California Welfare and Institutions Code ARTICLE 1 - General Provisions

• Section 14000.
  The purpose of this chapter is to afford to qualifying individuals health care and related remedial or preventive services, including related social services which are...
• Section 14000.01.
  The department shall seek federal approval, if necessary, and shall issue all-plan letters or similar instructions to implement subdivision (d) of Section 1367.25 of the...
• Section 14000.03.
  (a) The Legislature finds and declares that Section 1396a(a)(11)(A) of Title 42 of the United States Code provides that California’s state plan for medical assistance under...
• Section 14000.05.
  The State Department of Health Services shall consider the special needs and requirements of rural hospitals in California that are financially distressed and in danger...
• Section 14000.1.
  It is the intent of the Legislature that health care services available under this chapter shall be at least equivalent to the level provided in...
• Section 14000.2.
  During the time this chapter is effective and notwithstanding other provisions of the Welfare and Institutions Code and Health and Safety Code, the board of...
• Section 14000.3.
  To the extent permitted by federal law, the director may enter into contracts with the Secretary of Health, Education, and Welfare to obtain or provide...
• Section 14000.4.
  This chapter shall be known and may be cited as the “Medi-Cal Act.”(Added by Stats. 1970, Ch. 1030.)
• Section 14000.5.
  On a regional pilot project basis, to the extent authorized by law, the director may enter into contracts with one or more nonprofit organizations to...
• Section 14000.7.
  (a) The department shall provide assistance to any applicant or beneficiary that requests help with the application or redetermination process to the extent required by federal...
• Section 14001.
  Health care as administered under this chapter shall be considered a component of public social services.(Amended by Stats. 1977, Ch. 1252.)
• Section 14001.1.
  It is the intention of the Legislature, whenever feasible, that the needs of categorically needy persons for health care and related remedial or preventive services...
• Section 14001.11.
  (a) The department shall implement the federal requirements described in Section 1396u-5 of Title 42 of the United States Code.(b) In each of the several counties of...
• Section 14002.
  Health care granted under the provisions of this chapter is held subject to the provisions of any law hereafter enacted amending, repealing, or supplementing in...
• Section 14002.5.
  For the purposes of this article, the following definitions shall apply:(a) “Annuity” means a contract that names an annuitant and gives a person or entity the...
• Section 14003.
  The Governor may enter into and execute in behalf of the state all necessary agreements in connection with this chapter as may be required by...
• Section 14004.
  If any individual in good faith adheres to the teachings of any bona fide church, sect, denomination, or organization, and in accordance with its principles...
• Section 14005.
  (a) The health care benefits and services specified in this chapter, to the extent that such services are neither provided under any other federal or state...
• Section 14005.1.
  Except for adults receiving aid pursuant to Chapter 2 (commencing with Section 11200) and for whom federal financial participation would not be obtainable for their...
• Section 14005.2.
  Unless otherwise specified in this chapter, the eligibility of a person eligible under the Cuban-Haitian Entrant Program or the Refugee Resettlement Program for health care...
• Section 14005.3.
  (a) Notwithstanding any other provision of this chapter, any person who: (1) Was once determined to be disabled in accordance with Section 1614 of Part A of...
• Section 14005.4.
  Unless otherwise specified in this chapter, the eligibility of a state-only Medi-Cal person for health care services under Section 14005 shall be determined by applying...
• Section 14005.5.
  (a) In determining eligibility pursuant to Section 14005.4 or 14005.7, reparation or restitution payments received by victims of the Nazi persecution from the Federal Republic of...
• Section 14005.6.
  (a) The Legislature finds and declares as follows:(1) Under federal law, minors living at home with their families may not be eligible for the SSI and Medicaid...
• Section 14005.60.a.
  (a) Commencing January 1, 2014, the department shall provide Medi-Cal benefits for individuals who meet eligibility requirements of Section 1902(a)(10)(A)(i)(VIII) of Title XIX of the federal...
• Section 14005.61.
  (a) Except as provided in subdivision (e), individuals who are enrolled in a Low Income Health Program (LIHP) as of December 31, 2013, under California’s Bridge...
• Section 14005.63.
  (a) A person who wishes to apply for an insurance affordability program shall be allowed to file an application on his or her own behalf or...
• Section 14005.64.
  (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,...
• Section 14005.65.
  (a) The department shall file a state plan amendment to exercise the federal option under subdivision (h) of Section 435.603 of Title 42 of the Code...
• Section 14005.66.
