Existing law establishes various public social services programs under the jurisdiction of the State Department of Social Services, including, among others, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, the CalFresh program, the California Food Assistance Program (CFAP), the In-Home Supportive Services (IHSS) program, and the Cash Assistance Program for Immigrants (CAPI).

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 and funded by federal Medicaid program provisions.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, requires a health care service plan to provide an enrollee who has been displaced or whose health may otherwise be affected by a state of emergency, as declared by the Governor, or a health emergency, as declared by the State Public Health Officer, with access to medically necessary health care services, as specified.

This bill would require the State Department of Social Services, for purposes of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, and the State Department of Health Care Services, for Medi-Cal purposes, to provide continuous eligibility for the applicable programs to a recipient or beneficiary who has been displaced by, or who has otherwise been affected by, a state of emergency. For affected by a state of emergency, including through displacement.

For Medi-Cal purposes, the bill would also specify additional qualifying circumstances, including certain disruptions in providers, infrastructure, or other services, and would also require this continuous eligibility in the case of displacement or other effect an by a health emergency. The bill would authorize the State Department of Health Care Services to implement these Medi-Cal provisions by providing continuous eligibility to all Medi-Cal beneficiaries within a geographic region where the department finds that multiple Medi-Cal beneficiaries within the geographic region have experienced any of these circumstances due to a state of emergency or health emergency.

Under the bill, the continuous eligibility would maintain a recipients or beneficiarys current scope of benefits under the applicable program for at least 90 calendar days starting from the proclamation or declaration, as applicable, and would continue through at least the conclusion of the proclamation or declaration, as applicable. certain timelines. The bill would require the 2 departments to implement the continuous eligibility through automated programming of eligibility systems, with notifications, as specified.

The bill would require a county to immediately restore eligibility for the applicable program for any recipient or beneficiary whose eligibility was discontinued and who informs the county that they have been impacted as described above, without requesting any further verifications from the recipient or beneficiary.

In the case of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, if a recipient fails to submit a semiannual report or an annual redetermination or recertification of eligibility, if applicable, the bill would require the county to determine that the recipient had good cause for failing to submit that information. The bill would set forth related provisions for the county, the State Department of Social Services, and the Director of Social Services.

Under the bill, these provisions would be implemented only to the extent not in conflict with federal law. The bill would authorize the Director of Social Services to waive, subject to receipt of any necessary federal approvals, the enforcement of specific federal requirements, regulations, or standards necessary to implement the above-described applicable provisions. Under the bill, implementation of the Medi-Cal provisions would be conditioned on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would authorize the Director of Social Services or the Director of Health Care Services to issue county directives regarding compliance with these the respective provisions.

By creating new duties for counties with regard to eligibility for the above-described programs, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing these provisions.

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.

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.

Existing law establishes various public social services programs under the jurisdiction of the State Department of Social Services, including, among others, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, the CalFresh program, the California Food Assistance Program (CFAP), the In-Home Supportive Services (IHSS) program, and the Cash Assistance Program for Immigrants (CAPI).

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 and funded by federal Medicaid program provisions.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, requires a health care service plan to provide an enrollee who has been displaced or whose health may otherwise be affected by a state of emergency, as declared by the Governor, or a health emergency, as declared by the State Public Health Officer, with access to medically necessary health care services, as specified.

This bill would require the State Department of Social Services, for purposes of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, and the State Department of Health Care Services, for Medi-Cal purposes, to provide continuous eligibility for the applicable programs to a recipient or beneficiary who has been displaced by, or who has otherwise been affected by, a state of emergency or a health emergency, as described above. emergency. For Medi-Cal purposes, the bill would also require this continuous eligibility in the case of displacement or other effect by a health emergency.

Under the bill, the continuous eligibility would maintain a recipients or beneficiarys current scope of benefits under the applicable program for at least 90 calendar days starting from the proclamation or declaration, whichever one is later, as applicable, and would continue through at least the conclusion of the proclamation or declaration, whichever one is later. as applicable. The bill would require the 2 departments to implement the continuous eligibility through automated programming of eligibility systems, with notifications, as specified.

The bill would require a county to immediately restore eligibility for the applicable program for any recipient or beneficiary whose eligibility was discontinued and who informs the county that they have been impacted as described above, without requesting any further verifications from the recipient or beneficiary.

In the case of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, if a recipient fails to submit a semiannual report or an annual redetermination or recertification of eligibility, if applicable, the bill would require the county to determine that the recipient had good cause for failing to submit that information. The bill would set forth related provisions for the county, the State Department of Social Services, and the Director of Social Services.

Under the bill, these provisions would be implemented only to the extent not in conflict with federal law. The bill would authorize the Director of Social Services or the Director of Health Care Services to issue county directives regarding compliance with these provisions.

By creating new duties for counties with regard to eligibility for the above-described programs, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing these provisions.

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.

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.

Existing law establishes various public social services programs under the jurisdiction of the State Department of Social Services, including, among others, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, the CalFresh program, the California Food Assistance Program (CFAP), the In-Home Supportive Services (IHSS) program, and the Cash Assistance Program for Immigrants (CAPI).

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 and funded by federal Medicaid program provisions.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, requires a health care service plan to provide an enrollee who has been displaced or whose health may otherwise be affected by a state of emergency, as declared by the Governor, or a health emergency, as declared by the State Public Health Officer, with access to medically necessary health care services, as specified.

