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 generally imposes penalties on a person who negligently, willfully, or maliciously discloses the results of a human immunodeficiency virus (HIV) test to a third party in a manner that identifies or provides identifying characteristics of the person to whom the test results apply, as specified.

Existing law, notwithstanding the above-described restrictions, authorizes the recording of the HIV test results by the physician who ordered the test in the test subjects medical record and authorizes other disclosure of the results without written authorization of the test subject, or the subjects representative, to the test subjects providers of health care, excluding a regulated health care service plan, for purposes of diagnosis, care, or treatment of the patient.

This bill would authorize a provider of health care to disclose the results of an HIV test that identifies or provides identifying characteristics of a Medi-Cal beneficiary without written authorization of the test subject, or the subjects representative, to the Medi-Cal managed care plan to which the beneficiary is assigned, if applicable, and to external quality review organizations conducting external quality reviews of Medi-Cal managed care plans, for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries.

Under the bill, HIV test results that do not identify or provide identifying characteristics of the test subjects would be authorized for disclosure without written authorization by the Medi-Cal managed care plan to departmental staff for the above-described purpose.

The bill would make certain clarifying or declaratory statements with regard to related provisions.

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 generally imposes penalties on a person who negligently, willfully, or maliciously discloses the results of a human immunodeficiency virus (HIV) test to a third party in a manner that identifies or provides identifying characteristics of the person to whom the test results apply, as specified.

Existing law, notwithstanding the above-described restrictions, authorizes the recording of the HIV test results by the physician who ordered the test in the test subjects medical record and authorizes other disclosure of the results without written authorization of the test subject, or the subjects representative, to the test subjects providers of health care, excluding a regulated health care service plan, for purposes of diagnosis, care, or treatment of the patient.

This bill would authorize a provider of health care to disclose the results of an HIV test that identifies or provides identifying characteristics of a Medi-Cal beneficiary without written authorization of the test subject, or the subjects representative, to the Medi-Cal managed care plan to which the beneficiary is assigned, if applicable, and to external quality review organizations conducting external quality reviews of Medi-Cal managed care plans, for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries.

Under the bill, HIV test results that do not identify or provide identifying characteristics of the test subjects would be authorized for disclosure without written authorization by the Medi-Cal managed care plan to departmental staff for the above-described purpose.

The bill would make certain clarifying or declaratory statements with regard to related provisions.

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 generally imposes penalties on a person who negligently, willfully, or maliciously discloses the results of a human immunodeficiency virus (HIV) test to a third party in a manner that identifies or provides identifying characteristics of the person to whom the test results apply, as specified.

Existing law, notwithstanding the above-described restrictions, authorizes the recording of the HIV test results by the physician who ordered the test in the test subjects medical record and authorizes other disclosure of the results without written authorization of the test subject, or the subjects representative, to the test subjects providers of health care, excluding a regulated health care service plan, for purposes of diagnosis, care, or treatment of the patient.

This bill would authorize the disclosure of a provider of health care to disclose the results of an HIV test that identifies or provides identifying characteristics of a Medi-Cal beneficiary without written authorization of the test subject, or the subjects representative, to the Medi-Cal managed care plan to which the beneficiary is assigned, if applicable, and to external quality review organizations conducting external quality reviews of Medi-Cal managed care plans, for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries. The bill would make an exception for Medi-Cal beneficiaries who have opted out through a mechanism that the department would be required to develop by December 31, 2026, as specified.

Under the bill, HIV test results that do not identify or provide identifying characteristics of the test subjects would be authorized for disclosure without written authorization by the Medi-Cal managed care plan to departmental staff for the above-described purpose.

The bill would make certain clarifying or declaratory statements with regard to related provisions.

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 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.

Under existing law, public health records relating to human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), containing personally identifying information, that were developed or acquired by a state or local public health agency, or an agent of that agency, are generally confidential and are prohibited from being disclosed.

Under existing law, in the form of exceptions, certain disclosures of the information are authorized for the purpose of facilitating appropriate HIV/AIDS medical care and treatment, including disclosures by state or local public health agency staff to agency staff, the designated health care provider, or the HIV-positive person who is the subject of the record, as specified.

This bill would additionally authorize state public health agency HIV surveillance staff to disclose the information to State Department of Health Care Services staff, followed by authorized disclosures to the Medi-Cal managed care plan if applicable, the HIV-positive person who is the subject of the record, and the designated health care provider, for the purpose of proactively offering and coordinating care and treatment services to the person or for the purpose of administering quality improvement programs, as specified, designed to improve HIV care for Medi-Cal beneficiaries.

This bill would require the State Department of Health Care Services, in consultation with the State Department of Public Health, to develop a mechanism by which a Medi-Cal beneficiary would be authorized to opt out of the disclosure of personally identifying information in public health records relating to HIV or AIDS to State Department of Health Care Services staff or the Medi-Cal managed care plan for the above-described purposes. The bill would require the mechanism to be implemented no later than December 31, 2026.

This bill would make a conforming change to a related provision regarding authorized disclosure of HIV test results for the purpose of administering quality improvement programs under Medi-Cal as described above.

This bill would make certain clarifying or declaratory statements in relation to those provisions.

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.

Under existing law, public health records relating to human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), containing personally identifying information, that were developed or acquired by a state or local public health agency, or an agent of that agency, are generally confidential and are prohibited from being disclosed.

Under existing law, in the form of exceptions, certain disclosures of the information are authorized for the purpose of facilitating appropriate HIV/AIDS medical care and treatment, including disclosures by state or local public health agency staff to agency staff, the designated health care provider, or the HIV-positive person who is the subject of the record, as specified.

This bill would additionally authorize state public health agency HIV surveillance staff to disclose the information to State Department of Health Care Services staff, followed by authorized disclosures to the Medi-Cal managed care plan if applicable, the HIV-positive person who is the subject of the record, and the designated health care provider, for the purpose of proactively offering and coordinating care and treatment services to the person or for the purpose of administering quality improvement programs, as specified, designed to improve HIV care for Medi-Cal beneficiaries.

The bill would require the State Department of Health Care Services, in consultation with the State Department of Public Health, to develop a mechanism by which a Medi-Cal beneficiary would be authorized to opt out of the disclosure of personally identifying information in public health records relating to HIV or AIDS to State Department of Health Care Services staff or the Medi-Cal managed care plan for the above-described purposes.

The bill would make a conforming change to a related provision regarding authorized disclosure of HIV test results for the purpose of administering quality improvement programs under Medi-Cal as described above.

The bill would make certain clarifying or declaratory statements in relation to those provisions.

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.

Under existing law, public health records relating to human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), containing personally identifying information, that were developed or acquired by a state or local public health agency, or an agent of that agency, are generally confidential and are prohibited from being disclosed.

Under existing, existing law, in the form of exceptions, certain disclosures of the information are authorized for the purpose of facilitating appropriate HIV/AIDS medical care and treatment, including disclosures by state or local public health agency staff to agency staff, the designated health care provider, or the HIV-positive person who is the subject of the record, as specified.

This bill would additionally authorize specified state public health agency HIV surveillance staff to disclose the information to State Department of Health Care Services staff, followed by authorized disclosures to the Medi-cal Medi-Cal managed care plan if applicable, the HIV-positive person who is the subject of the record, and the designated health care provider, for the purpose of proactively offering and coordinating care and treatment services to the person or for the purpose of administering quality improvement programs programs, as specified, designed to improve HIV care for Medi-Cal beneficiaries.

The bill would make a conforming change to a related provision regarding authorized disclosure of HIV test results for the purpose of administering quality improvement programs under Medi-Cal as described above.

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.

Under existing law, public health records relating to human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), containing personally identifying information, that were developed or acquired by a state or local public health agency, or an agent of that agency, are generally confidential and are prohibited from being disclosed.

Under existing, in the form of exceptions, certain disclosures of the information are authorized for the purpose of facilitating appropriate HIV/AIDS medical care and treatment, including disclosures by state or local public health agency staff to agency staff, the designated health care provider, or the HIV-positive person who is the subject of the record, as specified.

This bill would additionally authorize specified staff to disclose the information to State Department of Health Care Services staff, followed by authorized disclosures to the Medi-cal managed care plan if applicable, the HIV-positive person who is the subject of the record, and the designated health care provider, for the purpose of proactively offering and coordinating care and treatment services to the person or for the purpose of administering quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries.

The bill would make a conforming change to a related provision regarding authorized disclosure of HIV test results for the purpose of administering quality improvement programs under Medi-Cal as described above.

 UNFINISHED BUSINESS  

Bill No: SB 278

Author: Cabaldon (D), et al.

Amended: 9/2/25 in Assembly

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 3/26/25

AYES: Menjivar, Valladares, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener

NO VOTE RECORDED: Grove

SENATE JUDICIARY COMMITTEE: 13-0, 4/8/25

AYES: Umberg, Niello, Allen, Arreguín, Ashby, Caballero, Durazo, Laird, Stern, Valladares, Wahab, Weber Pierson, Wiener

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/23/25

AYES: Caballero, Seyarto, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Dahle

SENATE FLOOR: 38-0, 5/29/25

AYES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

NO VOTE RECORDED: Limón, Reyes

ASSEMBLY FLOOR: 79-0, 9/8/25 - See last page for vote

SUBJECT: Health data: HIV test results

SOURCE: San Francisco AIDS Foundation

DIGEST: This bill allows for a health care provider to share HIV test results with an individual’s Medi-Cal managed care plan or external quality review organization contracted by the Department of Health Care Services to conduct external quality reviews of Medi-Cal plans without the written authorization of the individual tested for the purpose of administering quality improvement programs designed to improve HIV care for Medi-Cal recipient.

Assembly Amendments

remove provisions allowing the Department of Public Health (CDPH) to share HIV test results with the Department of Health Care Services (DHCS) and the Medi-Cal plan a Medi-Cal recipient is assigned to for purposes of administering quality improvement programs, and provisions requiring DHCS, in consultation with CDPH, to develop an opt out mechanism for Medi-Cal recipients who do not wish to have this information shared by CDPH to DHCS or their plan.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, which is administered by DHCS, and under which qualified low-income individuals receive health care services. [Welfare and Institutions Code (WIC) §14000, et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes benefits required under federal law and benefits provided at the state’s option, both of which are funded with federal and state dollars. The schedule of benefits includes prescribed drugs, inpatient and outpatient services, subject to utilization controls, as well as investigational new drugs and any related inpatient or outpatient services for the treatment of HIV/AIDS. [WIC §14132 and §14137.6]
3. Authorizes the DHCS Director to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal enrollees and establishes managed care models that DHCS contracts with in each county. [WIC §14087.3, §14089, §14087.98, §14087.967, and §14087.5]
4. Defines a Medi-Cal managed care plan (Medi-Cal plan) as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. [WIC §14184.101]
5. Requires DHCS to develop a value-based payment program aimed at improving chronic disease management by Medi-Cal plans that requires Medi-Cal plans to give incentive payments to qualified network providers who meet designated high-performance standards or partial incentive payments for meeting above-minimum standards. [WIC §14188.1]
6. Prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. Excludes state-regulated health care service plans from being considered health care providers. [Health and Safety Code (HSC) §120980 and §120985]
7. Prohibits the California Department of Public Health (CDPH) or a local public health agency from disclosing public health records related to HIV/AIDS except for public health purposes or pursuant to a written authorization by the person whose record it is or their guardian or conservator. [HSC §121025]
8. Provides an exemption from the prohibition in 7) above, that allows for the disclosure of personally identifying information in public health records related to HIV/AIDS to CDPH or other local or federal public health agency or collaborating researchers when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, or the coordination of, linkage to, or reengagement in care for a person or persons as determined by CDPH or the local public health agency, provided that information is otherwise kept confidential. [HSC §121025]
9. Additionally authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS by specified state and local public health staff to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person. [HSC §121025]

This bill:

1. Allows the results of an HIV test to be disclosed, without the written authorization of the subject of the test, to the subject’s Medi-Cal plan for the purpose of administering quality improvement programs including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees. Also allows the results of an HIV test to be disclosed to external quality review organizations contracted with DHCS to conduct external quality reviews of Medi-Cal plans.
2. Authorizes the disclosure of HIV test results that do not identify or provide identifying characteristics of the subjects of the tests by Medi-Cal plans to DHCS to administer the quality improvement programs described in 1) above.
3. Clarifies that the existing prohibition on further disclosure of HIV test results includes disclosure to any federal agency or authority in another state, unless otherwise required by federal law.

Comments

According to the author of this bill:

Nearly one-third of Californians living with HIV depend on Medi-Cal for their healthcare. However, around one in four of these individuals are not receiving essential care, such as viral load testing. Existing law restricts CDPH and healthcare providers from sharing public-health data about viral-load suppression with the DHCS and Medi-Cal plans. This restriction is an outlier from an era of HIV panic and impedes the use of crucial tools that could improve health outcomes. Because of these restrictions, incentive programs that have been used successfully in other states – such as value-based payment programs that reward providers for improvements in patient outcomes or programs that offer financial incentives like gift cards to enrollees utilizing preventative care services– cannot be used to support HIV-positive Medi-Cal enrollees. This limitation prevents providers from utilizing performance-based funding to enhance care for this vulnerable population. This bill will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. This change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.

