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<ns0:Id>20250AB__216199INT</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-18</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Bonta</ns0:AuthorText>
<ns0:AuthorText authorType="COAUTHOR_ORIGINATING">(Coauthors: Assembly Members Boerner and Stefani)</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Bonta</ns0:Name>
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<ns0:Name>Boerner</ns0:Name>
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<ns0:Contribution>COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Stefani</ns0:Name>
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<ns0:Title> An act to add Section 14005.69 to the Welfare and Institutions Code, relating to Medi-Cal.</ns0:Title>
<ns0:RelatingClause>Medi-Cal</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Medi-Cal: work or community engagement.</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 federal law, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, cost sharing, and retroactive coverage, among other factors, for certain Medicaid populations, including beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults.</html:p>
<html:p>The above-described federal law generally requires a Medicaid expansion adult, commencing
January 1, 2027, or earlier at state option, to demonstrate community engagement as a condition of Medicaid eligibility. Existing law sets forth the mechanisms for complying with that requirement on a monthly basis, including, among others, a minimum of 80 hours of work or community service or a minimum of half-time enrollment in an educational program. Existing law exempts certain categories of individuals from the requirement, including, among others, a parent or family caregiver of a dependent child 13 years of age or younger or a disabled individual, and a medically frail person.</html:p>
<html:p>This bill would state the intent of the Legislature that the department implement work or community engagement requirements under the above-described federal law to ensure that all eligible Medi-Cal applicants and beneficiaries obtain and maintain coverage in ways that are least administratively burdensome to those individuals. The bill would set forth provisions to conform to the
above-described federal provisions, including work or community engagement requirements, exemptions, and notices of noncompliance if applicable.</html:p>
<html:p>The bill would require the department, before verifying an individual’s compliance, to ensure and confirm that systems are programmed to maintain coverage with minimal data request to an applicant or beneficiary, as specified. For beneficiaries who cannot be deemed compliant following ex-parte review, the bill would require the county to request a Medi-Cal managed care plan to provide any data that will verify that a beneficiary is exempted or meets the requirements before requesting information directly from the beneficiary.</html:p>
<html:p>By creating new duties for counties relating to Medi-Cal eligibility determinations with regard to work or community engagement, the bill would impose a state-mandated local program.</html:p>
<html:p>The bill would require the
department to adopt regulations by July 1, 2028. The bill would require the department, beginning July 1, 2027, to provide a semiannual status report on implementation to the Legislature, until regulations have been adopted.</html:p>
<html:p>Under the bill, these provisions would be implemented only after the Director of Health Care Services determines, and communicates in writing to the Department of Finance, that systems have been programmed for implementation. Under the bill, these provisions would remain operative only as long as the above-described federal law is operative.</html:p>
<html:p>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.</html:p>
<html:p>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.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_19E3FE7E-471A-4883-B394-948566B70FD6">
<ns0:Num>SECTION 1.</ns0:Num>
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Section 14005.69 is added to the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
,
<ns0:Positioning>immediately following Section 14005.68</ns0:Positioning>
, to read:
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<ns0:LawSection id="id_11A380F0-65D2-435A-9840-1A6841F67ED7">
<ns0:Num>14005.69.</ns0:Num>
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<html:p>
(a)
<html:span class="EnSpace"/>
It is the intent of the Legislature that the department implement work or community engagement requirements set forth in Section 1396a(xx) of Title 42 of the United States Code (Section 71119 of federal House Resolution 1 (Public Law 119-21)) to ensure that all eligible Medi-Cal applicants and beneficiaries obtain and maintain coverage in ways that are least administratively burdensome to applicants and beneficiaries.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
For purposes of this section, the following definitions apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Applicable individual” means an individual, other than a specified excluded individual as defined in paragraph (2), who is either of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
An individual who is eligible to enroll, or is enrolled, in the Medi-Cal program under Section 1396a(a)(10)(A)(i)(VIII) of Title 42 of the United States Code, including an individual who receives state-funded Medi-Cal coverage.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An individual who has attained 19 years of age and is under 65 years of age, is not pregnant, and is not entitled to, or enrolled for, benefits under federal Medicare Part A (42 U.S.C. Section 1395c et seq.), or eligible for, or enrolled for benefits under Medicare Part B (42 U.S.C. Section 1395j et seq.).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Specified excluded individual” means any of the following individuals:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
An individual who is a foster youth or former foster youth under 26 years of age, as described in Section 1396a(a)(10)(A)(i)(IX) of Title 42 of
the United States Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An Indian or an Urban Indian, as defined in paragraphs (13) and (28) of Section 1603 of Title 25 of the United States Code, respectively.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A California Indian, as described in Section 1679(a) of Title 25 of the United States Code.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
An individual who has otherwise been determined eligible as an Indian for the Indian Health Service under regulations promulgated by the United States Secretary of Health and Human Services.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
The parent, guardian, caretaker relative, or family caregiver of a dependent child 13 years of age or younger.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
The parent, guardian, caretaker relative, or family caregiver of an individual with a chronic or other health condition,
disability, or functional limitation.
