AB 461: Coordinated Care Initiative.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. One of the methods by which these services are provided is pursuant to contracts with various types of managed care health plans. Existing federal law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age.

Existing law requires the department to seek federal approval pursuant to a Medicare or a Medicaid demonstration project or waiver, or a combination thereof, to establish a demonstration project that enables beneficiaries dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between the programs. Existing law requires, with some exceptions, the department to enroll dual eligible beneficiaries into a managed care plan that is selected to participate in the demonstration project unless the beneficiary makes an affirmative choice to opt out of enrollment or is already enrolled in a specified managed care organization on or before June 1, 2013. Existing law excludes a dual eligible beneficiary from enrollment in the demonstration project if, among other reasons, the beneficiary is receiving services through a regional center or state developmental center. Existing law also excludes a dual eligible beneficiary from enrollment in the demonstration project if, among other reasons, the beneficiary is enrolled in a home- and community-based waiver except for persons enrolled in Multipurpose Senior Services Program services.

This bill would authorize a beneficiary receiving services through a regional center who resides in the County of San Mateo to participate voluntarily in the demonstration project if certain requirements are met.

This bill would make legislative findings and declarations as to the necessity of a special statute for the County of San Mateo.