  The department shall seek any federal waivers necessary to use the eligibility information of individuals who have been determined eligible for the CalFresh program under...
• Section 14005.67.
  The department shall seek any federal waivers necessary to automatically enroll parents in the Medi-Cal program who apply for Medi-Cal benefits and have one or...
• Section 14005.68.
  The department may seek any federal waivers or state plan amendments necessary to use the eligibility information of individuals determined eligible for other state-only funded...
• Section 14005.7.
  (a) Medically needy persons and medically needy family persons are entitled to health care services under Section 14005 providing all eligibility criteria established pursuant to this...
• Section 14005.70.a.
  (a) The State Department of Health Care Services shall ensure that its contracts with a health care service plan or health insurer to provide Medi-Cal managed...
• Section 14005.73.
  A person who is otherwise eligible for Medi-Cal benefits under either Section 14005.4 or 14005.7, except for income and resource eligibility, and who is receiving...
• Section 14005.75.
  (a) The Legislature finds and declares all of the following:(1) As a result of federal welfare reform, unprecedented numbers of welfare recipients will be leaving welfare for...
• Section 14005.76.
  (a) The department shall provide a Medi-Cal beneficiary whose Medi-Cal eligibility is established pursuant to Section 1930 of the federal Social Security Act (42 U.S.C. Sec....
• Section 14005.8.
  (a) (1) To the extent required by Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code and regulations adopted...
• Section 14005.84.
  (a) The department shall develop and conduct a community outreach and education campaign to assist persons whose Medi-Cal eligibility is established pursuant to Section 1931 of...
• Section 14005.85.
  (a) Families who, because of marriage or because separated spouses reunite, lose AFDC eligibility under the chapter because the family no longer meets the need requirement...
• Section 14005.88.
  (a) The department shall contract for an independent evaluation, to be completed no later than January 1, 2001, in order to determine the effect of changes...
• Section 14005.89.
  (a) The department shall monitor participation rates for transitional Medi-Cal and seek input from beneficiaries, beneficiary representatives, and counties, on a regular basis throughout each year...
• Section 14005.9.
  (a) Share of cost shall be determined on a monthly basis. No person or family shall be required to incur more than one month’s share of...
• Section 14005.10.a.
  For purposes of facilitating arrangements for health care through prepaid health plans, the department may set standards for determining monthly income, for purposes of eligibility,...
• Section 14005.11.
  (a) To the extent required by federal law for qualified Medicare beneficiaries, the department shall pay the premiums, deductibles, and coinsurance for elderly and disabled persons...
• Section 14005.12.
  (a) For the purposes of Sections 14005.4 and 14005.7, the department shall establish the income levels for maintenance need at the lowest levels that reasonably permit...
• Section 14005.13.
  (a) Notwithstanding Section 14005.12, when an individual residing in a long-term care facility would incur a share of cost for services under this chapter due to...
• Section 14005.14.
  (a) In addition to the income exemptions specified in subdivision (a) of Section 14005.7, an income exemption shall be allowed each month for the amount actually...
• Section 14005.15.
  Notwithstanding the provisions of Section 14005, Medi-Cal beneficiaries shall obtain family planning services through the Medi-Cal program to the extent they are available through such...
• Section 14005.16.
  (a) In determining the eligibility of a married individual pursuant to Section 14005.4 or 14005.7, who resides in a nursing facility, and who is in a...
• Section 14005.17.
  (a) In determining the eligibility of an institutionalized spouse pursuant to Section 14005.4 or 14005.7, who resides in a medical institution or nursing facility, and who...
• Section 14005.18.
  A woman is eligible, to the extent required by federal law, as though she were pregnant, for all pregnancy-related and postpartum services for a 60-day...
• Section 14005.19.
  The receipt of respite care, as defined in Section 1418.1 of the Health and Safety Code, shall not affect the eligibility of any individual with...
• Section 14005.20.a.
  (a) The State Department of Health Care Services shall adopt the option made available under Section 1902(a)(10)(A)(ii)(XII) of Title XIX of the federal Social Security Act...
• Section 14005.21.
  (a) Any medically needy aged, blind, or disabled person who was categorically needy under this chapter on the basis of eligibility under Chapter 3 (commencing with...
• Section 14005.22.
  (a) A woman is eligible for Medi-Cal benefits under Section 1396a(a)(10)(A)(i)(III) of Title 42 of the United States Code if her income is less than or...
• Section 14005.225.
  (a) The department shall seek any state plan amendments or federal waivers necessary to provide pregnant women whose income is over 109 percent of, and is...
