An act to add Sections 14045.195 and 14184.2051 to the Welfare and Institutions Code, relating to Medi-Cal.
AB 2138 would amend the Medi-Cal statutes to require enhanced care management (ECM) providers serving a sufficiently large and high-need caseload to include at least one peer support specialist or trainee on the interdisciplinary care team. The peer would have to be integrated into ECM service delivery and available to support members, with duties that include outreach, engagement, self-advocacy support, care planning, warm handoffs, transition support, and linkage to behavioral health, housing, and social services. The bill also directs the Department of Health Care Services to update managed care plan contracts, policies, and guidance, and to establish monitoring and compliance mechanisms to ensure providers meet the new requirement.
The bill further limits the use of criminal background checks as a basis for excluding peer support specialists from Medi-Cal peer roles. State agencies, counties, managed care plans, and providers could not disqualify a peer solely or primarily because of a criminal background check or similar screening, although an individual criminal record could still be considered when it has a nexus to the job. The bill preserves exceptions for federal law, setting-specific background check requirements, and individualized safety policies, and it conditions implementation on any needed federal approvals and federal financial participation. Providers subject to the new ECM staffing rule would have until January 1, 2028, to fully comply, and during 2027 they could avoid payment reductions if they submit an implementation plan by July 1, 2027.
AB 2138 would add new requirements to the Welfare and Institutions Code governing Medi-Cal peer support services and ECM provider staffing. It would effectively make peer support a required component of ECM for certain providers, while also constraining categorical exclusion of peer workers based on criminal history. The bill would affect the Department of Health Care Services, Medi-Cal managed care plans, ECM contractors, counties, and providers that furnish peer support services, and it would likely require contract, policy, and oversight changes within the Medi-Cal managed care system.
The bill appears to have generally favorable support among legislators who voted on it, as reflected by the 15-1 committee vote to pass it as amended and re-refer it to Appropriations. The bill’s findings frame peer support as evidence-informed and beneficial for hard-to-engage Medi-Cal members, and the amendments suggest an effort to align the policy with federal Medicaid rules and operational realities. At the same time, the fact that it was later held under submission indicates that fiscal, implementation, or administrative concerns remained unresolved.
The main points of contention are likely to be implementation burden, fiscal impact, and the background-check restriction. Providers and managed care plans may be concerned about workforce availability, compliance timelines, staffing flexibility, and the cost of adding peer support specialists to ECM teams. The criminal-history provision may also draw concern from entities that rely on screening policies for safety or program integrity, though the bill preserves exceptions for federal requirements and job-related individualized assessments. Supporters, by contrast, are likely to emphasize that people with lived experience can improve engagement and outcomes and that prior justice involvement should not automatically bar qualified peers from serving Medi-Cal members.