AB543 - Medi-Cal: field medicine.

Assembly Bill No. 543 CHAPTER 374 An act to amend Section 15926 of, and to repeal the heading of, and to add, Article 5.7 (commencing with Section 14186) of Chapter 7 of Part 3 of Division 9 of, the Welfare and Institutions Code, relating to Medi-Cal. [ Approved by Governor October 06, 2025. Filed with Secretary of State October 06, 2025. ] LEGISLATIVE COUNSEL'S DIGEST AB 543, Mark González. Medi-Cal: field medicine. 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 sets forth various provisions for Medi-Cal coverage of community health worker services, enhanced care management, and community supports, subject to any necessary federal approvals. Under existing law, these benefits are designed to, respectively, provide a link between health and social services and the community; address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries, including individuals experiencing homelessness; and provide housing transition navigation services, among other supports. This bill would set forth provisions regarding field medicine, as defined, under the Medi-Cal program for persons experiencing homelessness, as defined. The bill would state the intent of the Legislature that the field medicine-related provisions coexist with, and not duplicate, other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports. The bill would authorize a Medi-Cal managed care plan to elect to offer Medi-Cal covered services through a field medicine provider, as defined. Under the bill, a managed care plan that elects to do so would be required to allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member’s in-network assignment, as specified. The bill would also require the managed care plan to allow an in-network, contracted field medicine provider enrolled in Medi-Cal to directly refer a member who is experiencing homelessness for covered services within the appropriate network, as specified. The bill would require a managed care plan to have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member’s plan or independent practice association, and the member’s primary care provider for purposes of care coordination and to prevent the duplication of services. The bill would require a managed care plan to provide a method for a Medi-Cal member to inform the managed care plan online, in person, or via telephone that the member is experiencing homelessness. The bill would require the department to inform a managed care plan if a member has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application. In the case of a Medi-Cal beneficiary who is experiencing homelessness and who receives services within the fee-for-service delivery system, the bill would require the department to reimburse a field medicine provider enrolled in Medi-Cal for providing Medi-Cal covered services. The bill would condition implementation of the above-described provisions on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would require, on or before January 1, 2027, that the standard application form for insurance affordability programs include an optional question for an applicant to identify whether they are experiencing homelessness. The bill would make conforming changes to related provisions under existing law regarding the application process. The bill would also remove obsolete references within related provisions. To the extent that the bill would create new duties for counties with regard to data sharing under Medi-Cal, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill Text The people of the State of California do enact as follows: SECTION 1. The Legislature finds and declares all of the following: (a) People experiencing homelessness have poorer health outcomes and increased mortality rates compared to the general population. This has been linked to barriers to accessing primary care, such as lack of transportation, lack of government-issued identification, limited means to make appointments, mobility challenges, and competing priorities, including, but not limited to, finding food and maintaining safety. (b) Poor health outcomes have also been attributed to institutional trauma in the traditional health care system, including experiences of discrimination and exclusion, resulting in distrust of the health care system and hesitation about seeking medical care. (c) The mortality rate among people experiencing homelessness is 10 times higher than that of housed individuals and continues to rise across California. Deaths of people experiencing homelessness in the County of Los Angeles have increased by over 3.5 times, while the annual mortality rate roughly doubled between 2014 and 2022, according to a 2024 report from the Department of Public Health for the County of Los Angeles. (d) Homelessness and homeless deaths disproportionately affect people of color, with this population accounting for 68 percent of deaths on the street and demonstrating a gross health inequity. (e) Poor access to primary care directly contributes to the increased mortality rates observed among people experiencing homelessness. Only 8 percent of people experiencing homelessness have a primary care provider (PCP) versus 82 percent of the general population. This disparity persists, even though 78 percent are insured. (f) People experiencing homelessness with Medi-Cal coverage rely on referrals from their PCPs to access specialty care and durable medical equipment, such as wheelchairs. Lack of access to primary care furthers lack of access to specialty care. (g) There are effective, evidence-based models for delivering health care to persons experiencing homelessness, including field medicine, shelter-based care, and care provided in transitional housing. These models were developed specifically to address the unique needs and circumstances of persons experiencing homelessness onsite where they reside. (h) Through field medicine, shelter-based care, mobile clinics, and related delivery models, providers remove access barriers for persons experiencing homelessness in order to deliver patient-centered care. Services provided include medical care for acute and chronic health conditions, behavioral health care treatment, treatment for substance use disorders, dispensing common medications, and drawing blood. (i) Less than 30 percent of people experiencing homelessness who are insured have ever seen their primary care physician, versus 70 percent of those treated by field medicine teams, who are actively engaged in primary care within one week of referral. (j) Providing medical care to persons experiencing homelessness outside of traditional medical settings has