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<ns0:Id>20250AB__234898AMD</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-19</ns0:ActionDate>
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<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2026-04-07</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>
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<ns0:Name>Bonta</ns0:Name>
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<ns0:Title> An act to add Article 5.52 (commencing with Section 14184.1000) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal.</ns0:Title>
<ns0:RelatingClause>Medi-Cal</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Medi-Cal: community supports.</ns0:Subject>
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<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, 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.</html:p>
<html:p>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.</html:p>
<html:p>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.</html:p>
<html:p>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.</html:p>
<html:p>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.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Article 5.52 (commencing with Section 14184.1000) is added to Chapter 7 of Part 3 of Division 9 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
, to read:
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<ns0:Num>5.52.</ns0:Num>
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<ns0:LawHeadingText>CalAIM Successor Programs</ns0:LawHeadingText>
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<ns0:Num>14184.1000.</ns0:Num>
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(a)
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Commencing on January 1, 2027, and to the extent that federal financial participation is available and is not otherwise jeopardized, 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.
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(b)
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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.
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(c)
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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.
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<ns0:LawSection id="id_758DF936-8A0A-4796-9FC1-255F80C80607">
<ns0:Num>14184.1001.</ns0:Num>
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(a)
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(1)
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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 Section 14184.1000.
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<html:p>
(2)
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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.
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(3)
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The department shall engage stakeholders, including community providers of each community support, and solicit and accept feedback in developing the Evidence of Coverage document.
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<html:p>
(b)
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Until December 1, 2030, the department shall regularly review and update the Evidence of Coverage document and related policies produced and developed pursuant to subdivision (a) as needed to ensure effective and efficient delivery of CalAIM programs.
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<html:p>
(1)
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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.
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(2)
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The department shall publicly release written updates to its community supports policy guidance 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, and 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.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
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.
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<html:p>
(d)
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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.
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(e)
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Until December 31, 2030, the department shall continue to convene the currently established CalAIM Implementation Advisory Group.
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