This bill would require the State Department of Social Services, for purposes of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, and the State Department of Health Care Services, for Medi-Cal purposes, to provide continuous eligibility for the applicable programs to a recipient or beneficiary who has been displaced by, or who has otherwise been affected by, a state of emergency or a health emergency, as described above.

Under the bill, the continuous eligibility would maintain a recipients or beneficiarys current scope of benefits under the applicable program for at least 90 calendar days starting from the proclamation or declaration, whichever one is later, and would continue through at least the conclusion of the proclamation or declaration, whichever one is later. The bill would require the 2 departments to implement the continuous eligibility through automated programming of eligibility systems, with notifications, as specified.

The bill would require a county to immediately restore eligibility for the applicable program for any recipient or beneficiary whose eligibility was discontinued and who informs the county that they have been impacted as described above, without requesting any further verifications from the recipient or beneficiary.

In the case of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, if a recipient fails to submit a semiannual report or an annual redetermination or recertification of eligibility, if applicable, the bill would require the county to determine that the recipient had good cause for failing to submit that information. The bill would set forth related provisions for the county, the State Department of Social Services, and the Director of Social Services.

Under the bill, these provisions would be implemented only to the extent not in conflict with federal law. The bill would authorize the Director of Social Services or the Director of Health Care Services to issue county directives regarding compliance with these provisions.

By creating new duties for counties with regard to eligibility for the above-described programs, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing these provisions.

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.

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.

Date of Hearing: May 21, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 1161

Author:(Harabedian) – As Amended Ver:May 1, 2025

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill requires the Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) to provide continuous eligibility, as specified, for Medi-Cal, California Work Opportunity and Responsibility to Kids (CalWORKs), CalFresh, California Food Assistance Program (CFAP), In-home Supportive Services (IHSS), and the Cash Assistance Program for Immigrants (CAPI) to a beneficiary or recipient affected by a proclaimed state of emergency.

Specifically, this bill:

1. Requires DHCS and CDSS to provide continuous eligibility, as specified, for Medi-Cal, CalWORKs, CalFresh, CFAP, IHSS, and CAPI programs, as applicable, to a recipient displaced by or otherwise affected by a proclaimed state of emergency by the Governor. Also requires, for purposes of Medi-Cal, continuous eligibility based on a health emergency declared by the State Public Health Officer.
2. Requires a department or program that must provide continuous eligibility, as described above, to maintain a beneficiary’s current scope of benefits under the applicable program for at least 90 calendar days or through the conclusion of the proclamation or declaration, whichever is later.
3. Requires DHCS and CDSS to implement continuous enrollment, as described above, through automated programming of eligibility systems to pause all discontinuances and all negative actions, without requiring manual eligibility worker action, and establishes requirements for notifications to beneficiaries, as specified.
4. Requires a county to immediately restore eligibility for the applicable program for any beneficiary whose eligibility was discontinued and who informs the county that they have been impacted by emergencies, as described above, as specified.
5. Establishes other rules specific to various social services programs to protect beneficiaries impacted by an emergency described above.
6. Specifies this bill will be implemented only to the extent not in conflict with federal law and, for purposes of Medi-Cal eligibility, makes implementation contingent on the receipt of any necessary federal approvals and the availability of federal financial participation.
7. Allows DHCS and CDSS to implement this bill through all-county letters or eligibility division letters, exempt from the Administrative Procedures Act, during the first three years following the proclamation of a state of emergency or the declaration of a health emergency, or until the state of emergency or the health emergency is terminated, whichever occurs first.

FISCAL EFFECT:

1. General Fund costs to CDSS of an unknown amount, but likely in the millions of dollars, for one-time automation for each declared emergency. Additional costs for extended benefits are unknown, but benefit extensions must last for least 90 days and continue for the length of each proclamation. The affected caseload is unknown and will vary with each emergency.
2. General Fund costs to DHCS of an unknown amount, but likely in mid-hundreds of thousands of dollars for one-time automation for each declared emergency.

COMMENTS:

1. Purpose. According to the author:

When disaster strikes, no one should be left without food, medical care, or the basic support they need to survive. Yet, under current law, there are no protections to ensure that low-income Californians, seniors, people with disabilities, and immigrant communities maintain access to critical public benefits in the wake of a crisis. Families relying on CalWORKs, CalFresh, Medi-Cal, IHSS, and CAPI face an unnecessary and preventable risk: losing their benefits at the exact moment they need them most. Public benefits programs are designed to provide stability, yet without guaranteed protections during disasters, recipients are left vulnerable to abrupt terminations due to administrative barriers, lost documents, or mail disruptions—through no fault of their own. [This bill] creates the necessary protections to ensure that individuals and families do not lose their benefits simply because they have been displaced or are struggling to recover from a disaster.

1. Background. Medi-Cal Redeterminations. For individuals enrolled in Medi-Cal, a county must redetermine eligibility every 12 months for the individual to retain coverage for the next year. State law establishes specific process requirements and due process safeguards for redeterminations of eligibility. Many individuals are redetermined eligible automatically, but if a county needs additional information, a beneficiary generally has 30 days to respond. If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a ten-day Notice of Action of terminating their eligibility. If the county terminates eligibility, the beneficiary still has 90 days from termination to “cure” or provide the information requested. Beneficiaries also have the right to appeal an adverse determination, and may also receive a period of retroactive eligibility.

CalWORKs, CalFresh, CFAP, IHSS and CAPI Redeterminations. These social safety net programs are primarily overseen by CDSS, but services are delivered at the county level. While every program has its own eligibility requirements, all programs generally have guidelines related to income level, household size, compliance with program requirements, immigration status, and time spent on the program, among others. After a person is determined eligible, a county then requires future redetermination or recertification. For CalWORKs and CalFresh, this occurs every 12 months and is subject to certain requirements.