• Section 14005.23.
  To the extent federal financial participation is available, the department shall, when determining eligibility for children under Section 1396a(l)(1)(D) of Title 42 of the United...
• Section 14005.24.
  The department shall instruct counties, by means of an all county letter or similar instruction, as to the process that is to be used to...
• Section 14005.25.
  (a) To the extent federal financial participation is available, the department shall exercise the option under Section 1902(e)(12) of the federal Social Security Act (42 U.S.C....
• Section 14005.26.
  (a) (1) Except as provided in subdivision (b), the department shall exercise the option pursuant to Section 1902(a)(l0)(A)(ii)(XIV) of the federal Social Security Act (42 U.S.C. Sec....
• Section 14005.27.
  (a) Individuals enrolled in the Healthy Families Program pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code on June 27,...
• Section 14005.271.
  (a) The Healthy Families Advisory Board established by former Section 12693.90 of the Insurance Code is hereby renamed the Medi-Cal Children’s Health Advisory Panel.(b) The Medi-Cal Children’s...
• Section 14005.275.
  The department shall ensure coordination of covered services across all delivery systems of care in order to minimize disruption in services for children transitioning from...
• Section 14005.276.
  (a) By October 1, 2017, the department shall report to the Legislature on progress towards the goal of raising the Denti-Cal utilization rate among eligible child...
• Section 14005.277.
  In order to assist the California Health Benefit Exchange, established pursuant to Title 22 (commencing with Section 100500) of the Government Code, to conduct outreach...
• Section 14005.28.
  (a) To the extent federal financial participation is available pursuant to an approved state plan amendment, the department shall implement Section 1902(a)(10)(A)(i)(IX) of the federal Social...
• Section 14005.285.
  (a) To the extent federal financial participation is available pursuant to an approved state plan amendment, the department shall exercise its option under Section 1902(a)(10)(A)(ii)(XVII) of...
• Section 14005.287.
  (a) To the extent federal financial participation is available pursuant to an approved state plan amendment, the department shall exercise its option under Section 1902(a)(10)(A)(ii)(I) of...
• Section 14005.288.
  (a) To the extent federal financial participation is available pursuant to an approved state plan amendment, the department shall exercise its option under Section 1902(a)(10)(A)(ii)(VIII) of...
• Section 14005.29.
  To the extent that federal matching funds are available, disabled persons who are otherwise eligible for benefits under this chapter, except for income due to...
• Section 14005.30.a.
  (a) Medi-Cal benefits under this chapter shall be provided to individuals eligible for services under Section 1396u-1 of Title 42 of the United States Code with...
• Section 14005.31.
  (a) (1) Subject to paragraph (2), for any person whose eligibility for benefits under Section 14005.30 has been determined with a concurrent determination of eligibility for cash...
• Section 14005.32.
  (a) (1) If the county has evidence clearly demonstrating that a beneficiary is not eligible for benefits under this chapter pursuant to Section 14005.30, but is eligible...
• Section 14005.33.
  (a) If a Medi-Cal beneficiary’s Medi-Cal eligibility worker is changed, notice shall be sent to the beneficiary within 10 days of the change. This notice shall...
• Section 14005.34.
  (a) For an individual whose cash aid was terminated pursuant to Chapter 2 (commencing with Section 11200), but whose Medi-Cal eligibility was continued either pursuant to...
• Section 14005.35.
  The department, in consultation with the counties and representatives of consumers, managed care plans, and Medi-Cal providers, shall study the feasibility of adopting a mechanism...
• Section 14005.36.
  (a) The county shall undertake outreach efforts to beneficiaries receiving benefits under this chapter, in order to maintain the most up-to-date home addresses, telephone numbers, and...
• Section 14005.37.
  (a) Except as provided in Section 14005.39, a county shall perform redeterminations of eligibility for Medi-Cal beneficiaries every 12 months and shall promptly redetermine eligibility whenever...
• Section 14005.39.
  (a) If a county has facts clearly demonstrating that a Medi-Cal beneficiary cannot be eligible for Medi-Cal due to an event, such as death or change...
• Section 14005.40.a.
  (a) To the extent federal financial participation is available, the department shall exercise its option under Section 1902(a)(10)(A)(ii)(X) of the federal Social Security Act (42 U.S.C....
• Section 14005.41.
  (a) Notwithstanding any other provision of law, the department shall deem to have met the income documentation requirements for participation in the Medi-Cal program, without a...
• Section 14005.42.
  (a) The department shall provide full-scope benefits under this chapter, without share of cost, to all individuals on behalf of whom kinship guardians are receiving aid...