</html:p>
<html:p>
(G)
<html:span class="EnSpace"/>
A veteran with a disability rated as total under Section 1155 of Title 38 of the United States Code.
</html:p>
<html:p>
(H)
<html:span class="EnSpace"/>
An individual who is medically frail or otherwise has special medical needs, as defined by the United States Secretary of Health and Human Services, including, but not limited to, any of the following individuals:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
An individual who is blind or disabled, as defined in Section 1382c of Title 42 of the United States Code.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
An individual with a substance use disorder.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
An individual with a disabling mental disorder.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
An individual with a physical, intellectual, or
developmental disability that significantly impairs their ability to perform one or more activities of daily living.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
An individual with a serious or complex medical condition.
</html:p>
<html:p>
(I)
<html:span class="EnSpace"/>
An individual in compliance with the work requirements under the federal Temporary Assistance for Needy Families (TANF).
</html:p>
<html:p>
(J)
<html:span class="EnSpace"/>
A member of a household that receives supplemental nutrition assistance program benefits under the federal Food and Nutrition Act of 2008 (Public Law 88-525) and is not exempt from a work requirement under that act.
</html:p>
<html:p>
(K)
<html:span class="EnSpace"/>
An individual participating in a drug addiction or alcoholic treatment and rehabilitation program, as defined in Section 2012(h) of Title 7 of the United States Code.
</html:p>
<html:p>
(L)
<html:span class="EnSpace"/>
An inmate of a public institution.
</html:p>
<html:p>
(M)
<html:span class="EnSpace"/>
An individual who is pregnant or entitled to postpartum medical assistance under Section 1396a(e)(5) or (16) of Title 42 of the United States Code.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Educational program” includes both of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
An institution of higher education, as defined in Section 1001 of Title 20 of the United States Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A program of career and technical education, as defined in Section 2302 of Title 20 of the United States Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Work program” has the meaning as set forth in Section 2015(o)(1) of Title 7 of the United States Code, which includes, among other programs, certain employment and training programs described in paragraph (4)
of subdivision (d) of that section, subject to the exclusions described in paragraph (1) of subdivision (o) of that section.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Before verifying an individual’s compliance with work or community engagement requirements, the department shall ensure and confirm that systems are programmed to maintain coverage with minimal data request to an applicant or beneficiary by doing both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Limiting compliance to applicants or beneficiaries who are federally required under Section 1396a(xx) of Title 42 of the United States Code to meet work or community engagement requirements.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Measuring compliance through interfaces with data sources that include, but are not limited to, wage data, gig economy, Medi-Cal eligibility aid codes, Medi-Cal claims and encounter data, and data from the State Department of
Social Services.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
No sooner than January 1, 2027, pursuant to the requirements set forth in Section 1396a(xx) of Title 42 of the United States Code, as a condition of Medi-Cal eligibility and following the department’s confirmation that systems are programmed to maintain coverage with minimal data request to an applicable individual, an applicable individual shall demonstrate work or community engagement.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
An applicable individual who applies for the Medi-Cal program shall demonstrate work or community engagement for one month immediately preceding the month during which the individual applies for the Medi-Cal program.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An applicable individual enrolled and receiving Medi-Cal services shall demonstrate work or community engagement for any one month during the period between the individual’s most recent
determination or redetermination, as applicable, of eligibility and their next regularly scheduled redetermination of eligibility as described in Section 14005.37.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Subject to this subdivision and subdivision (f), an applicable individual demonstrates work or community engagement for a month if they meet one or more of the following conditions with respect to that month, as determined in accordance with criteria established by federal regulation:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The individual works no less than 80 hours.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The individual completes no less than 80 hours of community service.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The individual participates in a work program for no less than 80 hours.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The individual is enrolled in an