This bill requires CDSS, for purposes of CalWORKs, CalFresh, CFAP, IHSS, and CAPI, and DHCS, for Medi-Cal purposes, to provide continuous eligibility for the applicable programs to a recipient or beneficiary who has been affected by a state of emergency, including through displacement.

1. Prior Legislation. AB 2956 (Boerner), of the 2023-24 Legislative Session, would have extended numerous temporary federally allowable processes (federal flexibilities) related to the redetermination of Medi-Cal eligibility, following the COVID-19 PHE, and established 12-month continuous Medi-Cal eligibility for adults. AB 2956 was held on this committee’s suspense file.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 29, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 1161

Author:(Harabedian) – As Amended Ver:April 21, 2025

SUBJECT: Public social services: state of emergency or health emergency.

SUMMARY: Provides for continuous eligibility for at least 90 calendar days or the conclusion of the proclamation, to a Medi-Cal beneficiary that was displaced by or affected by a proclaimed a state of emergency by the Governor or a health emergency declared by the State Public Health Officer. Provides similar protections for a recipient of California Work Opportunity and Responsibility to Kids (CalWORKs), CalFresh, California Food Assistance Program (CFAP), In-home Supportive Services (IHSS), and/or the Cash Assistance Program for Immigrants (CAPI) with respect to a recipient affected by a state of emergency. Specifically, this bill:

1. Requires the Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) to provide continuous eligibility to programs, as specified, for a recipient that was displaced or affected by an event proclaimed a state of emergency by the Governor for Medi-Cal, CalWORKs, CalFresh, CFAP, IHSS, and/or CAPI. Requires, for purposes of Medi-Cal, continuous eligibility based on a health emergency declared by the State Public Health Officer.
2. Requires, for the purposes of 1) above, continuous eligibility to maintain a recipient’s current scope of benefits under the applicable program for at least 90 calendar days starting from the proclamation or declaration, whichever one is later, and continues eligibility through at least the conclusion of the proclamation or declaration.
3. Requires DHCS and CDSS to implement 2) above, or each recipient described in 1) above, through automated programming of eligibility systems to pause all discontinuances and all negative actions, without requiring manual eligibility worker action, and establishes requirements for notifications to beneficiaries, as specified.
4. Requires a county to immediately restore eligibility for the applicable program for any recipient whose eligibility was discontinued and who informs the county that they have been impacted by emergencies described in 1) above, as specified.
5. Establishes other rules specific to various social services programs to protect beneficiaries impacted by an emergency described in 1) above.
6. Clarifies that this bill is not to be construed as limiting the Governor’s authority under the California Emergency Services Act or the authority of the State Public Health Officer.
7. Specifies that this bill will only be implemented to extent not in conflict with federal law.
8. Permits the DHCS and CDSS directors to implement this bill by issuing county directives in the form of all-county letters or eligibility division letters, exempt from the Administrative Procedures Act, during the first three years following the proclamation of a state of emergency or the declaration of a health emergency, or until the state of emergency or the health emergency is terminated, whichever occurs first.

EXISTING LAW:

1. Establishes the California Emergency Services Act, which defines emergencies and the emergency powers of the Governor. [Government Code (GOV) § 8550, et seq.]
2. Defines “state of emergency” as the duly proclaimed existence of conditions of disaster or of extreme peril to the safety of persons and property within the state caused by conditions such as air pollution, fire, flood, storm, epidemic, riot, drought, cyberterrorism, sudden and severe energy shortage, plant or animal infestation or disease, the Governor’s warning of an earthquake or volcanic prediction, or an earthquake, or other conditions, other than conditions resulting from a labor controversy or conditions causing a “state of war emergency,” which, by reason of their magnitude, are or are likely to be beyond the control of the services, personnel, equipment, and facilities of any single county, city and county, or city and require the combined forces of a mutual aid region or regions to combat, or with respect to regulated energy utilities, a sudden and severe energy shortage requires extraordinary measures beyond the authority vested in the California Public Utilities Commission. [GOV § 8558]
3. Empowers the Governor to proclaim a state of emergency in an area affected or likely to be affected when:
   1. He (sic) finds that circumstances described in 2) above exist; and either,
   2. He is requested to do so by local authorities; or,
   3. He finds that local authority is inadequate to cope with the emergency. [GOV § 8625]
4. Grants the Governor the authority, during a state of emergency, to the extent he deems necessary, have complete authority over all agencies of the state government and the right to exercise within the area designated all police power vested in the state by the Constitution and laws of the State of California to address the emergency. Requires the Governor to promulgate, issue, and enforce such orders and regulations as he deem necessary. [GOV § 8627]
5. Authorizes the Governor to make, amend, and rescind orders and regulations necessary to carry out provisions related to emergency declarations and gives such orders and regulations the force and effect of law. [GOV § 8567]
6. Allows the Governor, during a state of emergency, to suspend any regulatory statute, or statute prescribing the procedure for conduct of state business, or the orders, rules, or regulations of any state agency, where the Governor determines and declares that strict compliance with any statute, order, rule, or regulation would in any way prevent, hinder, or delay the mitigation of the effects of the emergency. [GOV § 8571]
7. Allows the Governor, during a state of emergency, to direct all agencies of the state government to utilize and employ state personnel, equipment, and facilities for the performance of any and all activities designed to prevent or alleviate actual and threatened damage due to the emergency, as well as direct such agencies to provide supplemental services and equipment to political subdivisions to restore any services which must be restored in order to provide for the health and safety of the citizens of the affected area. [GOV § 8628]
8. Requires the Governor to proclaim the termination of a state of emergency at the earliest possible date that conditions warrant, and terminates all emergency powers when the state of emergency has been terminated by proclamation of the Governor or by concurrent resolution of the Legislature declaring it at an end. [GOV § 8629]
9. Authorizes the State Public Health Officer or local health officers to declare a local health emergency due to hazardous waste, medical waste, infectious disease, or chemical, biologic, toxic, or radioactive agents and establishes powers of the state or local health officers to address such a health threat. [Health and Safety Code (HSC) § 101075 et seq. and HSC § 101080]
10. Establishes the Medi-Cal Program, administered by DHCS, to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria. [Welfare and Institutions Code (WIC) § 14000 et seq.]
11. Makes Medi-Cal eligibility and enrollment functions a county function and responsibility, subject to the direction, authority, and regulations of DHCS. [WIC § 14001.11]
12. Establishes a processes for the determination and redetermination of an individual’s eligibility for Medi-Cal. [WIC § 14005, et seq.]
13. Requires a county to perform redeterminations of eligibility for beneficiaries every 12 months and promptly redetermine eligibility whenever the county receives information about changes in a beneficiary’s circumstance that may affect eligibility. [WIC § 14005.37]
14. Requires a loss of contact, as evidenced by the return of mail marked in such a way as to indicate it could not be delivered or that there was no forwarding address, to prompt a redetermination of eligibility. [Ibid.]
15. Requires eligibility to continue during the redetermination process and prohibits eligibility from being terminated until the county makes a specific determination based on facts clearly demonstrating the beneficiary is no longer eligible, and due process rights have been met. [Ibid.]
16. Specifies procedures whereby an individual can request to receive retroactive eligibility for the three months preceding an eligibility determination. [Ibid.]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS: This analysis only discusses policy issues germane to the jurisdiction of the Assembly Committee on Health.

