10200. (a) (1) The State Department of Health Care Services and the
State Department of Social Services shall develop a statewide
eligibility and enrollment determination process for the California
Work Opportunity and Responsibility to Kids (CalWORKs) program, the
Medi-Cal program, and the Supplemental Nutrition Assistance Program
(SNAP), in accordance with this part. It is the intent of the
Legislature that the development of this process shall achieve all of
the following outcomes:
(A) Facilitate better access to services and aid for eligible
clients.
(B) Lower the costs of enrolling persons into CalWORKs, Medi-Cal,
and SNAP without reducing access.
(C) Improve consistency of eligibility determination and
enrollment approach and processes statewide.
(D) Create an efficient process that eliminates redundancies and
inefficiencies.
(E) Employ state-of-the-art technology to improve efficiency of
the eligibility determination process.
(F) Minimize the number of technology systems that the state shall
support in preforming the eligibility process.
(2) The development of the statewide eligibility and enrollment
determination process and the comprehensive plan required in
subdivision (b) shall be accomplished in consultation with a
stakeholder steering committee established pursuant to subdivision
(h).
(b) The State Department of Health Care Services and the State
Department of Social Services shall develop a comprehensive plan,
which shall include, at a minimum, all of the following components:
(1) Project description.
(2) Business case.
(3) Business and technical requirements.
(4) Cost benefit analysis, including all aspects as traditionally
provided in a feasibility study report for information technology
projects, including, but not limited to, the following components:
(A) An analysis of the benefits and drawbacks of procuring a new
statewide eligibility and enrollment determination process and
contracting out eligibility functions as compared to building upon
existing enrollment and eligibility determination systems.
(B) An assessment of risks, including an analysis of other states
in automating and contracting out centralized eligibility
determinations and the state's history and experience in other
procurement efforts.
(C) An analysis of the state and local staffing and costs, and any
program impacts resulting from any new statewide eligibility and
enrollment system.
(5) Project timelines, including key milestones.
(6) Recommendations of other health or social services programs
that should be added to the process, if any.
(7) Description of any federal waivers and any state statutory
changes that may be needed for full, phased-in implementation of the
process.
(8) Project budget, including necessary budget proposal documents.
(9) Competitive procurement strategy and process.
(10) Transition plan for phasing in any new statewide eligibility
and enrollment system.
(11) Strategy to inform the public and beneficiaries of any new
statewide eligibility and enrollment system.
(12) Description of stakeholder steering committee involvement in
the development of the comprehensive plan.
(c) The State Department of Health Care Services and the State
Department of Social Services may utilize a contractor to develop and
complete the comprehensive plan as specified.
(d) The State Department of Health Care Services and the State
Department of Social Services shall submit the comprehensive plan to
the fiscal and applicable policy committees of the Legislature,
including the Joint Legislative Budget Committee, at least 45 days
prior to a request for an appropriation.
(e) Contingent upon legislative approval of the comprehensive plan
and an appropriation for this purpose, the State Department of
Health Care Services and the State Department of Social Services may
proceed with procurement activities consistent with the approved
plan, including any request for proposals being issued and the
utilization of a performance-based contract model, or subsequent
process as identified in the comprehensive plan, to implement a
statewide eligibility and enrollment determination process. Any
contractor, county consortia, nonprofit providers, or any
partnerships shall be authorized to compete for any aspect of this
process. At a minimum, an entity shall be required to comply with all
of the following requirements:
(1) Make accurate determinations and redeterminations of
eligibility for CalWORKs, Medi-Cal, and SNAP.
(2) Coordinate with community-based organizations to assist
individuals with the application process, in various languages, as
specified by the State Department of Health Care Services and the
State Department of Social Services and as required in state and
federal law and regulation.
(3) Represent the departments as applicable in fair hearings
arising out of eligibility determinations and redeterminations.
(4) Assist applicants and recipients requiring assistance for
program eligibility, enrollment, and redeterminations for enrollment.
