AB 2348

AB2348:v96#DOCUMENT

Bill Start

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

Assembly Bill

No. 2348

An act to add Article 5.52 (commencing with Section 14184.1000) to Chapter 7 of Part 3 of Division 9 of amend Sections 14184.205 and 14184.206 of, and to add and repeal Section 14184.209 of, the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

AB 2348, as amended, Bonta. Medi-Cal: enhanced care management and community supports.

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 law, the California Advancing and Innovating Medi-Cal (CalAIM) Act, subject to any necessary federal approvals, establishes the CalAIM initiative in order to, among other things, improve quality outcomes, reduce health disparities, and transition and transform the Medi-Cal program to a more consistent and seamless system by reducing complexity and increasing flexibility. Under existing law, the CalAIM initiative ends on December 31, 2026. Existing law authorizes the department to seek to extend the payment methodologies or programs set forth in CalAIM, as specified, consistent with applicable federal requirements.

Existing law, subject to implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, requires the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans. Under existing law, target populations include, among others, high utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits, and individuals experiencing homelessness.This bill would recast the definition of ECM, referring to community-based, high-touch coordination and comprehensive care management services, as specified. The bill would delete certain provisions that designate 2022 or 2023 timelines for commencing ECM coverage, depending on whether or not a Medi-Cal managed care plan operates in a county in which the Whole Person Care pilot program or the Health Home Program was implemented.

Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports. Under existing law, community supports that the department is authorized to approve include, among others, housing transition navigation services and medically supportive food and nutrition services. Existing law requires the department to annually publish a public report on reported community supports utilization data, populations served, and demographic data, as specified.

This bill would authorize a Medi-Cal managed care plan to continue to cover those community supports approved by the department as cost effective and medically appropriate, as specified. Under the bill, this continued coverage would commence on January 1, 2027, would be conditioned on the availability of federal financial participation, and would be set forth as part of a CalAIM successor program.

The bill would require the department to continue to publish the above-described public report, but on a quarterly basis. The bill would require the department to provide ongoing technical assistance to Medi-Cal managed care plans and providers of community supports to enhance their ability to effectively provide these services.

The bill would require the department to produce a model Evidence of Coverage document that contains comprehensive and detailed instructions on model eligibility and coverage policies, and to develop related policies for each community support provided, as specified. The bill would require the department to solicit and accept feedback in developing the Evidence of Coverage document, as specified. The bill would require the department to regularly review and update its policy as needed until a specified date. The bill would require the department to publicly release written updates to its community supports policy guidance no later than 6 months prior to the effective date of the update, subject to limited exceptions. The bill would require Medi-Cal managed care plans to track and report to the department the number and percentage of their providers that are community providers, and would define “community provider” for these purposes. The bill would require the department to continue to convene the currently established CalAIM Implementation Advisory Group until a specified date.

This bill would require the department, by July 1, 2027, to produce model managed care coverage standards and policy, reflecting best practices, for each community support provided for plan years beginning on January 1, 2028. If a managed care plan deviates from the standards and policy, the bill would require the plan to provide to the department a specific explanation and justification for that deviation. The bill would require the department to provide ongoing technical assistance to managed care plans and to require the plans to continue to provide technical assistance to providers of community supports. The bill would require the department to publicly post any policy changes for stakeholder input, and to publicly release written updates to the department’s policy guidance, as specified.The bill would require a managed care plan to track and report to the department certain quantitative data regarding nonprofit community providers, as defined, and would require the department to publish a report on these data not less than annually. The bill would modify a requirement for the department to publish a public report on ECM and community supports utilization data, populations served, and demographic data, from annual to quarterly publications instead. The bill would require the department, by March 31, 2029, to provide to the legislative committees information necessary to inform legislative consideration of transitioning community supports to benefits that are required to be covered under the Medi-Cal program.The bill would require the department, until January 1, 2032, to continue to convene the CalAIM Implementation Advisory Group that is in effect on January 1, 2026, and as most recently updated. For purposes of the above-described provisions on ECM and community supports coverage, the bill would remove references to their implementation in accordance with CalAIM Terms and Conditions.

Digest Key

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

Bill Text

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

SECTION 1.

Section 14184.205 of the Welfare and Institutions Code is amended to read:

14184.205.

(a) (1)Subject to subdivision (f) of Section 14184.102, the department shall implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans, in accordance with this section and the CalAIM Terms and Conditions. in accordance with this section.