1. PURPOSE OF THIS BILL. According to the author, when disaster strikes, no one should be left without food, medical care, or the basic support they need to survive. The author indicates that public benefits programs are designed to provide stability, yet without guaranteed protections during disasters, recipients are left vulnerable to abrupt terminations due to administrative barriers, lost documents, or mail disruptions—through no fault of their own. The author argues the absence of clear, permanent safeguards means that each disaster brings uncertainty, forcing people already facing immense hardship to fight for the assistance they should never have to fear losing. The author concludes is bill is intended to ensure individuals and families do not lose their benefits simply because they have been displaced or are struggling to recover from a disaster.
2. BACKGROUND.
   1. Medi-Cal Eligibility, Redetermination, and Termination. Individuals who have been found eligible and are enrolled in Medi-Cal must have their eligibility redetermined every 12 months in order to retain coverage for the next year. If, during the 12-month period, new information that affects eligibility becomes available to the county, either reported by the individual or accessed through other electronic data sources, a beneficiary or enrollee will automatically have their eligibility redetermined based on the new information. Beneficiaries must also report to the county any change in their circumstances that may affect their Medi-Cal eligibility within ten calendar days of the change.

State law establishes specific process requirements and due process safeguards for redeterminations of eligibility. Many individuals are redetermined eligible automatically. However, if additional information is needed to establish eligibility, a beneficiary generally has 30 days to respond to a request for information. If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a ten-day Notice of Action of terminating their eligibility. If terminated, the beneficiary still has 90 days from termination to “cure” or provide the information requested. Beneficiaries also have the right to appeal an adverse determination, and can also receive a period of retroactive eligibility.

This bill is intended to make exceptions to the normal Medi-Cal redetermination process for beneficiaries affected by disasters.

• 1. State and Federal Disasters and Emergencies. At the federal level, the President can declare a major disaster for any natural disaster event, or, regardless of cause, if the President determines has caused damage of such severity that it is beyond the combined capabilities of state and local governments to respond. A major disaster declaration provides a wide range of federal assistance programs for individuals and public infrastructure, including funds for both emergency and permanent work. In addition, the President can declare an emergency for any occasion or instance when the President determines federal assistance is needed—for instance, to protect lives, property, public health, and safety, or to lessen or avert the threat of a catastrophe. 

Similarly, California law authorizes the California Governor to declare a state of emergency based on a range of natural disasters, as well as cyberterrorism, sudden and severe energy shortage, plant or animal infestation or disease, the Governor’s warning of an earthquake or volcanic prediction, or other conditions. States of emergency may be requested by a local entity or declared by the Governor when the Governor deems the conditions are beyond the control of local entities to manage. The significant flexibility offered in the law to suspend laws and regulations, as well as to issue orders, allows the Governor to respond to the unique and unpredictable circumstances created by disasters.

