SB 324: Medi-Cal: enhanced care management and community supports.

Official summary

Legislative Counsel’s Digest (official, as of the latest version). Written by nonpartisan legislative staff; reproduced verbatim.

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 and funded by federal Medicaid program provisions.

Existing law, subject to implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, requires the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans. Under existing law, target populations include, among others, high utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits, and individuals experiencing homelessness.

Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports, as specified. Under existing law, community supports that the department is authorized to approve include, among others, housing transition navigation services and medically supportive food and nutrition services.

This bill would require a Medi-Cal managed care plan, for purposes of covering the ECM benefit, or if it elects to cover a community support, to contract with community providers, as defined, that can demonstrate that they are capable of providing access and meeting quality requirements in accordance with Medi-Cal guidelines. In determining which community providers to contract with, the bill would authorize Medi-Cal managed care plans to take into consideration whether those providers are available in the respective county and have experience in providing the applicable ECM or community support. The bill would require the department, for purposes of enforcing these provisions, to require Medi-Cal managed care plans to set goals every other year for the level of contracting and utilization of community providers and local entities, as defined. The bill would require these goals to be established in consultation with the department, as specified.

If a community provider contracted to provide ECM services or community supports submits a referral or authorization request for the applicable service on behalf of an eligible member, the bill would require a Medi-Cal managed care plan to assign the member to the contracted referring provider if the plan determines that the provider can appropriately meet the needs of the member.

The bill would prohibit the above-described provisions from being construed to limit the department’s authority to grant eligibility for presumptive authorization for categories of ECM providers that have extensive experience and expertise in serving certain ECM populations of focus.

Sponsors

Sponsors by party (alphabetical): Democratic 3

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. August 29, 2025August 29 hearing: Held in committee and under submission.
2. August 20, 2025August 20 set for first hearing. Placed on APPR. suspense file.
3. July 3, 2025Read second time and amended. Re-referred to Com. on APPR.
4. July 2, 2025From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (July 1).
5. June 18, 2025From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
6. June 5, 2025Referred to Com. on HEALTH.
7. May 28, 2025In Assembly. Read first time. Held at Desk.
8. May 27, 2025Read third time. Passed. (Ayes 39. Noes 0. Page 1252.) Ordered to the Assembly.
9. May 23, 2025Read second time. Ordered to third reading.
10. May 23, 2025From committee: Do pass. (Ayes 6. Noes 0. Page 1196.) (May 23).
11. May 16, 2025Set for hearing May 23.
12. April 21, 2025April 21 hearing: Placed on APPR. suspense file.