(2) (A) For purposes of this section, “enhanced care management” or “ECM” means community-based, high-touch coordination and comprehensive care management services designed to address the clinical and nonclinical needs on a whole-person-care basis of certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans.(B) ECM services comply with the ECM service model, as defined by the department, and include access to a lead care manager, outreach and engagement, comprehensive assessment and care management planning, coordination of care, health promotion, comprehensive transitional care, member and family support, and coordination of and referral to community and social support services.

(b) (1) Subject to the effective dates listed in subdivision (c), the The ECM benefit shall be available on a statewide basis to an eligible Medi-Cal beneficiary who is enrolled in an applicable Medi-Cal managed care plan and who meets the criteria in the CalAIM Terms and Conditions for one or more target populations, as determined by the department. A Medi-Cal beneficiary is excluded from ECM while enrolled in a 1915(c) waiver or the Family Mosaic Project, or while receiving California Community Transitions (CCT) Money Follows the Person (MFTP) services. services, or otherwise eligible for other high-intensity care management services, as defined by the department. ECM shall be available to a qualifying dual eligible beneficiary, as described under Section 14184.200, except for a dual eligible beneficiary enrolled in a fully integrated program for members who are dually eligible for Medicare and Medicaid, including Cal MediConnect during the duration of the demonstration authorized in Section 14132.275, Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), and the Programs of All-Inclusive Care for the Elderly (PACE).

(2) ECM only shall be available as a covered Medi-Cal benefit under a comprehensive risk contract with a Medi-Cal managed care plan. A Medi-Cal beneficiary who is eligible for ECM shall enroll in a Medi-Cal managed care plan in order to receive those services.

(c)(1)A Medi-Cal managed care plan operating in counties in which either the Whole Person Care pilot program, pursuant to Section 14184.60, or the Health Home Program, pursuant to Article 3.9 (commencing with Section 14127), or both, were implemented, as determined by the department, shall be required to cover ECM under its comprehensive risk contract as follows:

(A)Commencing January 1, 2022, a Medi-Cal managed care plan described in this paragraph shall be required to cover ECM for existing target populations under either the Whole Person Care pilot program or the Health Home Program, or both, as identified by the department.

(B)(i)Commencing January 1, 2023, a Medi-Cal managed care plan described in this paragraph shall be required to cover ECM for other select target populations described in subdivision (d), as identified by the department and in accordance with the CalAIM Terms and Conditions.

(ii)Commencing July 1, 2023, a Medi-Cal managed care plan described in this paragraph shall be required to cover ECM for all target populations described in subdivision (d) and in accordance with the CalAIM Terms and Conditions.

(2)A Medi-Cal managed care plan operating in counties in which neither the Whole Person Care pilot program, pursuant to Section 14184.60, or the Health Home Program, pursuant to Article 3.9 (commencing with Section 14127), was implemented, as determined by the department, shall be required to cover select ECM target populations, as identified by the department, under its comprehensive risk contract, commencing July 1, 2022. All other target populations, including the target population described in paragraph (7) of subdivision (d), shall be covered commencing January 1, 2023, or July 1, 2023, in accordance with the CalAIM Terms and Conditions.

(d)

(c) Target populations shall include include, but shall not be limited to, the following, consistent with the department’s eligibility criteria, and to the extent approved in the CalAIM Terms and Conditions: criteria:

(1) Children or youth with complex physical, behavioral, developmental, or oral health needs, including, but not limited to, those eligible for California Children’s Services, those involved or with a history of involvement in child welfare or the juvenile justice system, or youth with clinical high-risk syndrome or a first episode of psychosis.

(2) Individuals experiencing homelessness.

(3) High utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits.

(4) Individuals at risk for institutionalization and eligible for long-term care services.

(5) Nursing facility residents who want to transition to the community.

(6) Individuals with serious mental illness (SMI), and children with serious emotional disturbance (SED) or substance use disorder (SUD).

(7) Individuals transitioning from incarceration requiring immediate transition of services to the community.

(e)

(d) Notwithstanding any other law, for any time period in which a Medi-Cal beneficiary is eligible to receive ECM services through enrollment in their Medi-Cal managed care plan, the beneficiary shall not receive duplicative targeted case management services as described in Section 14132.44 or otherwise authorized in the Medi-Cal State Plan, as determined by the department.

(f)

(e) Medi-Cal managed care plans shall consult and collaborate with Medi-Cal behavioral health delivery systems for the delivery of ECM for beneficiaries with an SMI, SED, or SUD.