• 1. Recent Disaster Experience: COVID-19 Public Health Emergency (PHE) and Los Angeles (LA) County Fires. The author, sponsor, and supporters of this bill point to continuous coverage during the COVID-19 PHE and the actions taken in response to recent fires as examples of beneficiary protections that the state should normalize in response to disasters.
     1. Eaton and Palisades Fires. On January 7^th, 2025, wildfires spread quickly into urban parts of northeastern and western Los Angeles County. The Eaton and Palisades fires burned over 37,000 acres, destroying over 16,000 structures and killing 30 civilians and 10 firefighters. In response to these disasters, DHCS took a number of actions to ensure continuity of eligibility and health care for Medi-Cal beneficiaries, including:
        1. DHCS issued guidance to counties, providing reminders on processing applications, delaying disenrollments, and reinstating coverage for individuals affected by the wildfires;
        2. Medi-Cal members in LA County, who reside in areas affected by the wildfires, with eligibility renewals in February, March, and April 2025 will have their renewals extended for six months;
        3. Medi-Cal members who were disenrolled in January 2025 for being unable to return their Medi-Cal eligibility renewal packet will be reinstated immediately with no gap in their Medi-Cal coverage/benefits;
        4. Families in affected areas can quickly enroll or renew Medi-Cal coverage, with streamlined processes to minimize delays in accessing care;
        5. Applicants impacted by the disaster can self-attest to residency and income when documentation is unavailable;
        6. Counties are required to extend benefits for affected populations throughout the emergency;
        7. Applicants impacted by the disaster are provided additional time to submit verifications; and,
        8. When documentation is unavailable, applicants may self-attest to California residency and income through signed affidavits under penalty of perjury.

Additionally, DHCS reports that Medi-Cal managed care plans that operate in the areas subject to the emergency have activated their emergency response protocols, which include deploying care management teams to conduct member outreach, waiving prior authorization requirements, providing transportation to care, and ensuring members do not face out-of-pocket costs for receiving care from out-of-network providers, as needed.

• • 1. Continuous Coverage During the COVID-19 PHE. The Medicaid continuous coverage requirement initiated by the federal government during the federally declared COVID-19 PHE also offers another recent example of pausing and restarting Medi-Cal eligibility determinations based on a declared emergency. The federal Families First Coronavirus Response Act (FFCRA) authorized enhanced federal funding for Medicaid (Medi-Cal in California) programs, conditioned upon Maintenance of Eligibility requirements that prohibited disenrolling Medicaid beneficiaries in most circumstances for the length of the PHE. Under these temporary rules and a variety of federal flexibilities offered to states, California paused regular eligibility redeterminations statewide from March 2020 to March 31, 2023, allowing millions of Californians to maintain coverage through a volatile period in the state’s history. Counties began processing Medi-Cal eligibility redeterminations in June 2023, which required a significant statewide administrative, training, and communications effort.
  1. Considerations for Basing Program Eligibility on Emergency Declarations.
     1. Types of Emergencies and their Effect on Medi-Cal Beneficiaries. This bill limits continuous eligibility to beneficiaries “affected by” a proclaimed a state of emergency or a health emergency. States of emergency can be declared for a number of different types of disasters. Many disasters, like the examples discussed directly above, could significantly affect Medi-Cal beneficiaries’ access to health care or ability to renew their Medi-Cal eligibility, while others may have a limited effect. Disasters have been declared in the last few years, for instance, for numerous fires of varying severity, winter storms and wind storms, a 2022 earthquake in Humboldt County, bird flu, and impacts to utility services.
     2. Length of Emergencies. This bill continues Medi-Cal eligibility through at least the conclusion of the proclamation or declaration or an emergency. Current law requires the Governor to proclaim the termination of a state of emergency at the earliest possible date that conditions warrant. However, it is unclear whether emergency declarations are always terminated at the earliest possible date that conditions warrant, and there may be administrative or fiscal reasons that emergencies remain active for months or even years after the immediate damage is contained. For example, a July 1, 2024, proclamation by Governor Newsom terminated 22 emergency declarations that had been declared over a number of years, the oldest of which was declared in March of 2017. Because of how emergency declarations are practically used, and because some emergency periods last for multiple years, in many cases the length of a continuous Medi-Cal eligibility period that may be meaningful in the wake of a disaster is shorter than the length of declared emergency.

