Bill Sponsor
California Senate Bill 324
Session 20252026
Medi-Cal: enhanced care management and community supports.
Active
Active
Passed Senate on May 27, 2025
First Action
Feb 11, 2025
Latest Action
Aug 29, 2025
Origin Chamber
Senate
Type
Bill
Bill Number
324
State
California
Session
20252026
Sponsorship by Party
Democrat
Principal Coauthor
Summary
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. Existing law requires the department to develop, in consultation with Medi-Cal managed care plans and other appropriate stakeholders, a monitoring plan and reporting template for the implementation of ECM or community supports. Existing law requires the department to annually publish a public report on reported ECM or community support utilization data, populations served, and demographic data, stratified by age, sex, race, ethnicity, and languages spoken, to the extent that statistically reliant data are available. This bill would expressly include providers of ECM or community supports within the consultation process. The bill would require the department to publish the public report on a quarterly basis instead and would require additional demographic data. The bill would also require the department to develop standardized and streamlined templates to be used by Medi-Cal managed care plans or their contracted providers, as specified, and to develop guidance to allow community providers to act as a primary subcontractor with Medi-Cal managed care plans and to subcontract with other community providers as a 3rd-tier subcontractor, as specified.
Actions (20)
08/29/2025
Assembly
August 29 hearing: Held in committee and under submission.
08/20/2025
Assembly
August 20 set for first hearing. Placed on APPR. suspense file.
07/03/2025
Assembly
Read second time and amended. Re-referred to Com. on APPR.
07/02/2025
Assembly
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (July 1).
06/18/2025
Assembly
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
06/05/2025
Assembly
Referred to Com. on HEALTH.
05/28/2025
Assembly
In Assembly. Read first time. Held at Desk.
05/27/2025
Senate
Read third time. Passed. (Ayes 39. Noes 0. Page 1252.) Ordered to the Assembly.
05/23/2025
Senate
Read second time. Ordered to third reading.
05/23/2025
Senate
From committee: Do pass. (Ayes 6. Noes 0. Page 1196.) (May 23).
05/16/2025
Senate
Set for hearing May 23.
04/21/2025
Senate
April 21 hearing: Placed on APPR. suspense file.
04/08/2025
Senate
Set for hearing April 21.
04/07/2025
Senate
Read second time and amended. Re-referred to Com. on APPR.
04/03/2025
Senate
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 636.) (April 2).
03/24/2025
Senate
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
03/17/2025
Senate
Set for hearing April 2.
02/19/2025
Senate
Referred to Com. on HEALTH.
02/12/2025
Senate
From printer. May be acted upon on or after March 14.
02/11/2025
Senate
Introduced. Read first time. To Com. on RLS. for assignment. To print.
Sources
Record Created
Feb 12, 2025 4:02:18 PM
Record Updated
Mar 17, 2026 8:31:59 PM