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 and funded by federal Medicaid program provisions.
Existing law sets forth various provisions for Medi-Cal coverage of community health worker services, enhanced care management, and community supports, subject to any necessary federal approvals. Under existing law, these benefits are designed to, respectively, provide a link between health and social services and the community; address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries, including individuals experiencing homelessness; and provide housing transition navigation services, among other supports.
Existing law establishes mechanisms for Medi-Cal presumptive eligibility for certain target populations, including, among others, pregnant persons, children, and patients of qualified hospitals, for purposes of Medi-Cal coverage while other Medi-Cal eligibility determination procedures are pending, as specified.
This bill would set forth provisions regarding street medicine, as defined, under the Medi-Cal program for persons experiencing homelessness, as defined. The bill would state the intent of the Legislature that the street medicine-related provisions coexist with, and not duplicate, other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports.
The bill would require the department to implement a program of presumptive eligibility for persons experiencing homelessness for purposes of full-scope Medi-Cal benefits without a share of cost. The bill would authorize an enrolled Medi-Cal provider to make a presumptive eligibility determination for those persons.
The bill would require a Medi-Cal managed care plan to allow a beneficiary who is experiencing homelessness to seek Medi-Cal covered services directly from any participating Medi-Cal provider off the premises of the provider's site. The bill would impose related reimbursement requirements on a managed care plan and the department. The bill would authorize a managed care plan to establish reasonable requirements governing participation in the plan network, if protocols and network participation requirements are consistent with the goal of authorizing services to Medi-Cal beneficiaries who are experiencing homelessness.
The bill would require a managed care plan to provide a beneficiary with the ability to inform the managed care plan online, in person, or via telephone that the beneficiary is experiencing homelessness. The bill would require the department to inform a managed care plan if a beneficiary has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application.
The bill would require the department to ensure that the Medi-Cal program and the California Statewide Automated Welfare System (CalSAWS) mutually share data on the status of Medi-Cal applicants or beneficiaries experiencing homelessness, including through codes relating to unsheltered status, to the extent not in conflict with privacy laws. The bill would require the coordination to enable a person applying for the Medi-Cal program to identify that they are experiencing homelessness.
The bill would condition implementation of the above-described provisions on receipt of any necessary federal approvals and the availability of federal financial participation.
The bill would make conforming changes to related provisions under existing law regarding the application process. The bill would also remove obsolete references within related provisions.
To the extent that the bill would create new duties for counties with regard to presumptive eligibility determinations or data sharing under Medi-Cal, the bill 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.

Statutes affected:
AB 543: 15926 WIC
02/11/25 - Introduced: 15926 WIC