Article 4.7 - Perinatal Services Program

California Welfare and Institutions Code — §§ 14148-14148.85

Sections (14)

Amended by Stats. 2022, Ch. 47, Sec. 123. (SB 184) Effective June 30, 2022.

(a)(1) (A) Except as provided in subparagraph (B), the department shall adopt the federal option provided under Section 4101 of the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203) to extend eligibility for medical assistance under Medicaid to all pregnant individuals and infants with family incomes not in excess of 185 percent of the federal poverty level.

(B) Effective January 1, 2014, the federal poverty level percentage income eligibility threshold used pursuant to subdivision (c) of Section 14005.64 to determine eligibility for medical assistance under this section pursuant to subparagraph (A) shall equal 208 percent of the federal poverty level.

(C) Effective January 1, 2022, eligibility for medical assistance to pregnant individuals with family incomes not in excess of 208 percent of the federal poverty level, before the application of the 5-percent income disregard pursuant to subdivision (b) of Section 14005.64, shall be as described in Section 14005.22.

(2)If a premium is imposed, the amount of the premium shall not exceed 10 percent of the amount by which the family’s income, less actual child care costs, exceeds 150 percent of the federal poverty level as provided in Section 1916(c) of the federal Social Security Act (42 U.S.C. Sec. 1396o(c)) as determined, counted, and valued in accordance with the requirements of Section 14005.64. The department shall implement this section by emergency regulation.

(b)Upon order of the Department of Finance, the

Controller shall transfer funds from Item 4260-101-001 of the Budget Act of 1988 to Item 4260-111-001 of the Budget Act of 1988 during the 1988–89 fiscal year for the purpose of funding outreach efforts for perinatal services.

(c)Notwithstanding subdivision (a), the state may limit implementation of this section during the 1988–89 fiscal year, based upon the availability of department funds. The department may use maternal and child health funds to finance the increased costs of implementing an expansion of Medi-Cal eligibility to pregnant individuals and to children with incomes of up to 185 percent of federal poverty levels if both of the following conditions exist:

(1)The department has allocated for expenditure at least sixteen million dollars ($16,000,000) in funds redirected from the Medi-Cal program for that expansion.

(2)If, and to the extent, the department determines that estimates of costs based on actual data indicate that the funds are needed to cover costs.

(d)To assist Medi-Cal eligible pregnant individuals in receiving prenatal care promptly, all pregnant individuals applying for Medi-Cal shall be determined to have an immediate need. Counties, within existing resources, shall expedite the eligibility determination process for all pregnant individuals on the basis of their immediate needs. Upon determination of eligibility, a Medi-Cal card shall be issued immediately.

(e)The amendments made to subdivision (a) by Senate Bill 508 during the 2013–14 Regular Session shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

§ 14148.03

Amended by Stats. 2023, Ch. 372, Sec. 2. (AB 1481) Effective January 1, 2024.

(a)Pursuant to options provided in federal law and notwithstanding any other provision of law, the form used by a provider to collect information about a pregnant person pursuant to the Medi-Cal temporary benefits program under Section 14148.7 as that program is implemented on January 1, 2003, shall itself qualify as a simplified application for the Medi-Cal program for pregnant people, or, if necessary to ensure federal financial participation, the form shall be modified to add only those elements required for federal financial participation and be as simple as the department considers practicable.

(b)For purposes of this section, the department

shall determine whether to grant eligibility for temporary benefits under Section 14148.7 and the county shall make the final eligibility determination for the Medi-Cal program. The department shall develop and adopt a process for transferring the application to the county and a followup process that is as simple as the department considers practicable to be used by the county if followup is necessary. Based on the department’s instructions, the county shall make a determination whether followup is necessary to determine the pregnant person’s final eligibility for the Medi-Cal program or to refer the pregnant person to the Medi-Cal Access Program.

(c)The department shall adopt an electronic enrollment process for pregnant people to use when applying for the Medi-Cal program from a provider’s office. The application form for this electronic

enrollment shall use the elements of the application form described in subdivision (a) and the procedures specified in subdivision (b). This electronic enrollment process shall be known as the Prenatal Gateway. In developing the Prenatal Gateway required by this subdivision, the department shall consult with consumer, provider, county, and health plan representatives.

(d)The purpose of this section is to begin eligibility and benefits at the time of an eligible pregnant person’s visit to a provider and to continue eligibility and benefits until a final eligibility determination is made without the submission of any other application form to the department, the county, or a single point of entry and to make the followup process as simple as the department considers practicable.

(e)The Prenatal Gateway may not be adopted until both of the following occur:

(1)Sufficient moneys have been deposited in the Special Funds Account of the Gateway Fund to defray the costs of developing the Prenatal Gateway.

