Bill Full Text
Home
-
Bills
-
Bill
-
Authors
-
Dates
-
Locations
-
Analyses
-
Organizations
<?xml version="1.0" ?>
<ns0:MeasureDoc xmlns:html="http://www.w3.org/1999/xhtml" xmlns:ns0="http://lc.ca.gov/legalservices/schemas/caml.1#" xmlns:ns3="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" version="1.0" xsi:schemaLocation="http://lc.ca.gov/legalservices/schemas/caml.1# xca.1.xsd">
<ns0:Description>
<ns0:Id>20250AB__213899INT</ns0:Id>
<ns0:VersionNum>99</ns0:VersionNum>
<ns0:History>
<ns0:Action>
<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-18</ns0:ActionDate>
</ns0:Action>
</ns0:History>
<ns0:LegislativeInfo>
<ns0:SessionYear>2025</ns0:SessionYear>
<ns0:SessionNum>0</ns0:SessionNum>
<ns0:MeasureType>AB</ns0:MeasureType>
<ns0:MeasureNum>2138</ns0:MeasureNum>
<ns0:MeasureState>INT</ns0:MeasureState>
</ns0:LegislativeInfo>
<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Krell</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Krell</ns0:Name>
</ns0:Legislator>
</ns0:Authors>
<ns0:Title> An act to add Sections 14045.195 and 14184.2051 to the Welfare and Institutions Code, relating to Medi-Cal.</ns0:Title>
<ns0:RelatingClause>Medi-Cal</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Medi-Cal: enhanced care management: peer support specialists.</ns0:Subject>
</ns0:GeneralSubject>
<ns0:DigestText>
<html:p>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.</html:p>
<html:p>Existing law 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.</html:p>
<html:p>Existing law
authorizes a county, or an agency representing a county, to develop a peer support specialist certification program, subject to departmental approval. Under existing law, these specialists are individuals, at least 18 years of age, who self-identify as having lived experience with the process of recovery from mental illness, substance use disorder, or both, as specified. Existing law requires the department to seek any federal waivers that it deems necessary to establish a demonstration or pilot project for the provision of peer support services in counties that agree to participate.</html:p>
<html:p>This bill would require the department to require, as a condition of providing ECM, that each ECM provider maintain an interdisciplinary care team that includes at least one peer support specialist who is integrated into ECM service delivery and available to support ECM members. The bill would set forth the functions of a peer support specialist for ECM purposes.</html:p>
<html:p>The bill would authorize the department to allow an ECM provider to satisfy the requirement through any combination of staffing models, as specified. The bill would require the department to ensure that Medi-Cal managed care plan contracts, policies, and guidance reflect the requirement and to establish monitoring and compliance mechanisms to ensure that ECM providers implement the requirement.</html:p>
<html:p>The bill would prohibit the department, a Medi-Cal managed care plan, or a Medi-Cal provider, as applicable, from disqualifying a peer support specialist solely or primarily on the basis of a criminal background check, fingerprint-based background check, or similar screening that is a condition of employment, contracting, certification, credentialing, enrollment, or participation in providing peer support services.</html:p>
<html:p>Under the bill, this restriction would be implemented to the extent not in
conflict with federal law, and the restriction would not prohibit background checks under specified circumstances. The bill would also authorize consideration of an individual’s criminal record as part of their overall fitness for the position of peer support specialist. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation.</html:p>
</ns0:DigestText>
<ns0:DigestKey>
<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
<ns0:Appropriation>NO</ns0:Appropriation>
<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
<ns0:LocalProgram>NO</ns0:LocalProgram>
</ns0:DigestKey>
<ns0:MeasureIndicators>
<ns0:ImmediateEffect>NO</ns0:ImmediateEffect>
<ns0:ImmediateEffectFlags>
<ns0:Urgency>NO</ns0:Urgency>
<ns0:TaxLevy>NO</ns0:TaxLevy>
<ns0:Election>NO</ns0:Election>
<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
<ns0:BudgetBill>NO</ns0:BudgetBill>
<ns0:Prop25TrailerBill>NO</ns0:Prop25TrailerBill>
</ns0:ImmediateEffectFlags>
</ns0:MeasureIndicators>
</ns0:Description>
<ns0:Bill id="bill">
<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_58BE7C84-E3BB-4639-B223-382C00773497">
<ns0:Num>SECTION 1.</ns0:Num>
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
The Legislature finds and declares all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
California’s Medi-Cal population includes a significant number of individuals with complex physical health conditions, serious mental illness, substance use disorders, justice involvement, and histories of homelessness or housing instability who benefit from intensive, relationship-based care coordination and support.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The enhanced care management (ECM) benefit established under the California Advancing and Innovating Medi-Cal (CalAIM) initiative is intended to provide whole-person, interdisciplinary care management that addresses clinical and nonclinical needs, reduces avoidable
emergency department use and hospitalization, improves continuity of care, and supports stability in housing and community living.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Peer support specialists—individuals with lived experience of mental health conditions, substance use disorders, homelessness, disability, or justice involvement who use that experience to support others—are an evidence-informed component of a high-functioning behavioral health and recovery-oriented system of care.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Peer support services improve engagement, trust, and retention in care; help individuals navigate complex systems; promote hope and recovery; and support improved outcomes, including reduced crisis utilization and increased connection to treatment, housing, and community supports.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Despite the demonstrated value of peers, access to peer support within ECM is
inconsistent and limited by workforce shortages, contracting practices, and exclusionary screening requirements that can disqualify individuals because of prior justice involvement—precisely the lived experience that can make peer services effective for many ECM members.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
It is the intent of the Legislature to strengthen ECM by ensuring that peer support specialists are integrated as a standard member of the ECM interdisciplinary care team, and to remove unnecessary barriers that prevent qualified peers from serving Medi-Cal members.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
It is further the intent of the Legislature that peer support specialist participation in ECM be expanded in a manner consistent with federal Medicaid requirements and without reducing member access to clinically appropriate screening, safety standards, or settings-based requirements that are mandated by federal
law.
