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    AB-499
    Health & Public Health

    Robert F. Kennedy Farm Workers Medical Plan.

    Enrolled
    CA
    ∙
    2025-2026 Regular Session
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    0
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    Track

    Key Takeaways

    • Lowers the eligibility threshold from $70,000 to $50,000 per single episode of care.
    • Maintains the $3,000,000 cap and is subject to fiscal committee review.
    • Requires CPA-verified data covering Sept 1 to Aug 31 and reimburses within 60 days.
    • Expires January 1, 2031 unless extended.

    Summary

    Assembly Member Ortega’s AB 499 would recalibrate the Robert F. Kennedy Farm Workers Medical Plan’s state reimbursement framework by lowering the per-episode eligibility threshold from $70,000 to $50,000 while preserving a $3 million annual cap, and by introducing a formal, CPA-verified data reporting and reimbursement process that runs on a defined annual cycle and carries a sunset date in early 2031.

    Under the bill, the state would annually reimburse the plan for claim payments that exceed $50,000 per eligible employee or dependent for a single episode of care, with a cap of $3 million per year. Beginning after September 1, 2017, the plan must submit to the Department of Health Care Services completed data, verified by an independent certified public accountant, covering claims paid during the prior year from September 1 to August 31. If the department receives the data, it must analyze it to determine the total of claims exceeding $50,000, and reimburse the plan the determined amount no later than 60 days after data receipt, up to the annual cap.

    The bill formalizes the reimbursement process and data workflow, creating a defined sequence: CPA-verified annual data submission, department analysis of eligible high-cost claims, and a 60-day payment timeline that is constrained by the $3 million cap. The annual data cycle and reimbursement timing are tied to a September–August reporting period, and the provision is set to expire on January 1, 2031 unless extended by later statute.

    Fiscal and implementation considerations accompany the policy changes. The measure does not itself designate a new appropriation, leaving funding to the normal budgeting process, while creating ongoing administrative duties for both the RFK Plan and the department, including CPA verification of data and department-led analyses. Data specifications and definitions of a “single episode of care” are not detailed in the bill, suggesting that regulatory guidance may be needed to operationalize the framework. The sunset date provides a built-in expiration unless extended. The policy engages stakeholders—primarily the RFK Plan and its eligible members—through a more formal reimbursement mechanism and clearer reporting obligations, while preserving the overarching structure of state support through 2031 subject to extension.

    Key Dates

    Vote on Senate Floor
    Senate Floor
    Vote on Senate Floor
    Assembly 3rd Reading AB499 Ortega By Richardson
    Senate Appropriations Hearing
    Senate Committee
    Senate Appropriations Hearing
    Do pass
    Senate Appropriations Hearing
    Senate Committee
    Senate Appropriations Hearing
    Placed on suspense file
    Senate Health Hearing
    Senate Committee
    Senate Health Hearing
    Do pass, but first be re-referred to the Committee on [Appropriations]
    Vote on Assembly Floor
    Assembly Floor
    Vote on Assembly Floor
    AB 499 Ortega Assembly Third Reading
    Assembly Appropriations Hearing
    Assembly Committee
    Assembly Appropriations Hearing
    Do pass
    Assembly Health Hearing
    Assembly Committee
    Assembly Health Hearing
    Do pass and be re-referred to the Committee on [Appropriations]
    Introduced
    Assembly Floor
    Introduced
    Read first time. To print.

    Contacts

    Profile
    Liz OrtegaD
    Assemblymember
    Bill Author
    Not Contacted
    Not Contacted
    0 of 1 row(s) selected.
    Page 1 of 1
    Select All Legislators
    Profile
    Liz OrtegaD
    Assemblymember
    Bill Author

    Similar Past Legislation

    Bill NumberTitleIntroduced DateStatusLink to Bill
    AB-494
    Robert F. Kennedy Farm Workers Medical Plan.
    February 2023
    Passed
    View Bill
    Showing 1 of 1 items
    Page 1 of 1

    Get Involved

    Act Now!

    Email the authors or create an email template to send to all relevant legislators.