1. SUPPORT. This bill is supported by a number of consumer, senior, children’s, and health advocacy organizations as well as health care provider organizations, who point to the need to ensure we have processes and systems in place to protect our most vulnerable Californians when disaster strikes. According to Western Center on Law and Poverty (WCLP), the bill’s sponsor, California’s public benefits programs are set up to automatically terminate eligibility if people do not submit required documentation within certain timeframes, typically 30 days. During ordinary times, WCLP notes, people can check their mail and return information needed to keep their benefits active; however, during and after disasters, these rules penalize survivors at the most vulnerable time of their lives. WCLP notes the emergency protections require manual workarounds and emergency systems programming, which has highlighted the need for both information technology systems and processes to be in place to allow for continued eligibility of all public benefit programs during the next disasters.
2. PREVIOUS LEGISLATION.
   1. AB 2956 (Boerner) of 2024 would have extended numerous temporary federally allowable processes (federal flexibilities) related to the redetermination of Medi-Cal eligibility, following the COVID-19 PHE, and established 12-month continuous Medi-Cal eligibility for adults. AB 2956 was held on the Suspense File of the Assembly Appropriations Committee.
   2. SB 979 (Dodd), Chapter 421, Statutes of 2022, expands provisions of law permitting the Department of Managed Health Care and the Department of Insurance to take actions to protect enrollee access to health care during a state of emergency proclaimed by the Governor by extending this ability to health emergencies declared by the State Public Health Officer, and by extending this authority to when the emergency affects health care providers or the enrollee’s health, rather than just when the emergency displaces enrollees.
   3. AB 1494 (Aguiar-Curry), Chapter 829, Statutes of 2019, prohibits face-to-face contact or a patient's physical presence on the premises of an enrolled community clinic, as specified, to be required for services provided to a Medi-Cal beneficiary during or immediately following a state of emergency. Requires Medi-Cal reimbursement for telephonic services and a broader availability for telehealth services when provided by an enrolled community clinic during and up to 90 calendar days of the conclusion of a state of emergency. Requires federally qualified health centers (FQHCs) and rural health centers (RHCs) services provided outside the four walls of the FQHC or RHC to be Medi-Cal reimbursable, if within the boundaries of the state of proclamation declaring the state of emergency. Permits DHCS to allow other enrolled fee-for-service Medi-Cal providers, clinics or facilities to provide receive Medi-Cal reimbursement for the telephone and extended telehealth services. Permits DHCS to grant an extension beyond 90 calendar days after the conclusion of the emergency if necessary for the health and safety of the public. Implements the requirements above only to the extent DHCS obtains any necessary federal approvals and DHCS obtains federal matching funds to the extent permitted by federal law. Requires DHCS to issue guidance to facilitate reimbursement.
   4. AB 690 (Aguiar-Curry), Chapter 679, Statutes of 2019, allows for a pharmacy license to be transferred in a declared state of emergency.
   5. AB 607 (Gloria), Chapter 501, Statutes of 2017, establishes the Community Resiliency and Disaster Preparedness Act of 2017 to provide for expanded and improved disaster readiness and response in the CalWORKs and CalFresh programs, as specified.
3. AMENDMENTS. To ensure the bill is specific to disasters that affect a beneficiary’s ability to complete the redetermination process, to correct drafting errors, and to ensure the bill is implemented, like the vast majority of the Medi-Cal provisions, pursuant to federal approval and the availability of federal financial participation, the author and Committee have agreed to the amendments listed below. In addition, per the discussion of the significant length of some emergency declarations, the author is encouraged to engage with DHCS and other stakeholders to further refine the length of the period of continuous eligibility to ensure it is terminated at a time appropriate to circumstances on the ground.

Amendments are reflected below in bold underlined italics as follows:

(a) (1) The department shall provide continuous Medi-Cal eligibility to a beneficiary who, has been displaced by, or who has otherwise been affected by, due to a state of emergency, as proclaimed by the Governor pursuant to Section 8625 of the Government Code, or a health emergency, as declared by the State Public Health Officer pursuant to Section 101080 of the Health and Safety Code, has been affected by any of the following circumstances:

(A) County social service office(s) operating at reduced capacity, including but not limited to staffing, office closures or operating at reduced hours.

(B) Being displaced or otherwise experiencing limited freedom of movement, including but not limited to relocating to shelter or emergency housing, stay-at-home orders, and evacuation orders or warnings.

(C) A disruption in providers, infrastructure, or other services necessary to maintain daily life and health, including but not limited to disruption in utilities, school, childcare, medical services or providers, access to food, transportation, or mail services.

(2) The department may implement paragraph (1) by providing continuous eligibility to all beneficiaries within a geographic region where the department finds, after consulting with counties, consumer stakeholders, and the Governor’s Office of Emergency Services, that multiple beneficiaries within the geographic region have experienced any of the circumstances described in subparagraph (A) through (C), inclusive, of paragraph (1), due to a state of emergency or health emergency.

(b) The continuous Medi-Cal eligibility described in subdivision (a) shall maintain a beneficiary’s current scope of Medi-Cal coverage for at least 90 calendar days starting from the date of the proclamation or declaration described in subdivision (a), whichever one is later, and shall continue or through at least the date conclusion of the proclamation or declaration described in subdivision (a) is terminated, whichever one is later.

Add: This section shall be implemented only to the extent that any necessary federal approvals are obtained, and federal financial participation is available and not otherwise jeopardized.

REGISTERED SUPPORT / OPPOSITION:

Support

Asian Americans Advancing Justice-southern California

California Association of Food Banks

California Coalition for Youth

California Community Foundation

California Hospital Association

California Senior Legislature

CANHR

Children Now

Disability Rights Education and Defense Fund

Health Access California

Justice in Aging

LeadingAge California

National Health Law Program

Second Harvest Food Bank of Orange County

The Arc and United Cerebral Palsy California Collaboration

The Children's Partnership

Western Center on Law & Poverty

Opposition

None on file

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097

Date of Hearing: April 8, 2025

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

ABPCA Bill Id:AB 1161 (

Author:Harabedian) – As Introduced Ver:February 20, 2025

SUBJECT: Public social services: state of emergency or health emergency

SUMMARY: Provides for continuous eligibility for at least 90 calendar days or the conclusion of the proclamation, to a recipient of Medi-Cal, California Work Opportunity and Responsibility to Kids (CalWORKs), CalFresh, California Food Assistance Program (CFAP), In-home Supportive Services (IHSS), and/or the Cash Assistance Program for Immigrants (CAPI) that was displaced by or affected by a proclaimed a state of emergency by the Governor or a health emergency declared by the State Public Health Officer. Specifically, this bill:

