system and provided to the department, along with its proposed enrollment target, by November 30, 2013. The county public hospital health system may notify the department of a proposed reduction to its enrollment target based on its capacity to accept new patients. A standardized protocol for determining the target shall be developed by the department in consultation with the public hospital health system counties.

assigned by each Medi-Cal managed care plan to primary care providers within the county public hospital health system until the county public hospital health system meets its enrollment target.

other Medi-Cal members of the Medi-Cal managed care plan who do not affirmatively select primary care providers. Medi-Cal managed care plans shall not modify the assignment procedures due to the default assignment requirements of this section with respect to primary care providers within the county public hospital health system.

data demonstrating which default members have accessed the county public hospital health system providers prior to assignment to a primary care provider.

provider has notified the Medi-Cal managed care plan that it does not have capacity to accept new patients.

arrangements in place with county public hospital health systems that provide for implementing the requirements of this section. To the extent a Medi-Cal managed care plan is not compliant with any of the requirements of this section, the department shall reduce by 25 percent the default assignment into the Medi-Cal managed care plan with respect to all Medi-Cal beneficiaries, as long as the other Medi-Cal managed care plan or plans in that county have the capacity to receive the additional default membership.

demonstration project authorized under Section 1115 of the Social Security Act entitled the “Bridge to Health Care Reform” (waiver number 11-W-00193/9), including protocols pending federal approval, and under Section 14166.8.

hospital health system.

Title

This chapter shall be known and may be cited as the Protect Access to Health Care Act of 2024.

Findings and Declarations

The people of the State of California find and declare all of the following:

investment and initial outcomes appear to be successful, these investments are at risk in future years and need to be protected.

delivery are at risk of being reduced or eliminated.

health services can take even longer. California suffers not only from a shortage of mental health care professionals, but also from a shortage of psychiatric beds and treatment for patients with serious mental health conditions. When patients with serious mental health needs cannot obtain adequate care, they frequently wait days in the emergency room or may ultimately be left untreated and become homeless.

rooms. This puts additional, and avoidable, strains on our state’s emergency rooms. When Medi-Cal patients are forced to rely on emergency rooms as their primary source of health care, the additional strain makes it harder for all patients to obtain life-saving care.

First, it ensures the existing tax is continued permanently so that California obtains its fair share of federal health care funding. Second, it guarantees that all of the revenue from the continued tax will be spent on investments to improve access to critical health care services and makes it impossible to divert these dollars to unrelated uses.

prescription drug programs, and increasing our health care workforce, bed capacity, and treatment options, and protecting these dollars from unauthorized uses, this chapter will improve our overall health care system by providing all patients with greater access to quality health care and affordable drugs.

Statement of Purpose

In enacting this chapter, the purpose and intent of the people of the State of California is to do all of the following:

Creation of the Protect Access to Health Care Fund

Enrollment Fund have been exhausted, the Managed Care Enrollment Fund is hereby abolished, and Section 14199.82 shall become inoperative, and is hereby repealed one year after becoming inoperative.

after becoming inoperative.

Fund Oversight and Accountability

website.

required by this paragraph.

Treatment of Moneys Deposited in and Expended from the Fund

Notwithstanding any other law:

only be used for the specific purposes set forth in this chapter. Action shall not be taken that permanently or temporarily changes the status of the fund or any subfund, account, or subaccount within the fund as a trust fund, trust subfund, trust account, or trust subaccount, or borrows, diverts, or appropriates the moneys in the fund in a manner inconsistent with this chapter.

the fund are continuously appropriated to the department without regard to fiscal year for the purposes set forth in this chapter.

moneys resulting therefrom described in paragraph (1) as “state revenues” or “state tax revenues” for purposes of Title XIX and Title XXI of the Federal Social Security Act.

Administration

The Treasurer’s office shall calculate and publish the adjustments required by this paragraph.

(B) The department may choose to comply with this requirement on a calendar year or fiscal year basis and may account for such expenditures on an accrual or cash basis. The department shall publish its choices under this subparagraph on its internet website.

(C) For purposes of this paragraph, unexhausted moneys in the fund that are allocated for expenditures associated with payments to Medi-Cal providers pursuant to a federally approved methodology, or a methodology for which federal approval is pending, shall be considered otherwise encumbered at the end of each applicable calendar year or fiscal year.

indemnify the government defendants or the State of California for any damage the restraining order or preliminary injunction may cause.