• Section 14005.50.a.
  (a) To the extent that federal financial participation is available, the department shall exercise the option made available under Section 1902(a)(10)(A)(ii)(I) of the federal Social Security...
• Section 14006.
  (a) This section applies to medically needy persons, medically needy family persons, and state-only Medi-Cal persons.(b) For the purposes of this section, the term “principal residence” means...
• Section 14006.01.
  (a) This section applies to any individual who is residing in a continuing care retirement community, as defined in paragraph (11) of subdivision (c) of Section...
• Section 14006.1.
  (a) The State Director of Health Services shall adopt emergency regulations pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of...
• Section 14006.15.
  (a) For the purposes of this section, “equity interest” means the lesser of the following:(1) The assessed value of the principal residence determined under the most...
• Section 14006.2.
  (a) In determining the eligibility of a married individual, pursuant to Section 14005.4 or 14005.7, who, in accordance with Title XIX of the federal Social Security...
• Section 14006.3.
  The department, at the time of application or the assessment pursuant to Section 14006.6, and any nursing facility enrolled as a provider in the Medi-Cal...
• Section 14006.4.
  (a) The statement required by Sections 14006.2 and 14006.3 shall be in the following form:“NOTICE REGARDING STANDARDS FOR MEDI-CAL ELIGIBILITYIf you or your spouse is in...
• Section 14006.41.
  (a) To be eligible for medical assistance for home and facility care, an individual shall disclose at the time of the individual’s application or redetermination a...
• Section 14006.5.
  The department shall include training regarding the treatment of separate and community income and resources in determining eligibility for Medi-Cal benefits, as part of the...
• Section 14006.6.
  (a) To the extent required by Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) and regulations adopted pursuant thereto, upon...
• Section 14006.7.
  (a) At the time of application for Medi-Cal benefits, the department shall provide to any applicant who is aged, blind, or disabled, other than an individual...
• Section 14007.
  No period of residence in this state shall be required as a condition of eligibility under this chapter, but an individual who does not reside...
• Section 14007.1.
  (a) The department shall electronically verify an individual’s state residency using information from the federal Supplemental Nutrition Assistance Program, the CalWORKs program, the California Health Benefit...
• Section 14007.15.
  (a) Except as provided in subdivision (f), an individual is a resident of this state if he or she is 21 years of age or older,...
• Section 14007.2.
  (a) Any individual who is otherwise eligible for Medi-Cal services, but who does not meet the documentation requirements described in subdivision (e) of Section 14011.2, shall...
• Section 14007.4.
  Any children under the jurisdiction of the county welfare department, who are dependent children in relative placement, foster home placement, or group home placement, and...
• Section 14007.45.
  (a) To the extent federal financial participation is available, the department shall exercise the option provided in Section 1920A of the federal Social Security Act (42...
• Section 14007.5.
  (a) Aliens shall be eligible for Medi-Cal, whether federally funded or state-funded, only to the same extent as permitted under federal law and regulations for receipt...
• Section 14007.6.
  (a) A recipient who maintains a residence outside of this state for a period of at least two months shall not be eligible for services under...
• Section 14007.65.
  (a) Aliens who were receiving long-term care services under the authority of subdivision (f) of Section 1 of Chapter 1441 of the Statutes of 1988 on...
• Section 14007.7.
  Any alien who is otherwise eligible for Medi-Cal services, but who does not meet the requirements under subdivision (b) or (c) of Section 14007.5, shall...
• Section 14007.705.
  (a) Through its courts and statutes, and under its Constitution, California protects a woman’s right to reproductive privacy. California reaffirms these protections and specifically its Supreme...
• Section 14007.71.
  (a) The department shall adopt the option made available under Section 1396a(a)(10)(A)(ii)(XVIII) of Title 42 of the United States Code, to provide medical assistance during the...
• Section 14007.8.
  (a) (1) After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of this section,...
• Section 14007.9.
  (a) The department shall adopt the option made available under Section 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(ii)(XIII)). In order to be...
• Section 14007.9.a.
  (a) (1) The department shall adopt the option made available under Section 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(ii)(XIII)). In order to be...
• Section 14007.95.
  The department shall report to the Governor and the Legislature any information the department gathers from the California Health Improvement Project, or from any other...
• Section 14008.
  (a) No relative, other than the spouse, shall be held to be financially responsible for the cost of health care received by an adult eligible under...
• Section 14008.6.