(5) Applicable state and federal technology standards, inclusive
of the alignment with Medicaid Information Technology Architecture
requirements or applicable successor framework promulgated by the
federal Centers for Medicare and Medicaid Services.
(6) Applicable privacy and security requirements, including, but
not limited to, the protection of personal health information, as
defined by applicable federal and state regulations.
(7) Rules and regulations governing the federal Health Insurance
Portability and Accountability Act (HIPAA; Public Law 104-191).
(8) State and federal disability accessibility laws and standards,
including Section 508 of the federal Rehabilitation Act as
referenced in Section 11135 of the Government Code and the
Information Organization, Usability, Currency, and Accessibility
Working Group accessibility recommendations from the Office of the
Chief Information Officer.
(f) Contingent on the Legislature's approval of the comprehensive
plan and an appropriation for this purpose, pursuant to subdivision
(e), the State Department of Health Care Services and the State
Department of Social Services shall have the authority necessary to
implement this part, including the authority to enter into contract
amendments, change orders, or change requests and project or system
development notices as consistent with the approved plan.
(g) The State Department of Health Care Services and the State
Department of Social Services may contract with another state
department or agency for project management services of any statewide
enrollment process developed or enhanced as a result of the
comprehensive plan developed in accordance with subdivision (b).
(h) (1) The State Department of Health Care Services and the State
Department of Social Services shall convene a stakeholder steering
committee for consultation in the development of the statewide
eligibility and enrollment determination process and comprehensive
plan. As appropriate, subcommittees may be formed to facilitate work
product development and outcomes. The stakeholder steering committee
shall include representatives of advocacy organizations representing
clients and consumers, county employees, county human services
agencies, the California State Association of Counties, and
legislative staff. Other representatives may be included as deemed
appropriate by the State Department of Health Care Services and the
State Department of Social Services. At a minimum, the stakeholder
steering committee shall advise on all of the following matters:
(A) Program eligibility and enrollment simplifications without
increasing program costs.
(B) Revisions to program applications and procedures for making
eligibility and enrollment determinations, including notices of
action and other forms processing.
(C) Development of new processes and procedures for making
eligibility determinations and for enrolling eligible individuals.
(D) Beneficiary needs to ensure access to services and transition
to any new system.
(E) Development of a public outreach campaign to inform people of
any new system.
(F) Other issues as applicable for the development of the
implementation plan and any ongoing efforts.
(2) The stakeholder steering committee shall remain in place to
advise on any issues regarding the implementation of any new or
revised statewide eligibility and enrollment determination process
for the CalWORKs program, the Medi-Cal program, and SNAP.
(i) This part shall be implemented only if, and to the extent
that, federal financial participation is available for this purpose.
(j) The State Department of Health Care Services and the State
Department of Social Services may seek a federal waiver or waivers
and state plan amendments to the extent necessary to implement the
eligibility determination process as specified in the approved
implementation plan.
10202. Notwithstanding any other law, this part is not to be
construed to change, or in any manner modify, eligibility for the
CalWORKs program, the Medi-Cal program, or Supplemental Nutrition
Assistance Program (SNAP).
10203. Contingent on the Legislature's approval of the
comprehensive plan required pursuant to subdivision (b) of Section
10200 and an appropriation for this purpose, pursuant to subdivision
(e) of Section 10200, and notwithstanding Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the State Department of Health Care Services and the
State Department of Social Services may implement this part by means
of all-county letters or similar instructions without taking
regulatory action. As an alternative to, or in addition to, that
implementation, the departments shall have emergency regulation
authority, as needed, to implement the system authorized under this
section.
10205. Contingent on the Legislature's approval of the
comprehensive plan required pursuant to subdivision (b) of Section
10200 and an appropriation for this purpose, pursuant to subdivision
(e) of Section 10200, and upon implementation of the process provided
for in this part, and to the extent necessary to achieve the
purposes of this part, references in this division to the county or
the county welfare department for purposes of the administration of
enrollment and eligibility determination for the CalWORKs program,
Medi-Cal program, or SNAP shall mean the State Department of Health
Care Services or the State Department of Social Services, as
applicable.