Controller shall make the transfer required by this paragraph and issue a notice to the parties, the department, and the committee that the transfer has been completed.

Nonsupplantation

only to increase and enhance, and not replace or supplant, each and every preexisting state revenue source for the services and programs that receive additional financial support pursuant to Article 3 (commencing with Section 14199.108) and Article 4 (commencing with Section 14199.109) of this chapter.

be posted on the department’s internet website.

Stakeholder Input

Implementation; Federal Financial Participation; Modifications and Adjustments Necessary for Federal Approval

(A) Meet the requirements of federal statutes or regulations.

(B) Obtain or maintain federal approval.

(C) Ensure federal financial participation is available or is not otherwise jeopardized.

department shall comply with the stakeholder input requirements of Section 14199.121.

payments made pursuant to Article 4 (commencing with Section 14199.109) may be implemented using one or more of the following:

to submit information the department deems necessary to implement and monitor compliance with this chapter, at the times and in the form and manner specified by the department.

to administer and implement a portion of this chapter, that other agency or department shall be covered by paragraph (1).

Continued Imposition of Tax

Implementation of Tax

to, Section 433.68 of Title 42 of the Code of Federal Regulations.

modify or make minor adjustments to any methodology, tax amount, taxing tier, or other provision specified in this article to the extent it is reasonably necessary to meet the requirements of federal statute or regulations, to obtain or maintain federal approval, or to ensure federal financial participation is available or is not otherwise jeopardized.

the department may establish a specific calendar year as the base year and use the base data source to determine for each health plan each of the enrollment totals described in paragraphs (1) to (6), inclusive, of subdivision (a) of Section 14199.83, as that section read in Chapter 13 of the Statutes of 2023.

Tax Computation and Collection

based on countable other enrollees in a health plan.

plan-to-plan cumulative enrollment, cumulative enrollment through the Federal Employees Health Benefits Act of 1959 (Public Law 86-382), and other cumulative enrollment. The director’s determination as to whether to exercise discretion under this subdivision and any determination made by the director under this subdivision shall not be subject to judicial review, except that a health plan may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the department in correcting that health plan’s data when that correction results in a greater tax amount for that health plan.

Limits on Tax Amounts

paragraph (2) of subdivision (a) may be increased by the department quinquennially to reflect any increase in inflation as measured by the Consumer Price Index for All Urban Consumers (CPI-U) beginning on January 1, 2030. At the request of the department, the Controller’s office shall calculate and publish the adjustments permitted by this subdivision.

modified pursuant to subdivision (b), and including the amount of any prior adjustments made pursuant to this subdivision.

Operation

described in subdivision (a), or a final determination as described in subdivision (b), the director shall implement a plan for conducting all appropriate wind-down and closeout activities, including issuance of any refunds, in consultation with the Department of Finance and the stakeholder advisory committee.

Amendment of Chapter

Construction of Chapter

declared invalid.

Standing to Defend Chapter

Notwithstanding any other law, if the State of California or any of its officers or officials fail to defend the constitutionality of this chapter, following its approval by the voters, any other state or local government agency of this state shall have the authority to intervene on behalf of the State of California or the department in a court action challenging the constitutionality of this chapter for the purpose of defending its constitutionality, whether that action is in state or federal trial court, on appeal, or on discretionary review by the Supreme Court of California or the Supreme Court of the United States. The reasonable fees and costs of defending the action by the other state or local government agency shall be a charge on funds

appropriated to the Department of Justice, which shall be satisfied promptly.

Deposit and Allocation of Moneys

Notwithstanding any other law:

Accountability Subfund to cover all of the following:

(A) For the 2025 and 2026 calendar years only, the amount of moneys necessary to cover the appropriations made pursuant to Section 14199.108.3.

(B) Commencing with the 2025 calendar year and each calendar year thereafter, the nonfederal share of increased capitation payments to Medi-Cal managed care plans to account for their projected tax obligation pursuant to Section 14199.84 or Article 6 (commencing with Section 14199.123), for the subject calendar year or years, as applicable.

(C) Reimbursement of the Controller for its responsibilities under this chapter.

(D) Payment of the department’s administrative costs.

(E) Repayment of any

refunds, as applicable.

(F) Costs incurred pursuant to Section 14199.133.

