An act to add Section 14132.37 to the Welfare and Institutions Code, relating to Medi-Cal.
Summary
AB 403 would add a new section to the Welfare and Institutions Code requiring the Department of Health Care Services to annually review Medi-Cal managed care plans’ outreach and education efforts related to the community health worker (CHW) benefit. It also requires the department to produce an annual analysis of the CHW services benefit, with the first report due by July 1, 2027, and to submit that analysis to the Legislature and post it publicly on the department’s website.
The required analysis is broad and data-focused. It must assess CHW capacity and Medi-Cal beneficiary needs, break findings down by geography and demographics such as race, ethnicity, language, age, and other sociodemographic factors, and examine utilization of CHW services, referrals, the number and types of CHWs and employers providing services, the diversity of CHWs and beneficiaries served, and Medi-Cal reimbursement amounts for CHW services. The bill also limits published demographic data to statistically significant information and prohibits personally identifiable information from being collected or disclosed in the reporting.
Impact
AB 403 would not create a new Medi-Cal benefit, but it would expand state oversight and reporting requirements for an existing one. It would add a new statutory duty for the Department of Health Care Services to monitor managed care plan outreach, compile annual utilization and capacity data, and report that information to the Legislature and the public. The bill would affect Medi-Cal managed care plans, community health workers, providers, supervising entities, and beneficiaries by increasing the amount of program data collected and analyzed, while preserving privacy protections.
Sentiment
The bill appears to have generally favorable support in committee. It passed the Assembly Appropriations Committee on a 15-0 vote and was recommended for the consent calendar, suggesting little opposition at that stage. The absence of committee transcript opposition and the unanimous vote indicate broad agreement with the bill’s oversight and transparency goals.
Contention
The main issues raised by the bill are not ideological but operational. The department would need to gather and analyze detailed demographic, utilization, workforce, and reimbursement data across managed care and fee-for-service delivery systems, which may require additional administrative effort and coordination with plans and providers. Potential points of concern include the feasibility of collecting statistically significant demographic data, protecting beneficiary privacy, and ensuring that reporting requirements do not create undue burden for managed care plans, CHW employers, or the department.
An act to add Chapter 10 (commencing with Section 8300) to Division 8 of Section 4755 to the Welfare and Institutions Code, relating to behavioral health. developmental services.
An act to add Section Sections 1371.143 and 128739 to, and to add Article 4 (commencing with Section 127480) to Chapter 2.5 of Part 2 of Division 107 of, the Health and Safety Code, and to add Section 10123.858 to the Insurance Code, relating to health care.