Background

HIV monitoring in California. According to CDPH, the prevalence of diagnosed HIV infection was 355.6 per 100,000 population in 2022, compared to 343.1 per 100,000 in 2018 – an increase of 3.7%. Of the 142,772 people living with diagnosed HIV infection in 2022, 73.7% were in HIV care and 64.7% achieved viral suppression. Among all racial/ethnic groups, African Americans are the most disproportionately affected by HIV. While Latinx and white individuals make up the largest percentage of persons living with diagnosed HIV, the rate of HIV among African Americans is substantially higher (1,012.3 per 100,000 population, versus 319.5 per 100,000 among whites and 364.8 per 100,000 among Latinx). The rate of new HIV diagnoses among African Americans is 4.4 times higher than whites among men and 5.7 times higher among women. Latinx are also disproportionately affected by HIV with rates of new HIV diagnoses 2.7 times higher than white among men and 1.6 times higher among women.

According to CDPH’s Office of AIDS, in California and the rest of the U.S., HIV infections and AIDS diagnoses are reported through a combination of passive and active surveillance. Passive surveillance is conducted through state required reporting of HIV and AIDS cases by health care providers and reporting of HIV-positive test results from laboratories to local health departments. Active surveillance is accomplished through routine visits to hospitals, physician offices, laboratories, counseling and testing clinics, and outpatient clinics to ensure accuracy of reported data. In California and other states, HIV/AIDS surveillance has historically relied heavily upon active case surveillance, through on-site chart reviews and case report completion by local surveillance staff at the health care provider’s office. To improve timeliness and completeness of reporting and ensure prompt identification and response to emerging problems in the field, the Office of AIDS supports a decentralized reporting system where HIV/AIDS case reports are identified through passive and active surveillance efforts coordinated by California’s 61 local health departments. HIV/AIDS surveillance case data and laboratory reports, reported to local health departments by health care providers and laboratories, is then sent to the HIV/AIDS Surveillance Section via the Lab Data Entry Tool or on the Adult Case Report Form. The Surveillance Section surveillance coordinators review the forms for accuracy and input the information into the Enhanced HIV/AIDS Reporting System (eHARS), and in turn, submit electronic HIV/AIDS case reports, without personal identifiers, to the federal Centers for Disease Control and Prevention.

Medi-Cal quality improvement efforts. DHCS periodically sets a standard for Medi-Cal plans to meet via its Comprehensive Quality Strategy that includes steps Medi-Cal plans must take to improve health care quality and health equity. Within this strategy is a set of performance standards that includes specific clinical standards for specified health conditions, many of which are drawn from the Center for Medicare and Medicaid Services’ (CMS) standardized quality measures. SB 78 (Committee on Budget and Fiscal Review, Chapter 38, Statutes of 2019), the health trailer bill to the 2019-2020 budget, added value-based payment programs as a means of improving Medi-Cal plan quality by allowing plans to give providers incentive payments for meeting performance standards specified by DHCS. While the initial 2019 draft of the existing 2022 Comprehensive Quality Strategy included the HIV viral load suppression metric that is part of CMS’s standardized quality measures, this was not included in the final.

A January 2025, U.S. Health & Human Services Agency Guidance “Opportunities to Improve HIV Testing, Prevention, and Care Delivery for Medicaid and CHIP Beneficiaries” discusses a number of measures that states can implement to improve HIV testing and treatment, including adopting the HIV viral load suppression metric and highlighted states that have done this and have data-sharing agreements between their state Medicaid agencies and their state HIV surveillance program. DHCS and the Office of AIDS have previously published data on Medi-Cal plan viral load suppression. To produce that data, DHCS provided to the Office of AIDS a list of all Medi-Cal HIV-positive beneficiaries age 18 years or older, along with a variable indicating whether the patient received a medical visit during the given calendar year and variables necessary for matching to CDPH’s HIV surveillance data. Using a probabilistic matching algorithm, the Office of AIDS matched the Medi-Cal beneficiaries with HIV-positive individuals in the CDPH HIV surveillance system to confirm HIV infection and determine whether patients were virally suppressed. This bill would allow Medi-Cal providers to share HIV test information directly with the subject’s Medi-Cal plan and deidentified data with DHCS.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Assembly Appropriations Committee, the most recent version of this bill would have no state costs.

SUPPORT: (Verified 9/8/25)

San Francisco AIDS Foundation (source)

Bienestar Human Services

California Legislative LGBTQ Caucus

California LGBTQ Health and Human Services Network

California Pan-Ethnic Health Network

DAP Health

End the Epidemics

Equality California

Essential Access Health

GLIDE

Health Access California

Los Angeles LGBT Center

National Health Law Program

Sacramento LGBT Community Center

Sunburst Projects

The Source LGBT+ Center

Viet Rainbow of Orange County

ViiV Healthcare

Western Center on Law & Poverty

OPPOSITION: (Verified 9/8/25)

None received

ARGUMENTS IN SUPPORT: Sponsor San Francisco AIDS Foundation writes that more than 50,000 Californians living with HIV are not virally suppressed despite the availability of effective HIV treatment. They argue that giving the Medi-Cal program more tools to share HIV data with the Medi-Cal plans will enable DHCS to base Medi-Cal plan payments on their members’ HIV health outcomes. They point to a program in Louisiana that allowed the state Medicaid agency to withhold a portion of the Medicaid plan payments unless the plans achieved target goals, which lead to an increase in the viral suppression rate from 67% to 80% of Louisiana’s Medicaid enrollees. Letters submitted by other provider and consumer supporters point out that one in three people living with HIV in California is on Medi-Cal. They also point out that the state currently uses value-based payment programs to manage other chronic conditions in the Medi-Cal program but it is only state law prohibiting disclosure of HIV information that prevents this from occurring with HIV.

ASSEMBLY FLOOR: 79-0, 9/8/25

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Flora, Fong, Gabriel, Gallagher, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Johnson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NO VOTE RECORDED: Nguyen

Prepared by: Jen Flory / HEALTH / (916) 651-4111

9/8/25 19:46:29

**** END ****

SENATE THIRD READING

STR Bill Id:SB 278

Author:(Cabaldon)

As Amended Ver:September 2, 2025

Majority vote

SUMMARY

This bill expands the circumstances under which personally identifying Human Immunodeficiency Virus (HIV) test results may be shared without specific consent from a patient, to allow data-sharing of HIV test results with the Department of Health Care Services (DHCS) and a Medi-Cal managed care plan, for purposes of implementing quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries.

Major Provisions

COMMENTS

HIV in California. HIV is a virus that attacks the body's immune system. Without treatment, it can lead to AIDS. In California, HIV is mostly transmitted through sexual contact and, to a lesser extent, through injection drug use, although there are other, less common transmission routes such as perinatal transmission (from a birthing parent to a child). Although there is no cure for HIV, it can be effectively treated and the "viral load" (the amount of the virus present in the body) can be controlled. Surveillance and prevention of HIV transmission and treatment for HIV/AIDS are significant public health challenges worldwide. In California, the Department of Public Health (DPH) Office of AIDS works with local health jurisdictions to collect, analyze, and disseminate surveillance data on people living and diagnosed with HIV in California. DPH receives laboratory data on HIV tests, which are reported to local and state public health agencies on a mandatory basis.

Despite national, state, and local public health efforts over the last decade to "get to zero" new HIV infections, California still has a significant number of new infections annually. According to DPH, the number of new diagnoses increased by 6.0%, from 4,669 in 2019 to 4,948 in 2023, while the rate of new diagnoses per 100,000 population increased by 5.1%, from 11.7 to 12.3 during the same time period.

Of the 143,254 people in California living with diagnosed HIV infection in 2023, 75.1% were in HIV care and 66.5% achieved viral suppression. Viral suppression in HIV-positive individuals, through treatment with HIV drugs, is critical to prevent new infections because a person living with HIV who is being treated and maintains an undetectable viral load has zero risk of transmitting HIV to their sexual partners. This concept is sometimes called "Undetectable = Untransmittable," or "U=U". "Ending the HIV Epidemic in the US," a federal effort of the Centers for Disease Control and Prevention (CDC) as of late 2024, had a goal of increasing linkage to care and viral suppression to 95% of HIV-positive individuals.

HIV disproportionately affects certain groups of people. Over 80% of people newly diagnosed with HIV infection in California from 2019-2023 were men. Men who have sex with men (MSM) make up a shrinking but still-large share of all the people newly diagnosed (falling from about 72% in 2019 to about 62% in 2023). According to the "Ending The Epidemics: Implementation Blueprint" published by DPH in 2023, people who are Black/African Americans are more likely to be living with diagnosed HIV than any other race/ethnicity in California compared to their population size (this group makes up 17% of people with HIV despite representing only 6% of the population in California). As of 2019, a disproportionate number of new HIV infections are among Black (17% of new infections vs. 6% population size) and Latino (50% of new infections vs. 39% population size) Californians. Young Black and Latino gay and bisexual men and Black heterosexual women are becoming infected with HIV at especially high rates. Transgender women were overrepresented among new HIV diagnoses in 2019, especially transgender women of color.

Data-Sharing Restrictions. California law severely restricts the sharing and disclosure of HIV-related data and includes specific penalties for unauthorized disclosure. These HIV-specific restrictions have been put in place over the years to protect people living with HIV from undesired disclosure of their HIV status. According to "Forty Years of HIV: The Intersection of Laws, Stigma, and Sexual Behavior and Identity," a 2021 article published in the American Journal of Public Health, since its initial identification in the early 1980's, HIV brought widespread fear and stigmatizing laws and policies, and the crisis revealed injustices in existing laws that compounded stigma and health disparities among the most affected groups, including communities of gay and bisexual men and other MSM and people who inject drugs.

Although general federal and state medical privacy and confidentiality laws, as well as HIV-specific laws, offer protection against undesired disclosure of a person's HIV status, the inability to share data can sometimes pose difficulties for health care and public health entities looking to identify, prevent, and treat HIV. This bill creates a narrow exception to certain California data-sharing restrictions to facilitate better care for HIV-positive people in Medi-Cal managed care.

Public Health and Health Care Collaboration. Respected national bodies have promoted the idea of partnership between public health and health care to improve public health outcomes. The National Academy of Medicine issued a report in 2012, "Primary Care and Public Health: Exploring Integration to Improve Population Health," which made the case for tighter integration of public health and health care to improve public health. The Centers for Disease Control and Prevention (CDC) Office of Policy, Performance, and Evaluation, as of December 2024, specifically endorses the approach of partnership with the health care system to promote health care quality measures that promote progress toward public health goals. For instance, one of the priority health care quality measures listed is "Hepatitis C Virus (HCV) Screening and Treatment Initiation." Improvements on such a metric (a health care measure) can potentially reduce preventable mortality by slowing and eliminating the spread of HCV (a public health goal).

In California, many of the Managed Care Accountability Set (MCAS) measures and DHCS "Bold Goals" address issues important to public health, including sexually transmitted infection (STI) screening, cancer screening, timely prenatal care, and immunizations, among others. By allowing disclosure of HIV test result data to DHCS and managed care plans, this bill would create the conditions necessary to implement similar quality measurement and reporting related to HIV. For instance, DHCS could incentivize plans to meet a health care quality metric that would measure viral load suppression, which would in turn meet the public health goal of reducing HIV transmission.

Medi-Cal Comprehensive Quality Strategy and Managed Care Quality Improvement Programs. DHCS implements a number of quality improvement efforts: measuring quality performance, identifying priority metrics, and implementing a "carrot and stick" approach—financial incentives and other rewards, coupled with minimum performance levels and sanctions. DHCS's wide-ranging 2022 Comprehensive Quality Strategy outlines specific clinical goals across the Medi-Cal program and creates "Bold Goals" for quality metrics related to children's preventive care, maternal care, and behavioral health follow-up. The document includes additional high-priority goals with measurable targets for each managed care delivery system (Medi-Cal managed care, behavioral health, and dental). DHCS currently does not include an HIV-related metric among their priority quality measures.

Louisiana Quality Improvement Program for HIV Viral Suppression. In 2016, Louisiana's Medicaid agency began withholding a portion of its payments to managed care plans unless they achieved or made progress toward a target viral suppression rate among their members. The state reports this value-based payment strategy has improved collaboration between the plans and the state's public health agency, including via a regular HIV quality improvement meeting where participants share strategies for engaging their members in care. Since 2016, information from the program shows that the viral suppression rate among Louisiana's Medicaid enrollees has increased from 67% to 80%.

According to the Author

Nearly one-third of Californians living with HIV rely on Medi-Cal. Yet, about one in four of these individuals are not receiving essential care, such as viral load testing. The author notes that under current law, Medi-Cal managed care plans are restricted from accessing key tools that could improve health outcomes. Specifically, incentive programs, such as value-based payment programs that reward quality improvement, cannot be used to support HIV-positive Medi-Cal recipients due to restrictions on sharing of HIV test results. This restriction prevents providers from utilizing performance-based funding to enhance care for this vulnerable population. The author indicates this bill will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. The author concludes that this change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.

Arguments in Support

The sponsor of the bill, the San Francisco AIDS Foundation (SFAF), notes that despite medical advances that can prevent HIV transmission through viral suppression, in California, more than 50,000 people living with HIV are not virally suppressed. SFAF writes this bill is thoughtfully constructed to achieve its goal of improving HIV care for Medi-Cal patients without increasing patients' risk of harm. The Sacramento LGBT Center writes in support that we must use every tool at our disposal to end the epidemic.

Arguments in Opposition

None.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations, no state costs.