(g)

(f) If a Medi-Cal managed care plan proposes to keep some level of ECM in house in-house instead of contracting with direct providers, the Medi-Cal managed care plan shall demonstrate to the state that its ECM benefit is appropriately community based and shall provide a rationale for not contracting with existing providers.

(h)

(g) The department shall develop, in consultation with Medi-Cal managed care plans and other appropriate stakeholders, a monitoring plan and reporting template for the implementation of ECM pursuant to this section. The department shall annually quarterly publish a public report on reported ECM utilization data, populations served, and demographic data, stratified by age, sex, race, ethnicity, and languages spoken, to the extent statistically reliant data is reliable data are available.

SEC. 2.

Section 14184.206 of the Welfare and Institutions Code is amended to read:

14184.206.

(a) Commencing January 1, 2022, and subject Subject to subdivision (f) of Section 14184.102, a Medi-Cal managed care plan may elect to cover those community supports approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services, in accordance with the CalAIM Terms and Conditions. as described in subdivision (c).

(b) (1) Approved community supports pursuant to this section shall be available only to beneficiaries enrolled in a Medi-Cal managed care plan under a comprehensive risk contract, subject to paragraph (2).

(2) Approved community supports shall not supplant other covered Medi-Cal benefits that are not the responsibility of the Medi-Cal managed care plan under the comprehensive risk contract, including, but not limited to, in-home supportive services provided pursuant to Article 7 (commencing with Section 12300) of Chapter 3, and Sections 14132.95, 14132.952, and 14132.956.

(3) An enrolled Medi-Cal beneficiary shall not be required by their Medi-Cal managed care plan to use the community support.

(c) Subject to subdivision (f) of Section 14184.102, community supports that the department may approve include, but need not be limited to, all of the following when authorized by the department in the comprehensive risk contract with each Medi-Cal managed care plan and to the extent the department determines that the community support is a cost-effective and medically appropriate substitute for the applicable covered Medi-Cal benefit under the comprehensive risk contract:

(1) Housing transition navigation services.

(2) Housing deposits.

(3) Housing tenancy and sustaining services.

(4) Short-term post-hospitalization housing.

(5) Recuperative care or medical respite.

(6) Respite.

(7) Day habilitation programs.

(8) Nursing facility transition or diversion to assisted living facilities, including, but not limited to, residential care facilities for the elderly or adult residential facilities.

(9) Nursing facility transition to a home.

(10) Personal care and homemaker services.

(11) Environmental accessibility adaptations or home modifications.

(12) Medically supportive food and nutrition services, including medically tailored meals.

(13) Sobering centers.

(14) Asthma remediation.

(d) The department shall publicly post on its internet website a list of which community supports are offered to enrollees by each Medi-Cal managed care plan.

(e) (1) By July 1, 2027, the department shall produce model managed care coverage standards and policy for each community support provided pursuant to subdivision (a), for plan years beginning on January 1, 2028.(2) The model managed care coverage standards and policy shall reflect best practices and shall provide comprehensive and detailed instructions on model eligibility and coverage policies sufficient for a Medi-Cal managed care plan to adopt, in whole, as its coverage policy.(3) The department shall engage stakeholders, including community providers of each community support, and shall solicit and accept feedback in developing the model managed care coverage standards and policy.(4) If a managed care plan deviates from the model managed care coverage standards and policy, the plan shall provide to the department a specific explanation and justification for that deviation.

(e)

(f) A Medi-Cal managed care plan shall provide information on the available community supports in its member handbook and plan website, including any limitations on community supports on the plan website.

(f)

(g) The department shall develop, in consultation with Medi-Cal managed care plans and other appropriate stakeholders, a monitoring plan and reporting template for the implementation of community supports pursuant to this section. The department shall annually quarterly publish a public report on reported community supports utilization data, populations served, and demographic data, stratified by age, sex, race, ethnicity, and languages spoken, to the extent statistically reliant reliable data are available.

(g)

(h) The department shall conduct an independent evaluation of the effectiveness of community supports in accordance with the parameters and timeframes specified in the CalAIM Terms and Conditions.

(h)

(i) The department shall take into account the utilization and actual cost of community supports in developing capitation rates.

