Medi-Cal eligibility: work or community engagement.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions. Existing federal law generally requires, commencing in 2027, Medicaid beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, to demonstrate community engagement as a condition of Medicaid eligibility. Existing state law sets forth various provisions to conform to that federal requirement. Existing law requires, no sooner than January 1, 2027, as specified, an applicable individual to demonstrate work or community engagement. Existing law sets forth the mechanisms for an applicable individual to comply with that requirement on a monthly basis, including, among others, a minimum of 80 hours of work, community service, or participation in a work program, or a minimum of half-time enrollment in an educational program. This bill would make changes to the definitions of "applicable individual," "work program," and "educational program," and to some of the compliance mechanisms regarding monthly income, for purposes of the above-described provisions. When there is a conflict in reliable data sources that adversely impacts the eligibility of an applicant or beneficiary, the bill would require the county to request the applicant or beneficiary to confirm information before taking any adverse action on the application or renewal. Existing law requires a county, if it is unable to verify that an applicable individual either has met the requirement to demonstrate work or community engagement or was deemed to have demonstrated work or community engagement, to provide the individual with a notice of noncompliance, as specified, and to continue to provide the individual with Medi-Ca