    Introduced By

    Liz Ortega
    Liz OrtegaD
    California State Assembly Member
    70% progression
    Bill has passed both houses in identical form and is being prepared for the Governor (9/8/2025)

    Latest Voting History

    View History
    September 8, 2025
    PASS
    Senate Floor
    Vote on Senate Floor
    AyesNoesNVRTotalResult
    2910140PASS

    Key Takeaways

    • Lowers the eligibility threshold from $70,000 to $50,000 per single episode of care.
    • Maintains the $3,000,000 cap and is subject to fiscal committee review.
    • Requires CPA-verified data covering Sept 1 to Aug 31 and reimburses within 60 days.
    • Expires January 1, 2031 unless extended.

    Get Involved

    Act Now!

    Email the authors or create an email template to send to all relevant legislators.

    Introduced By

    Liz Ortega
    Liz OrtegaD
    California State Assembly Member

    Summary

    Assembly Member Ortega’s AB 499 would recalibrate the Robert F. Kennedy Farm Workers Medical Plan’s state reimbursement framework by lowering the per-episode eligibility threshold from $70,000 to $50,000 while preserving a $3 million annual cap, and by introducing a formal, CPA-verified data reporting and reimbursement process that runs on a defined annual cycle and carries a sunset date in early 2031.

    Under the bill, the state would annually reimburse the plan for claim payments that exceed $50,000 per eligible employee or dependent for a single episode of care, with a cap of $3 million per year. Beginning after September 1, 2017, the plan must submit to the Department of Health Care Services completed data, verified by an independent certified public accountant, covering claims paid during the prior year from September 1 to August 31. If the department receives the data, it must analyze it to determine the total of claims exceeding $50,000, and reimburse the plan the determined amount no later than 60 days after data receipt, up to the annual cap.

    The bill formalizes the reimbursement process and data workflow, creating a defined sequence: CPA-verified annual data submission, department analysis of eligible high-cost claims, and a 60-day payment timeline that is constrained by the $3 million cap. The annual data cycle and reimbursement timing are tied to a September–August reporting period, and the provision is set to expire on January 1, 2031 unless extended by later statute.

    Fiscal and implementation considerations accompany the policy changes. The measure does not itself designate a new appropriation, leaving funding to the normal budgeting process, while creating ongoing administrative duties for both the RFK Plan and the department, including CPA verification of data and department-led analyses. Data specifications and definitions of a “single episode of care” are not detailed in the bill, suggesting that regulatory guidance may be needed to operationalize the framework. The sunset date provides a built-in expiration unless extended. The policy engages stakeholders—primarily the RFK Plan and its eligible members—through a more formal reimbursement mechanism and clearer reporting obligations, while preserving the overarching structure of state support through 2031 subject to extension.

    70% progression
    Bill has passed both houses in identical form and is being prepared for the Governor (9/8/2025)

    Key Dates

    Vote on Senate Floor
    Senate Floor
    Vote on Senate Floor
    Assembly 3rd Reading AB499 Ortega By Richardson
    Senate Appropriations Hearing
    Senate Committee
    Senate Appropriations Hearing
    Do pass
    Senate Appropriations Hearing
    Senate Committee
    Senate Appropriations Hearing
    Placed on suspense file
    Senate Health Hearing
    Senate Committee
    Senate Health Hearing
    Do pass, but first be re-referred to the Committee on [Appropriations]
    Vote on Assembly Floor
    Assembly Floor
    Vote on Assembly Floor
    AB 499 Ortega Assembly Third Reading
    Assembly Appropriations Hearing
    Assembly Committee
    Assembly Appropriations Hearing
    Do pass
    Assembly Health Hearing
    Assembly Committee
    Assembly Health Hearing
    Do pass and be re-referred to the Committee on [Appropriations]
    Introduced
    Assembly Floor
    Introduced
    Read first time. To print.

    Latest Voting History

    View History
    September 8, 2025
    PASS
    Senate Floor
    Vote on Senate Floor
    AyesNoesNVRTotalResult
    2910140PASS

    Contacts

    Profile
    Liz OrtegaD
    Assemblymember
    Bill Author
    Not Contacted
    Not Contacted
    0 of 1 row(s) selected.
    Page 1 of 1
    Select All Legislators
    Profile
    Liz OrtegaD
    Assemblymember
    Bill Author

    Similar Past Legislation

    Bill NumberTitleIntroduced DateStatusLink to Bill
    AB-494
    Robert F. Kennedy Farm Workers Medical Plan.
    February 2023
    Passed
    View Bill
    Showing 1 of 1 items
    Page 1 of 1