2023 California Code › Welfare and Institutions Code - WIC › DIVISION 9 - PUBLIC SOCIAL SERVICES › PART 3.3 - Health Care Coverage Assistance › CHAPTER 3 - County Children s Health Initiative Program › Section 15854.

15854. (a) The department, in consultation with other appropriate parties, shall establish the criteria for evaluating an applicant’s proposal, which shall include, but not be limited to, the following:
(1) The extent to which the program described in the proposal provides comprehensive coverage, including health, dental, and vision benefits.
(2) Whether the proposal includes a promotional component to notify the public of its provision of health insurance to eligible children.
(3) The simplicity of the proposal’s procedures for applying to participate and for determining eligibility for participation in its program.
(4) The extent to which the proposal provides for coordination and conformity with benefits provided through the Medi-Cal program.
(5) The extent to which the proposal provides for coordination and conformity with existing Medi-Cal administrative entities in order to prevent administrative duplication and fragmentation.
(6) The ability of the health care providers designated in the proposal to serve the eligible population and the extent to which the proposal includes traditional and safety net providers, as defined by the department.
(7) The extent to which the proposal intends to work with the school districts and county offices of education.
(8) The total amount of funds available to the applicant to implement the program described in its proposal, and the percentage of this amount proposed for administrative costs as well as the cost to the state to administer the proposal.
(9) The extent to which the proposal seeks to minimize the substitution of private employer health insurance coverage for health benefits provided through a governmental source.
(10) The extent to which local resources may be available after the depletion of federal funds to continue any current program expansions for persons covered under local health care financing programs or for expanded benefits.
(11) For the purposes of defining an applicant’s eligibility for funding under this chapter, the following shall apply:
(A) The same income methodology shall be used for the proposed program that is currently used for the Medi-Cal program.
(B) Only participating Medi-Cal managed care plans may be used. However, the department may permit exceptions to this requirement consistent with the purpose, of this chapter.
(b) The department may, in its sole discretion, approve or disapprove projects for funding pursuant to this chapter on an annual basis.
(c) To the extent that an applicant’s proposal pursuant to this chapter provides for health plan or administrative services under a contract entered into by the department or at rates negotiated for the applicant by the department, a contract entered into by the department or by an applicant shall be exempt from any provision of law relating to competitive bidding, and shall be exempt from the review or approval of any division of the Department of General Services to the same extent as contracts entered into pursuant to subdivision (p) of Section 14005.26. The department and the applicant shall not be required to specify the amounts encumbered for each contract, but may allocate funds to each contract based on the projected or actual subscriber enrollments to a total amount not to exceed the amount appropriated for the project, including family contributions, when applicable.
(Amended by Stats. 2022, Ch. 47, Sec. 141. (SB 184) Effective June 30, 2022.)