VOTES

SENATE FLOOR: 38-0-2

YES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

ABS, ABST OR NV: Limón, Reyes

ASM HEALTH: 15-0-1

YES: Bonta, Chen, Addis, Aguiar-Curry, Caloza, Carrillo, Flora, Mark González, Krell, Patel, Patterson, Celeste Rodriguez, Sanchez, Schiavo, Sharp-Collins

ABS, ABST OR NV: Stefani

ASM PRIVACY AND CONSUMER PROTECTION: 15-0-0

YES: Bauer-Kahan, Dixon, Bryan, DeMaio, Irwin, Lowenthal, Macedo, McKinnor, Ortega, Patterson, Pellerin, Petrie-Norris, Ward, Wicks, Wilson

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Calderon, Caloza, Elhawary, Fong, Mark González, Ahrens, Pacheco, Pellerin, Solache

ABS, ABST OR NV: Sanchez, Dixon, Ta, Tangipa

UPDATED

VERSION: September 2, 2025

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0001455

Date of Hearing: August 20, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 278

Author:(Cabaldon) – As Amended Ver:July 17, 2025

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

SUMMARY:

This bill authorizes the disclosure of a Medi-Cal managed care (MCMC) beneficiary’s HIV test result that includes identifying information to the beneficiary’s MCMC plan, without the beneficiary’s authorization, for the purpose of administering quality improvement programs.

Specifically, this bill:

1. Allows, notwithstanding existing penalties and prohibitions on disclosure of HIV test results, and except for a person who has opted out of disclosure through the mechanism in item 3, below, disclosure of results of a MCMC beneficiary’s HIV test that provides identifying information to the beneficiary’s MCMC plan, without that beneficiary or their representative’s written authorization, for the purpose of administering quality improvement programs. The quality improvement programs include value-based payment programs and healthy behavior incentive programs designed to improve HIV care for Medi-Cal beneficiaries.
   
2. Clarifies that HIV test results that do not provide identifying characteristics of the subjects may be disclosed without written authorization by the MCMC plan to Department of Health Care Services (DHCS) staff for the purpose described in item 1, above.
   
3. Requires DHCS, by December 31, 2026 and in consultation with the California Department of Public Health (CDPH), develop a mechanism by which a Medi-Cal beneficiary may opt out of the disclosure of the results of an HIV test that identifies or provides identifying characteristics of the beneficiary to their MCMC plan for the purpose described in item 1, above.
   
4. Prohibits the disclosure of an MCMC beneficiary’s HIV test that provides identifying information to a health plan, except the beneficiary’s MCMC plan, without the written authorization of the beneficiary or their representative.
   
5. Provides that the provisions of this bill are subject to specified statutes protecting privacy and restricting disclosure of HIV test results.
   
6. Clarifies that this bill does not authorize further disclosure of an individual’s HIV test results to a federal agency or an authority in another state, unless otherwise required by federal law.
   

FISCAL EFFECT:

One-time costs to DHCS of an unknown amount, potentially over $150,000 (50% General Fund, 50% federal funds), to develop and implement an opt-out mechanism.

No costs to CDPH.

COMMENTS

1. Purpose. This bill is sponsored by San Francisco AIDS Foundation. According to the author:

Nearly one-third of Californians living with HIV rely on Medi-Cal for their healthcare. Yet, about one in four of these individuals are not receiving essential care, such as viral load testing. Under current law, managed care organizations responsible for coordinating this care are restricted from accessing key tools that could improve health outcomes.

Due to existing law, incentive programs—such as value-based payment programs that reward quality improvement—cannot be used to support HIV-positive Medi-Cal recipients. This limitation prevents providers from utilizing performance-based funding to enhance care for this vulnerable population.

SB 278 will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. This change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.

1. Background. To protect people living with HIV from undesired disclosure of their HIV status, California law severely restricts the sharing and disclosure of HIV-related data. However, restrictions on data sharing can pose difficulties for health care and public health entities seeking to identify, prevent, and treat HIV.

Medicaid quality-based incentive programs have been successful throughout the country. For example, Louisiana’s Medicaid agency began withholding a portion of its payments to managed care plans unless the plans achieved or made progress toward a target HIV viral suppression rate among their members. The state reports this value-based payment strategy improved collaboration between the plans and the state’s public health agency. The viral suppression rate among Louisiana’s Medicaid enrollees increased from 67% to 80%.

1. Related Legislation. SB 504 (Laird), also pending in this committee, authorizes a health care provider of a patient diagnosed with HIV to disclose personally identifying information to a local health officer or CDPH under specified circumstances.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: July 16, 2025

Fiscal:

ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION

Rebecca Bauer-Kahan, Chair

SBPCA Bill Id:SB 278

Author:(Cabaldon) – As Amended Ver:June 19, 2025

SENATE VOTE: 38-0

PROPOSED AMENDMENTS

SUBJECT: Health data: HIV test results

SYNOPSIS

According to the most recent data, approximately 142,700 Californians are living with HIV and approximately are 45,000 Medi-Cal beneficiaries. Of those Californians, in 2023, 75.1% were in HIV care and 66.5% achieved viral suppression. Due to the historical stigma and discrimination associated with HIV/AIDs, California law restricts the sharing and disclosure of HIV-related data and includes specific penalties for unauthorized disclosure. These HIV-specific restrictions have been put in place over the years to protect people living with HIV from undesired disclosure of their HIV status.

The goal of this bill is to increase those numbers by creating incentive programs that are designed to reduce the viral load of Medi-Cal beneficiaries. The bill allows the Department of Public Health (DPH) Human Immunodeficiency Virus (HIV) surveillance staff to disclose all personally identifying HIV test results to the Department of Health Care Services (DHCs) and Medi-Cal managed care plans without patient consent for purposes of implementing quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries.

The question before this Committee is whether or not the sharing of all personally identifiable viral load test results, without the consent of the patient, is too great a privacy risk to take with the hope of achieving better outcomes for the one-third of people living with HIV who are Medi-Cal beneficiaries. The author has agreed to accept Committee amendments that reduce the privacy risk by limiting the sharing to the physicians of Medi-Cal beneficiaries and their Medi-Cal managed care plans. (See Comment # 6 for amendment details.)

This bill is an LGBTQ Caucus priority bill and it is sponsored by the San Francisco AIDs foundation. It enjoys the support of approximately one dozen advocacy organizations and has no opposition.

This bill was previously heard by the Health Committee, where it passed on a 15-0-1 vote.

THIS BILL:

1. Authorizes, notwithstanding existing penalties and prohibitions on disclosure of HIV test results, personally identifying HIV test results from every Californian to be disclosed by the Department of Public Health (DPH) to the Department of Health Care Services (DHCs) and Medi-Cal managed care plans without the person’s consent.
2. Allows the disclosure of test results for the purpose of administering quality improvement programs for Medi-Cal beneficiaries, including, but not limited to, value-based payment programs and healthy behavior incentive programs designed to improve HIV care.
3. Requires DHCS to develop an opt-out mechanism from the disclosure for Medi-Cal recipients.
4. Limits disclosure to a health plan licensed by the Department of Managed Health Care to a Medi-Cal managed care plan to which a Medi-Cal beneficiary is assigned.
5. Specifies privacy and confidentiality protections, as well as prohibitions on willful, malicious, or negligent disclosure of HIV test results and related penalties, apply to the HIV test result data shared under these provisions.
6. Expands the application of current-law prohibitions on further disclosure of HIV test results; specifically, prohibits further disclosure to any federal agency or any authority in another state unless otherwise required by federal law.

EXISTING LAW:

1. Provides, pursuant to the California Constitution, that all people are by nature free and independent and have inalienable rights. Among these is the fundamental right to privacy. (Cal. Const. art. I, § 1.)
2. Establishes the CMIA to protect an individual’s medical information from unauthorized disclosure by providers of health care. Provides an individual right of action for a patient whose information was disclosed in violation of CMIA’s provisions. (Civ. Code § 56 et seq.)
3. Defines “medical information,” for the purposes of the CMIA, as any individually identifiable information, in electronic or physical form, that is in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental health application information, reproductive or sexual health application information, mental or physical condition, or treatment. Specifies that “individually identifiable” information means medical information that includes any element of personal identifying information sufficient to allow the individual to be identified. (Civ. Code 56.05(j).)
4. Prohibits providers of health care, health care service plans, or contractors from disclosing medical information regarding a patient of the provider of health care or an enrollee or subscriber without first obtaining authorization, except for as provided. Specifies that a provider of health care, health care service plan, or a contractor must disclose medical information if the disclosure is compelled by:
   1. A court order.
   2. A board, commission, or administrative agency for purposes of adjudication.
   3. A party to a proceeding before a court or administrative agency pursuant to a subpoena, subpoena duces tecum, notice to appear, or any provision authorizing discovery in a proceeding before a court or administrative agency.
   4. A board, commission, or administrative agency pursuant to an investigative subpoena.
   5. An arbitrator or arbitration panel, when arbitration is lawfully requested by either party.
   6. A search warrant lawfully issued to a governmental law enforcement agency.
   7. A patient or patient’s representative.
   8. A medical examiner, forensic pathologist, or coroner when requested in the course of an investigation, as specified.
   9. When otherwise specifically required by law. (Civ. Code § 56.10(b).)
5. Establishes the Medi-Cal program, which is administered by DHCS, and under which qualified low-income individuals receive health care services. (Welf & Inst. Code § 14000, et seq.)
6. Defines a Medi-Cal managed care plan as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. (Welf & Inst. Code § 14184.101.)
7. Requires DHCS to develop a value-based payment program aimed at improving chronic disease management, which requires Medi-Cal plans to give incentive payments to qualified network providers who meet designated performance standards or partial incentive payments for exceeding standards. (Welf & Inst. Code § 14188.1.)
8. Requires health care providers and laboratories to report cases of HIV infection to local health officers using patient names on a form developed by DPH. (Health. & Saf. Code § 121022.)
9. Provides various protections for the confidentiality of HIV test results and the identity of the person who took the test, including a prohibition on compelled disclosure of identifying information regarding HIV tests in civil, criminal, administrative, or legislative proceedings, and establishes civil penalties for negligently disclosing the result of such a test in a manner that identifies or provides identifying characteristics of the person to whom the test results apply. (Health. & Saf. Code §§ 120975, 120980.)
10. Prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. Excludes state-regulated health care service plans from being considered health care providers. (Health. & Saf. Code §§ 120980, 120985.)
11. Prohibits DPH or a local public health agency from disclosing public health records related to HIV/Acquired Immune Deficiency Syndrome (AIDS) except for public health purposes or pursuant to a written authorization by the person whose record it is or their guardian or conservator. (Health. & Saf. Code § 121025.)
12. Provides an exemption from the prohibition against disclosure of personal information, that allows for the disclosure of personally identifying information in public health records related to HIV/AIDS to DPH or other local or federal public health agency or collaborating researchers when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, or the coordination of, linkage to, or reengagement in care for a person or persons as determined by DPH or the local public health agency, provided that information is otherwise kept confidential. (Ibid.)
13. Authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS by specified state and local public health staff to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person. (Ibid.)

COMMENTS:

1) Author’s statement. According to the author:

Nearly one-third of Californians living with HIV rely on Medi-Cal for their healthcare. Yet, about one in four of these individuals are not receiving essential care, such as viral load testing. Under current law, managed care organizations responsible for coordinating this care are restricted from accessing key tools that could improve health outcomes.

Due to existing law, incentive programs—such as value-based payment programs that reward quality improvement—cannot be used to support HIV-positive Medi-Cal recipients. This limitation prevents providers from utilizing performance-based funding to enhance care for this vulnerable population.

SB 278 will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. This change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.

2) HIV in California. According to the Health Committee analysis:

HIV is a virus that attacks the body's immune system. Without treatment, it can lead to AIDS. In California, HIV is mostly transmitted through sexual contact and, to a lesser extent, through injection drug use, although there are other, less common transmission routes such as perinatal transmission (from a birthing parent to a child). Although there is no cure for HIV, it can be effectively treated and the “viral load” (the amount of the virus present in the body) can be controlled. Surveillance and prevention of HIV transmission and treatment for HIV/AIDS are significant public health challenges worldwide. In California, the DPH Office of AIDS works with local health jurisdictions to collect, analyze, and disseminate surveillance data on people living and diagnosed with HIV in California. DPH receives laboratory data on HIV tests, which are reported to local and state public health agencies on a mandatory basis.

Despite national, state, and local public health efforts over the last decade to “get to zero” new HIV infections, California still has a significant number of new infections annually. According to DPH:

• • 1. From 2019 through 2023, both the annual number and rate of new HIV diagnoses increased in California. The number of new diagnoses increased by 6.0%, from 4,669 in 2019 to 4,948 in 2023, while the rate of new diagnoses per 100,000 population increased by 5.1%, from 11.7 to 12.3 during the same time period.
    2. From 2019 through 2023, the number of persons in California living with diagnosed HIV infection increased from approximately 137,777 to over 143,000.
    3. In 2023, the prevalence rate of diagnosed HIV infection was 355.0 per 100,000 population, compared to 346.5 in 2019, an increase of 2.5%.
    4. Of the 143,254 people in California living with diagnosed HIV infection in 2023, 75.1% were in HIV care and 66.5% achieved viral suppression. Viral suppression in HIV-positive individuals, through treatment with HIV drugs, is critical to prevent new infections because a person living with HIV who is being treated and maintains an undetectable viral load has zero risk of transmitting HIV to their sexual partners. This concept is sometimes called “Undetectable = Untransmittable,” or “U=U”. Ending the HIV Epidemic in the US, a federal effort of the Centers for Disease Control and Prevention (CDC) as of late 2024, had a goal of increasing linkage to care and viral suppression to 95% of HIV-positive individuals.

HIV disproportionately affects certain groups of people. Over 80% of people newly diagnosed with HIV infection in California from 2019-2023 were men. Men who have sex with men (MSM) make up a shrinking but still-large share of all the people newly diagnosed (falling from about 72% in 2019 to about 62% in 2023). According to the “Ending The Epidemics: Implementation Blueprint” published by DPH in 2023, people who are Black/African Americans are more likely to be living with diagnosed HIV than any other race/ethnicity in California compared to their population size (this group makes up 17% of people with HIV despite representing only 6% of the population in California). As of 2019, a disproportionate number of new HIV infections are among Black (17% of new infections vs. 6% population size) and Latino (50% of new infections vs. 39% population size) Californians. Young Black and Latino gay and bisexual men and Black heterosexual women are becoming infected with HIV at especially high rates. Transgender women were overrepresented among new HIV diagnoses in 2019, especially transgender women of color.

