cal program, Healthy Families Program, or Access for Infants and Mothers program.
(b)CA Welfare and Institutions Code § 15902(b) Funding for the Health Care Coverage Initiative shall be used to expand health care coverage for eligible uninsured individuals.
(c)CA Welfare and Institutions Code § 15902(c) Any expansion of health care coverage for uninsured individuals shall not diminish access to health care available for other uninsured individuals, including access through disproportionate share hospitals, county clinics, or community clinics.
(d)CA Welfare and Institutions Code § 15902(d) Services provided under the Health Care Coverage Initiative shall be available to those eligible uninsured individuals enrolled in a Health Care Coverage program, and nothing in this part shall be construed to create an entitlement program of any kind.
(e)CA Welfare and Institutions Code § 15902(e) No state General Fund moneys shall be used to fund the Health Care Coverage Initiative, nor to fund any related administrative costs provided to counties.
Health Care Coverage Initiative low-income uninsured individuals Medi-Cal eligibility Healthy Families Program Access for Infants and Mothers disproportionate share hospitals county clinics community clinics expansion of health coverage enrollment no entitlement program state General Fund administrative costs uninsured access health care coverage
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15903

Explanation

This law outlines the goals for the Health Care Coverage Initiative in California. Its main objectives are to increase the number of residents with health coverage, enhance the local health care safety net system, and improve the quality and outcomes of health care services. The law also focuses on creating cost-saving efficiencies, ensuring the long-term sustainability of funded programs, and quickly implementing these measures to meet federal spending deadlines.

The Health Care Coverage Initiative shall be designed and implemented to achieve all of the following outcomes:
(a)CA Welfare and Institutions Code § 15903(a) Expand the number of Californians who have health care coverage.
(b)CA Welfare and Institutions Code § 15903(b) Strengthen and build upon the local health care safety net system, including disproportionate share hospitals, county clinics, and community clinics.
(c)CA Welfare and Institutions Code § 15903(c) Improve access to high quality health care and health outcomes for individuals.
(d)CA Welfare and Institutions Code § 15903(d) Create efficiencies in the delivery of health services that could lead to savings in health care costs.
(e)CA Welfare and Institutions Code § 15903(e) Provide grounds for long-term sustainability of the programs funded under the initiative.
(f)CA Welfare and Institutions Code § 15903(f) Implement programs in an expeditious manner in order to meet federal requirements regarding the timing of expenditures.
Health Care Coverage Initiative expanding health coverage health care safety net disproportionate share hospitals county clinics community clinics high quality health care health outcomes improvement health care cost savings program sustainability federal expenditure timing health services delivery local health system Californian residents health coverage implementation efficiency
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15904

Explanation

This section outlines how California's Health Care Coverage Initiative is funded and managed. The State Department of Health Care Services will request applications and allocate federal funds to programs that help provide medical coverage. These programs must meet criteria like effective enrollment processes, using electronic medical records, offering comprehensive health care services, and promoting preventive care. Counties, cities, or health authorities can apply for funding, but they must submit only one proposal and provide local funds to match the federal money. The department will rank applications based on their strengths and spread funds geographically throughout the state, selecting at least five programs with no single program receiving more than 30% of total funding. Programs use funds over a three-year period and must not replace existing funding sources. If a program can't meet its goals, the department can reallocate funds to other programs. Administrative costs are separate from allocated health care funds.