  (a) As a condition of eligibility for medical services provided under this chapter or Chapter 8 (commencing with Section 14200), each applicant or beneficiary shall do...
• Section 14008.7.
  If the applicant or beneficiary does not cooperate in the manner described in subdivisions (b) and (c) of Section 14008.6 to establish paternity and medical...
• Section 14009.
  (a) Any applicant for, or beneficiary of Medi-Cal, or person acting on behalf of an applicant or beneficiary shall be informed as to the provisions of...
• Section 14009.5.
  (a) It is the intent of the Legislature, with the amendments made to this section by the act that added subdivision (g), to do all of...
• Section 14009.6.
  (a) As a result of providing medical assistance for home and facility care to an individual, the state shall, by operation of law, become a remainder...
• Section 14009.7.
  (a) If an annuity is considered part or all of the community spouse resource allowance allowed under subdivision (c) of Section 14006, the state shall only...
• Section 14010.
  (a) Notwithstanding any other provision of law, the parent or parents of a person under 21 years of age shall not be held financially responsible, nor...
• Section 14011.
  (a) Each applicant who is not a recipient of aid under the provisions of Chapter 2 (commencing with Section 11200) or Chapter 3 (commencing with Section...
• Section 14011.1.
  (a) The department shall, not later than July 1, 1998, create and implement a simplified application package for the following Medi-Cal applicants, as described under Section...
• Section 14011.10.a.
  (a) Except as provided in Sections 14053.7 and 14053.8, benefits provided under this chapter to an individual who is an inmate of a public institution shall...
• Section 14011.15.
  (a) The department shall, not later than July 1, 2000, create and implement a simplified application package for children, families, and adults applying for Medi-Cal benefits....
• Section 14011.2.
  (a) The department shall require that each applicant for or beneficiary of Medi-Cal, including a child, who is not a recipient of aid under the provisions...
• Section 14011.25.
  To the extent federal financial participation is available, the department shall take all steps necessary to comply with the terms and conditions of the State...
• Section 14011.3.
  (a) To the same extent as required by federal law, an alien whose entry into the United States has been sponsored by an individual who, or...
• Section 14011.4.
  The department shall, subject to the requirements of federal law, and not later than six months after the effective date of this section, develop a...
• Section 14011.5.
  The department shall be responsible for establishing the necessary systems for the identification, review and approval, disbursement, and reimbursement systems for those health services provided...
• Section 14011.6.
  (a) To the extent federal financial participation is available, the department shall exercise the option provided in Section 1920a of the federal Social Security Act (42...
• Section 14011.65.
  (a) To the extent allowed under federal law and only if federal financial participation is available under Title XXI of the Social Security Act (42 U.S.C....
• Section 14011.65a.
  (a) To the extent allowed under federal law under Title XIX (42) U.S.C. 1396 et seq.) and Title XXI (42 U.S.C. 1397aa et seq.) of the...
• Section 14011.65b.
  (a) To the extent federal financial participation is available, the department shall exercise the option provided in Section 1920a of the federal Social Security Act (42...
• Section 14011.66.
  (a) Effective January 1, 2014, the department shall provide Medi-Cal benefits during a presumptive eligibility period to individuals who have been determined eligible on the basis...
• Section 14011.7.
  (a) To the extent allowed under federal law and only if federal financial participation is available, the department shall exercise the option provided in Section 1396r-1a...
• Section 14011.75.
  (a) The department shall conduct, or contract for the conducting of, a feasibility study report of technological requirements for modifying the electronic application authorized pursuant to...
• Section 14011.78.
  (a) The department may contract with public or private entities, or utilize existing health care service provider payment mechanisms, including the Medi-Cal program’s fiscal intermediary, in...
• Section 14011.8.
  (a) Benefits provided to an individual pursuant to a preliminary determination as described in Section 1396r-1, 1396r-1a, or 1396r-1b of Title 42 of the United States...
• Section 14011.9.
  (a) On or before October 1, 2002, the department shall issue instructions to counties via an all-county letter or similar instructions to establish an automated system...
• Section 14012.5.
  (a) By July 1, 2007, the department shall implement a process that allows applicants and beneficiaries to self-certify the amount and nature of assets and income...
• Section 14013.
  The department shall establish a system for investigation of a sufficient sample of applications and affirmations as shall be deemed necessary to assure the validity...
• Section 14013.3.
  (a) When determining whether an individual is eligible for Medi-Cal benefits, the department shall verify the accuracy of the information identified in this section that is...
• Section 14013.5.