educational program at least half-time.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The individual engages in any combination of the activities described in paragraphs (1) to (4), inclusive, for a total of no less than 80 hours.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The individual has a total monthly income, including, but not limited to, earned income, unemployment benefits, state disability insurance, retirement income, or dividends, that is no less than the applicable minimum wage requirement under Section 206 of Title 29 of the United States Code, multiplied by 80 hours.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The individual had an average monthly income, including, but not limited to, earned income, unemployment benefits, state disability insurance, retirement income, or dividends, over the preceding six months that is no less than the applicable minimum wage requirement under Section 206 of Title 29 of the United
States Code, multiplied by 80 hours, and is a seasonal worker, as described in Section 45R(d)(5)(B) of the federal Internal Revenue Code of 1986.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
An applicable individual is excluded from work or community engagement requirements under subdivision (d) for a month if, for part or all of the month, the individual either is a specified excluded individual, as defined under paragraph (2) of subdivision (b), or is any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
An individual under 19 years of age.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An individual entitled to, or enrolled for, benefits under federal Medicare Part A (42 U.S.C. Section 1395c et seq.), or enrolled for benefits under federal Medicare Part B (42 U.S.C. Section 1395j et seq.).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An individual described in any of subclauses (I) through (VII) of
Section 1396a(a)(10)(A)(i) of Title 42 of the United States Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
An inmate of a public institution at any point during the three-month period ending on the first day of that month.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
An individual excluded based on any other federally required or approved exemptions outlined in the state plan or waivers.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Any other individual not specifically required by federal law to comply with work or community engagement requirements.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
An applicable individual shall be deemed to have demonstrated work or community engagement under subdivision (d) for that month if they experience a short-term hardship.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
For purposes of this section, and in accordance with applicable federal law, an
applicable individual experiences a short-term hardship event during a month if, for part or all of that month, any of the following is met:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The individual receives inpatient hospital services, nursing facility services, services in an intermediate care facility for individuals with intellectual disabilities, inpatient psychiatric hospital services, or other services of similar acuity, including outpatient care relating to other services specified in this paragraph, as determined by the United States Secretary of Health and Human Services, and the individual requests a short-term hardship exemption.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The individual resides in a county in which an emergency or disaster was declared by the United States President pursuant to the federal National Emergencies Act (50 U.S.C. Sec. 1601 et seq.) or the federal Robert T. Stafford Disaster Relief and Emergency Assistance Act (42
U.S.C. Sec. 5121 et seq.).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The individual resides in a county with an unemployment rate that is at or above the lesser of 8 percent or 1.5 times the national unemployment rate, subject to a request from the department to the United States Secretary of Health and Human Services.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The individual or their dependent must travel outside of their community for an extended period of time to receive medical services necessary to treat a serious or complex medical condition, as described in 42 U.S.C. Section 1396a(xx)(9)(A)(ii)(V)(ee), that are not available within their community of residence, and the individual requests a short-term hardship exemption.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
For beneficiaries who cannot be deemed compliant following ex-parte review, as required by Section 1396a(xx)(5) of Title 42 of the United States Code, the county
shall request a Medi-Cal managed care plan to provide any data that will verify that a beneficiary is exempted or meets work or community engagement requirements before requesting information directly from the beneficiary.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
When there is a conflict in reliable data sources that adversely impacts an applicant’s or beneficiary’s eligibility, the county shall use data that are most beneficial to the applicant or beneficiary or to maintain eligibility following verification from an applicant or beneficiary.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
For purposes of verifying that an applicable individual has met the requirement to demonstrate work or community engagement under subdivision (e), or determining that the individual is excluded from, or deemed to have demonstrated, work or community engagement under subdivision (f) or (g), or determining that the individual is a specified excluded individual under paragraph
(2) of subdivision (b), the department shall establish processes and use available and reliable information without requiring, where possible and only when sufficient verification has been submitted, the applicable individual to submit additional information.