3) Data-Sharing Restrictions. Due to the historical stigma and discrimination associated with HIV/AIDs, California law restricts the sharing and disclosure of HIV-related data and includes specific penalties for unauthorized disclosure. These HIV-specific restrictions have been put in place over the years to protect people living with HIV from undesired disclosure of their HIV status.

Although general federal and state medical privacy and confidentiality laws, as well as HIV-specific laws, offer protection against undesired disclosure of a person’s HIV status, the Health Committee notes that “the inability to share data can sometimes pose difficulties for health care and public health entities looking to identify, prevent, and treat HIV.”

4) What this bill would do. As currently drafted, this bill would allow the sharing of personally identifying HIV test results for everyone in California living with HIV to help facilitate better care for HIV-positive people in Medi-Cal managed care. Specifically, this bill would do the following:

1. Require the Department of Public Health (DPH) share test results and personal identifying information of the approximately 142,700 Californians who are HIV positive with the Department of Health Care Services (DHCS), without first seeking the consent of those individuals.^[1]
2. Require DHCS to share the approximately 45,000 Medi-Cal beneficiaries^[2] test result data with the managed care plan to which the person is assigned for the purpose of administering quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries.
3. Require DHCS, in consultation with DPH, to develop a mechanism that allows the Medi-Cal beneficiaries to opt out of the disclosure of their test results.
4. Prohibits the further sharing of results that identifies or provides identifying characteristics of the person to whom the test results apply, unless that person or their authorized representative provides written authorization.

5) Analysis. The question before this Committee is whether or not the risks associated with sharing the personally identifying test results of everyone living with HIV is offset by the hope that DHCS will be able to create a program improvement plan that will improve outcomes for Medi-Cal beneficiaries. Given the federal administration’s open attacks on LGBTQ+ people and recent disclosures about the sharing of protected health care information, this question potentially takes on more significance than it otherwise would.

The federal government’s war on the LGBTQ+ community. Despite the President disavowing knowledge of Project 2025^[3], a large number of the principles outlined in that document have shown up in the federal administration’s policies. Among them are the following:

1. “It is the policy of the United States to recognize two sexes, male and female. These sexes are not changeable and are grounded in fundamental and incontrovertible reality.”^[4]

One troubling example of the federal government’s commitment to denying the validity of the continuum of gender identity can be found on the Center for Disease Control website on pages related to HIV^[5]:

1. “Eliminat[e] Federal funding or support for illegal and discriminatory treatment and indoctrination in K-12 schools, including based on gender ideology and discriminatory equity ideology.”^[6]
2. A number of the President’s policy goals, also outlined in Project 2025, include prioritizing “traditional families,” a decades-old phrase that denies the validity of the diversity of family structures, by limiting the notion of family to “a married mother and father and their children.”

Prioritizing messaging and policies to promote “traditional families.” Project 2025 states:

Families comprised of a married mother, father, and their children are the foundation of a well-ordered nation and healthy society. Unfortunately, family policies and programs under President Biden’s HHS are fraught with agenda items focusing on “LGBTQ+ equity,” subsidizing single-motherhood, disincentivizing work, and penalizing marriage. These policies should be repealed and replaced by policies that support the formation of stable, married, nuclear families.^[7]

The blueprint goes on to state:

For the sake of child well-being, programs should affirm that children require and deserve both the love and nurturing of a mother and the play and protection of a father.^[8]

Further, it asserts that the Health and Human Services Secretary “should proudly state that men and women are biological realities that are crucial to the advancement of life sciences and medical care and that married men and women are the ideal, natural family structure because all children have a right to be raised by the men and women who conceived them.”^[9]

As part of the effort to center “traditional families,” an undated memo from the Secretary of Transportation announced:

To the maximum extent permitted by law, DOT-supported or -assisted programs and activities, including without limitation, all DOT grants, loans, contracts, and DOT-supported or -assisted State contracts, shall prioritize projects and goals that … mitigate the unique impacts of DOT programs, policies, and activities on families and family-specific difficulties, such as the accessibility of transportation to families with young children, and give preference to communities with marriage and birth rates higher than the national average.^[10]

Revoking guidance that prohibited adoption/foster agencies from discriminating based on sexual orientation and gender identity by removing prohibitions against faith-based agencies that will only work with “traditional” families.^[11]

1. Calling for the outlawing of “pornography,” which among other things is defined as “the omnipresent propagation of transgender ideology and sexualization of children” and requiring that “[e]ducators and public librarians who purvey [pornography] should be classed as registered sex offenders.”^[12]

Of critical importance is the fact that throughout Project 2025 the authors equate teaching children about non-traditional families, sexual orientation, and sexual identity with child sexual abuse and call for the federal government to pursue the death penalty for perpetrators of child sexual abuse.^[13] It is not beyond the realm of possibility that perpetrators would include librarians and teachers who have been required to register as sex offenders.

Recent concerns related to the sharing of sensitive personal information by DHCS and Covered California. Given how closely this administration is hewing to the policies outlined in Project 2025, in all areas, any legislation that increases data sharing, particularly among state departments that have federal partners with data sharing agreements, should be examined closely.

News reports have recently disclosed that the US Health and Human Services Agency recently shared sensitive personal information of Medicaid recipients that included immigration status with the Department of Homeland Security. The datasets included “information of people living in California, Illinois, Washington state and Washington, D.C., all of which allow non-U. S. citizens to enroll in Medicaid programs that pay for their expenses using only state taxpayer dollars. CMS transferred the information just as the Trump administration was ramping up its enforcement efforts in Southern California.”^[14]

While states routinely must share extensive data about Medicaid enrollees with the Centers for Medicaid & Medicare Services (CMS), including names, addresses, Social Security numbers, immigration status and healthcare information, that data is supposed to stay confidential. As a result of the disclosure of the data sharing with immigration officials, 20 states, led by California, have sued the federal administration.^[15]

Covered California data sharing with LinkedIn. Recently, a news investigation discovered that Covered California had shared Californians’ sensitive personal health data, including pregnancy and intimate partner abuse information with social media site LinkedIn. According to the non-profit news organization, The Markup:

As visitors filled out forms on the [Covered California] website, trackers on the same pages told LinkedIn their answers to questions about whether they were blind, pregnant, or used a high number of prescription medications. The trackers also monitored whether the visitors said they were transgender or possible victims of domestic abuse.

[. . .]

Visitors who filled out health information on the site may have had their data tracked for more than a year, according to Donohue, who said the LinkedIn campaign began in February 2024.

The Markup observed the trackers directly in February and March of this year. It confirmed most ad trackers, including the Meta “pixel” tracker, as well as all third-party cookies, have been removed from the site as of April 21 [2025].^[16]

Both of these incidents, combined with the agenda detailed throughout Project 2025 and the speed with which the federal government has moved to implement that agenda warrant extra attention when considering any legislation that increases the sharing of sensitive personal information, particularly that which may expose a person’s gender identity and sexual orientation.

As currently drafted, this bill does not appear to include adequate privacy protections. By allowing DPH to share personally identifying test results with DHCS who will further share a portion of the data with Medi-Cal managed care plans without making patients aware of the sharing or allowing them to opt out of the sharing, the bill potentially puts close to 150,000 Californians at risk of having their information inappropriately shared.

6) Amendments. In order to address the concerns raised by this Committee, the author has agreed to significantly modify the bill to do the following:

1. Eliminate the data sharing through multiple parties and instead limit the sharing to the physicians of Medi-Cal beneficiaries who are HIV positive, with those patients’ Medi-Cal managed care plans.
2. Limit the data shared with DHCS to only that which has been deidentified by shifting the way the data is shared so that once the managed care plan receives it, it will be required to remove any identifying information about its patients prior to reporting the data to DHCS.
3. Delay the implementation of the data sharing until DHCS creates a mechanism that allows patients to opt out of having their physician share they test results with their managed care plan.

Specifically, the amendments are the following:

SECTION 1. Section 120985 of the Health and Safety Code is amended to read:

120985. (a) (1) Notwithstanding Section 120980, the results of an HIV test that identifies or provides identifying characteristics of the person to whom the test results apply may be recorded by the physician who ordered the test in the test subject’s medical record or otherwise disclosed without written authorization of the subject of the test, or the subject’s representative as set forth in Section 121020, to the test subject’s providers of health care, as defined in Section 56.05 of the Civil Code, except as described in paragraph (3), for purposes of diagnosis, care, or treatment of the patient.

(2) (A) Notwithstanding Section 120980, and except for persons who have opted out through the mechanism described in subparagraph (BC), the results of an HIV test that identifies or provides identifying characteristics of the a Medi-Cal beneficiary person to whom the test results apply may be disclosed without written authorization of the subject of the test, or the subject’s representative as set forth in Section 121020, to State Department of Health Care Services staff and the Medi-Cal managed care plan to which the personbeneficiary is assigned, if applicable, once the opt-out mechanism described in (C) is implemented, for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries.

(B) Notwithstanding Section 120980, HIV test results that do not identify or provide identifying characteristics of the subjects of the tests may be disclosed without written authorization by the Medi-Cal managed care plan to State Department of Health Care Services staff for the purpose described in subparagraph (A).

(BC) The State Department of Health Care Services, in consultation with the State Department of Public Health, shall develop a mechanism by which a Medi-Cal beneficiary may opt out of the disclosure of the results of an HIV test that identifies or provides identifying characteristics of the beneficiary to State Department of Health Care Services staff or the Medi-Cal managed care plan to which the beneficiary is assigned for the purpose described in subparagraph (A). This mechanism shall be implemented no later than December 31, 2026.

(3) Except for a Medi-Cal managed care plan to which a beneficiary is assigned, the results of an HIV test that identifies or provides identifying characteristics of the person to whom the test results apply may not be disclosed without written authorization of the subject of the test, or the subject’s representative, to a health care service plan regulated pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2.

(4) This subdivision shall be construed as being subject to Sections 120975 and 120980, including for purposes of individuals or entities described in this subdivision.

(b) (1) Recording or disclosure of HIV test results pursuant to subdivision (a) does not authorize further disclosure unless otherwise permitted by law.

(2) Paragraph (1) also applies to further disclosure to any federal agency or any authority in another state, unless otherwise required by federal law.

The amendments also delete section 2 of the bill.

ARGUMENTS IN SUPPORT: The San Francisco Aids Foundation, sponsors of the bill, write in support:

More than 40 years after the first cases of HIV/AIDS in the United States were reported, our country is still struggling to end this devastating epidemic. We have all the scientific tools we need to do so, including HIV treatments that can suppress the amount of the virus in a person’s body to the point they cannot transmit HIV through sex. Despite these medical advances, here in California, more than 50,000 people living with HIV are not “virally suppressed.” Many of these Californians have not been able to achieve viral suppression due to mental-health conditions, substance-use disorder, or housing instability. Others are simply struggling to navigate the convoluted and exclusionary healthcare system. To engage and retain this population in effective HIV care, our state will need more than innovative drugs; we will need innovative systems that address behavioral health and the social determinants of health, in addition to physical health.

California policymakers have worked hard to make Medi-Cal just such a system, shifting the financial incentives for managed-care plans (MCPs) and healthcare providers away from providing billable services and toward achieving health outcomes (which requires providing whole-person care). Research shows that in our state and beyond, this shift toward “value-based payment” is positively affecting patients’ health. And, it has the potential to positively affect many HIV patients’ health: Over 40,000 people living with HIV are enrolled in Medi-Cal, and data suggests that one out of every four is not engaged in essential HIV care.

Unfortunately, state law currently prevents the use of value-based payment strategies on HIV. This is because state law prohibits the disclosure of HIV lab-test results to MCPs and the Department of Health Care Services (DHCS). DHCS cannot reasonably base payments to MCPs on their members’ HIV health outcomes if the plans cannot receive data telling them which of their members are experiencing poor HIV health outcomes and need extra support. HIV lab-test results are already regularly reported to the California Department of Public Health (CDPH); the only barrier to utilizing it in Medi-Cal is state statute. SB 278 would eliminate this barrier, by amending the two sections of the Health and Safety Code that block CDPH from sharing HIV lab-test results with DHCS and MCPs.

Recognizing that these code sections exist because HIV has been used as grounds for discrimination and criminalization—and that the current political climate demands a conservative approach to information-sharing—SB 278 is thoughtfully constructed to achieve its goal of improving HIV care for Medi-Cal patients without increasing patients’ risk of harm.

Also in support, the LGBTQ Legislative Caucus writes:

In California, we have extensive resources to support those living and at risk of HIV. Over 42,000 Californians with HIV rely on Medi-Cal for care, making up nearly a third of the state's HIV-positive population. However, about one in four Medi-Cal enrollees with HIV aren’t receiving essential care like viral-load testing, often due to lack of support, such as case management.1 The Medicaid program features several tools that can be used to promote access to and ongoing engagement in health services for people with health risks, including HIV.

In spite of this, the state’s existing tools have not been entirely effective to address viral-suppression rates. One of the primary reasons for this is that state law does not allow the sharing of public-health data about HIV viral-load suppression with MCOs and DHCS. Without data on which enrollees are virally suppressed, DHCS cannot feasibly reward MCOs for achieving high viral-suppression rates among their enrollees, MCOs can’t reward providers for doing the same among their patients, and neither DHCS nor MCOs can reward enrollees for reaching and sustaining viral suppression.

