Title WIC, California Welf. & Inst. Code

(a) Pursuant to the provisions of this chapter, the department may contract with one or more prepaid health plans in order to provide the benefits authorized under this chapter and Chapter 7 (commencing with Section 14000) of this part. The department may contract with one or mor…

Except where the context otherwise requires, or where specific exceptions are authorized, all provisions of Chapter 7 (commencing with Section 14000) of this part shall be applicable to the provisions of this chapter and the violation of the provisions of this chapter or any rule…

(a) No prepaid health plan or pilot program shall be deemed to transact insurance or to be subject to any provision of the Insurance Code by virtue of negotiating, executing, or performing a prepaid health plan or pilot program contract under this chapter, or by virtue of complia…

This chapter shall be known and may be cited as the Relief Law of 1945. (Added by Stats. 1965, Ch. 1784.)

The provisions of this chapter (except the provisions of this section) are suspended and continue suspended from operation until the occurrence of an economic emergency in this state, which results from widespread hardship and destitution and necessitates immediate action for the…

After the provisions of this chapter become operative, the provisions of Part 5 of this division, relating to county aid and relief to indigents, shall not apply to any person who receives or is eligible to receive relief under this chapter; but Part 5 is not repealed by this cha…

As used in this chapter, the terms defined in this article have the meanings set forth in this article. (Added by Stats. 1965, Ch. 1784.)

“Department” means the State Department of Social Services. (Amended by Stats. 1977, Ch. 1252.)

“Aid” means state financial assistance to counties for the direct cost of relief and the cost of administration thereof. (Added by Stats. 1965, Ch. 1784.)

“Relief” means assistance in cash or in kind provided to individuals or families to relieve hardship and destitution. Relief to a person includes relief to his dependents, but relief does not include hospital or medical care. (Added by Stats. 1965, Ch. 1784.)

In accordance with the provisions of this chapter, every county shall provide relief to needy persons who are residents of this state. (Added by Stats. 1965, Ch. 1784.)

For the purposes of this chapter, a resident of the state is a person who comes within all of the following descriptions: (a) Who has lived continuously in the state for a period of one year preceding his application for relief. (b) Who, during the one-year period, has not receiv…

For the purposes of this chapter, a person who is a resident of the state is a resident of the county in which he has resided continuously for one year immediately preceding his application for relief. (Added by Stats. 1965, Ch. 1784.)

A county may incur all necessary expenses in transporting a nonresident applicant for or recipient of relief under this chapter to another state or county, when information at hand reasonably tends to show that the person has a legal residence in that state or county. The state s…

Unless the context otherwise requires, the definitions set forth in this article govern the construction of this chapter. (Added by Stats. 1972, Ch. 1366.)

(a) (1) “Prepaid health plan” means a plan that meets all of the following criteria: (A) Is licensed as a health care service plan by the Director of the Department of Managed Health Care pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing wit…

“Medi-Cal beneficiary” means a person who is eligible to receive benefits under Chapter 7 (commencing with Section 14000) of this part. (Added by Stats. 1972, Ch. 1366.)

“Subcontract” means an agreement entered into by the prepaid health plan with any of the following: (a) A provider of health care services who agrees to furnish such services to Medi-Cal beneficiaries enrolled in the prepaid health plan. (b) A marketing organization. (c) Any othe…

(a) “Primary care physician” is a physician who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. A primary care physician shall be either a physician who has…

“Specialist” means a physician who is board certified or board eligible in the specialty of medical care provided. (Amended by Stats. 1974, Ch. 983.)

The “basic scope of health care benefits” means: (a) Physician’s services; (b) Hospital outpatient services; (c) Laboratory and X-ray; (d) Prescription drugs; (e) Hospital inpatient care; (f) Skilled nursing facility care. (Amended by Stats. 1974, Ch. 1240.)

Nothing in this act shall preclude the director from contracting with licensed specialized health care service plans which provide only dental, pharmaceutical, optometric, or psychological services in accordance with regulations issued by the department. (Amended by Stats. 1977, …

“Service area” means a geographical area designated by the department within which a prepaid health plan shall provide health care services and within which the Medi-Cal beneficiaries eligible for enrollment in the prepaid health plan reside. (Added by Stats. 1974, Ch. 983.)