</html:p>
<html:p>
(l)
<html:span class="EnSpace"/>
If a county is unable to verify that an applicable individual either has met the requirement to demonstrate work or community engagement under subdivision (e) or was deemed to have demonstrated work or community engagement under subdivision (f) or (g), the county shall do all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Provide the applicable individual with the notice of noncompliance described in subdivision (n).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Provide the applicable individual with a period of 30 calendar days, beginning on the date on which the notice of noncompliance is received by the individual, to do
any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Make a satisfactory showing of compliance with the requirement for work or community engagement under subdivision (e).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Make a satisfactory showing that the applicable individual was deemed to have demonstrated work or community engagement under subdivision (f) or (g).
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Make a satisfactory showing that the work or community engagement requirement does not apply to the individual on the basis that the individual does not meet the definition of applicable individual under paragraph (1) of subdivision (b).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Continue to provide the applicable individual with Medi-Cal services during the 30-calendar-day period if the applicable individual is enrolled in the Medi-Cal program.
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For an applicable individual newly applying for the Medi-Cal program, the county shall approve applicants pending verification of work or community engagement and maintain active Medi-Cal eligibility until at least the last day of the 30-day calendar period.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For an applicable individual renewing their Medi-Cal enrollment during a six-month redetermination period, the county shall maintain active eligibility until at least the last day of the month of the 30-day calendar period.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
For purposes of this subdivision, an applicable individual is deemed to have received the notice of noncompliance 10 business days after the county provides the letter to the United States Postal Service, except when the applicable individual attests to not receiving the notice or has good cause for not meeting the 30-calendar-day
period.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
When an applicable individual attests to not receiving the notice of noncompliance or has good cause, the county shall maintain or reactivate Medi-Cal eligibility, without a gap in coverage, until the applicable time period in subparagraph (A) or (B) expires.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Deny the applicable individual’s application for the Medi-Cal program, or disenroll the individual from the Medi-Cal program, if no satisfactory showing is made pursuant to paragraph (2) and the applicable individual is not a specified excluded individual as defined in paragraph (2) of subdivision (b), no later than the end of the month following the month in which the 30-calendar-day period ends.
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Before denying the applicable individual’s application or disenrolling the individual, the county shall first do both of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Determine whether there is any other basis for eligibility for the Medi-Cal program or for another insurance affordability program for the individual.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Provide written notice and grant the individual an opportunity for a fair hearing.
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
As specified by the department, and pursuant to federal requirements, the county shall notify applicable individuals enrolled in the Medi-Cal program of the requirement to demonstrate work or community engagement pursuant to this section.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The notice required under paragraph (1) shall be delivered by regular mail or, if elected by the individual, in an electronic format, and shall be delivered in one or more additional forms, which may include telephone, text message, an internet
website, other commonly available electronic means, and such other forms as the United States Secretary of Health and Human Services determines appropriate.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
The notice of noncompliance provided to an applicable individual shall be on a form prescribed by the department and shall include the name and telephone number of the county department worker, county department call center, or other appropriate county department contact that is available to assist applicants and beneficiaries with questions about their notice, and the date the form was completed. A copy of the notice shall be placed in the case file. The notice shall include all of the following information:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A statement explaining that the applicable individual has been determined to be subject to work or community engagement requirements, including the specific factual basis for that determination and the applicable
law or regulation.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A statement explaining that the applicable individual has been determined to be noncompliant with work or community engagement requirements, and a description of how the individual may make a satisfactory showing as described in paragraph (2) of subdivision (l).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An outline of how the individual may reapply for the Medi-Cal program if the individual’s application is denied or the individual is disenrolled.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The applicable individual’s right to request a state hearing, including the procedures for requesting a state hearing and the time limits within which a state hearing must be requested.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The circumstances under which aid will be continued if a state hearing is requested.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
(1)
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Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, until regulations are adopted.
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(2)
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The department shall adopt regulations by July 1, 2028, for purposes of this section, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
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(3)
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Notwithstanding Section 10231.5 of the Government Code, beginning July 1, 2027, the department shall provide a semiannual status report on implementation of this section to the Legislature, in accordance with Section 9795 of the Government Code,
until regulations have been adopted.
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(p)
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This section shall remain operative only as long as Section 1396a(xx) of Title 42 of the United States Code (Section 71119 of federal House Resolution 1 (Public Law 119-21)) is operative.
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(q)
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This section shall be implemented only after the director determines, and communicates in writing to the Department of Finance, that systems have been programmed for implementation of this section.
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<ns0:Num>SEC. 2.</ns0:Num>
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<html:p>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.</html:p>
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