  (a) Pursuant to, and only to the extent required by, Section 1940 of the federal Social Security Act (42 U.S.C. Sec. 1396w) and subject to the...
• Section 14014.
  (a) Any person receiving health care for which he or she was not eligible on the basis of false declarations as to his or her eligibility...
• Section 14014.5.
  (a) It is the intent of the Legislature to protect individual privacy and the integrity of Medi-Cal and other insurance affordability programs by restricting the disclosure...
• Section 14015.
  (a) (1) The providing of health care under this chapter shall not impose any limitation or restriction upon the person’s right to sell, exchange or change the...
• Section 14015.1.
  (a) The department shall consider, at initial application or redetermination, whether an undue hardship, as described in subdivision (b), exists prior to finding that an applicant...
• Section 14015.12.
  (a) For the purposes of this section, the following definitions shall apply:(1) “Opposite-sex spouse” means a person of the opposite sex who is legally married to an...
• Section 14015.2.
  (a) In accordance with Section 1917(c)(2)(D) of the federal Social Security Act (42 U.S.C. Sec. 1396p(c)(2)(D)), any of the following may request a fair hearing on...
• Section 14015.5.
  (a) Notwithstanding any other state law, the department shall retain or delegate the authority to perform Medi-Cal eligibility determinations as set forth in this section.(b) If after...
• Section 14015.7.
  (a) (1) Notwithstanding any other provision of law, for persons who call the customer service center operated by the Exchange for the purpose of applying for an...
• Section 14015.8.
  (a) The department, any other government agency that is determining eligibility for, or enrollment in, the Medi-Cal program or any other program administered by the department,...
• Section 14016.
  (a) The county in which the person resides, except as specified in subdivision (d), shall determine the eligibility of each person pursuant to Sections 14005.1, 14005.4,...
• Section 14016.1.
  If a patient at a health facility operated by the county either directly or through contract is received in a comatose condition or suffering from...
• Section 14016.2.
  If a person who is incapable of acting on his own behalf and who would otherwise be eligible is discontinued from Medi-Cal eligibility because the...
• Section 14016.3.
  The department shall provide technical assistance to counties in order to maximize the identification of private health care coverage as defined by Section 10020. A...
• Section 14016.4.
  The department may enter into an agreement with a county to have the county detect and recover the value of any Medi-Cal benefits which have...
• Section 14016.5.
  (a) At the time of determining or redetermining the eligibility of a Medi-Cal program or Aid to Families with Dependent Children (AFDC) program applicant or beneficiary...
• Section 14016.51.
  Upon the availability of federal funding, the department shall modify the Medi-Cal program mail-in application form, and other appropriate materials, and the single point-of-entry application...
• Section 14016.55.
  (a) It is the intent of the Legislature that Medi-Cal beneficiaries who are required to enroll in a Medi-Cal managed care health plan make an informed...
• Section 14016.6.
  The State Department of Health Care Services shall develop a program to implement subdivision (p) of Section 14016.5 and to provide information and assistance to...
• Section 14016.7.
  (a) Managed care contracts entered into by the department under the act adding this section shall include all of the following: (1) Contractor requirements concerning eligibility and...
• Section 14016.8.
  (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a fundamental...
• Section 14016.9.
  Where determined to be cost effective, the department shall utilize the earnings clearance system to verify the eligibility of persons who have applied for or...
• Section 14016.10.a.
  The department shall implement the federal requirement under Section 4603 of the Omnibus Budget Reconciliation Act of 1990 (P.L. 101–508) which provides for the continuity...
• Section 14017.
  On a regional pilot project basis, the department may issue an identification card to a person eligible for Medi-Cal program benefits under Section 14005.1, 14005.4,...
• Section 14017.1.
  The Joint Legislative Audit Committee shall conduct an audit of one or more county eligibility departments.(Amended by Stats. 2001, Ch. 745, Sec. 247. Effective October...
• Section 14017.5.
  The department shall not issue identification cards to Medi-Cal recipients on a statewide basis until (1) a pilot project has been completed which indicates that...
• Section 14017.6.
  For the purposes of this chapter, all references to “the Medi-Cal card,” identified in Section 14017.8, shall be deemed to also be a reference to...
• Section 14017.7.
  (a) In addition to the issuance of Medi-Cal cards, pursuant to Section 14017.8, the department may issue a benefits identification card for the purpose of identifying...
• Section 14017.8.
  Each person eligible under Section 14005.1 and each person eligible under Section 14005.4 or 14005.7 who is certified eligible shall be provided, by the department,...
• Section 14018.