Health Care Subfund.

one-half of 1 percent in the Family Planning Account.

inclusive, of subdivision (d) shall be 200 percent of the average annual amount deposited therein during the immediately preceding two calendar years. This shall be known as the “maximum allowable balance.”

(A) Thirty-two million dollars ($32,000,000) into the Community Health Workers Account.

(B) Sixty-four million dollars ($64,000,000) into the Health Care Workforce Loan Repayment Account.

(C) One hundred twenty million dollars ($120,000,000) into the Medi-Cal Workforce Subaccount.

(D) Ten million dollars ($10,000,000) into the

Affordable Prescription Drugs Account.

(A) Twenty-five percent to the accounts described in paragraphs (1) to (13), inclusive, of subdivision (d) on a pro rata basis according to and consistent with the relative distribution among those paragraphs.

(B) Seventy-five percent to the Medi-Cal Access and Support Account.

Primary Care Account

department may, subject to federal approval and after obtaining stakeholder input pursuant to Section 14199.121, utilize different payment mechanisms, including quality incentive payments or value-based payment models, to recruit, retain, and improve primary care provider participation in Medi-Cal and improve quality.

Specialty Care Account

pursuant to this section.

Community Health Workers Account

balance.

Outpatient and Clinic Access Account

Family Planning Account

providers to offset the costs of providing uncompensated outpatient services and supports.

Reproductive Health Account

Emergency Medical Transportation Account

department shall, subject to the stakeholder input requirements of Section 14199.121, establish and implement increased net reimbursement to private ground emergency medical transport providers for ground emergency medical transports above the rates in effect as of January 1, 2024. To the extent permitted by federal law, the department shall increase net reimbursement based on the regional cost of living where the transport was rendered.

care patients pursuant to Section 14129.3 or any successor statute are eligible to receive payments for ground emergency medical transports rendered to Medi-Cal managed care patients pursuant to this section.

transport providers.

Emergency Department and Hospital Services Account

Designated Public Hospital Account

for the nonfederal share of the Medi-Cal payments to the designated public hospital systems. The department may apply the moneys in the Designated Public Hospital Account for these purposes.

Affordable Prescription Drugs Account

and consumers, and to increase patient access to affordable drugs.

inclusive, and (11) to (13), inclusive, of subdivision (d) are all simultaneously at or above their maximum allowable balance.

Improving Mental Health Account

licensed acute care hospitals and acute psychiatric hospitals. These payments shall:

Health Care Workers Account

achieve the goal of increasing the number of physician and surgeon residency slots and expanding the number of locations offering physician and surgeon residency programs, as compared to the number of residency slots and program locations in place on December 31, 2023. For the purposes of this section, all allopathic and osteopathic residency programs accredited by federally recognized accrediting organizations and located in California shall be eligible to apply to receive funding to support resident education in California. No later than January 1, 2027, the department may seek federal approval for the programs created or expanded pursuant to this subdivision. However, the graduate medical education programs are not contingent upon federal approval and federal financial participation.

Account. The department may enter into an interagency agreement with another state government agency or entity to administer and implement a grant program funded by the Medi-Cal Workforce Subaccount as set forth in this subdivision.

this subdivision, the department or its designated state government agency or entity may give preference to a bona fide labor-management cooperation committee that is organized on a multiemployer basis and involves multiple labor organizations.

Definitions

For purposes of this chapter, as used in both the singular and plural form, the following definitions shall apply:

necessary to meet the requirements of federal statute or regulations, to obtain or maintain federal approval, or to ensure federal financial participation is available or is not otherwise jeopardized.

organized labor unions that represent health workers in the state.

federal Health Resources and Services Administration as meeting FQHC program requirements as set forth in Sections 1395x(aa)(4)(B) and 1396d(1)(2)(B) of Title 42 of the United States Code.

subdivision (b) of Section 1206 of the Health and Safety Code. If clinics exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code choose to participate in a directed payment program described in Section 14199.120.5, the directed payment program will use the “classes of provider” functionality at a minimum to create a tier for those clinics and allow for payments to those clinics to be based on an amount allocated to their class’s pool.