(j) In order to enhance the ability of Medi-Cal managed care plans and providers to effectively provide community supports, the department shall provide ongoing technical assistance to Medi-Cal managed care plans and shall require Medi-Cal managed care plans to continue to provide technical assistance to providers of these services.(k) (1) The department shall post any policy changes publicly for stakeholder input for a minimum of one month before making updates to its community supports policy guidance.(2) The department shall publicly release written updates to its community supports policy guidance, including the model managed care coverage standards and policy, no later than six months prior to the effective date of the policy update. Updates shall commence on an effective date of January 1 or July 1 of the applicable year. Exceptions shall be allowed to address urgent issues, as determined by the department, including changes in federal approvals and the availability of federal financial participation. If an exception is allowed under this subdivision, interested stakeholders shall be notified, and a rationale for the irregular update shall be provided.(l) (1)A Medi-Cal managed care plan shall track and report to the department the number and percentage of the plan’s providers that fit the definition of “nonprofit community provider” in paragraph (3) of subdivision (m), and the number and percentage of services provided by these community providers. The department shall organize these data by plan and shall publish a report on these data not less than annually.(2) This subdivision does not restrict plans from contracting with a provider that does not fit the definition of a nonprofit community provider.

(i)

(m) For purposes of this section, the following definitions apply:

(1) “Community supports” means those alternative services and settings approved in the CalAIM Terms and Conditions and administered according to paragraph (2) of subsection (e) of Section 438.3 of Title 42 of the Code of Federal Regulations.

(2) “Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.

(3) “Nonprofit community provider” means a locally available community-based nonprofit organization that has direct experience with providing services to Medi-Cal beneficiaries in the county or region where the organization operates.(n) By March 31, 2029, the department shall provide to the appropriate policy and fiscal committees of the Legislature information necessary to inform legislative consideration of transitioning community supports to benefits that are required to be covered under the Medi-Cal program, including information on cost, effectiveness, and provider availability.

SEC. 3.

Section 14184.209 is added to the Welfare and Institutions Code, to read:

14184.209. (a) The department shall continue to convene the CalAIM Implementation Advisory Group that is in effect on January 1, 2026, and as most recently updated.(b) This section shall remain in effect only until January 1, 2032, and as of that date is repealed.

SECTION 1.Article 5.52 (commencing with Section 14184.1000) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:

5.52.CalAIM Successor Programs

14184.1000.

(a)Commencing on January 1, 2027, a Medi-Cal managed care plan may continue to cover those community supports approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services, as described in subdivision (c) of Section 14184.206.

(b)The department shall continue to publish a public report on community supports utilization data, as described in subdivision (f) of Section 14184.206, except that the public report shall be published quarterly.

(c)The department shall provide ongoing technical assistance to Medi-Cal managed care plans and providers of community supports in order to enhance their ability to effectively provide these services.

(d)(1)By July 1, 2027, the department shall produce a model “Evidence of Coverage” document and develop related policies for each community support provided pursuant to subdivision (a).

(2)The Evidence of Coverage document and related policies shall provide comprehensive and detailed instructions on model eligibility and coverage policies sufficient for a Medi-Cal managed care plan to adopt, in whole, as its coverage policy.

(3)The department shall engage stakeholders, including community providers of each community support, and solicit and accept feedback in developing the Evidence of Coverage document.

(e)Until December 1, 2030, the department shall regularly review and update the Evidence of Coverage document and policy guidance related to community supports as needed to ensure effective and efficient delivery of services.

(f)(1)The department shall post any policy changes publicly for stakeholder input for a minimum of one month before making updates to its community supports policy guidance.

(2)The department shall publicly release written updates to its community supports policy guidance, including the Evidence of Coverage Document, no later than six months prior to the effective date of the policy update. Updates shall commence on an effective date of January 1 or July 1 of the applicable year. Exceptions shall be allowed to address urgent issues, as determined by the department, including changes in federal approvals and the availability of federal financial participation. If an exception is allowed under this subdivision, interested stakeholders shall be notified and a rationale for the nonregular update shall be provided.

(g)A Medi-Cal managed care plan shall track and report to the department the number and percentage of their providers that fit the definition of “community provider” under this section, and the number and percentage of services provided by these community providers. The department shall organize this data by plan and shall publish a report on this data not less than annually.

(h)For purposes of this section, “community provider” means a locally available community-based nonprofit organization that has direct experience with providing services to Medi-Cal beneficiaries in the county or region where the organization operates.

(i)Until December 31, 2030, the department shall continue to convene the currently established CalAIM Implementation Advisory Group.

(j)This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized.

(k)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may implement this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking any further regulatory action, subject to the requirements of subdivision (f).