  (a) (1) The Medi-Cal card shall be authorization for payment for health care services rendered, during and subsequent to the month of application of a person eligible...
• Section 14018.1.
  The department shall prospectively notify a Medi-Cal managed care plan of the date of the regularly scheduled annual redetermination of a Medi-Cal beneficiary in a...
• Section 14018.2.
  (a) Reimbursement shall not be denied to any qualified health care provider for care rendered to an eligible Medi-Cal beneficiary for the sole reason that a...
• Section 14018.4.
  (a) Reimbursement shall not be denied to any hospital, licensed primary care clinic, or long-term health care facility as defined in Section 1326 of the Health...
• Section 14018.5.
  Notwithstanding any other provision of law, Section 3275 of the Civil Code does not apply to Medi-Cal reimbursement or prior authorization.(Added by Stats. 1999, Ch....
• Section 14018.7.
  (a) Notwithstanding any other provision of law, neither a member of the governing body of the commission nor a member of any advisory panel to the...
• Section 14019.
  Notwithstanding the provisions of Section 14018, except as provided in Sections 14019.1 and 14019.6, a Medi-Cal card shall be authorization for payment for health care...
• Section 14019.3.
  (a) A beneficiary or any person on behalf of a beneficiary who has paid for medically necessary health care services, otherwise covered by the Medi-Cal program,...
• Section 14019.4.
  (a) A provider of health care services who obtains a label or copy from the Medi-Cal card or other proof of eligibility pursuant to this chapter...
• Section 14019.5.
  Nothing in this chapter shall be construed as imposing any control over the management of any medical or health care facility, except that each such...
• Section 14019.6.
  Notwithstanding any other provision of law, no person, whose property reserve exceeds the property limit, may establish eligibility for any of the three months immediately...
• Section 14019.7.
  (a) Notwithstanding Section 14019.4 and if permitted by federal law, a relative of a skilled nursing facility resident who is a beneficiary under this chapter may...
• Section 14020.
  All sections of this chapter shall remain in operation during such times as grants-in-aid are provided or made available to the state on the basis...
• Section 14021.
  Notwithstanding any other provision of this chapter, health care shall include the following mental health and substance use disorder services:(a) Mental health services provided by a...
• Section 14021.2.
  (a) The department shall develop a proposal for the United States Secretary of Health and Human Services for selection as a participating state in the time-limited...
• Section 14021.3.
  The state plan for medical assistance under Medicaid pursuant to Section 1915(g) of Title 19 of the federal Social Security Act, as amended by Public...
• Section 14021.30.a.
  (a) It is the intent of the Legislature to transfer to the State Department of Health Care Services, no later than July 1, 2012, the administration...
• Section 14021.31.
  The department, in collaboration with the State Department of Alcohol and Drug Programs, shall develop an administrative and programmatic transition plan to guide the transfer...
• Section 14021.33.
  A regulation or order concerning the Drug Medi-Cal Treatment Program adopted by the State Department of Alcohol and Drug Programs pursuant to former Chapter 3.4...
• Section 14021.35.
  (a) The department shall prepare and submit amendments to the Medicaid state plan and apply for any necessary waivers in order to obtain federal financial participation...
• Section 14021.4.
  (a) California’s plan for federal Medi-Cal grants for medical assistance programs, pursuant to Subchapter XIX (commencing with Section 1396) of Title 42 of the United States...
• Section 14021.5.
  (a) Notwithstanding any other provision of law, rates for reimbursing specialty mental health and substance use disorder services allowable under the Medi-Cal program and rendered to...
• Section 14021.51.
  (a) For purposes of this chapter, “LAAM” means levoalphacetylmethadol.(b) (1) The department shall establish a narcotic replacement therapy dosing fee for methadone and LAAM.(2) In addition to the narcotic...
• Section 14021.52.
  (a) (1) The Legislature finds and declares all of the following:(A) Medical treatment for indigent patients who are not eligible for Medi-Cal is essential to protecting the public...
• Section 14021.53.
  A narcotic treatment program provider may use the following instructions and financial evaluation form to comply with the requirements of paragraph (4) of subdivision (c)...
• Section 14021.6.
  (a) For the fiscal years prior to fiscal year 2004–05, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal...
• Section 14021.7.
  (a) The department shall amend the state plan for medical assistance under the Medicaid program pursuant to subdivision (g) of Section 1396n of Title 42 of...
• Section 14021.8.
  The department may not utilize any information regarding whether a beneficiary’s psychiatric inpatient admission was made on a voluntary or involuntary basis for the purpose...
