SB 1202

SB1202:v95#DOCUMENT

Bill Start

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

Senate Bill

No. 1202

An act to amend Section 14005.36 of, and to add Sections 14005.365 and 14197.81 to, the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

SB 1202, as amended, Weber Pierson. Medi-Cal: dashboard and outreach.

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 sharing of 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.

Digest Key

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES

Bill Text

The people of the State of California do enact as follows:

SECTION 1.

Section 14005.36 of the Welfare and Institutions Code is amended to read:

14005.36.

(a) (1) (A) The department shall undertake efforts to conduct outreach about work or community engagement requirements, more frequent redeterminations, and changes to retroactive eligibility to impacted Medi-Cal beneficiaries pursuant to changes made under federal House Resolution 1 (Public Law 119-21).

(B) The outreach shall include information on how to comply with the work or community engagement requirements, an explanation of the definition of an “applicable individual” as set forth in subsection (xx) of Section 1396a of Title 42 of the United States Code, and those beneficiaries who may be exempted, including any reporting requirements and processes to meet an exemption, and the consequences of noncompliance.

(C) The department shall provide an outreach notice to the beneficiary by mail, or an electronic format if elected by the individual, and by one or more additional formats. Additional formats may include telephone, text message, an internet website, other commonly available electronic means, and other formats that the United States Secretary of Health and Human Services determines appropriate.

(D) Beneficiary outreach and education shall be coordinated across public social services programs to help minimize barriers to administrative disenrollments.

(E) The department shall conduct listening sessions, to the extent feasible, with Medi-Cal beneficiaries, CalFresh recipients, eligibility workers, counties, and community-based organizations representing the diversity of the Medi-Cal population to help inform member communications and outreach strategies.

(2) (A) The county shall undertake outreach efforts to beneficiaries receiving benefits under this chapter, in order to maintain the most up-to-date home addresses, telephone numbers, and other necessary contact information, and to encourage and assist with timely submission of the annual reaffirmation form, and, when applicable, transitional Medi-Cal program reporting forms and to facilitate the Medi-Cal redetermination process, including the requirements of Public Law 119-21. In implementing this subdivision, a county shall make a good faith effort to collaborate with community-based organizations, provided that confidentiality is protected. A county shall exercise its discretion in determining which community-based organizations are best situated to assist in outreach efforts, particularly in efforts aimed at difficult-to-reach individuals and communities.

(B) The county outreach efforts shall meet cultural and linguistic appropriateness standards, in alignment with the National Standards for Culturally and Linguistically Appropriate Services.

(b) The department shall encourage and facilitate efforts by managed care plans to report updated beneficiary contact information to counties.

(c) (1) The department and each county shall incorporate, in a timely manner, updated contact information received from managed care plans pursuant to subdivision (b) into the beneficiary’s Medi-Cal case file and into all systems used to inform plans of their beneficiaries’ enrollee status. Updated Medi-Cal beneficiary contact information shall be limited to the beneficiary’s telephone number, change of address information, and change of name.

(2) When a managed care plan obtains a beneficiary’s updated contact information, the managed care plan shall provide the beneficiary’s updated contact information to the appropriate county.

(d) The department shall require the sharing of share, or require each county to share, beneficiary redetermination data, including the date of redetermination, with applicable managed care plans to aid in managed care plans’ efforts to assist beneficiaries with retaining Medi-Cal coverage, including incorporation into the managed care plans’ outreach and education efforts described in Section 14197.81.

(e) This section shall be implemented only to the extent that federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available.

(f) To the extent otherwise required by Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall adopt emergency regulations implementing this section no later than July 1, 2015. The department may thereafter readopt the emergency regulations pursuant to that chapter. The adoption and readoption, by the department, of regulations implementing this section shall be deemed to be an emergency and necessary to avoid serious harm to the public peace, health, safety, or general welfare for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the department is hereby exempted from the requirement that it describe facts showing the need for immediate action and from review by the Office of Administrative Law.

SEC. 2.

Section 14005.365 is added to the Welfare and Institutions Code, immediately following Section 14005.36, to read:

14005.365.