10200. (a) (1) The State Department of Health Care Services and the
State Department of Social Services shall develop a statewide
eligibility and enrollment determination process for the California
Work Opportunity and Responsibility to Kids (CalWORKs) program, the
Medi-Cal program, and the Supplemental Nutrition Assistance Program
(SNAP), in accordance with this part. It is the intent of the
Legislature that the development of this process shall achieve all of
the following outcomes:
(A) Facilitate better access to services and aid for eligible
clients.
(B) Lower the costs of enrolling persons into CalWORKs, Medi-Cal,
and SNAP without reducing access.
(C) Improve consistency of eligibility determination and
enrollment approach and processes statewide.
(D) Create an efficient process that eliminates redundancies and
inefficiencies.
(E) Employ state-of-the-art technology to improve efficiency of
the eligibility determination process.
(F) Minimize the number of technology systems that the state shall
support in preforming the eligibility process.
(2) The development of the statewide eligibility and enrollment
determination process and the comprehensive plan required in
subdivision (b) shall be accomplished in consultation with a
stakeholder steering committee established pursuant to subdivision
(h).
(b) The State Department of Health Care Services and the State
Department of Social Services shall develop a comprehensive plan,
which shall include, at a minimum, all of the following components:
(1) Project description.
(2) Business case.
(3) Business and technical requirements.
(4) Cost benefit analysis, including all aspects as traditionally
provided in a feasibility study report for information technology
projects, including, but not limited to, the following components:
(A) An analysis of the benefits and drawbacks of procuring a new
statewide eligibility and enrollment determination process and
contracting out eligibility functions as compared to building upon
existing enrollment and eligibility determination systems.
(B) An assessment of risks, including an analysis of other states
in automating and contracting out centralized eligibility
determinations and the state's history and experience in other
procurement efforts.
(C) An analysis of the state and local staffing and costs, and any
program impacts resulting from any new statewide eligibility and
enrollment system.
(5) Project timelines, including key milestones.
(6) Recommendations of other health or social services programs
that should be added to the process, if any.
(7) Description of any federal waivers and any state statutory
changes that may be needed for full, phased-in implementation of the
process.
(8) Project budget, including necessary budget proposal documents.
(9) Competitive procurement strategy and process.
(10) Transition plan for phasing in any new statewide eligibility
and enrollment system.
(11) Strategy to inform the public and beneficiaries of any new
statewide eligibility and enrollment system.
(12) Description of stakeholder steering committee involvement in
the development of the comprehensive plan.
(c) The State Department of Health Care Services and the State
Department of Social Services may utilize a contractor to develop and
complete the comprehensive plan as specified.
(d) The State Department of Health Care Services and the State
Department of Social Services shall submit the comprehensive plan to
the fiscal and applicable policy committees of the Legislature,
including the Joint Legislative Budget Committee, at least 45 days
prior to a request for an appropriation.
(e) Contingent upon legislative approval of the comprehensive plan
and an appropriation for this purpose, the State Department of
Health Care Services and the State Department of Social Services may
proceed with procurement activities consistent with the approved
plan, including any request for proposals being issued and the
utilization of a performance-based contract model, or subsequent
process as identified in the comprehensive plan, to implement a
statewide eligibility and enrollment determination process. Any
contractor, county consortia, nonprofit providers, or any
partnerships shall be authorized to compete for any aspect of this
process. At a minimum, an entity shall be required to comply with all
of the following requirements:
(1) Make accurate determinations and redeterminations of
eligibility for CalWORKs, Medi-Cal, and SNAP.
(2) Coordinate with community-based organizations to assist
individuals with the application process, in various languages, as
specified by the State Department of Health Care Services and the
State Department of Social Services and as required in state and
federal law and regulation.
(3) Represent the departments as applicable in fair hearings
arising out of eligibility determinations and redeterminations.
(4) Assist applicants and recipients requiring assistance for
program eligibility, enrollment, and redeterminations for enrollment.