demonstrated a decrease in hospital admissions by two-thirds with a hospital-based consultation service. (k) Persons experiencing homelessness have twice the length of stay while hospitalized compared to the housed population, and spend 740 percent more days in the hospital at a 170-percent greater cost per day than people who are housed. For homeless patients admitted to the hospital, field medicine reduces the length of hospital stays from 12 to 7.9 days. (l) Providing health care and social services on the street or outside of traditional medical facilities improves housing placement compared to only providing nonmedical outreach services. In the City of Los Angeles, field medicine teams have successfully transitioned 42 percent of their homeless patients into permanent housing, compared to 4 percent when the Los Angeles Homeless Services Authority is the responsible party. (m) Although field medicine services substantially reduce morbidity and mortality among individuals experiencing homelessness, various policy barriers prevent those living unsheltered from fully accessing the benefits of these services and other supports. These barriers include all of the following: (1) Individuals experiencing homelessness often face delays in accessing critical health care due to gaps in Medi-Cal coverage. When their Medi-Cal coverage lapses or when they are not enrolled, the process for redetermination or initial enrollment can take weeks, either delaying care or forcing field medicine providers to provide unreimbursed care and medically necessary services. (2) While field medicine providers can order medically necessary services, such as wheelchairs or diagnostics, Medi-Cal managed care plans continue to deny medically necessary services based on primary care provider (PCP) or independent practice association (IPA) assignment alone. This has profound consequences for patients on the street, contributing to increased morbidity, mortality, and suffering. (3) Existing administrative systems for accessing benefits for low-income persons, including, but not limited to, the California Statewide Automated Welfare System (CalSAWS) and the California Advancing and Innovating Medi-Cal (CalAIM) initiative within Medi-Cal, lack a definitive identifier for individuals experiencing homelessness, resulting in missed opportunities to connect them to eligible services and making it difficult to determine eligibility, track benefits received, or ensure access to future programs from which they would benefit. SEC. 2. The heading of Article 5.7 (commencing with Section 14186) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code is repealed. SEC. 3. Article 5.7 (commencing with Section 14186) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read: Article 5.7. Medi-Cal Field Medicine 14186. For purposes of this article, the following definitions apply: (a) “Medi-Cal managed care plan” has the same meaning as set forth in Section 14184.101. (b) “Person experiencing homelessness,” or a variation thereof, means a person who lacks a fixed, regular, and adequate nighttime residence. This may include living in shelters, transitional housing, or places not meant for habitation, like cars or outdoors. (c) “Field medicine” means a set of health and social services developed specifically to address the unique needs and circumstances of persons experiencing homelessness utilizing a whole-person, patient-centered approach to provide medically necessary health care services, and to address social drivers of health that impede health care access. (d) “Field medicine provider” means a licensed medical provider, including, but not limited to, a physician and surgeon, osteopathic physician and surgeon, physician assistant, nurse practitioner, or certified nurse-midwife, who conducts patient visits outside of the four walls of health facilities, clinics, or other locations, and instead directly on the street, in environments where persons experiencing homelessness might be, such as living in a car, recreational vehicle, encampment, abandoned building, or other outdoor areas. 14186.1. (a) (1) The department shall seek any federal approvals necessary to implement this article. (2) Each section of this article shall be implemented only to the extent that any necessary federal approvals are obtained and that federal financial participation is available and is not otherwise jeopardized. (b) 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 article by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until any necessary regulations are adopted. 14186.2. It is the intent of the Legislature that implementation of this article not be duplicative of implementation of other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports, as described in Sections 14132.36, 14184.205, and 14184.206, respectively. It is the intent of the Legislature that the field medicine-related provisions set forth in this article coexist with those other Medi-Cal benefits in order to fill significant gaps within the health care system for persons experiencing homelessness. 14186.3. (a) A Medi-Cal managed care plan may elect to offer Medi-Cal covered services through an in-network, contracted field medicine provider pursuant to this article. (b) A Medi-Cal managed care plan that elects to offer Medi-Cal covered services through an in-network, contracted field medicine provider shall allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member’s in-network assignment, such as primary care provider (PCP) or independent practice association (IPA) assignment. (c) (1) A Medi-Cal managed care plan that elects to offer Medi-Cal covered services through an in-network, contracted field medicine provider shall allow an in-network, contracted field medicine provider enrolled in the Medi-Cal program to directly refer a member who is experiencing homelessness for covered services, including specialist, diagnostic services, medications, durable medical equipment, transportation, or other medically necessary covered services, within the appropriate network of the Medi-Cal managed care plan or in-network IPA. (2) The Medi-Cal managed care plan or IPA shall create referral and authorization mechanisms in order to facilitate the referrals described in paragraph (1). (d) Medi-Cal managed care plans contracting with field medicine providers pursuant to this section shall have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member’s plan or IPA, and the member’s assigned primary care provider for purposes of care coordination and to prevent the duplication of [Text truncated for display. Full text available on Congress.gov.]