(a)CA Welfare and Institutions Code § 15904(a) The State Department of Health Care Services shall issue a request for applications for funding the Health Care Coverage Initiative.
(b)CA Welfare and Institutions Code § 15904(b) The department shall allocate federal funds available to be claimed under the Health Care Coverage programs.
(c)CA Welfare and Institutions Code § 15904(c) The department shall select the Health Care Coverage programs that best meet the requirements and desired outcomes set forth in this part.
(d)CA Welfare and Institutions Code § 15904(d) The following elements shall be used in evaluating the proposals to make selections and to determine the allocation of the available funds:
(1)CA Welfare and Institutions Code § 15904(d)(1) Enrollment processes, with an identification system to demonstrate enrollment of the uninsured into the program.
(2)CA Welfare and Institutions Code § 15904(d)(2) Use of a medical record system, which may include electronic medical records.
(3)CA Welfare and Institutions Code § 15904(d)(3) Designation of a medical home and assignment of eligible individuals to a primary care provider. For purposes of this paragraph, “medical home” means a single provider or facility that maintains all of an individual’s medical information. The primary care provider shall be a provider from which the enrollee can access primary and preventive care.
(4)CA Welfare and Institutions Code § 15904(d)(4) Provision of a benefit package of services, including preventive and primary care services, and care management services designed to treat individuals with chronic health care conditions, mental illness, or who have high costs associated with their medical conditions, to improve their health and decrease future costs. Benefits may include case management services.
(5)CA Welfare and Institutions Code § 15904(d)(5) Quality monitoring processes to assess the health care outcomes of individuals enrolled in the Health Care Coverage program.
(6)CA Welfare and Institutions Code § 15904(d)(6) Promotion of the use of preventive services and early intervention.
(7)CA Welfare and Institutions Code § 15904(d)(7) The provision of care to Medi-Cal beneficiaries by the applicant and the degree to which the applicant coordinates its care with services provided to Medi-Cal beneficiaries.
(8)CA Welfare and Institutions Code § 15904(d)(8) Screening and enrollment processes for individuals who may qualify for enrollment into Medi-Cal, the Healthy Families Program, and the Access for Infants and Mothers Program prior to enrollment into the Health Care Coverage program.
(9)CA Welfare and Institutions Code § 15904(d)(9) The ability to demonstrate how the Health Care Coverage program will promote the viability of the existing safety net health care system.
(10)CA Welfare and Institutions Code § 15904(d)(10) Documentation to support the applicant’s ability to implement the Health Care Coverage program by September 1, 2007, and to use its allocation for each project year.
(11)CA Welfare and Institutions Code § 15904(d)(11) Demonstration of how the program will provide consumer assistance to individuals applying to, participating in, or accessing services in the program.
(e)CA Welfare and Institutions Code § 15904(e) Entities eligible to apply for the initiative funds are a county, city and county, consortium of counties serving a region consisting of more than one county, or health authority. No entity shall submit more than one proposal.
(f)CA Welfare and Institutions Code § 15904(f) The department shall rank the program applications based on the criteria in this section. The amount of federal funding available to be claimed shall be allocated based upon the ranking of the applications. The department shall allocate the available federal funding to the highest ranking applications until all of the funding is allocated. The department shall select at least five programs, and no single program shall receive an allocation greater than 30 percent of the total federal allotment. The department is not required to fund the entire amount requested in a program application.
(g)CA Welfare and Institutions Code § 15904(g) The department shall seek to balance the allocations throughout geographic areas of the state.
(h)CA Welfare and Institutions Code § 15904(h) Each county, city and county, consortium of counties, or health authority that is selected to receive funding shall provide the necessary local funds for the nonfederal share of the certified public expenditures, or intergovernmental transfers to the extent allowable under the demonstration project, required to claim the federal funds made available from the federal allotment. The certified public expenditures, or intergovernmental transfers to the extent allowable under the demonstration project, shall meet the requirements of the Special Terms and Conditions of California’s Section 1115 Medicaid demonstration project waiver number 11-W-00193/9 relating to hospital financing and health coverage expansion that became effective September 1, 2005.
(i)CA Welfare and Institutions Code § 15904(i) The federal allocation shall be available to the selected programs for the three-year period covering the Health Care Coverage program pursuant to the Special Terms and Conditions of California’s Section 1115 Medicaid demonstration project waiver number 11-W-00193/9 relating to hospital financing and health coverage expansion, unless the selected programs do not incur expenditures sufficient to claim the allocation of federal funds in the particular program year. Selected programs shall expend the funds according to an expenditure schedule determined by the department.
(j)CA Welfare and Institutions Code § 15904(j) The department may reallocate the available federal funds among selected programs or other program applicants that were previously not selected for funding, if necessary to meet federal requirements regarding the timing of expenditures, notwithstanding subdivision (f). If a selected program fails to substantially comply with the requirements of this article, the department may reallocate the available federal funds from that selected program to other selected programs or other program applications that previously were not selected for funding. If a selected program is unable to meet its spending targets, determined at the end of the second quarter of each program year, the department may reallocate funds to other selected programs or other program applications that previously were not selected for funding, to ensure that all available federal funds are claimed. Selected programs receiving reallocated funds must have the ability to make the certified public expenditures necessary to claim the reallocated federal funds.
(k)CA Welfare and Institutions Code § 15904(k) Federal funds provided for the initiative shall supplement, and not supplant, any county, city and county, health authority, state, or federal funds that would otherwise be spent on health care services in the county, city and county, consortium of counties, or a health authority region. Federal funds allocated under the initiative shall reimburse the selected county, city and county, consortium of counties, or health authority for the benefits and services provided under subdivision (d) of Section 15904. Administrative costs associated with the development and management of the initiative shall not be paid from the Health Care Coverage program allocation, and any allocations for administrative funds shall be in addition to the allocations made for the initiative.
Health Care Coverage Initiative federal funds allocation program selection criteria enrollment processes electronic medical records medical home preventive services primary care provider Medi-Cal coordination funding reallocation certified public expenditures Section 1115 Medicaid waiver health care services reimbursement initiative funding applications local funding match
(Amended by Stats. 2007, Ch. 483, Sec. 52. Effective January 1, 2008. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15905