SB 278 allows Medi-Cal enrollees living with HIV to benefit from these incentive programs by allowing viral-load information to be shared confidentially for the purpose of administering quality-improvement programs. For these reasons, the California Legislative LGBTQ Caucus is proud to support this 2025 endorsed bill.

REGISTERED SUPPORT / OPPOSITION:

Support

San Francisco Aids Foundation (Sponsor)
Bienestar Human Services
California Legislative Lgbtq Caucus
California Pan - Ethnic Health Network
Dap Health
End the Epidemics: Californians Mobilizing to End Hiv, Viral Hepatitis, Stis, and Overdose
Equality California
Essential Access Health
Glide
Health Access California
Los Angeles Lgbt Center
Sunburst Projects
Viiv Healthcare

Opposition

None on file.

Analysis Prepared by: Julie Salley / P. & C.P. / (916) 319-2200

1. California HIV Surveillance Report – 2022, California Department of Public Health (Feb. 9, 2024) https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/California-HIV-Surveillance-Report-2022.pdf. ↑

2. According to the Health Committee’s analysis of the bill, almost one-third of people living with HIV in California are Medi-Cal beneficiaries. ↑

3. Released in 2023, Project 2025 is an extensive set of plans by the Heritage Foundation designed to provide a roadmap for “the next conservative President” to downsize the federal government and fundamentally change how it works, including the tax system, immigration enforcement, social welfare programs and energy policy, particularly those designed to address climate change. In addition, it contains policies for what conservatives over the last 40 years as “traditional family values.” A 900 page summary, Mandate for Leadership: The Conservative Promise, of the 20-volume, 3,000 page “governing handbook” is available at https://www.mandateforleadership.org/. ↑

4. January 20, 2025 Executive Order https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ and Project 2025, Chapter 11. ↑

5. https://www.cdc.gov/hiv/health-equity/index.html. ↑

6. January 29, 2025 Executive Order https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-indoctrination-in-k-12-schooling/ and Project 2025, Chapter 11. ↑

7. Project 2025, Page 451. ↑

8. Project 2025, Page 481. ↑

9. Project 2025, Page 489 ↑

10. Lauren Irwin, “Duffy tells DOT to prioritize areas with high birth rates,” The Hill (Feb. 3, 2025) https://thehill.com/homenews/administration/5124322-duffy-dot-transportation-trump-birth-rate/. ↑

11. Establishment of The White House Faith Office (Feb. 7, 2025) https://www.whitehouse.gov/presidential-actions/2025/02/establishment-of-the-white-house-faith-office/ and Project 2025, Page 494. ↑

12. Project 2025, Page 5. ↑

13. Project 2025, Page 554. ↑

14. Kimberly Kindy and Amanda Seitz, “Trump administration gives personal data of immigrant Medicaid enrollees to deportation officials,” Associated Press News (Jun. 14, 2025) https://apnews.com/article/medicaid-deportation-immigrants-trump-4e0f979e4290a4d10a067da0acca8e22. ↑

15. Office of the Attorney General, Attorney General Bonta Sues Trump Administration for Illegally Sharing Californians’ Personal Health Data with ICE (Jul. 1, 2025) https://oag.ca.gov/news/press-releases/attorney-general-bonta-sues-trump-administration-illegally-sharing-californians%E2%80%99. ↑

16. Tomas Apodaca and Colin Lecher, “Pixel Hunt: How California sent residents’ personal health data to LinkedIn,” The Markup (Apr. 28, 2025) https://themarkup.org/pixel-hunt/2025/04/28/how-california-sent-residents-personal-health-data-to-linkedin. ↑

Date of Hearing: June 17, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 278

Author:(Cabaldon) – As Amended Ver:March 28, 2025

SENATE VOTE: 38-0

SUBJECT: Health data: HIV test results.

SUMMARY: This bill expands the circumstances under which personally identifying Human Immunodeficiency Virus (HIV) test results may be shared without specific consent from a patient, to allow data-sharing of HIV test results with the Department of Health Care Services (DHCS) and a Medi-Cal managed care plan, for purposes of implementing quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries. Specifically, this bill:

1. Allows, notwithstanding existing penalties and prohibitions on disclosure of HIV test results, and except for persons who have opted out of disclosure through a specified mechanism, HIV test results to be disclosed for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs designed to improve HIV care for Medi-Cal beneficiaries. Specifically allows state public health agency HIV surveillance staff to disclose HIV test results to DHCS and Medi-Cal managed care plans for these purposes.
2. Requires DHCS to develop an opt-out mechanism from the disclosure described in 1) above.
3. Prohibits disclosure to a health plan licensed by the Department of Managed Health Care other than a Medi-Cal managed care plan to which a Medi-Cal beneficiary is assigned.
4. Specifies privacy and confidentiality protections, as well as prohibitions on willful, malicious, or negligent disclosure of HIV test results and related penalties, apply to the HIV test result data shared as described in 1) above.
5. Expands the application of current-law prohibitions on further disclosure of HIV test results; specifically, prohibits further disclosure to any federal agency or any authority in another state unless otherwise required by federal law.

EXISTING LAW:

1. Establishes the Confidentiality of Medical Information Act, which establishes protections for the use of medical information. Prohibits providers of health care, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. [Civil Code § 56, et. seq.]
2. Establishes the Medi-Cal program, which is administered by DHCS, and under which qualified low-income individuals receive health care services. [Welfare and Institutions Code (WIC) § 14000, et seq.]
3. Defines a Medi-Cal managed care plan as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. [WIC § 14184.101]
4. Requires DHCS to develop a value-based payment program aimed at improving chronic disease management, which requires Medi-Cal plans to give incentive payments to qualified network providers who meet designated performance standards or partial incentive payments for exceeding standards. [WIC § 14188.1]
5. Requires health care providers and laboratories to report cases of HIV infection to local health officers using patient names on a form developed by Department of Public Health (DPH). [Health and Safety Code (HSC) § 121022]
6. Provides various protections for the confidentiality of HIV test results and the identity of the person who took the test, including a prohibition on compelled disclosure of identifying information regarding HIV tests in civil, criminal, administrative, or legislative proceedings, and establishes civil penalties for negligently disclosing the result of such a test in a manner that identifies or provides identifying characteristics of the person to whom the test results apply. [HSC §§ 120975, 120980]
7. Prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. Excludes state-regulated health care service plans from being considered health care providers. [HSC §§ 120980, 120985]
8. Prohibits DPH or a local public health agency from disclosing public health records related to HIV/Acquired Immune Deficiency Syndrome (AIDS) except for public health purposes or pursuant to a written authorization by the person whose record it is or their guardian or conservator. [HSC § 121025]
9. Provides an exemption from the prohibition in 8) above, that allows for the disclosure of personally identifying information in public health records related to HIV/AIDS to DPH or other local or federal public health agency or collaborating researchers when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, or the coordination of, linkage to, or reengagement in care for a person or persons as determined by DPH or the local public health agency, provided that information is otherwise kept confidential. [Ibid.]
10. Authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS by specified state and local public health staff to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person. [Ibid.]

FISCAL EFFECT: According to the Senate Committee on Appropriations:

1. Unknown, potential costs for DHCS for state administration (General Fund and federal funds).
2. The California Department of Public Health (CDPH) estimates minor and absorbable costs.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, nearly one-third of Californians living with HIV rely on Medi-Cal. Yet, about one in four of these individuals are not receiving essential care, such as viral load testing. The author notes that under current law, Medi-Cal managed care plans are restricted from accessing key tools that could improve health outcomes. Specifically, incentive programs, such as value-based payment programs that reward quality improvement, cannot be used to support HIV-positive Medi-Cal recipients due to restrictions on sharing of HIV test results. This restriction prevents providers from utilizing performance-based funding to enhance care for this vulnerable population. The author indicates this bill will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. The author concludes that this change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.
2. BACKGROUND.
   1. HIV in California. HIV is a virus that attacks the body's immune system. Without treatment, it can lead to AIDS. In California, HIV is mostly transmitted through sexual contact and, to a lesser extent, through injection drug use, although there are other, less common transmission routes such as perinatal transmission (from a birthing parent to a child). Although there is no cure for HIV, it can be effectively treated and the “viral load” (the amount of the virus present in the body) can be controlled. Surveillance and prevention of HIV transmission and treatment for HIV/AIDS are significant public health challenges worldwide. In California, the DPH Office of AIDS works with local health jurisdictions to collect, analyze, and disseminate surveillance data on people living and diagnosed with HIV in California. DPH receives laboratory data on HIV tests, which are reported to local and state public health agencies on a mandatory basis.

Despite national, state, and local public health efforts over the last decade to “get to zero” new HIV infections, California still has a significant number of new infections annually. According to DPH:

• • 1. From 2019 through 2023, both the annual number and rate of new HIV diagnoses increased in California. The number of new diagnoses increased by 6.0%, from 4,669 in 2019 to 4,948 in 2023, while the rate of new diagnoses per 100,000 population increased by 5.1%, from 11.7 to 12.3 during the same time period.
    2. From 2019 through 2023, the number of persons in California living with diagnosed HIV infection increased from approximately 137,777 to over 143,000.
    3. In 2023, the prevalence rate of diagnosed HIV infection was 355.0 per 100,000 population, compared to 346.5 in 2019, an increase of 2.5%.
    4. Of the 143,254 people in California living with diagnosed HIV infection in 2023, 75.1% were in HIV care and 66.5% achieved viral suppression. Viral suppression in HIV-positive individuals, through treatment with HIV drugs, is critical to prevent new infections because a person living with HIV who is being treated and maintains an undetectable viral load has zero risk of transmitting HIV to their sexual partners. This concept is sometimes called “Undetectable = Untransmittable,” or “U=U”. Ending the HIV Epidemic in the US, a federal effort of the Centers for Disease Control and Prevention (CDC) as of late 2024, had a goal of increasing linkage to care and viral suppression to 95% of HIV-positive individuals.

HIV disproportionately affects certain groups of people. Over 80% of people newly diagnosed with HIV infection in California from 2019-2023 were men. Men who have sex with men (MSM) make up a shrinking but still-large share of all the people newly diagnosed (falling from about 72% in 2019 to about 62% in 2023). According to the “Ending The Epidemics: Implementation Blueprint” published by DPH in 2023, people who are Black/African Americans are more likely to be living with diagnosed HIV than any other race/ethnicity in California compared to their population size (this group makes up 17% of people with HIV despite representing only 6% of the population in California). As of 2019, a disproportionate number of new HIV infections are among Black (17% of new infections vs. 6% population size) and Latino (50% of new infections vs. 39% population size) Californians. Young Black and Latino gay and bisexual men and Black heterosexual women are becoming infected with HIV at especially high rates. Transgender women were overrepresented among new HIV diagnoses in 2019, especially transgender women of color.

• 1. Data-Sharing Restrictions. California law severely restricts the sharing and disclosure of HIV-related data and includes specific penalties for unauthorized disclosure. These HIV-specific restrictions have been put in place over the years to protect people living with HIV from undesired disclosure of their HIV status. According to “Forty Years of HIV: The Intersection of Laws, Stigma, and Sexual Behavior and Identity,” a 2021 article published in the American Journal of Public Health, since its initial identification in the early 1980’s, HIV brought widespread fear and stigmatizing laws and policies, and the crisis revealed injustices in existing laws that compounded stigma and health disparities among the most affected groups, including communities of gay and bisexual men and other MSM and people who inject drugs.

Although general federal and state medical privacy and confidentiality laws, as well as HIV-specific laws, offer protection against undesired disclosure of a person’s HIV status, the inability to share data can sometimes pose difficulties for health care and public health entities looking to identify, prevent, and treat HIV. This bill creates a narrow exception to certain California data-sharing restrictions to facilitate better care for HIV-positive people in Medi-Cal managed care.

• 1. Public Health and Health Care Collaboration. Respected national bodies have promoted the idea of partnership between public health and health care to improve public health outcomes. The National Academy of Medicine issued a report in 2012, “Primary Care and Public Health: Exploring Integration to Improve Population Health,” which made the case for tighter integration of public health and health care to improve public health. The Centers for Disease Control and Prevention (CDC) Office of Policy, Performance, and Evaluation, as of December 2024, specifically endorses the approach of partnership with the health care system to promote health care quality measures that promote progress toward public health goals. For instance, one of the priority health care quality measures listed is “Hepatitis C Virus (HCV) Screening and Treatment Initiation.” Improvements on such a metric (a health care measure) can potentially reduce preventable mortality by slowing and eliminating the spread of HCV (a public health goal).

In California, many of the Managed Care Accountability Set (MCAS) measures and DHCS “Bold Goals” address issues important to public health, including sexually transmitted infection (STI) screening, cancer screening, timely prenatal care, and immunizations, among others. By allowing disclosure of HIV test result data to DHCS and managed care plans, this bill would create the conditions necessary to implement similar quality measurement and reporting related to HIV. For instance, DHCS could incentivize plans to meet a health care quality metric that would measure viral load suppression, which would in turn meet the public health goal of reducing HIV transmission.

• 1. Medi-Cal Comprehensive Quality Strategy and Managed Care Quality Improvement Programs. DHCS implements a number of quality improvement efforts: measuring quality performance, identifying priority metrics, and implementing a “carrot and stick” approach—financial incentives and other rewards, coupled with minimum performance levels and sanctions. DHCS’s wide-ranging 2022 Comprehensive Quality Strategy outlines specific clinical goals across the Medi-Cal program and creates “Bold Goals” for quality metrics related to children’s preventive care, maternal care, and behavioral health follow-up. The document includes additional high-priority goals with measurable targets for each managed care delivery system (Medi-Cal managed care, behavioral health, and dental).