• Section 14021.9.
  (a) Notwithstanding any other law, for the 2009–10 fiscal year, a 10-percent reduction shall be applied to rates for Drug Medi-Cal services developed by the State...
• Section 14022.
  (a) This section shall be known as the “Medi-Cal Conflict of Interest Law.”It is the intent of the Legislature that provisions be made for disclosure of...
• Section 14022.1.
  Any nursing facility or any category of intermediate care facility for the developmentally disabled participating in the Medi-Cal program shall supply to the department full...
• Section 14022.3.
  Long-term health care facilities shall reveal to applicants for admission, or their designated representatives, orally and in writing and prior to admission, whether the facility...
• Section 14022.4.
  (a) Any nursing facility or any category of intermediate care facility for the developmentally disabled currently certified to participate in the Medi-Cal program may not voluntarily...
• Section 14022.5.
  (a) It is the intent of the Legislature to recognize the challenges and unique dental treatment needs of the developmentally disabled population that cannot be addressed...
• Section 14023.
  (a) Any applicant for coverage under this chapter who at the time of application has any other contractual or legal entitlement to any health care service...
• Section 14023.7.
  Any provider of service seeking payment for health care services for a person eligible for these services under this chapter shall first seek to obtain...
• Section 14024.
  When health care services are provided to a person under this chapter who at the time the service is provided has any other contractual or...
• Section 14025.
  (a) Any person who buys or sells a Medi-Cal card, Medi-Cal label, or Medi-Cal beneficiary identification number is guilty of a public offense punishable by imprisonment...
• Section 14026.
  (a) It is a misdemeanor for a Medi-Cal beneficiary to furnish, give, or lend his Medi-Cal card or labels to any person other than a provider...
• Section 14026.5.
  (a) The State Director of Health Services may issue Medi-Cal cards to Medi-Cal fraud investigators for the purpose of conducting investigations of Medi-Cal fraud, or a...
• Section 14027.
  (a) The department may designate participating county health service agencies as health care service providers of home nursing services, subject to appropriate statutory licensing and certification...
• Section 14028.
  (a) (1) In order to ensure appropriate oversight of psychotropic medications prescribed for children, pursuant to Section 2245 of the Business and Professions Code, the department and...
• Section 14029.
  Whenever a request for services authorized pursuant to subdivision (s), (t), or (v) of Section 14132 is made to the department for a child who...
• Section 14029.5.
  (a) (1) Commencing January 1, 2008, immediately following the issuance of an order of the juvenile court, pertaining to the disposition of a ward of the county,...
• Section 14029.8.
  Section 124260 of the Health and Safety Code shall not apply to the receipt of benefits under the Medi-Cal program.(Added by Stats. 2010, Ch. 503,...
• Section 14029.91.
  (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal...
• Section 14029.92.
  (a) The department shall notify Medi-Cal beneficiaries, prospective beneficiaries, and members of the public of all of the following information:(1) The availability of language assistance services, including...
• Section 14040.
  (a) Each contract for fiscal intermediary services shall allow, to the extent practicable, providers to utilize electronic means for transmitting claims to the fiscal intermediary contractor....
• Section 14040.1.
  (a) “Billing agent” or “billing agent of the provider” means any individual, partnership, group, association, corporation, institution, or entity, and the officers, directors, owners, managing employees,...
• Section 14040.5.
  (a) A provider may, by written contract, do either of the following:(1) Authorize a billing agent to submit claims, including electronic claims, on behalf of the provider...
• Section 14041.
  (a) The director shall develop and implement standards for the timely processing and payment of each claim type. The standards shall be sufficient to meet minimal...
• Section 14041.1.
  (a) Notwithstanding any other provision of law, and to the extent not otherwise conflicting with federal law, the department may hold for a period of one...
• Section 14041.5.
  (a) The department shall develop, disseminate, and update, on a periodic basis, claims preparation and processing software programs that may be used on computers at individual...
• Section 14042.
  Each contract for fiscal intermediary services shall provide for an automated system for verifying the eligibility of Medi-Cal recipients. The automated eligibility verification system shall...
• Section 14042.1.
  (a) No earlier than January 1, 2018, the State Department of Health Care Services shall establish a Medically Tailored Meals Pilot Program to operate for a...
• Section 14043.1.
  (a) The Legislature finds and declares the following:(1) The Medi-Cal Managed Care Ombudsman helps resolve issues between Medi-Cal managed care members and health plans, assists members with...

Last modified: October 22, 2018