</html:p>
</ns0:Content>
</ns0:BillSection>
<ns0:BillSection id="id_54C87FFD-B0C2-4B1F-B4EA-9013E27E6CDC">
<ns0:Num>SEC. 2.</ns0:Num>
<ns0:ActionLine action="IS_ADDED" ns3:type="locator" ns3:href="urn:caml:codes:WIC:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2F%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'14045.195'%5D)" ns3:label="fractionType: LAW_SECTION">
Section 14045.195 is added to the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
,
<ns0:Positioning>immediately following Section 14045.19</ns0:Positioning>
, to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_7BEDD6D9-A9A7-4011-B0D8-D62B539A6FBC">
<ns0:Num>14045.195.</ns0:Num>
<ns0:LawSectionVersion id="id_6111ED4F-5A00-4823-90E4-F56CF0B0BC1C">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
Notwithstanding any other law, the department, a Medi-Cal managed care plan, or a Medi-Cal provider, as applicable, shall not disqualify a peer support specialist solely or primarily on the basis of a criminal background check, fingerprint-based background check, or similar screening that is a condition of employment, contracting, certification, credentialing, enrollment, or participation in providing peer support services pursuant to this article. However, an individual’s criminal record may be considered as part of their overall fitness for the position of peer support specialist.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Subdivision (a) shall be implemented to the extent not in conflict with Section 455.434 of Title 42 of the Code of Federal
Regulations or any other federal law applicable to the background checks or screenings described in subdivision (a).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Subdivision (a) shall be implemented in accordance with Section 14043.38.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Implementation of subdivision (a) shall not prohibit any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Compliance with a background check, clearance, or disqualification standards expressly required by federal law as a condition of receiving federal financial participation for a specific service, setting, or program.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Compliance with background check requirements that are specifically applicable to a distinct service setting where the peer will work, including, but not limited to, schools or facilities where state or federal law mandates those background checks for all
staff.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The applicable supervisory entity adopting and applying job-related, individualized safety and suitability policies that do not categorically exclude individuals based on arrest records or convictions and that consider evidence of rehabilitation, time elapsed, and relevance to the duties of peer support, consistent with state and federal nondiscrimination laws.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
This section shall be implemented only to the extent that the department obtains any necessary federal approvals and that federal financial participation is available and is not otherwise jeopardized. The department shall seek any necessary federal approvals to implement this section.
</html:p>
</ns0:Content>
</ns0:LawSectionVersion>
</ns0:LawSection>
</ns0:Fragment>
</ns0:BillSection>
<ns0:BillSection id="id_E7C308B9-0B9B-49BD-85B5-D7E43C60BFAE">
<ns0:Num>SEC. 3.</ns0:Num>
<ns0:ActionLine action="IS_ADDED" ns3:type="locator" ns3:href="urn:caml:codes:WIC:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2F%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'14184.2051'%5D)" ns3:label="fractionType: LAW_SECTION">
Section 14184.2051 is added to the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
,
<ns0:Positioning>immediately following Section 14184.205</ns0:Positioning>
, to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_258241B4-54A7-460A-A198-E5DC65BC2204">
<ns0:Num>14184.2051.</ns0:Num>
<ns0:LawSectionVersion id="id_64232DDD-975C-4132-B8C2-48EDAE65B4AF">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
For purposes of this section, the following definitions apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Enhanced care management” or “ECM” has the same meaning as set forth in Section 14184.205.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“ECM provider” means an entity, provider, or organization contracted, delegated, or otherwise authorized by a Medi-Cal managed care plan to furnish ECM services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Peer support specialist” has the same meaning as set forth in Section 14045.12.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Interdisciplinary care team” means the set of staff, contractors, and team members responsible for delivering ECM, including care
management, care coordination, member engagement, and connection to clinical and community supports.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
The department shall require, as a condition of providing ECM under Section 14184.205, that each ECM provider maintain an interdisciplinary care team that includes at least one peer support specialist who is integrated into ECM service delivery and available to support ECM members.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The peer support specialist required under subdivision (b) shall be utilized in a manner that includes, but is not limited to, one or more of the following functions, consistent with the peer’s scope of practice and training:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Conducting outreach to, and engagement of, ECM members, including members who are difficult to engage or have experienced repeated crises.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Supporting member self-advocacy, recovery goals, and navigation of behavioral health, substance use disorder, housing, and social services systems.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Assisting with care planning, warm handoffs, transition support following inpatient or crisis episodes, and linkage to community-based supports.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Providing culturally responsive, trauma-informed, relationship-based support grounded in lived experience.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The department may allow an ECM provider to satisfy the requirement described in subdivision (b) through any combination of staffing models, including employment, contracting, shared staffing arrangements, or partnerships with community-based organizations, so long as the peer support specialist is accessible to ECM members served by the provider and is meaningfully integrated into ECM
operations.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
The department shall ensure that Medi-Cal managed care plan contracts, policies, and guidance reflect the requirement described in subdivision (b), and shall establish monitoring and compliance mechanisms to ensure that ECM providers implement the requirement.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
This section shall not be construed as limiting the department’s authority to establish clinical, quality, documentation, or supervision standards for ECM, or as limiting an ECM provider’s obligation to comply with applicable state and federal laws.
</html:p>
</ns0:Content>
</ns0:LawSectionVersion>
</ns0:LawSection>
</ns0:Fragment>
</ns0:BillSection>
</ns0:Bill>
</ns0:MeasureDoc>