DHCS requires Medi-Cal managed care plans to report annually on their performance on MCAS, a defined list of clinical quality measures. Plans are required to hit numerical targets on a subset of the measures; if the plans do not meet these requirements, they can be subject to sanctions. In 2024, most plans were assessed sanctions based on failure to meet minimum performance levels for one or more measure. In addition to sanctions, DHCS has a number of programs and initiatives related to quality measurement, including a Quality Withhold and Incentive program that withholds a percentage of capitated payments that can then be earned back by meeting performance targets, and an incentive program that auto-assigns more Medi-Cal enrollees into higher-performing plans in certain counties. DHCS currently does not include an HIV-related metric among their priority quality measures.

• 1. Louisiana Quality Improvement Program for HIV Viral Suppression. In 2016, Louisiana’s Medicaid agency began withholding a portion of its payments to managed care plans unless they achieved or made progress toward a target viral suppression rate among their members. The state reports this value-based payment strategy has improved collaboration between the plans and the state’s public health agency, including via a regular HIV quality improvement meeting where participants share strategies for engaging their members in care. Since 2016, information from the program shows that the viral suppression rate among Louisiana’s Medicaid enrollees has increased from 67% to 80%.

1. SUPPORT. The sponsor of the bill, the San Francisco AIDS Foundation (SFAF), notes that despite medical advances that can prevent HIV transmission through viral suppression, in California, more than 50,000 people living with HIV are not virally suppressed. SFAF writes this bill is thoughtfully constructed to achieve its goal of improving HIV care for Medi-Cal patients without increasing patients’ risk of harm. The Sacramento LGBT Center writes in support that we must use every tool at our disposal to end the epidemic.
2. RELATED LEGISLATION. SB 504 (Laird), also pending in this committee, would authorize a health care provider of a patient diagnosed with an HIV infection to disclose personally identifying information to a local health officer or DPH, under specified circumstances.
3. PREVIOUS LEGISLATION.
   1. SB 1333 (Eggman and Roth), Chapter 472, Statutes of 2024, permits DPH and local health departments to disclose personally identifying information in public health records for the coordination of, linkage to, or reengagement in care, as determined by DPH or the local health department.
   2. SB 78 (Committee on Budget and Fiscal Review), Chapter 38, Statutes of 2019, requires, among other things, DHCS to develop value-based payment programs for specified conditions, including chronic disease.

REGISTERED SUPPORT / OPPOSITION:

Support

San Francisco Aids Foundation (sponsor)

Beyond Aids Foundation

California Legislative LGBTQ Caucus

California LGBTQ Health and Human Services Network

California Pan-Ethnic Health Network

Dap Health

End the Epidemics: Californians Mobilizing to End HIV, Viral Hepatitis, STIs, and Overdose

Equality California

Essential Access Health

GlaxoSmithKline

Glide

Health Access California

National Health Law Program

Sacramento LGBT Community Center

The Source LGBT + Center

Viet Rainbow of Orange County

Viiv Healthcare

Opposition

None on file

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

 THIRD READING  

Bill No: SB 278

Author: Cabaldon (D), et al.

Amended: 3/28/25

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 3/26/25

AYES: Menjivar, Valladares, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener

NO VOTE RECORDED: Grove

SENATE JUDICIARY COMMITTEE: 13-0, 4/8/25

AYES: Umberg, Niello, Allen, Arreguín, Ashby, Caballero, Durazo, Laird, Stern, Valladares, Wahab, Weber Pierson, Wiener

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/23/25

AYES: Caballero, Seyarto, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Dahle

SUBJECT: Health data: HIV test results

SOURCE: San Francisco AIDS Foundation

DIGEST:

This bill allows for HIV test results to be shared with the Department of Health Care Services or an individual’s Medi-Cal managed care plan without the written authorization of the individual tested for the purpose of proactively offering and coordinating care and treatment services or to administer quality improvement programs designed to improve HIV care for Medi-Cal enrollees.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [Welfare and Institutions Code (WIC) §14000, et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes benefits required under federal law and benefits provided at the state’s option, both of which are funded with federal and state dollars. The schedule of benefits includes prescribed drugs, inpatient and outpatient services, subject to utilization controls, as well as investigational new drugs and any related inpatient or outpatient services for the treatment of HIV/AIDS.

[WIC §14132 and §14137.6]

1. Authorizes the DHCS Director to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal enrollees and establishes managed care models that DHCS contracts with in each county. [WIC §14087.3, §14089, §14087.98, §14087.967, and §14087.5]
2. Defines a Medi-Cal managed care plan (Medi-Cal plan) as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. [WIC §14184.101]
3. Requires DHCS to develop a value-based payment program aimed at improving chronic disease management by Medi-Cal plans that requires Medi-Cal plans to give incentive payments to qualified network providers who meet designated high-performance standards or partial incentive payments for meeting above-minimum standards. [WIC §14188.1]
4. Prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. Excludes state-regulated health care service plans from being considered health care providers. [Health and Safety Code (HSC) §120980 and §120985]
5. Prohibits the California Department of Public Health (CDPH) or a local public health agency from disclosing public health records related to HIV/AIDS except for public health purposes or pursuant to a written authorization by the person whose record it is or their guardian or conservator. [HSC §121025]
6. Provides an exemption from the prohibition in 7) above, that allows for the disclosure of personally identifying information in public health records related to HIV/AIDS to CDPH or other local or federal public health agency or collaborating researchers when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, or the coordination of, linkage to, or reengagement in care for a person or persons as determined by CDPH or the local public health agency, provided that information is otherwise kept confidential. [HSC §121025]
7. Authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS by specified state and local public health staff to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person. [HSC §121025]

This bill:

1. Allows the results of an HIV test to be disclosed, without the written authorization of the subject of the test, to DHCS staff and the subject’s Medi-Cal plan for the purpose of administering quality improvement programs, including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees.
2. Continues the prohibition of sharing of HIV test results with other state-regulated health plans that are not Medi-Cal plans. Clarifies that the HIV test results may not be further shared with a federal agency or another state authority unless otherwise required by federal law.
3. Authorizes the disclosure of public health records related to HIV/AIDS by CDPH HIV surveillance staff to DHCS, who may further disclose to the Medi-Cal plan to which a Medi-Cal enrollee is assigned and who is the subject of the record for the purpose of proactively offering and coordinating care and treatment services to that person or for the purpose of administering quality improvement programs, including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees.
4. Requires DHCS, in consultation with CDPH, to develop an opt-out mechanism for Medi-Cal enrollees who do not want their test results or health records shared as authorized by this bill.
5. Clarifies that existing protections and penalties regarding negligent, willful, or malicious disclosure of HIV tests or information, applies to these provisions as well as the existing prohibition on compelled disclosure of identifying information regarding HIV tests in civil, criminal, administrative, or legislative proceedings.

Comments

According to the author of this bill:

Nearly one-third of Californians living with HIV depend on Medi-Cal for their healthcare. However, around one in four of these individuals are not receiving essential care, such as viral load testing. Existing law restricts CDPH and healthcare providers from sharing public-health data about viral-load suppression with the DHCS and Medi-Cal plans. This restriction is an outlier from an era of HIV panic and impedes the use of crucial tools that could improve health outcomes. Because of these restrictions, incentive programs that have been used successfully in other states – such as value-based payment programs that reward providers for improvements in patient outcomes or programs that offer financial incentives like gift cards to enrollees utilizing preventative care services– cannot be used to support HIV-positive Medi-Cal enrollees. This limitation prevents providers from utilizing performance-based funding to enhance care for this vulnerable population. This bill will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. This change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.

Background

HIV monitoring in California. According to CDPH, the prevalence of diagnosed HIV infection was 355.6 per 100,000 population in 2022, compared to 343.1 per 100,000 in 2018 – an increase of 3.7%. Of the 142,772 people living with diagnosed HIV infection in 2022, 73.7% were in HIV care and 64.7% achieved viral suppression. Among all racial/ethnic groups, African Americans are the most disproportionately affected by HIV. While Latinx and white individuals make up the largest percentage of persons living with diagnosed HIV, the rate of HIV among African Americans is substantially higher (1,012.3 per 100,000 population, versus 319.5 per 100,000 among whites and 364.8 per 100,000 among Latinx). The rate of new HIV diagnoses among African Americans is 4.4 times higher than whites among men and 5.7 times higher among women. Latinx are also disproportionately affected by HIV with rates of new HIV diagnoses 2.7 times higher than white among men and 1.6 times higher among women.

According to CDPH’s Office of AIDS, in California and the rest of the U.S., HIV infections and AIDS diagnoses are reported through a combination of passive and active surveillance. Passive surveillance is conducted through state required reporting of HIV and AIDS cases by health care providers and reporting of HIV-positive test results from laboratories to local health departments. Active surveillance is accomplished through routine visits to hospitals, physician offices, laboratories, counseling and testing clinics, and outpatient clinics to ensure accuracy of reported data. In California and other states, HIV/AIDS surveillance has historically relied heavily upon active case surveillance, through on-site chart reviews and case report completion by local surveillance staff at the health care provider’s office. To improve timeliness and completeness of reporting and ensure prompt identification and response to emerging problems in the field, the Office of AIDS supports a decentralized reporting system where HIV/AIDS case reports are identified through passive and active surveillance efforts coordinated by California’s 61 local health departments. HIV/AIDS surveillance case data and laboratory reports, reported to local health departments by health care providers and laboratories, is then sent to the HIV/AIDS Surveillance Section via the Lab Data Entry Tool or on the Adult Case Report Form. The Surveillance Section surveillance coordinators review the forms for accuracy and input the information into the Enhanced HIV/AIDS Reporting System, and in turn, submit electronic HIV/AIDS case reports, without personal identifiers, to the federal Centers for Disease Control and Prevention.

Medi-Cal quality improvement efforts. DHCS periodically sets a standard for Medi-Cal plans to meet via its Comprehensive Quality Strategy that includes steps Medi-Cal plans must take to improve health care quality and health equity. Within this strategy is a set of performance standards that includes specific clinical standards for specified health conditions, many of which are drawn from the Center for Medicare and Medicaid Services’ (CMS) standardized quality measures. SB 78 (Committee on Budget and Fiscal Review, Chapter 38, Statutes of 2019), the health trailer bill to the 2019-2020 budget, added value-based payment programs as a means of improving Medi-Cal plan quality by allowing plans to give providers incentive payments for meeting performance standards specified by DHCS. While the initial 2019 draft of the existing 2022 Comprehensive Quality Strategy included the HIV viral load suppression metric that is part of CMS’s standardized quality measures, this was not included in the final.

A January 2025, U.S. Health & Human Services Agency Guidance “Opportunities to Improve HIV Testing, Prevention, and Care Delivery for Medicaid and CHIP Beneficiaries” discusses a number of measures that states can implement to improve HIV testing and treatment, including adopting the HIV viral load suppression metric and highlighted states that have done this and have data-sharing agreements between their state Medicaid agencies and their state HIV surveillance program. DHCS and the Office of AIDS have previously published data on Medi-Cal plan viral load suppression. To produce that data, DHCS provided to the Office of AIDS a list of all Medi-Cal HIV-positive beneficiaries age 18 years or older, along with a variable indicating whether the patient received a medical visit during the given calendar year and variables necessary for matching to CDPH’s HIV surveillance data. Using a probabilistic matching algorithm, the Office of AIDS matched the Medi-Cal beneficiaries with HIV-positive individuals in the CDPH HIV surveillance system to confirm HIV infection and determine whether patients were virally suppressed. This bill seeks to allow for information sharing in the other direction – HIV information from CDPH to DHCS and the Medi-Cal plans in order to administrate quality improvement programs or otherwise improve care and treatment for the individual.

Policy comment. Typically, it would be the holder of the information that would need to implement a consent process. However, because CDPH would be getting the information from a variety of sources, this bill is tasking DHCS with implementing the opt-out consent process. Given that under current state law, DHCS can already send information to CDPH, and because DHCS already controls the annual mailers that are sent to Medi-Cal enrollees that describe their rights in the Medi-Cal program, it likely makes sense to have DHCS add this information to those forms and then to only request information on Medi-Cal enrollees that have been notified of their right to opt out from having their personal HIV data sent back to DHCS and their Medi-Cal plan.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, this bill would have unknown, potential costs for DHCS for state administration (General Fund and federal funds), and CDPH estimates minor and absorbable costs.

SUPPORT: (Verified 5/23/25)

San Francisco AIDS Foundation (source)

California Legislative LGBTQ Caucus

California LGBTQ Health and Human Services Network

California Pan-Ethnic Health Network

DAP Health

End the Epidemics

Equality California

Essential Access Health

GLIDE

Health Access California

National Health Law Program

Sacramento LGBT Community Center

The Source LGBT+ Center

Viet Rainbow of Orange County

ViiV Healthcare

Western Center on Law & Poverty

OPPOSITION: (Verified 5/23/25)

None received

ARGUMENTS IN SUPPORT: Sponsor San Francisco AIDS Foundation writes that more than 50,000 Californians living with HIV are not virally suppressed despite the availability of effective HIV treatment. They argue that giving the Medi-Cal program more tools to share HIV data with the Medi-Cal plans will enable DHCS to base Medi-Cal plan payments on their members’ HIV health outcomes. They point to a program in Louisiana that allowed the state Medicaid agency to withhold a portion of the Medicaid plan payments unless the plans achieved target goals, which lead to an increase in the viral suppression rate from 67% to 80% of Louisiana’s Medicaid enrollees. Letters submitted by other provider and consumer supporters point out that one in three people living with HIV in California is on Medi-Cal. They also point out that the state currently uses value-based payment programs to manage other chronic conditions in the Medi-Cal program but it is only state law prohibiting disclosure of HIV information that prevents this from occurring with HIV.