Explanation

This section outlines the requirements for applications submitted to the department for a proposed Health Care Coverage program. It includes the criteria such as eligibility details, enrollment procedures, and screening for other programs like Medi-Cal. The application must also describe quality monitoring systems, the population served, participating healthcare providers, and organized healthcare delivery methods.

It should specify health benefits offered, care management services, and cost per individual. Furthermore, it requires information about funding sources, how the program enhances local healthcare systems, and a consent form for data provision. Additionally, it states the need for a robust medical record-keeping system and coordination with existing Medi-Cal services.

Applications submitted to the department shall include, but not be limited to, each of the following:
(a)CA Welfare and Institutions Code § 15905(a) A description of the proposed Health Care Coverage program, including, but not limited to, all of the following:
(1)CA Welfare and Institutions Code § 15905(a)(1) Eligibility criteria.
(2)CA Welfare and Institutions Code § 15905(a)(2) Screening and enrollment processes that include an identification system to demonstrate enrollment into the Health Care Coverage program.
(3)CA Welfare and Institutions Code § 15905(a)(3) Screening processes to identify individuals who may qualify for enrollment into Medi-Cal, the Healthy Families Program, or the Access for Infants and Mothers Program.
(b)CA Welfare and Institutions Code § 15905(b) A description of the quality monitoring system to be implemented with the Health Care Coverage program.
(c)CA Welfare and Institutions Code § 15905(c) A description of the population to be served.
(d)CA Welfare and Institutions Code § 15905(d) A list of health care providers who have agreed to participate in the Health Care Coverage program.
(e)CA Welfare and Institutions Code § 15905(e) A description of the organized health care delivery systems to be used for the Health Care Coverage program, including, but not limited to, designation of a medical home and processes used to assign eligible individuals to a primary care provider.
(f)CA Welfare and Institutions Code § 15905(f) A list of the health benefits to be provided, including the preventive and primary care services and how they will be promoted.
(g)CA Welfare and Institutions Code § 15905(g) A description of the care management services to be provided, and the providers of those services.
(h)CA Welfare and Institutions Code § 15905(h) A calculation of the average cost per individual served.
(i)CA Welfare and Institutions Code § 15905(i) The number of individuals to be served.
(j)CA Welfare and Institutions Code § 15905(j) The mechanism under which the proposed Health Care Coverage Initiative will make expenditures to, or on behalf of, providers and other entities, including, but not limited to, documentation to support the ability to implement the Health Care Coverage program by September 1, 2007, and to claim the full amount of the allocation for each program year.
(k)CA Welfare and Institutions Code § 15905(k) A description of the source of the local nonfederal share of funds.
(l)CA Welfare and Institutions Code § 15905(l) A description of how the proposed Health Care Coverage program will strengthen the local health care safety net system.
(m)CA Welfare and Institutions Code § 15905(m) A consent form signed by the applicant to provide requested data elements as required per the Special Terms and Conditions of California’s Section 1115 Medicaid demonstration project waiver number 11-W-00193/9 relating to hospital financing and health coverage expansion.
(n)CA Welfare and Institutions Code § 15905(n) Use of a reliable medical record system, that may include, but need not be limited to, existing electronic medical records.
(o)CA Welfare and Institutions Code § 15905(o) A complete description of health care services currently provided to Medi-Cal beneficiaries and a description as to how the proposed Health Care Coverage program will coordinate its Health Care Coverage program with services provided to Medi-Cal beneficiaries.
Health Care Coverage program eligibility criteria enrollment processes Medi-Cal screening quality monitoring population served healthcare providers organized healthcare delivery health benefits care management services local nonfederal share of funds local health care safety net electronic medical records Medi-Cal coordination program expenditures
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15906

