General Provisions

Cal. WIC § 14005.64

California Statutes

(

a) Effective January 1, 2014, and notwithstanding any other law, when determining eligibility for Medi-Cal benefits, an applicant’s or beneficiary’s income and resources shall be determined, counted, and valued in accordance with the requirements of

Section 1902(e)(14) of the federal Social Security Act (42 U.S.C.

Sec. 1396a(e)(14)), as added by the ACA, which prohibits the use of an assets or resources test for individuals whose income eligibility is determined based on modified adjusted gross income. (

b) When determining the eligibility of applicants and beneficiaries using the MAGI-based financial methods, the 5-percent income disregard required under

Section 1902(e)(14)(B)(

I) of the federal Social Security Act (42 U.S.C.

Sec. 1396a(e)(14)(B)(I)) shall be applied. (c)

(1) The department shall establish income eligibility thresholds for those Medi-Cal eligibility groups whose eligibility will be determined using MAGI-based financial methods. The income eligibility thresholds shall be developed using the financial methodologies described in

Section 1396a(e)(14) of Title of the United States Code and in conformity with

Section 1396a(gg) of Title of the United States Code as added by the ACA.

(2) In utilizing state data or the national standard methodology with Survey of Income and Program Participation data to develop the converted modified adjusted gross income standard for Medi-Cal applicants and beneficiaries, the department shall ensure that the financial methodology used for identifying the equivalent income eligibility threshold preserves Medi-Cal eligibility for applicants and beneficiaries to the extent required by federal law.

The department shall report to the Legislature on the expected changes in income eligibility thresholds using the chosen methodology for individuals whose income is determined on the basis of a converted dollar amount or federal poverty level percentage. The department shall convene stakeholders, including the Legislature, counties, and consumer advocates regarding the results of the converted standards and shall review with them the information used for the specific calculations before adopting its final methodology for the equivalent income eligibility threshold level.

(3) The income eligibility threshold levels required under this subdivision shall be as follows for the identified coverage groups: (

A) For those pregnant individuals and infants eligible under Sections 435.116 and 435.118 of Title of the Code of Federal Regulations, respectively, 208 percent of the federal poverty level. (

B) For those children one to five years of age, inclusive, eligible under

Section 1396a(a)(10)(A)(i)(VI) of Title of the United States Code, 142 percent of the federal poverty level. (

C) For those children to years of age, inclusive, eligible under

Section 1396a(a)(10)(A)(i)(VII) of Title of the United States Code, 133 percent of the federal poverty level. (

d) The department shall include individuals under years of age, or in the case of full-time students, under years of age, in the household for purposes of determining eligibility under

Section 1396a(e)(14) of Title of the United States Code, as added by the ACA. (

e) For purposes of this section, the following

definitions shall apply: (1) “ACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148) as originally enacted and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments. (2) “MAGI-based financial methods” means income calculated using the financial methodologies described in

Section 1396a(e)(14) of Title of the United States Code, and as added by the ACA. (

f) Notwithstanding

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this

section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. Thereafter, the department shall adopt regulations in accordance with the requirements of

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code. Beginning six months after the effective date of this section, and notwithstanding

Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis until regulations have been adopted. (

g) This

section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

Document details

CollectionCalifornia Statutes
CitationCal. WIC § 14005.64
Date2022-06-30
Typestatute
Languageen
SourceCA_STAT
IdentifierWIC14005.64.20224781

General Provisions

Cal. WIC § 14005.64

California Statutes

General Provisions

Cal. WIC § 14005.64

California Statutes

(

a) Effective January 1, 2014, and notwithstanding any other law, when determining eligibility for Medi-Cal benefits, an applicant’s or beneficiary’s income and resources shall be determined, counted, and valued in accordance with the requirements of

Section 1902(e)(14) of the federal Social Security Act (42 U.S.C.

Sec. 1396a(e)(14)), as added by the ACA, which prohibits the use of an assets or resources test for individuals whose income eligibility is determined based on modified adjusted gross income. (

b) When determining the eligibility of applicants and beneficiaries using the MAGI-based financial methods, the 5-percent income disregard required under

Section 1902(e)(14)(B)(

I) of the federal Social Security Act (42 U.S.C.

Sec. 1396a(e)(14)(B)(I)) shall be applied. (c)

(1) The department shall establish income eligibility thresholds for those Medi-Cal eligibility groups whose eligibility will be determined using MAGI-based financial methods. The income eligibility thresholds shall be developed using the financial methodologies described in

Section 1396a(e)(14) of Title of the United States Code and in conformity with

Section 1396a(gg) of Title of the United States Code as added by the ACA.

(2) In utilizing state data or the national standard methodology with Survey of Income and Program Participation data to develop the converted modified adjusted gross income standard for Medi-Cal applicants and beneficiaries, the department shall ensure that the financial methodology used for identifying the equivalent income eligibility threshold preserves Medi-Cal eligibility for applicants and beneficiaries to the extent required by federal law.

The department shall report to the Legislature on the expected changes in income eligibility thresholds using the chosen methodology for individuals whose income is determined on the basis of a converted dollar amount or federal poverty level percentage. The department shall convene stakeholders, including the Legislature, counties, and consumer advocates regarding the results of the converted standards and shall review with them the information used for the specific calculations before adopting its final methodology for the equivalent income eligibility threshold level.

(3) The income eligibility threshold levels required under this subdivision shall be as follows for the identified coverage groups: (

A) For those pregnant individuals and infants eligible under Sections 435.116 and 435.118 of Title of the Code of Federal Regulations, respectively, 208 percent of the federal poverty level. (

B) For those children one to five years of age, inclusive, eligible under

Section 1396a(a)(10)(A)(i)(VI) of Title of the United States Code, 142 percent of the federal poverty level. (

C) For those children to years of age, inclusive, eligible under

Section 1396a(a)(10)(A)(i)(VII) of Title of the United States Code, 133 percent of the federal poverty level. (

d) The department shall include individuals under years of age, or in the case of full-time students, under years of age, in the household for purposes of determining eligibility under

Section 1396a(e)(14) of Title of the United States Code, as added by the ACA. (

e) For purposes of this section, the following

definitions shall apply: (1) “ACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148) as originally enacted and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments. (2) “MAGI-based financial methods” means income calculated using the financial methodologies described in

Section 1396a(e)(14) of Title of the United States Code, and as added by the ACA. (

f) Notwithstanding

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this

section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. Thereafter, the department shall adopt regulations in accordance with the requirements of

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code. Beginning six months after the effective date of this section, and notwithstanding

Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis until regulations have been adopted. (

g) This

section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

Document details

CollectionCalifornia Statutes
CitationCal. WIC § 14005.64
Date2022-06-30
Typestatute
Languageen
SourceCA_STAT
IdentifierWIC14005.64.20224781
General Provisions | CaseLite