Prepared by: Jen Flory / HEALTH / (916) 651-4111

5/26/25 13:03:56

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

SB 278 (Cabaldon) - Health data: HIV test results

Bill Summary:

SB 278 would allow for human immunodeficiency virus (HIV) test results to be shared with the Department of Health Care Services (DHCS) or an individual’s Medi-Cal plan without the written authorization of the individual tested, for the purpose of proactively offering and coordinating care and treatment services or to administer quality improvement programs designed to improve HIV care for Medi-Cal enrollees.

Fiscal Impact:

• Unknown, potential costs for DHCS for state administration (General Fund and federal funds).
• The California Department of Public Health (CDPH) estimates minor and absorbable costs.

Background:

DHCS administers the Medi-Cal program, which provides health care services to low-income individuals. Current law requires DHCS to develop a value-based payment program aimed at improving chronic disease management that requires Medi-Cal plans to give incentive payments to qualified network providers who meet designated high-performance standards or partial incentive payments for meeting above-minimum standards. DHCS periodically sets a standard for Medi-Cal plans to meet via its Comprehensive Quality Strategy that includes steps Medi-Cal plans must take to improve health care quality and health equity. Within this strategy is a set of performance standards that includes specific clinical standards for specified health conditions, many of which are drawn from the federal Center for Medicare and Medicaid Services (CMS) standardized quality measures.

The existing Comprehensive Quality Strategy does not include the HIV viral load suppression metric that is part of CMS’s standardized quality measures, which can be used to help improve HIV testing and treatment. Specifically, state law prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. State law excludes state-regulated health plans from being considered health care providers for these purposes, thus the HIV test results for Medi-Cal beneficiaries cannot be disclosed to their Medi-Cal plan without written authorization.

The CDPH works with local health jurisdictions to collect, analyze, and disseminate surveillance data on people living and diagnosed with HIV in California. Health care providers and clinical laboratories provide HIV case surveillance data to local health jurisdictions and the CDPH as a routine public health activity required by state law. State law prohibits CDPH or a local public health agency from disclosing public health records containing personally identifying information related to HIV or acquired immunodeficiency syndrome (AIDS), except for public health purposes or pursuant to a written authorization by the person who is the subject of the record. However state law allows for the disclosure of personally identifying information in public health records related to HIV/AIDS to other local, state or federal public health agencies, or to collaborating researchers when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, or the coordination of, linkage to, or reengagement in care for a person or persons as determined by CDPH or the local public health agency, provided that information is otherwise kept confidential. State law also authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person.

Proposed Law:

Specific provisions of the bill would:

• Allow the results of an HIV test that identifies or provides identifying characteristics to be disclosed without written authorization of the subject of the test to DHCS staff and the Medi-Cal plan to which the person is assigned, if applicable, for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries; and require DHCS, in consultation with CDPH, to develop a mechanism by which a Medi-Cal beneficiary may opt out of this disclosure.
• Allow state HIV surveillance staff to disclose public health records related to HIV/AIDS to DHCS staff, who may further disclose the information to the Medi-Cal plan to which the person is assigned, if applicable, which may further disclose the information to the HIV-positive person who is the subject of the record, or the health care provider who provides their HIV care, for the purpose of proactively offering and coordinating care and treatment services to them or for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries; and require DHCS, in consultation with the CDPH, to develop a mechanism by which a Medi-Cal beneficiary may opt out of this disclosure.

Related Legislation:

SB 504 (Laird) would authorize a health care provider of a patient diagnosed with an HIV infection to disclose personally identifying confidential information to a local health officer or the CDPH, under specified circumstances. The bill is scheduled to be heard in the Senate Judiciary Committee on April 22, 2025.

-- END --

SENATE JUDICIARY COMMITTEE

Senator Thomas Umberg, Chair

2025-2026 Regular Session

Bill No: SB 278 (Author:Cabaldon)

Version: March 28, 2025

Hearing Date: April 8, 2025

Fiscal: Yes

Urgency: No

Consultant: AM

SUBJECT

Health data: HIV test results

DIGEST

The bill authorizes the sharing of HIV test information for the purpose of administering quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries, including value-based payment programs and healthy behavior incentive programs, as provided.

EXECUTIVE SUMMARY

Existing law provides strong confidentiality provisions for the protection of HIV test information and the identity of the test subject, including prohibitions on sharing that information and civil penalties for the negligent release of that information. There are limited exceptions to the prohibition on sharing this data. These exceptions serve various public health purposes, such as proactively offering and coordinating care and treatment or when necessary to carry out the duties of certain public health agencies in the investigation, control, or surveillance of disease. This bill seeks to authorize the sharing of this confidential HIV test information for the limited purpose of administering quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries. The bill provides an opt out for sharing HIV test information for this purpose and ensures that existing confidentiality protections also apply to this new authorization to share HIV test information. The bill is sponsored by the San Francisco AIDS Foundation and supported by a number of organizations dedicated to LGBTQ+ rights and civil rights and the California Legislative LGBTQ Caucus. No timely opposition was received by the Committee. The bill passed the Senate Health Committee on a vote of 10 to 0.

PROPOSED CHANGES TO THE LAW

Existing federal law:

1. Establishes the Health Insurance Portability and Accountability Act (HIPAA), which provides privacy protections for patients’ protected health information and generally prohibits a covered entity, as defined (health plan, health care provider, and health care clearing house), from using or disclosing protected health information except as specified or as authorized by the patient in writing. (45 C.F.R. §§ 164.500 et. seq.)
2. Provides that if HIPAA’s provisions conflict with a provision of state law, the provision that is the most protective of patient privacy prevails. (45 C.F.R. §§ 164.500 et. seq.)

Existing state law:

1. Establishes the Confidentiality of Medical Information Act, which establishes protections for the use of medical information. (Civ. Code §§ 56 et. seq.)
   1. Prohibits providers of health care, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. (Civ. Code § 56.10.)
2. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. (Welf. & Inst. Code §§ 14000 et. seq.)
3. Requires health care providers and laboratories to report cases of HIV infection to the local health officers (LHOs) using patient names on a form developed by CDPH.
   1. Requires CDPH and LHD employees and their contractors to sign confidentiality agreements annually. (Health & Saf. Code § 121022.)
4. Prohibits public health records relating to HIV/AIDS containing personally identifying information that were developed or acquired by CDPH or an LHD, or their agent, from being disclosed, except for public health purposes or pursuant to a written authorization by the person who is the subject of the record or by that person’s guardian or conservator. (Health & Saf. Code §121025(a).)
   1. Authorizes CDPH or an LHD, or their agent, to disclose personally identifying information in public health records to other local, state, or federal public health agencies or to corroborating medical researchers, when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, as determined by CDPH or an LHD. (Id. at (b).)
   2. Authorizes CDPH and LHDs to disclose personally identifying information in public health records for the coordination of, linkage to, or reengagement in care, as determined by CDPH or a LHD. (Ibid.)
   3. Any disclosures made are to include only the information necessary for the purpose of the disclosure and only upon agreement that the information will be kept confidential. (Id. at (c).)
5. Authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS by specified state and local public health staff to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person. (Id. at (c)(2).)
6. Prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. Excludes state-regulated health care service plans from being considered health care providers. (Health & Saf. Code § 120980 and §120985.)
7. Provides various protections for the confidentiality of the results of HIV tests and the identity of the person who took the test, including a prohibition on compelled disclosure of identifying information regarding HIV tests in civil, criminal, administrative, or legislative proceedings, and establishes civil penalties for negligently disclosing the result of such a test in a manner that identifies or provides identifying characteristics of the person to whom the test results apply. (Health & Saf. Code § 120975 & 120980.)

This bill:

1. Authorizes the results of an HIV test to be disclosed, without the written consent of the subject of the test, to DHCS staff and the subject’s Medi-Cal plan for the purpose of administering quality improvement programs, including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees.
2. Authorizes the disclosure of public health records related to HIV/AIDS by CDPH HIV surveillance staff to DHCS, who may further disclose to the Medi-Cal plan to which a Medi-Cal enrollee is assigned and who is the subject of the record for the purpose of proactively offering and coordinating care and treatment services to that person or for the purpose of administering quality improvement programs, including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees
3. Provides that HIV test results may not be further shared with a federal agency or another state authority unless otherwise required by federal law.
4. Requires DHCS, in consultation with CDPH, to develop an opt-out mechanism for Medi-Cal enrollees who do not want their test results or health records shared as authorized by this bill.
5. Specifies that existing protections and penalties regarding negligent, willful, or malicious disclosure of HIV tests or information also apply to these provisions, including the existing prohibition on compelled disclosure of identifying information regarding HIV tests in civil, criminal, administrative, or legislative proceedings.

COMMENTS

1. Stated need for the bill

The author writes:

Nearly one-third of Californians living with HIV depend on Medi-Cal for their healthcare. However, around one in four of these individuals are not receiving essential care, such as viral load testing. Existing law restricts the Department of Public Health and healthcare providers from sharing public-health data about viral-load suppression with the Department of Health Care Services and managed-care organizations. This restriction is an outlier from an era of HIV panic and impedes the use of crucial tools that could improve health outcomes.

Because of these restrictions, incentive programs that have been used successfully in other states – such as value-based payment programs that reward providers for improvements in patient outcomes or programs that offer financial incentives like gift cards to enrollees utilizing preventative care services– cannot be used to support HIV-positive Medi-Cal recipients. This limitation prevents providers from utilizing performance-based funding to enhance care for this vulnerable population.

SB 278 will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. This change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.

1. HIV monitoring, confidentiality, and Medi-Cal improvement programs

The author and sponsor of the bill are seeking an additional exception to allow for the sharing of HIV test information for the purpose of administering quality improvement programs designed to improve HIV care for Medi-Cal beneficiaries, including value-based payment programs and healthy behavior incentive programs. To accomplish this, the bill authorizes the sharing of HIV test information to DHCS, which in turn is authorized to share that information with the Medi-Cal managed care plan to which the subject of the test is assigned. Additionally, information is authorized to be shared with the health care provider and the subject of the test for the purpose of proactively offering and coordinating care and treatment services or for the purpose of administering quality improvement programs.

The sponsor of the bill, the San Francisco AIDS Foundation, notes that in California “more than 50,000 people living with HIV are not ‘virally suppressed’” and that the state “will need innovative systems that address behavioral health and the social determinants of health, in addition to physical health” to address this issue. They point to outcomes in other states as evidence that incentive programs produce beneficial results, writing:

[I]n 2015, Louisiana’s Medicaid agency began withholding a portion of its payments to MCPs [managed care plans] unless they achieved (or made progress toward) a target viral suppression rate among their members. This value-based payment strategy has improved collaboration between the plans and the state’s public-health agency, including via a regular HIV quality-improvement meeting where participants share strategies for engaging their members in care. The results speak for themselves: Since 2016, the viral-suppression rate among Louisiana’s Medicaid enrollees has increased from 67% to 80%.

The Senate Health Committee analysis of this bill notes:

A January 2025, U.S. Health & Human Services Agency Guidance “Opportunities to Improve HIV Testing, Prevention, and Care Delivery for Medicaid and CHIP Beneficiaries” discusses a number of measures that states can implement to improve HIV testing and treatment, including adopting the HIV viral load suppression metric and highlighted states that have done this and have data-sharing agreements between their state Medicaid agencies and their state HIV surveillance program. DHCS and the Office of AIDS have previously published data on Medi-Cal plan viral load suppression. To produce that data, DHCS provided to the Office of AIDS a list of all Medi-Cal HIV-positive beneficiaries age 18 years or older, along with a variable indicating whether the patient received a medical visit during the given calendar year and variables necessary for matching to CDPH’s HIV surveillance data. Using a probabilistic matching algorithm, the Office of AIDS matched the Medi-Cal beneficiaries with HIV-positive individuals in the CDPH HIV surveillance system to confirm HIV infection and determine whether patients were virally suppressed. This bill seeks to allow for information sharing in the other direction – HIV information from CDPH to DHCS and the Medi-Cal plans in order to administrate quality improvement programs or otherwise improve care and treatment for the individual.^[1]

In order to provide enhanced confidentiality protections, the bill requires DHCS, in consultation with CDPH, to provide a Medi-Cal beneficiary the ability to opt out of disclosing their personally identifying information in public health records relating to HIV or AIDS when that information is being shared to administer quality improvement programs under Medi-Cal. The bill also prohibits HIV testing information from being shared with a health care service plan, unless express authorization is received from the test subject or their representative. Additionally, the bill specifies that the new authorizations to share HIV patient information are covered by existing confidentiality provisions related to the prohibition on compelled disclosure of identifying information regarding HIV tests and civil penalties for negligent disclosure of that information. Finally, the bill clarifies that the specific authorizations to share HIV testing data does not allow for further sharing with a federal agency or authority in another state, unless specifically required by federal law.

1. Statements in support

Equality California writes in support stating:

Almost a third of all people living with HIV in California are enrolled in the state’s Medi-Cal program. Unfortunately, data shows that many Medi-Cal patients living with HIV are not receiving the care they need to stay healthy. For other health conditions, Medi-Cal can produce better outcomes using “quality improvement” strategies. For example, Medi-Cal can offer bonus payments to MCPs for achieving certain goals related to their members’ health.

Unfortunately, Medi-Cal cannot use these quality-improvement strategies to improve care for patients with HIV because state law prohibits the disclosure of any HIV lab-test result to health plans, including Medi-Cal MCPs. MCPs need HIV lab-test results to identify members experiencing poor HIV health outcomes and offer them additional support.