Explanation

This law requires the department to partner with a nonprofit, academic institution, or government entity to evaluate programs funded under an initiative. The evaluation must check if the programs meet certain outcomes as previously listed. Both the department and the programs themselves need to supply data for this evaluation. The evaluation should be sent to relevant legislative committees and the Secretary of Health and Human Services.

(a)CA Welfare and Institutions Code § 15906(a) The department shall seek partnership with an independent, nonprofit group or foundation, an academic institution, or a governmental entity providing grants for health-related activities, to evaluate the programs funded under the initiative.
(b)CA Welfare and Institutions Code § 15906(b) The evaluation shall, at a minimum, include an assessment of the extent to which the programs have met the outcomes listed in Section 15903.
(c)CA Welfare and Institutions Code § 15906(c) The department and the selected programs shall provide the data for the evaluation.
(d)CA Welfare and Institutions Code § 15906(d) The evaluation shall be submitted concurrently to the appropriate policy and fiscal committees of the Legislature and to the Secretary of Health and Human Services.
program evaluation independent partnership nonprofit group academic institution government grants health-related activities assessment outcomes data provision legislative committees Secretary of Health and Human Services
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15907

Explanation

The department is responsible for monitoring programs funded by an initiative to ensure they comply with federal and state requirements, and financing terms related to California's Medicaid waiver. By September 2006, the department must propose changes to the federal government about eligibility and benefits concerning the Health Care Coverage Initiative.

The department must check spending levels of allocated funds at least quarterly but cannot use support funds for administrative purposes. The process for selecting entities for operating programs is exempt from certain public contracting laws. Regulations to implement these programs can be issued as emergency regulations, or the department can use bulletins and letters to guide implementation.

The department also needs to keep legislative committees informed about upcoming instructions and must consult with stakeholders throughout the implementation process.