(5) Applicable state and federal technology standards, inclusive
of the alignment with Medicaid Information Technology Architecture
requirements or applicable successor framework promulgated by the
federal Centers for Medicare and Medicaid Services.
(6) Applicable privacy and security requirements, including, but
not limited to, the protection of personal health information, as
defined by applicable federal and state regulations.
(7) Rules and regulations governing the federal Health Insurance
Portability and Accountability Act (HIPAA; Public Law 104-191).
(8) State and federal disability accessibility laws and standards,
including Section 508 of the federal Rehabilitation Act as
referenced in Section 11135 of the Government Code and the
Information Organization, Usability, Currency, and Accessibility
Working Group accessibility recommendations from the Office of the
Chief Information Officer.
(f) Contingent on the Legislature's approval of the comprehensive
plan and an appropriation for this purpose, pursuant to subdivision
(e), the State Department of Health Care Services and the State
Department of Social Services shall have the authority necessary to
implement this part, including the authority to enter into contract
amendments, change orders, or change requests and project or system
development notices as consistent with the approved plan.
(g) The State Department of Health Care Services and the State
Department of Social Services may contract with another state
department or agency for project management services of any statewide
enrollment process developed or enhanced as a result of the
comprehensive plan developed in accordance with subdivision (b).
(h) (1) The State Department of Health Care Services and the State
Department of Social Services shall convene a stakeholder steering
committee for consultation in the development of the statewide
eligibility and enrollment determination process and comprehensive
plan. As appropriate, subcommittees may be formed to facilitate work
product development and outcomes. The stakeholder steering committee
shall include representatives of advocacy organizations representing
clients and consumers, county employees, county human services
agencies, the California State Association of Counties, and
legislative staff. Other representatives may be included as deemed
appropriate by the State Department of Health Care Services and the
State Department of Social Services. At a minimum, the stakeholder
steering committee shall advise on all of the following matters:
(A) Program eligibility and enrollment simplifications without
increasing program costs.
(B) Revisions to program applications and procedures for making
eligibility and enrollment determinations, including notices of
action and other forms processing.
(C) Development of new processes and procedures for making
eligibility determinations and for enrolling eligible individuals.
(D) Beneficiary needs to ensure access to services and transition
to any new system.
(E) Development of a public outreach campaign to inform people of
any new system.
(F) Other issues as applicable for the development of the
implementation plan and any ongoing efforts.
(2) The stakeholder steering committee shall remain in place to
advise on any issues regarding the implementation of any new or
revised statewide eligibility and enrollment determination process
for the CalWORKs program, the Medi-Cal program, and SNAP.
(i) This part shall be implemented only if, and to the extent
that, federal financial participation is available for this purpose.
(j) The State Department of Health Care Services and the State
Department of Social Services may seek a federal waiver or waivers
and state plan amendments to the extent necessary to implement the
eligibility determination process as specified in the approved
implementation plan.
10202. Notwithstanding any other law, this part is not to be
construed to change, or in any manner modify, eligibility for the
CalWORKs program, the Medi-Cal program, or Supplemental Nutrition
Assistance Program (SNAP).
10203. Contingent on the Legislature's approval of the
comprehensive plan required pursuant to subdivision (b) of Section
10200 and an appropriation for this purpose, pursuant to subdivision
(e) of Section 10200, and notwithstanding Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the State Department of Health Care Services and the
State Department of Social Services may implement this part by means
of all-county letters or similar instructions without taking
regulatory action. As an alternative to, or in addition to, that
implementation, the departments shall have emergency regulation
authority, as needed, to implement the system authorized under this
section.
10205. Contingent on the Legislature's approval of the
comprehensive plan required pursuant to subdivision (b) of Section
10200 and an appropriation for this purpose, pursuant to subdivision
(e) of Section 10200, and upon implementation of the process provided
for in this part, and to the extent necessary to achieve the
purposes of this part, references in this division to the county or
the county welfare department for purposes of the administration of
enrollment and eligibility determination for the CalWORKs program,
Medi-Cal program, or SNAP shall mean the State Department of Health
Care Services or the State Department of Social Services, as
applicable.