SB 278 would dismantle barriers to better HIV care—while safeguarding sensitive health information—by allowing the disclosure of a patient’s HIV lab-test results to their Medi-Cal MCP for the purpose of quality improvement.[…]

SB 278 will clear the way to ensuring that Medi-Cal members with HIV are receiving high quality care and bring the state one step closer to ending the HIV epidemic.

SUPPORT

San Francisco AIDS Foundation (sponsor)
California Legislative LGBTQ Caucus

California LGBTQ Health and Human Services Network

California Pan-Ethnic Health Network

DAP Health

End The Epidemics: Californians Mobilizing to End HIV, STIs, Viral Hepatitis, & Overdose

Equality California

Essential Access Health

National Health Law Program

Sacramento LGBT Community Center

The Source LGBT+ Center

Viet Rainbow of Orange County

ViiV Healthcare

OPPOSITION

None received

RELATED LEGISLATION

Pending Legislation: SB 504 (Laird, 2025) authorizes a health care provider of a patient with an HIV infection that has already been reported to a local health officer to communicate with CDPH or a LHO in order to obtain public health recommendations on care and treatment or to refer the patient to services provided by CDPH. SB 504 is currently pending in this Committee.

Prior Legislation:

SB 1333 (Eggman, Ch. 472, Stats. 2024) revised and recast existing law to permit the CDPH and LHOs to disclose personally identifying information in public health records for the coordination of, linkage to, or reengagement in care, as provided.

SB 78 (Committee on Budget and Fiscal Review, Ch. 38, Stats. 2019) required, among other things, DHCS to develop value-based payment programs for specified conditions.

PRIOR VOTES:

Senate Health Committee (10 Ayes, 0 Noes)

**************

1. Sen. Health Comm. analysis of SB 278 (2025-26 reg. sess.) as amended Mar. 17, 2025 at p. 3. ↑

SENATE COMMITTEE ON HEALTH

Senator Caroline Menjivar, Chair

BILL NO: SB 278

SUBJECT: Health data: HIV test results

SUMMARY:

Allows for HIV test results to be shared with the Department of Health Care Services or an individual’s Medi-Cal managed care plan without the written authorization of the individual tested for the purpose of proactively offering and coordinating care and treatment services or to administer quality improvement programs designed to improve HIV care for Medi-Cal enrollees.

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [WIC §14000, et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes benefits required under federal law and benefits provided at the state’s option, both of which are funded with federal and state dollars. The schedule of benefits includes prescribed drugs, inpatient and outpatient services, subject to utilization controls, as well as investigational new drugs and any related inpatient or outpatient services for the treatment of HIV/AIDS.

[WIC §14132 and §14137.6]

1. Authorizes the DHCS Director to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal enrollees and establishes managed care models that DHCS contracts with in each county. [WIC §14087.3, §14089, §14087.98, §14087.967, and §14087.5]
2. Defines a Medi-Cal managed care plan (Medi-Cal plan) as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. [WIC §14184.101]
3. Requires DHCS to develop a value-based payment program aimed at improving chronic disease management by Medi-Cal plans that requires Medi-Cal plans to give incentive payments to qualified network providers who meet designated high-performance standards or partial incentive payments for meeting above-minimum standards. [WIC §14188.1]
4. Prohibits the disclosure of the results of an HIV test to any third party in a manner that provides identifying characteristics of the subject of the test, except to the physician who ordered the test or the subject’s health care providers for the purposes of diagnosis, care, or treatment of the patient. Excludes state-regulated health care service plans from being considered health care providers. [HSC §120980 and §120985]
5. Prohibits the California Department of Public Health (CDPH) or a local public health agency from disclosing public health records related to HIV/AIDS except for public health purposes or pursuant to a written authorization by the person whose record it is or their guardian or conservator. [HSC §121025]
6. Provides an exemption from the prohibition in 7) above, that allows for the disclosure of personally identifying information in public health records related to HIV/AIDS to CDPH or other local or federal public health agency or collaborating researchers when the confidential information is necessary to carry out the duties of the agency or researcher in the investigation, control, or surveillance of disease, or the coordination of, linkage to, or reengagement in care for a person or persons as determined by CDPH or the local public health agency, provided that information is otherwise kept confidential. [HSC §121025]
7. Additionally authorizes the disclosure of personally identifying information in public health records related to HIV/AIDS by specified state and local public health staff to the HIV-positive person or health care provider for the purpose of proactively offering and coordinating care and treatment services to the HIV-positive person. [HSC §121025]

This bill:

1. Allows the results of an HIV test to be disclosed, without the written authorization of the subject of the test, to DHCS staff and the subject’s Medi-Cal plan for the purpose of administering quality improvement programs, including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees.
2. Continues the prohibition of sharing of HIV test results with other state-regulated health plans that are not Medi-Cal plans. Clarifies that the HIV test results may not be further shared with a federal agency or another state authority unless otherwise required by federal law.
3. Authorizes the disclosure of public health records related to HIV/AIDS by CDPH HIV surveillance staff to DHCS, who may further disclose to the Medi-Cal plan to which a Medi-Cal enrollee is assigned and who is the subject of the record for the purpose of proactively offering and coordinating care and treatment services to that person or for the purpose of administering quality improvement programs, including value-based payment programs and health behavior incentive programs, designed to improve HIV care for Medi-Cal enrollees.
4. Requires DHCS, in consultation with CDPH, to develop an opt-out mechanism for Medi-Cal enrollees who do not want their test results or health records shared as authorized by this bill.
5. Clarifies that existing protections and penalties regarding negligent, willful, or malicious disclosure of HIV tests or information, applies to these provisions as well as the existing prohibition on compelled disclosure of identifying information regarding HIV tests in civil, criminal, administrative, or legislative proceedings.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, nearly one-third of Californians living with HIV depend on Medi-Cal for their healthcare. However, around one in four of these individuals are not receiving essential care, such as viral load testing. Existing law restricts CDPH and healthcare providers from sharing public-health data about viral-load suppression with the DHCS and Medi-Cal plans. This restriction is an outlier from an era of HIV panic and impedes the use of crucial tools that could improve health outcomes. Because of these restrictions, incentive programs that have been used successfully in other states – such as value-based payment programs that reward providers for improvements in patient outcomes or programs that offer financial incentives like gift cards to enrollees utilizing preventative care services– cannot be used to support HIV-positive Medi-Cal enrollees. This limitation prevents providers from utilizing performance-based funding to enhance care for this vulnerable population. This bill will allow Medi-Cal enrollees living with HIV to benefit from these programs by allowing viral load data to be shared confidentially for the purpose of administering quality improvement programs. This change will ensure that Medi-Cal enrollees living with HIV can benefit from the same incentive-driven improvements in care as other patients.
2. HIV monitoring in California. According to CDPH, the prevalence of diagnosed HIV infection was 355.6 per 100,000 population in 2022, compared to 343.1 per 100,000 in 2018 – an increase of 3.7%. Of the 142,772 people living with diagnosed HIV infection in 2022, 73.7% were in HIV care and 64.7% achieved viral suppression. Among all racial/ethnic groups, African Americans are the most disproportionately affected by HIV. While Latinx and white individuals make up the largest percentage of persons living with diagnosed HIV, the rate of HIV among African Americans is substantially higher (1,012.3 per 100,000 population, versus 319.5 per 100,000 among whites and 364.8 per 100,000 among Latinx). The rate of new HIV diagnoses among African Americans is 4.4 times higher than whites among men and 5.7 times higher among women. Latinx are also disproportionately affected by HIV with rates of new HIV diagnoses 2.7 times higher than white among men and 1.6 times higher among women.

According to CDPH’s Office of AIDS, in California and the rest of the U.S., HIV infections and AIDS diagnoses are reported through a combination of passive and active surveillance. Passive surveillance is conducted through state required reporting of HIV and AIDS cases by health care providers and reporting of HIV-positive test results from laboratories to local health departments. Active surveillance is accomplished through routine visits to hospitals, physician offices, laboratories, counseling and testing clinics, and outpatient clinics to ensure accuracy of reported data. In California and other states, HIV/AIDS surveillance has historically relied heavily upon active case surveillance, through on-site chart reviews and case report completion by local surveillance staff at the health care provider’s office. To improve timeliness and completeness of reporting and ensure prompt identification and response to emerging problems in the field, the Office of AIDS supports a decentralized reporting system where HIV/AIDS case reports are identified through passive and active surveillance efforts coordinated by California’s 61 local health departments. HIV/AIDS surveillance case data and laboratory reports, reported to local health departments by health care providers and laboratories, is then sent to the HIV/AIDS Surveillance Section via the Lab Data Entry Tool or on the Adult Case Report Form. The Surveillance Section surveillance coordinators review the forms for accuracy and input the information into the Enhanced HIV/AIDS Reporting System (eHARS), and in turn, submit electronic HIV/AIDS case reports, without personal identifiers, to the federal Centers for Disease Control and Prevention.

1. Medi-Cal quality improvement efforts. DHCS periodically sets a standard for Medi-Cal plans to meet via its Comprehensive Quality Strategy that includes steps Medi-Cal plans must take to improve health care quality and health equity. Within this strategy is a set of performance standards that includes specific clinical standards for specified health conditions, many of which are drawn from the Center for Medicare and Medicaid Services’ (CMS) standardized quality measures. SB 78 (Committee on Budget and Fiscal Review, Chapter 38, Statutes of 2019), the health trailer bill to the 2019-2020 budget, added value-based payment programs as a means of improving Medi-Cal plan quality by allowing plans to give providers incentive payments for meeting performance standards specified by DHCS. While the initial 2019 draft of the existing 2022 Comprehensive Quality Strategy included the HIV viral load suppression metric that is part of CMS’s standardized quality measures, this was not included in the final.

A January 2025, U.S. Health & Human Services Agency Guidance “Opportunities to Improve HIV Testing, Prevention, and Care Delivery for Medicaid and CHIP Beneficiaries” discusses a number of measures that states can implement to improve HIV testing and treatment, including adopting the HIV viral load suppression metric and highlighted states that have done this and have data-sharing agreements between their state Medicaid agencies and their state HIV surveillance program. DHCS and the Office of AIDS have previously published data on Medi-Cal plan viral load suppression. To produce that data, DHCS provided to the Office of AIDS a list of all Medi-Cal HIV-positive beneficiaries age 18 years or older, along with a variable indicating whether the patient received a medical visit during the given calendar year and variables necessary for matching to CDPH’s HIV surveillance data. Using a probabilistic matching algorithm, the Office of AIDS matched the Medi-Cal beneficiaries with HIV-positive individuals in the CDPH HIV surveillance system to confirm HIV infection and determine whether patients were virally suppressed. This bill seeks to allow for information sharing in the other direction – HIV information from CDPH to DHCS and the Medi-Cal plans in order to administrate quality improvement programs or otherwise improve care and treatment for the individual.

1. Double referral. This bill has been double referred. Should it pass out of this Committee, it will be referred to the Committee on Judiciary.
2. Related legislation. SB 504 (Laird) authorizes a health care provider of a patient with an HIV infection that has already been reported to a local health officer to communicate with CDPH or a local health officer in order to obtain public health recommendations on care and treatment or to refer the patient to services provided by CDPH. SB 504 is set to be heard in this committee on March 26, 2025.
3. Prior legislation. SB 1333 (Eggman and Roth, Chapter 472, Statutes of 2024) revised existing law to permit CDPH and local health departments to disclose personally identifying information in public health records for the coordination of, linkage to, or reengagement in care, as determined by CDPH or the local health department.

SB 78 (Committee on Budget and Fiscal Review, Chapter 38, Statutes of 2019) required, among other things, DHCS to develop value-based payment programs for specified conditions, including chronic disease.

1. Support. Sponsor San Francisco AIDS Foundation writes that more than 50,000 Californians living with HIV are not virally suppressed despite the availability of effective HIV treatment. They argue that giving the Medi-Cal program more tools to share HIV data with the Medi-Cal plans will enable DHCS to base Medi-Cal plan payments on their members’ HIV health outcomes. They point to a program in Louisiana that allowed the state Medicaid agency to withhold a portion of the Medicaid plan payments unless the plans achieved target goals, which lead to an increase in the viral suppression rate from 67% to 80% of Louisiana’s Medicaid enrollees. Letters submitted by other provider and consumer supporters point out that one in three people living with HIV in California is on Medi-Cal. They also point out that the state currently uses value-based payment programs to manage other chronic conditions in the Medi-Cal program but it is only state law prohibiting disclosure of HIV information that prevents this from occurring with HIV.
2. Policy comment. Typically, it would be the holder of the information that would need to implement a consent process. However, because CDPH would be getting the information from a variety of sources, this bill is tasking DHCS with implementing the opt-out consent process. Given that under current state law, DHCS can already send information to CDPH, and because DHCS already controls the annual mailers that are sent to Medi-Cal enrollees that describe their rights in the Medi-Cal program, it likely makes sense to have DHCS add this information to those forms and then to only request information on Medi-Cal enrollees that have been notified of their right to opt out from having their personal HIV data sent back to DHCS and their Medi-Cal plan.

SUPPORT AND OPPOSITION:

Support: San Francisco AIDS Foundation (sponsor)

California Legislative LGBTQ Caucus

California LGBTQ Health and Human Services Network

California Pan-Ethnic Health Network

DAP Health

End the Epidemics: Californians Mobilizing to End HIV, STIs, Viral Hepatitis & Overdose

Equality California

Essential Access Health

GLIDE

Health Access California

National Health Law Program

Sacramento LGBT Community Center

The Source LGBT+ Center

Viet Rainbow of Orange County

ViiV Healthcare

Western Center on Law & Poverty

Oppose: None received.

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