Professions Code who serves Medi-Cal patients.

entity or local agency that contracts with the department to provide covered specialty mental health services pursuant to Section 14184.400 and Chapter 8.9 (commencing with Section 14700).

managed care plan that is approved by the federal Centers for Medicare and Medicaid Services as described in Section 438(c) of Title 42 of the Code of Federal Regulations, established pursuant to Section 438(c) of Title 42 of the Code of Federal Regulations, or otherwise required by the Medi-Cal managed care plan contract, and documented in a rate certification approved by the federal Centers for Medicare and Medicaid Services as applicable.

51323 of Title 22 of the California Code of Regulations, by air ambulance, as defined in Section 100280 of Title 22 of the California Code of Regulations.

Section 14199.103.

(aa) “General acute care hospital” has the same meaning as in subdivision (a) of Section 1250 of the Health and Safety Code.

(ab) “Ground emergency medical transports” means emergency medical transports, as defined in Section 14129, that originate from a 911 call center or equivalent public safety answering point.

(ac) “Health care service plan” or “health plan” means a health care service plan, other than a plan that provides only specialized or discount services, that is licensed by the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code) or a Medi-Cal managed care plan contracted with the department to provide full-scope Medi-Cal services.

(ad) “Medi-Cal patient” means a Medi-Cal beneficiary as defined in Section 14252.

(ae) “Medi-Cal enrollee” means an individual enrolled in a health plan, as defined in subdivision (ac), who is a Medi-Cal patient for whom the department directly pays the health plan a capitated payment.

(af) “Medi-Cal managed care plan” means any individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal patients pursuant to this chapter or Chapter 8 (commencing with Section 14200).

(ag) “Medi-Cal per enrollee tax amount” means the amount of tax assessed per countable Medi-Cal enrollee within a Medi-Cal taxing tier.

(ah) “Medi-Cal taxing tier” means a range of cumulative enrollment of countable Medi-Cal enrollees for the base year.

(ai) “Net reimbursement” or “net reimbursement levels” means the total payments to Medi-Cal providers for the applicable services and procedures received as of January 1, 2024, less any amounts financed by Medi-Cal providers as the nonfederal share of those payments via provider taxes or fees, certified public expenditures, or intergovernmental transfers.

(aj) “Network provider” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.

(ak) “Other enrollee” means an individual enrolled in a health plan who is not a Medi-Cal enrollee.

(al) “Other per enrollee tax amount” means the amount of tax assessed per countable other enrollee within an other taxing tier.

(am) “Other taxing tier” means a range of cumulative enrollment of countable other enrollees for the base year.

(an) “Plan-to-plan enrollee” means an individual who receives their health care services through a health plan pursuant to a subcontract from another health plan.

(ao) “Primary care” has the same meaning as in Section 51170.5 of Title 22 of the California Code of Regulations.

(ap) “Private ground emergency medical transport provider” means a provider of ground emergency medical transports that does not meet the definition of paragraph (1) of subdivision (a) of Section 14105.945.

(aq) “Qualified family planning provider” means a Medi-Cal provider that meets all of the following conditions:

(ar) “Specialist” means a physician or surgeon or other licensee pursuant to the Medical Practice Act (Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code) or the Osteopathic Act (Chapter 8 (commencing with Section 3600) of Division 2 of the Business and Professions Code) who delivers to

Medi-Cal patients health care services, treatment, or procedures at least some of which do not qualify as primary care.

(as) “Specialty care” means health care services provided by a specialist.

(at) “State-Only Family Planning Program” means the program established pursuant to Division 24 (commencing with Section 24000).

(au) “Tax period” means a period of not more than 12 months for which the tax imposed pursuant to Article 6 (commencing with Section 14199.123) is assessed.

Stakeholder Advisory Committee Established

capacity for two years and is eligible for reelection. The chairperson shall preside at all meetings and shall have all the powers and privileges of other committee members.

Committee Membership

and reproductive health providers on a statewide basis.

state.

and resident of the United States or satisfy the requirements of subdivision (b) of Section 1020 of the Government Code.

Committee Member Terms

vacant. Within 30 calendar days of receipt of the written notice, the appointing authority shall appoint a successor to serve the remainder of the former member’s term. Upon expiration of the unexpired term, the successor may be appointed to a full term.

Powers and Duties of the Committee

and 14199.102.

of its members, and may delegate to a subcommittee any right or responsibility bestowed upon the committee, including the right or responsibility of providing advice and written input to the department on a given subject.

Compensation

Members of the committee shall serve without compensation, but shall receive reimbursement for necessary expenses, subject to approval by the department.