Senate Bill 810 Chapter 4 Eligibility


All California residents shall be eligible for the system. Residency shall be based upon physical presence in the state with the intent to reside. The commissioner shall establish standards and a simplified procedure to demonstrate proof of residency.


The commissioner shall establish a procedure to enroll eligible residents and provide each eligible individual with identification that can be used by health care providers to determine eligibility for services.


(a) It is the intent of the Legislature for the system to provide health care coverage to California residents who are temporarily out of the state. The commissioner shall determine eligibility standards for residents temporarily out of state for longer than 90 days who intend to return and reside in California and for nonresidents temporarily employed in California. The commissioner may establish financial arrangements with medical providers in other states and foreign countries in order to facilitate coverage for California residents who are temporarily out of the state.
(b) Coverage for emergency care obtained out of state shall be at prevailing local rates. Coverage for nonemergency care obtained out of state shall be according to rates and conditions established by the commissioner. The commissioner may require that a resident be transported back to California when prolonged treatment of an emergency condition is necessary and when that transport will not adversely affect a patient’s care or condition.


Visitors to California shall be billed for all services received under the system. The commissioner may establish intergovernmental arrangements with other states and countries to provide reciprocal coverage for temporary visitors.


All persons eligible for health care benefits from California employers but who are working in another jurisdiction shall be eligible for health care benefits under this division providing that they make payments equivalent to the payments they would be required to make if they were residing in California.    140404.1.  All persons who under an employer-employee contract or under statute are eligible for retiree health care benefits, including retirees who elect to reside outside of California, shall remain eligible for those benefits in accordance with the contract or the statute.


Unmarried, unemancipated minors shall be deemed to have the residency of their parent or guardian. If a minor’s parents are deceased and a legal guardian has not been appointed, or if a minor has been emancipated by court order, the minor may establish his or her own residency.


(a) An individual shall be presumed to be eligible if he or she arrives at a health facility and is unconscious, comatose, or otherwise unable, because of his or her physical or mental condition, to document eligibility or to act on his or her own behalf, or if the patient is a minor, the patient shall be presumed to be eligible, and the health facility shall provide care as if the patient were eligible.
(b) Any individual shall be presumed to be eligible when brought to a health facility pursuant to any provision of Section 5150 of the Welfare and Institutions Code.
(c) Any individual involuntarily committed to an acute psychiatric facility or to a hospital with psychiatric beds pursuant to any provision of Section 5150 of the Welfare and Institutions Code, providing for involuntary commitment, shall be presumed eligible.
(d) All health facilities subject to state and federal provisions governing emergency medical treatment shall continue to comply with those provisions.
(e) In the event of an influx of people into the state for the purposes of receiving medical care, the commissioner shall establish an eligibility waiting period and other criteria needed to ensure the fiscal stability of the system.