CA AB1553

Allows eligible Medi-Cal beneficiaries to request fee-for-service Medi-Cal as an alternative to managed care plan enrollment if they are American Indian, receiving care from an Indian Health Service facility, or have a complex medical condition requiring continuity of care with a non-contracted provider.

Establishes specific complex medical conditions qualifying for exemption, including pregnancy, organ transplant evaluation/receipt, chronic renal dialysis, HIV/AIDS diagnosis, active cancer treatment, major surgery, neurological or hematological disorders, home nursing care, unavailable treatments in home county, terminal illness, and participation in specified pilot projects.

Limits medical exemptions to 12 months from approval date (except pregnancy exemptions which extend through delivery and 90 days postpartum), with automatic expiration notifications 45 days prior and ability to request extensions through the Health Care Options Program.

Requires exemption requests to be submitted by treating providers or Indian Health Service facilities via mail or facsimile, authorizes the department to verify medical condition validity and provider status, and establishes appeal rights and written notice procedures for denials.

Does not apply to beneficiaries enrolled in county organized health systems and prohibits managed care plans from directly submitting exemption requests.