SB 1202

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, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, retroactive coverage, and cost sharing, among other factors, for certain Medicaid populations pursuant to a specified implementation timeline. This bill would require the department to establish a data dashboard that provides data on applications, enrollment, redeterminations, disenrollments, and terminations, with certain objectives in consideration, related to the impact of the above-described federal law on Medi-Cal eligibility and enrollment, as specified. The bill would require the dashboard to track and report on the specific data for work or community engagement requirements and exemptions. The bill would require the department, commencing no later than January 1, 2028, to operationalize the dashboard and to post the information on a monthly basis in a downloadable format. The bill would require the department to undertake efforts to conduct outreach about work or community engagement requirements, more frequent redeterminations, and changes to retroactive eligibility to impacted Medi-Cal beneficiaries, and to conduct listening sessions, as specified. Under the bill, beneficiary outreach and education would be coordinated across public social services programs to help minimize barriers to administrative disenrollments. The bill would require a Medi-Cal managed care plan to establish and conduct an outreach and education plan for its enrollees about the work or community engagement guidelines set forth in federal law based on guidance provided by the department. The bill would require the outreach and education plan to address certain information on Medi-Cal eligibility, the right to appeal or reinstate Medi-Cal coverage, and resources, and to meet certain cultural and linguistic appropriateness standards. Existing law requires a county to undertake outreach efforts to beneficiaries receiving Medi-Cal benefits in order to, in part, facilitate the Medi-Cal redetermination process. Existing law authorizes a county to collaborate with community-based organizations in implementing this provision. This bill would incorporate the requirements of the above-described federal law into the Medi-Cal redetermination facilitation process. The bill would require a county to make a good faith effort to collaborate with community-based organizations, as specified. The bill would require the county outreach efforts to meet cultural and linguistic appropriateness standards. By creating new duties for counties relating to Medi-Cal outreach, the bill would impose a state-mandated local program. Existing law requires the department to encourage and facilitate efforts by managed care plans to report updated beneficiary contact information to counties. When a managed care plan obtains a beneficiary’s updated contact information, existing law requires the plan to ask the beneficiary for approval to provide the beneficiary’s updated contact information to the appropriate county. If the managed care plan does not obtain that approval, existing law requires the county to attempt to verify that the information that it receives from the plan is accurate, as specified, before updating the beneficiary’s case file. This bill would remove the requirement for the managed care plan to ask the beneficiary for approval for purposes of providing the contact information to the county. The bill would remove the requirement for the county to make the verification attempt and would remove a related provision on the method of contact. The bill would require the department to share, or require each county to share, beneficiary redetermination data with applicable managed care plans to aid in managed care plans’ efforts to assist beneficiaries with retaining Medi-Cal coverage, as specified. To the extent the bill creates new duties for counties relating to the sharing of Medi-Cal redetermination data, it 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.