10200. (a) (1) The State Department of Health Care Services and the
State Department of Social Services shall develop a statewide
eligibility and enrollment determination process for the California
Work Opportunity and Responsibility to Kids (CalWORKs) program, the
Medi-Cal program, and the Supplemental Nutrition Assistance Program
(SNAP), in accordance with this part. It is the intent of the
Legislature that the development of this process shall achieve all of
the following outcomes:
(A) Facilitate better access to services and aid for eligible
clients.
(B) Lower the costs of enrolling persons into CalWORKs, Medi-Cal,
and SNAP without reducing access.
(C) Improve consistency of eligibility determination and
enrollment approach and processes statewide.
(D) Create an efficient process that eliminates redundancies and
inefficiencies.
(E) Employ state-of-the-art technology to improve efficiency of
the eligibility determination process.
(F) Minimize the number of technology systems that the state shall
support in preforming the eligibility process.
(2) The development of the statewide eligibility and enrollment
determination process and the comprehensive plan required in
subdivision (b) shall be accomplished in consultation with a
stakeholder steering committee established pursuant to subdivision
(h).
(b) The State Department of Health Care Services and the State
Department of Social Services shall develop a comprehensive plan,
which shall include, at a minimum, all of the following components:
(1) Project description.
(2) Business case.
(3) Business and technical requirements.
(4) Cost benefit analysis, including all aspects as traditionally
provided in a feasibility study report for information technology
projects, including, but not limited to, the following components:
(A) An analysis of the benefits and drawbacks of procuring a new
statewide eligibility and enrollment determination process and
contracting out eligibility functions as compared to building upon
existing enrollment and eligibility determination systems.
(B) An assessment of risks, including an analysis of other states
in automating and contracting out centralized eligibility
determinations and the state's history and experience in other
procurement efforts.
(C) An analysis of the state and local staffing and costs, and any
program impacts resulting from any new statewide eligibility and
enrollment system.
(5) Project timelines, including key milestones.
(6) Recommendations of other health or social services programs
that should be added to the process, if any.
(7) Description of any federal waivers and any state statutory
changes that may be needed for full, phased-in implementation of the
process.
(8) Project budget, including necessary budget proposal documents.
(9) Competitive procurement strategy and process.
(10) Transition plan for phasing in any new statewide eligibility
and enrollment system.
(11) Strategy to inform the public and beneficiaries of any new
statewide eligibility and enrollment system.
(12) Description of stakeholder steering committee involvement in
the development of the comprehensive plan.
(c) The State Department of Health Care Services and the State
Department of Social Services may utilize a contractor to develop and
complete the comprehensive plan as specified.
(d) The State Department of Health Care Services and the State
Department of Social Services shall submit the comprehensive plan to
the fiscal and applicable policy committees of the Legislature,
including the Joint Legislative Budget Committee, at least 45 days
prior to a request for an appropriation.
(e) Contingent upon legislative approval of the comprehensive plan
and an appropriation for this purpose, the State Department of
Health Care Services and the State Department of Social Services may
proceed with procurement activities consistent with the approved
plan, including any request for proposals being issued and the
utilization of a performance-based contract model, or subsequent
process as identified in the comprehensive plan, to implement a
statewide eligibility and enrollment determination process. Any
contractor, county consortia, nonprofit providers, or any
partnerships shall be authorized to compete for any aspect of this
process. At a minimum, an entity shall be required to comply with all
of the following requirements:
(1) Make accurate determinations and redeterminations of
eligibility for CalWORKs, Medi-Cal, and SNAP.
(2) Coordinate with community-based organizations to assist
individuals with the application process, in various languages, as
specified by the State Department of Health Care Services and the
State Department of Social Services and as required in state and
federal law and regulation.
(3) Represent the departments as applicable in fair hearings
arising out of eligibility determinations and redeterminations.
(4) Assist applicants and recipients requiring assistance for
program eligibility, enrollment, and redeterminations for enrollment.
