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30 as previously stated, prescribes rules for the organization of health maintenance organizations and other managed care entities. It specifies plan standards, marketing rules, and consumer disclosure requirements. It also establishes fiscal solvency requirements and quality assurance standards.

Services are provided in accordance with the routine utilization review procedure used in the Medi-Cal program consistent with the Title XIX state plan, which operates under the Knox-Keene Act in a Managed Care setting.

Section 4. Eligibility Standards and Methodology

Guidance: States electing to use funds provided under Title XXI only to provide expanded eligibility under the State’s Medicaid plan or combination plan should check the appropriate box and provide the ages and income level for each eligibility group. If the State is electing to take up the option to expand Medicaid eligibility as allowed under section 214 of CHIPRA regarding lawfully residing, complete section 4.1-LR as well as update the budget to reflect the additional costs if the state will claim title XXI match for these children until and if the time comes that the children are eligible for Medicaid.

CA RESPONSE: Please see Attachment 1 for all of the references to the approved templates, including details regarding eligibility levels, in Section 4 below.

4.0.

Medicaid Expansion

4.0.1. Ages of each eligibility group and the income standard for that group:

CA REPSONSE:

OPTIONAL TARGETED LOW INCOME CHILDREN PROGRAM (OTLICP): Please see approved CS3 template for age and income standards.

ASSET WAIVER CHILDREN/CS3 PROXY: Please see approved CS3 template.

Please also see approved CS3 template for age and income levels for OTLICP, as well as the state’s narrative to the CS3 related to the proxy methodology for asset waiver children. 4.1.

Separate Program Check all standards that will apply to the State plan. (42CFR 457.305(a) and 457.320(a))

4.1.0 Describe how the State meets the citizenship verification requirements.