1. Requires the Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) to provide continuous eligibility to social service programs, as specified, for a recipient that was displaced or affected by an event proclaimed a state of emergency by the Governor or a health emergency declared by the State Public Health Officer for Medi-Cal, CalWORKs, CalFresh, CFAP, IHSS, and/or CAPI.
2. Provides that for the purposes of 1) above, continuous eligibility must maintain a recipient’s current scope of benefits under the applicable program for at least 90 calendar days starting from the proclamation or declaration, whichever one is later, and shall continue through at least the conclusion of the proclamation or declaration.
3. Requires DHCS and CDSS to implement 2) above, or each recipient described in 1) above, through automated programming of eligibility systems to pause all discontinuances and all negative actions, without requiring manual eligibility worker action, and must include the transmission of a notification by mail, and a notification through electronic, text, or telephonic format, that inform a recipient about their continued eligibility and about any changes to deadlines for any information required to continue eligibility after the state of emergency or the health emergency, as applicable.
4. Requires a county to immediately restore eligibility for the applicable program for any recipient whose eligibility was discontinued and who informs the county that they have been impacted by emergencies described in 1) above, without requesting any further verifications from the recipient. Requires the recipient’s attestation of their impact by any means, including, but not limited to, verbal communication.
5. Requires a county to determine that the recipient had good cause for failing to submit a semiannual report, an annual redetermination, or recertification of eligibility if they were impacted by an emergency described in 1) above.
6. Requires the county to rescind any discontinue notice for the full period of continuous eligibility.
   
   
   
7. Prohibits a county from terminating benefits due to a failure to submit:
   1. A semiannual report by the end of the semiannual reporting period if the recipient had good cause for failing to submit the report.
   2. An annual redetermination or recertification of eligibility by the end of the annual reporting period if the recipient had good cause for failing to submit the report.
8. To the extent permitted by federal law, requires CDSS to seek any necessary federal waivers to suspend or defer the federal Supplemental Nutrition Assistance Program (SNAP) recertification deadline, as applicable.
9. Authorizes CDSS to waive, subject to receipt of any necessary federal approvals, the enforcement of specific federal requirements, regulations, or standards necessary to implement this section.
10. Clarifies that this bill shall not be construed as limiting the Governor’s authority under the California Emergency Services Act or the authority of the director under any provision of this part.
11. Specifies that this bill shall only be implemented to extent not in conflict with federal law.
12. Permits the DHCS and CDSS directors to issue county directives in the form of all-county letters or eligibility division letters, exempt from the Administrative Procedures Act, regarding compliance with this section during the first three years following the proclamation of a state of emergency or the declaration of a health emergency, or until the state of emergency or the health emergency is terminated, whichever occurs first.

EXISTING LAW:

1. Grants the Governor the authority, during a state of emergency, to the extent he deem necessary, have complete authority over all agencies of the state government and the right to exercise within the area designated all police power vested in the state by the Constitution and laws of the State of California in order to effectuate the purposes of this chapter. In exercise thereof, the Governor shall promulgate, issue, and enforce such orders and regulations as he deem necessary. (Government Code [GOV] § 8627)
2. Authorizes the Governor to make, amend, and rescind orders and regulations necessary to carry out the provisions of this chapter. The orders and regulations have the force and effect of law. Due consideration shall be given to the plans of the federal government in preparing the orders and regulations. The Governor must cause widespread publicity and notice to be given to all such orders and regulations, or amendments or rescissions thereof. (GOV § 8567)
3. Establishes the CalFresh program to administer the provision of federal SNAP benefits to families and individuals meeting certain criteria, as specified. (Welfare and Institutions Code [WIC] § 18900 et seq.)
4. Requires CDSS and county human services agencies, if the President of the United States (U.S.) issues a Major Disaster Declaration with Individual Assistance (IA), to request to operate a federal Disaster Supplemental Nutrition Assistance Program for the regions affected by the major disaster. The request shall include a waiver request to provide automatic, mass replacement benefits to eligible households and a waiver request to allow households to purchase hot, prepared foods at authorized retailers with their benefits. (WIC § 18917(d))
5. Establishes in state law the CalWORKs program, to provide cash assistance and other social services for low-income families through the federal TANF program. Under CalWORKs, each county provides assistance through a combination of state, county, and federal TANF funds. (WIC § §11200 et seq.)
6. Establishes income, asset, and real property limits used to determine eligibility for the CalWORKs program and grant amounts based on family size and county of residence. (WIC § § 11150-11160, 11450 et seq.)

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS: This analysis only discusses policy issues germane to the jurisdiction of the Assembly Committee on Human Services.

Background: CalWORKs, CalFresh, CFAP, IHSS Eligibility Requirements. Social safety net programs, as prescribed in this bill, are delivered at the county-level. Eligibility requirements include, but are not limited to, income level, household size, compliance with program requirements, immigration status, and time spent on the program.

For CalWORKs, As of October 2024, the maximum monthly grant for a family of three on CalWORKs (one parent and two children), if the family has no other income and lives in a high cost-of-living county, is $1,039. In 2024-25, the administration estimates the average CalWORKs grant amount to be $1,001 per month across all family sizes and income levels. Unless deemed exempt, an adult in a one-parent assistance unit is required to participate in welfare-to-work activities for an average of 30 hours per week or, in the case of someone who is pregnant or parenting a child under six years of age, an average of 20 hours per week, monthly. In a two-parent assistance unit, one or both adults must participate in welfare-to-work activities for a combined average of 35 hours per week.

CalFresh eligibility is determined by federal law. The United States Department of Agriculture establishes the gross and net income requirements for CalFresh eligibility, limiting California’s flexibility in setting its own criteria. If a family passes the gross income test, the net income test is computed, and the amount is determined by deducting certain income from a household’s gross income. Currently, the maximum allowable gross income is 200% of the federal poverty level, although households with elderly members or members with disabilities are not subject to gross income criteria. Effective October 1, 2024, through September 30, 2025, these gross income limits for a household of three in the U.S. are currently $2,798 per month, or $33,576 annually. CFAP has similar income eligibility requirements as CalFresh. CalFresh does not currently have any work requirements.