(5) Applicable state and federal technology standards, inclusive
of the alignment with Medicaid Information Technology Architecture
requirements or applicable successor framework promulgated by the
federal Centers for Medicare and Medicaid Services.
(6) Applicable privacy and security requirements, including, but
not limited to, the protection of personal health information, as
defined by applicable federal and state regulations.
(7) Rules and regulations governing the federal Health Insurance
Portability and Accountability Act (HIPAA; Public Law 104-191).
(8) State and federal disability accessibility laws and standards,
including Section 508 of the federal Rehabilitation Act as
referenced in Section 11135 of the Government Code and the
Information Organization, Usability, Currency, and Accessibility
Working Group accessibility recommendations from the Office of the
Chief Information Officer.
(f) Contingent on the Legislature's approval of the comprehensive
plan and an appropriation for this purpose, pursuant to subdivision
(e), the State Department of Health Care Services and the State
Department of Social Services shall have the authority necessary to
implement this part, including the authority to enter into contract
amendments, change orders, or change requests and project or system
development notices as consistent with the approved plan.
(g) The State Department of Health Care Services and the State
Department of Social Services may contract with another state
department or agency for project management services of any statewide
enrollment process developed or enhanced as a result of the
comprehensive plan developed in accordance with subdivision (b).
(h) (1) The State Department of Health Care Services and the State
Department of Social Services shall convene a stakeholder steering
committee for consultation in the development of the statewide
eligibility and enrollment determination process and comprehensive
plan. As appropriate, subcommittees may be formed to facilitate work
product development and outcomes. The stakeholder steering committee
shall include representatives of advocacy organizations representing
clients and consumers, county employees, county human services
agencies, the California State Association of Counties, and
legislative staff. Other representatives may be included as deemed
appropriate by the State Department of Health Care Services and the
State Department of Social Services. At a minimum, the stakeholder
steering committee shall advise on all of the following matters:
(A) Program eligibility and enrollment simplifications without
increasing program costs.
(B) Revisions to program applications and procedures for making
eligibility and enrollment determinations, including notices of
action and other forms processing.
(C) Development of new processes and procedures for making
eligibility determinations and for enrolling eligible individuals.
(D) Beneficiary needs to ensure access to services and transition
to any new system.
(E) Development of a public outreach campaign to inform people of
any new system.
(F) Other issues as applicable for the development of the
implementation plan and any ongoing efforts.
(2) The stakeholder steering committee shall remain in place to
advise on any issues regarding the implementation of any new or
revised statewide eligibility and enrollment determination process
for the CalWORKs program, the Medi-Cal program, and SNAP.
(i) This part shall be implemented only if, and to the extent
that, federal financial participation is available for this purpose.
(j) The State Department of Health Care Services and the State
Department of Social Services may seek a federal waiver or waivers
and state plan amendments to the extent necessary to implement the
eligibility determination process as specified in the approved
implementation plan.
10202. Notwithstanding any other law, this part is not to be
construed to change, or in any manner modify, eligibility for the
CalWORKs program, the Medi-Cal program, or Supplemental Nutrition
Assistance Program (SNAP).
10203. Contingent on the Legislature's approval of the
comprehensive plan required pursuant to subdivision (b) of Section
10200 and an appropriation for this purpose, pursuant to subdivision
(e) of Section 10200, and notwithstanding Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the State Department of Health Care Services and the
State Department of Social Services may implement this part by means
of all-county letters or similar instructions without taking
regulatory action. As an alternative to, or in addition to, that
implementation, the departments shall have emergency regulation
authority, as needed, to implement the system authorized under this
section.
10205. Contingent on the Legislature's approval of the
comprehensive plan required pursuant to subdivision (b) of Section
10200 and an appropriation for this purpose, pursuant to subdivision
(e) of Section 10200, and upon implementation of the process provided
for in this part, and to the extent necessary to achieve the
purposes of this part, references in this division to the county or
the county welfare department for purposes of the administration of
enrollment and eligibility determination for the CalWORKs program,
Medi-Cal program, or SNAP shall mean the State Department of Health
Care Services or the State Department of Social Services, as
applicable.