(2)Sufficient new staff, not to exceed a total of three personnel years, is available at the department for the purposes of this section and Section 14148.04 and is funded through nonstate General Fund sources. Notwithstanding any other provision of law, the department may hire staff necessary to implement this section.

(f)The department shall implement the Prenatal Gateway within 12 months after the date upon which both of the conditions required under subdivision (e) have occurred.

(g)To implement this section, the department may contract with public or private entities, or utilize existing health care service provider enrollment and payment mechanisms, including the Medi-Cal program’s fiscal intermediary, only if services provided under the program are specifically identified and reimbursed in a manner that appropriately claims federal financial reimbursement. Contracts, including the Medi-Cal fiscal intermediary contract for the Child Health and Disability Prevention Program, and including any contract amendment, any system change pursuant to a change order, and any project or systems development notice shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, former Chapter 7 (commencing with Section 11700) of Part 1 of Division 3 of Title 2 of the Government Code,

Section 19130 of the Government Code, and any policies, procedures, or regulations authorized by these laws.

§ 14148.04

§ 14148.05

Added by Stats. 2003, Ch. 895, Sec. 4. Effective January 1, 2004.

(a)There is hereby created in the State Treasury the Gateway Fund.

(b)Moneys in the fund may be expended, upon appropriation by the Legislature, exclusively for purposes of establishing and maintaining the Prenatal Gateway, as provided for in Section 14148.03, and the Newborn Hospital Gateway, as provided for in Section 14148.04, and in accordance with subdivision (c).

(c)The fund shall consist of the

following accounts:

(1)The Special Funds Account, which shall consist of all funds received by the Controller for purposes of Sections 14148.03 and 14148.04 from private foundations and other nongovernmental sources and interest accrued thereon. Moneys in this account shall be used exclusively for the purposes of Sections 14148.03 and 14148.04. The department shall not be responsible for securing funding from private foundations or other nongovernmental sources.

(2)The Other Public Funds Account, which shall consist of all public funds, other than federal or state general funds, received by the Controller for purposes of Sections 14148.03 and 14148.04 from state or local sources, including, but not limited to, funds received under the California Families and Children Act of 1998, Division 108 (commencing with Section 130100) of the Health and Safety Code (Proposition 10), and

the interest accrued thereon.

(3)The Federal Funds Account, which shall consist of all public funds received by the Controller for purposes of Sections 14148.03 and 14148.04 from federal sources, and the interest accrued thereon.

§ 14148.1

Amended by Stats. 2023, Ch. 372, Sec. 3. (AB 1481) Effective January 1, 2024.

To maximize federal financial participation, the department shall seek flexibility in implementing the requirements of Section 121 of the Immigration Reform and Control Act of 1986 (Public Law 99-603) for Medi-Cal eligible people with confirmed pregnancies.

§ 14148.2

Added by Stats. 1988, Ch. 980, Sec. 3.

In order to assure access to obstetrical providers in the Medi-Cal program, the state department shall explore and adopt policies which improve provider relations with Medi-Cal maternity care providers. Policies to be considered shall include, but not be limited to, those which reduce the annual percentage of obstetrical billings going to the department’s suspense file, simplify provider claim forms, establish toll-free telephone lines for the exclusive use of maternity care providers, and establish clear reimbursement guidelines. In addition, the department shall explore policies to assure that obstetrical claims are processed on a prompt and predictable

basis, the feasibility of establishing a special claims processing unit for obstetrical claims, and the adequacy of current reimbursement levels and services reimbursed. The department shall advise the Chairs of the Assembly Health Committee and the Senate Health and Human Services Committee by July 1, 1989, on steps taken to improve provider relations and the impact these steps have had on provider participation.

§ 14148.3

Amended by Stats. 2023, Ch. 372, Sec. 4. (AB 1481) Effective January 1, 2024.

The department shall seek federal approval to implement obstetrical case management for Medi-Cal eligible pregnant people when provided through the Child Health and Disability Prevention program authorized under Article 6 (commencing with Section 124025) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code.

§ 14148.4

Repealed and added by Stats. 1989, Ch. 348, Sec. 2.

(a)The department shall eliminate the Medi-Cal reimbursement differential for obstetrical services by equalizing the rates of reimbursement for Caesarean section and non-Caesarean section care and delivery services. In implementing this section, savings that otherwise would have accrued due to lowered rates of reimbursement for Caesarean section services shall be used to fund across-the-board rate increases for all maternity care and delivery services.

(b)Revisions to the existing rate structure required to implement this section shall be adopted as emergency

regulations in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. The adoption of these regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. Notwithstanding Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code, emergency regulations adopted to implement this act shall not be subject to the review and approval of the Office of Administrative Law. These regulations shall become effective immediately upon filing with the Secretary of State.

§ 14148.5

§ 14148.6

Added by Stats. 1989, Ch. 1446, Sec. 4. Effective October 2, 1989.

The department shall engage in outreach activities in order to enhance participation in and access to perinatal services.