IHSS requires a Medi-Cal eligibility determination, which requires an income of 138% of the federal poverty level and equates to $36,777 per year for a family of three, as well as living in a home and not a licensed facility.

Counties determine eligibility using BenefitCal which is an automated online system that determines eligibility for social programs after an applicant fills out the required information. The system then determines what a person might be eligible for based on the information provided. Following the application, a county social worker from the county of residence makes a further evaluation including, but not limited to, documentation, a phone or in-person interview, and eventually an agreement on the program’s terms. After a person is determined eligible, the county then requires redetermination or recertification. For CalWORKs and CalFresh, this occurs every 12 months

Emergencies. According to the National Centers for Environmental Information, from 1980-2024, there were 46 confirmed weather/climate disaster events with losses exceeding $1 billion each to affect California. These events included 14 drought events, 6 flooding events, 3 freeze events, 4 severe storm events, and 19 wildfire events. With Climate Change worsening across the world, natural disasters will continue and likely become more catastrophic. CDSS plays a critical role in disaster response by supporting local jurisdictions with the provision of temporary shelter, feeding, and other essential services for individuals and families affected by emergencies. CDSS is designated the lead for mass care and shelter operations through an Administrative Order from the California Governor's Office of Emergency Services. During emergencies, CDSS can provide grant assistance through three programs: the State Supplemental Grant Program; the Disaster Case Management Program; and Crisis Counseling, Immediate Services Program.

In addition, CDSS oversees Disaster CalFresh. Disaster CalFresh is a way to meet the temporary nutritional needs of disaster victims following a natural disaster such as a flood, fire, earthquake or any other natural disaster. Disaster CalFresh provides a month's worth of benefits on an Electronic Benefit Transfer card, which can be used to purchase food at authorized retail stores. Disaster CalFresh is only available when all of the following elements occur:

• A Presidential Major Disaster Declaration for Individual Assistance has been declared in the affected area;
• Commercial channels of food distribution have been disrupted, and those commercial channels have been restored; and,
• The State of California has been approved to operate a Disaster CalFresh program.

In order to eligible, The household must have lived or worked in the disaster area at the time of the disaster, The household must purchase or plan to have purchased food during the disaster benefit period or have purchased food during that time, if the benefit period has passed, The household must experience at least one adverse effect: loss of income, inaccessible resources, and disaster expenses; and meet income eligibility requirements.

Current authority. Existing law permits departments to waive requirements during a declared emergency at the direction of the Governor. For example, during COVID-19, many eligibility requirements were waived to accommodate for public health guidelines which included waiving in-person recertification for a period of time and extending Medi-Cal redetermination timelines.

Author’s Statement: According to the Author, “When disaster strikes, no one should be left without food, medical care, or the basic support they need to survive. Yet, under current law, there are no protections to ensure that low-income Californians, seniors, people with disabilities, and immigrant communities maintain access to critical public benefits in the wake of a crisis. Families relying on CalWORKs, CalFresh, Medi-Cal, In-Home Supportive Services, and the Cash Assistance Program for Immigrants face an unnecessary and preventable risk: losing their benefits at the exact moment they need them most. Public benefits programs are designed to provide stability, yet without guaranteed protections during disasters, recipients are left vulnerable to abrupt terminations due to administrative barriers, lost documents, or mail disruptions—through no fault of their own. The absence of clear, permanent safeguards means that each disaster brings uncertainty, forcing people already facing immense hardship to fight for the assistance they should never have to fear losing. [This bill] creates the necessary protections to ensure that individuals and families do not lose their benefits simply because they have been displaced or are struggling to recover from a disaster. This bill establishes a critical safety net—one that prevents terminations, allows for benefit restoration, and ensures that aid reaches those who need it without unnecessary red tape. We cannot allow public benefits to become another casualty of disaster. [This bill] is a proactive, necessary safeguard to protect California's most vulnerable communities, ensuring that disaster survivors have the resources they need to recover with dignity and security."

Equity Implications: Lower-income households and renters are disproportionately impacted during disasters due to limited access to insurance, financial savings, and affordable housing options (GAO, 2020). This bill aims to ease the burdens on low-income households during disasters.

Policy Considerations: Public Health Declarations are broad and encompass many events including Sexually Transmitted Infections, diseases, or infections that are spread via food or interactions with animals. Many of these events do not impede the ability to establish eligibility for social programs. When a public health declaration rises to the level of an emergency, the Governor has the authority to issue an emergency proclamation.

Should the bill move forward, the Author may wish to remove references to public health declarations.

Proposed Committee Amendments: The Committee proposes amendments to address policy considerations stated above to remove public health declarations as a basis for continuous enrollment.

Double referral: Should this bill pass out of this committee, it will be referred to the Assembly Committee on Health.

REGISTERED SUPPORT / OPPOSITION:

Support

Western Center on Law & Poverty, INC. (Sponsor)

Asian Americans Advancing Justice-Southern California

California Advocates for Nursing Home Reform

California Association of Food Banks

California Coalition for Youth

California Community Foundation

California Family Resource Association

California Hospital Association

California-Hawaii State Conference of the NAACP

Child Abuse Prevention Center and Its Affiliates Safe Kids California, Prevent Child Abuse California and The California Family Resource Association

Children Now

Health Access California

Justice in Aging

LeadingAge California

National Health Law Program

The Arc and United Cerebral Palsy California Collaboration

The Children's Partnership

Opposition

None on file.

Analysis Prepared by: Alexandria Smith / HUM. S. / (916) 319-2089