“Director” means the State Director of Health Services. (Amended by Stats. 1977, Ch. 1252.)

“Department” means the State Department of Health Services. (Amended by Stats. 1977, Ch. 1252.)

“Vendor” means any person who provides services or supplies to a prepaid health plan or a subcontractor of a prepaid health plan and who does not have a subcontract as defined by Section 14253 with either the prepaid health plan or its subcontractors. (Repealed and added by Stats…

“Marketing” means any activity conducted by or on behalf of a prepaid health plan where information regarding the services offered by a prepaid health plan is disseminated in order to persuade Medi-Cal beneficiaries to enroll or accept any application for enrollment in the prepai…

“Marketing organization” means any subcontractor who agrees to provide marketing services for a prepaid health plan. (Amended by Stats. 1977, Ch. 1036.)

“Marketing representative” means any person who engages in marketing activities on behalf of a marketing organization or the prepaid health plan. (Added by Stats. 1974, Ch. 983.)

The direct administration of this chapter shall be carried out by the boards of supervisors of the several counties, directly or through their authorized agents. The administration shall be supervised by the department. (Added by Stats. 1965, Ch. 1784.)

The department shall: (a) Establish minimum and maximum standards for the amount and form of relief, on a budgetary basis, as provided in Sections 18472, 18473, and 18474. (b) Establish standards of eligibility for relief, which shall be of uniform application throughout the stat…

The department shall from time to time fix for each county maximum and minimum relief case budgets within the range of which the board of supervisors may establish its own policies. All budgets and standards shall be based upon need and minimum budgets shall be sufficient to main…

In determining and redetermining budgets and standards, the department may give consideration to living costs and may establish budgets and standards varying in monetary worth or amount, but providing a standard of living compatible with decency and health. (Added by Stats. 1965,…

Relief may be granted in cash or in kind, but relief may be granted in kind only after the method has been approved by the department. (Added by Stats. 1965, Ch. 1784.)

All income received by a person or family, regardless of source, shall be considered in determining the amount of relief to be provided. (Added by Stats. 1965, Ch. 1784.)

In administering any funds appropriated or made available to the department for disbursement through the counties for relief purposes, the department shall: (a) Require as a condition for receiving such grants-in-aid that the county shall bear the proportion of the total expense …

If any county fails to comply with the provisions of this chapter or the rules and regulations or orders of the department for the administration of relief by the county under this chapter, the director of the department shall formally notify the county of the particular respects…

The department may operate the relief administration in any county after the denial of financial assistance to the county in accordance with the provisions of Section 18477, and the county proportion of the costs thereof shall be charged against the county and shall be a proper c…

The department shall publish a notice of intent to contract at least 60 days prior to the effective date of any initial or renewed contract. The notice shall appear in local newspapers circulated in the service areas of the prepaid health plan. The notice shall announce the depar…

(a) The department shall determine, by actuarial methods, prospective per capita rates of payment for services provided under this chapter for Medi-Cal beneficiaries enrolled in a prepaid health plan. The rates of payment shall be determined annually, shall be effective no later …

(a) For rates established on or after August 1, 2007, the department shall pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods and may establish health-plan- and county-specific rates. Notwithstanding any other law, this…

(a) Notwithstanding any law, and subject to subdivisions (e) and (f), in order to account for the impacts of the COVID-19 public health emergency on Medi-Cal managed care capitation rates, the department shall develop and pay capitation rates and capitation increments under any M…

(a) The director may defer fee-for-service payments or payments to Medi-Cal managed care health plans contracting with the department pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14…

The department shall ensure that Medi-Cal managed care plans demonstrate ongoing ability and readiness to perform the obligations set forth in Section 14132.195. The department shall, as may be appropriate and in its discretion, adjust the capitation rate of a Medi-Cal managed ca…

(a) It is the intent of the Legislature, to the extent federal financial participation is not jeopardized and consistent with federal law, that the intergovernmental transfers described in this section provide support for the nonfederal share of risk-based payments to managed car…

(a) (1) To the extent federal financial participation is not jeopardized and consistent with federal law, and subject to the conditions set forth in subdivision (b), the department shall pay Medi-Cal managed care plans rate range increases, as defined by paragraph (4) of subdivis…