§ 14148.7

Amended by Stats. 2023, Ch. 372, Sec. 5. (AB 1481) Effective January 1, 2024.

(a)The department shall implement the federal options authorized by federal law to assist in the delivery of timely and continuing prenatal care by establishing the option of presumptive eligibility under Section 1396r-1 of Title 42 of the United States Code.

(b)The program shall be known, and may be cited, as “Presumptive Eligibility for Pregnant People (PE4PP).”

(c)For a pregnant person covered under PE4PP who applies for full-scope Medi-Cal

benefits, if the application is submitted at any time from the date of their presumptive eligibility determination through the last day of the subsequent calendar month, the department shall ensure the pregnant person is covered under PE4PP until the pregnant person is either enrolled in full-scope Medi-Cal benefits or has received a written denial notice in response to their application for full-scope Medi-Cal benefits.

(d)The department shall require providers participating in the PE4PP program to provide information to pregnant persons enrolled in PE4PP on how to contact the person’s county to expedite the county’s determination of a Medi-Cal application.

§ 14148.75

Amended by Stats. 1997, Ch. 624, Sec. 5. Effective January 1, 1998.

At the earliest date that it is administratively feasible, the department shall adopt the federal medicaid option under Section 1902(l)(3) of the federal Social Security Act (42 U.S.C. Sec. 1396a(l)(3)) to waive the use of a resource standard for determining the eligibility of pregnant women, infants, and children.

§ 14148.8

Amended by Stats. 2025, Ch. 595, Sec. 2. (AB 55) Effective January 1, 2026.

(a)(1) The State Department of Health Care Services shall provide Medi-Cal reimbursements to alternative birth centers for facility-related delivery costs at a statewide all-inclusive rate per delivery that shall not exceed 80 percent of the average Medi-Cal reimbursement received by general acute care hospitals with Medi-Cal contracts and shall be based on an average hospital length of stay of 1.7 days. The reimbursement rate shall be updated annually and shall be based on the California Medical Assistance Commission’s annually published legislative report of average contract rates for general acute care hospitals with Medi-Cal contracts. However, the reimbursement shall not exceed the alternative birth center’s charges to

any non-Medi-Cal patient for similar services. This paragraph shall apply to Medi-Cal reimbursement for facility-related delivery costs of alternative birth centers until the effective date of any necessary federal approval obtained by the department pursuant to paragraph (2).

(2)Effective no earlier than July 1, 2017, the department shall reimburse facility-related Medi-Cal delivery costs of eligible alternative birth centers based on a statewide all-inclusive rate per delivery that shall not exceed 80 percent of the average diagnosis-related groups (DRG) Level 1 rates received by general acute care hospitals pursuant to Section 14105.28 and the applicable provisions of the Medi-Cal State Plan. Reimbursement pursuant to this paragraph shall not exceed the alternative birth center’s charges to any non-Medi-Cal patient for similar services. The

department shall seek any federal approvals necessary to implement this paragraph. This paragraph shall not be implemented until any necessary federal approvals are obtained. This paragraph shall not be construed to make inoperative any existing payment reductions that are applicable to alternative birth center services, including, but not limited to, the payment reductions imposed pursuant to Section 14105.192, subject to paragraph (3).

(3)Effective July 1, 2022, or the effective date specified in any necessary federal approvals obtained by the department to implement subparagraph (B) of paragraph (13) of subdivision (h) of Section 14105.192, whichever is later, reimbursement to alternative birth centers shall be exempt from the payment reductions imposed by subdivision (d) of Section 14105.192.

(b)In order to be eligible for reimbursement pursuant to this section, an alternative birth center shall satisfy the following criteria as determined by the state department:

(1)The facility shall meet all applicable requirements of Section 1204.3 of the Health and Safety Code.

(2)The facility may utilize licensed midwives, certified nurse-midwives, certified nurse practitioners, and clinical nurse specialists when appropriate.

(3)The facility shall meet the standards for certification established by the American Association of Birth Centers, or at least equivalent standards as determined by the department, including those relating to the proximity and involvement of hospitals, obstetricians, and

pediatricians.

(c)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins or notices, policy letters, or other similar instructions, without taking regulatory action.

(d)This section does not alter the scope of practice for any health care professional or authorize the delivery of health care services in a setting or in a manner not authorized by the Health and Safety Code or the Business and Professions Code.

(e)This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation

is available and is not otherwise jeopardized.

§ 14148.85

Amended by Stats. 2023, Ch. 372, Sec. 6. (AB 1481) Effective January 1, 2024.

The department shall provide for the receipt and initial processing of Medi-Cal applications from pregnant people and from children born after September 30, 1983, who have not yet attained 19 years of age, at facilities other than the county welfare department as described in Title XIX of the Social Security Act (42 U.S.C. Sec. 1396 and following).