(a)CA Welfare and Institutions Code § 15907(a) The department shall monitor the programs funded under the initiative for compliance with applicable federal requirements and the requirements under this part, and pursuant to the Special Terms and Conditions of California’s Section 1115 Medicaid demonstration project waiver number 11-W-00193/9 relating to hospital financing and health coverage expansion.
(b)CA Welfare and Institutions Code § 15907(b) To the extent necessary to implement this part, the department shall submit, by September 1, 2006, to the federal Centers for Medicare and Medicaid Services, proposed waiver amendments on the structure of, and eligibility and benefits under, the Health Care Coverage Initiative.
(c)CA Welfare and Institutions Code § 15907(c) The department shall monitor the allocations to selected programs at least quarterly for spending levels.
(d)CA Welfare and Institutions Code § 15907(d) No funds made available from the Health Care Support Fund for the Health Care Coverage Initiative shall be used by the department for administration.
(e)CA Welfare and Institutions Code § 15907(e)  The request for applications, including any part of the process described herein for selecting entities to operate the Health Care Coverage programs, and any agreements entered into with a county, city and county, consortium of counties, or health authority pursuant to this part shall not be subject to Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code.
(f)CA Welfare and Institutions Code § 15907(f) The department may adopt regulations to implement this part. These regulations may initially be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this part, the adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, and safety or general welfare. Any emergency regulations adopted pursuant to this section shall not remain in effect subsequent to the date that this part is repealed pursuant to Section 15908.
(g)CA Welfare and Institutions Code § 15907(g) As an alternative to subdivision (f), and notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, or any other provision of law, the department may implement and administer this part by means of provider bulletins, county letters, manuals, or other similar instructions, without taking regulatory action. The department shall notify the fiscal and appropriate policy committees of the Legislature of its intent to issue a provider bulletin, county letter, manual, or other similar instruction, at least five days prior to issuance. In addition, the department shall provide a copy of any provider bulletin, county letter, manual, or other similar instruction issued under this paragraph to the fiscal and appropriate policy committees of the Legislature.
(h)CA Welfare and Institutions Code § 15907(h) The department shall consult with interested parties and appropriate stakeholders regarding the implementation and ongoing administration of this part.
Medicaid demonstration waiver Health Care Coverage Initiative program compliance federal requirements emergency regulations Health Care Support Fund quarterly spending monitoring eligibility and benefits proposal public contract exemption provider bulletins stakeholder consultation county letters fiscal committees administrative procedure hospital financing
(Added by Stats. 2006, Ch. 76, Sec. 2. Effective July 18, 2006. Inoperative on date prescribed in Section 15908. Repealed six months after inoperative date, pursuant to Section 15908.)

Section § 15908

Explanation

This law will be inactive once a specific program called the Low Income Health Program is put in place. The director of the program must make a formal declaration when this happens and share it with the Legislature and make it publicly available online.

After six months from this declaration, the law will be repealed. In the meantime, the director can continue any projects connected to this program, as long as they are approved by federal health services.

(a)CA Welfare and Institutions Code § 15908(a) This part shall become inoperative on the date that the director executes a declaration, which shall be retained by the director and provided to the fiscal and appropriate policy committees of the Legislature, stating that the Low Income Health Program authorized under Part 3.6 (commencing with Section 15909) and under the Special Terms and Conditions of the demonstration project, as defined in Section 15909.1, has been implemented, and that each Health Care Coverage Initiative program approved under this part that has sought approval under Part 3.6 (commencing with Section 15909) has been transitioned to a Low Income Health Program, if authorized under the demonstration project and Part 3.6 (commencing with Section 15909), and shall, six months after the date the declaration is executed, be repealed.
(b)CA Welfare and Institutions Code § 15908(b) In addition to the requirements specified in subdivision (a), the director shall post the declaration on the department’s Internet Web site and the director shall send the declaration to the Secretary of State and the Legislative Counsel.
(c)CA Welfare and Institutions Code § 15908(c) Until the effective date of the repeal of this part pursuant to subdivision (a), the director may continue and administer any extensions, modifications, or continuation of the projects under this part approved by the federal Centers for Medicare and Medicaid Services.
Low Income Health Program Health Care Coverage Initiative demonstration project declaration execution program transition health program implementation program repeal federal approval Medicare and Medicaid Services policy committees Legislature notification program extensions program modifications program continuation health law transition
(Amended by Stats. 2011, Ch. 86, Sec. 23. (AB 1066) Effective July 15, 2011. Repealed on date prescribed by its own provisions. Note: Termination clause affects Part 3.5, commencing with Section 15900.)