(a) It is the intent of the Legislature to develop a data dashboard to collect, track, analyze, and report on metrics related to the impact of federal House Resolution 1 (Public Law 119-21) on Medi-Cal eligibility and enrollment.

(b) The department, in collaboration with the California Health and Human Services Agency and in consultation with the California Health Benefit Exchange (Covered California), shall establish a data dashboard that provides data on applications, enrollment, redeterminations, disenrollments, and terminations, stratified by county and by demographic data, including, but not limited to, age, race, ethnicity, language, and gender. The dashboard shall exclude any personally identifiable information.

(c) The dashboard shall track and report on the specific data for work or community engagement requirements and exemptions under Public Law 119-21, including all of the following:

(1) All reasons that applications are denied and enrollees are terminated or disenrolled or whose coverage is modified based on work or community engagement requirements.

(2) All exemptions requested and granted based on each exemption type.

(3) All ex parte approvals, all procedural or administrative denials or terminations, and all appeals data.

(d) (1) Commencing no later than January 1, 2028, the department shall operationalize the data dashboard and shall post the information described in subdivisions (a), (b), and (c) on a monthly basis in a downloadable format.

(2) The department shall develop the dashboard in consultation with stakeholders, including consumers, advocates, Medi-Cal managed care plans, providers, counties, and the Legislature to ensure that the dashboard is user-friendly and that the data relied on can be accessed by the public to run reports.

(e) In developing the dashboard, the department shall consider all of the following objectives, among others:

(1) To learn and document the impact of Public Law 119-21 on Californians who apply for, or are enrolled in, the Medi-Cal program.

(2) To allow the department and stakeholders to identify trends or problems with eligibility and enrollment in the Medi-Cal program based on the monthly data reported, tracked, and analyzed over time to improve the program and address systemic or electronic application technology issues with the eligibility systems.

(3) To obtain reliable data that are collected and analyzed in a timely fashion.

SEC. 3.

Section 14197.81 is added to the Welfare and Institutions Code, immediately following Section 14197.8, to read:

14197.81.

(a) A Medi-Cal managed care plan shall establish and conduct an outreach and education plan for its enrollees about the work or community engagement guidelines set forth in Section 71119 of federal House Resolution 1 (Public Law 119-21) (subsection (xx) of Section 1396a of Title 42 of the United States Code), based on guidance provided by the department.

(b) (1) The outreach and education plan shall be informed by information shared by the department on best practices on supporting Medi-Cal members in maintaining coverage, and the Medi-Cal managed care plan’s stakeholder engagement, including the community advisory committee established by the Medi-Cal managed care plan, and by local stakeholders representing diverse racial and ethnic communities.

(2) The outreach and education plan shall address all of the following:

(A) Information on maintaining Medi-Cal eligibility, with emphasis on work or community engagement requirements, exemptions, and exceptions, including exemptions that require a request by the member.

(B) Information on the right of Medi-Cal applicants and beneficiaries to appeal or reinstate their Medi-Cal coverage, when Medi-Cal eligibility is denied or terminated, and appropriate county contact details.

(C) Information for local resources and supports, including, but not limited to, community health workers, navigators, legal services, midwives, and doulas, as identified through community advisory committees or other relevant and appropriate local community forums.

(c) The outreach and education plan shall be informed by the Medi-Cal managed care plan’s Population Needs Assessment, and shall ensure that materials and messaging are appropriate for the diversity of the plan enrollee membership.

(d) The outreach and education plan shall meet cultural and linguistic appropriateness standards, in alignment with the National Standards for Culturally and Linguistically Appropriate Services, and shall provide multiple points of contact for enrollees to learn more about work or community engagement requirements, exceptions, and exemptions, and what enrollees need to do in order to maintain Medi-Cal eligibility.

(e) The department may require modification to the existing outreach and education efforts of a Medi-Cal managed care plan for purposes of implementation of this section.

(f) A Medi-Cal managed care plan may share beneficiary redetermination data, including the date of redetermination, with applicable contracted providers to assist those providers to help beneficiaries retain Medi-Cal coverage.

SEC. 4.

If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.