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AB 636

Medi-Cal: diapers.

2025-2026 Regular Session Introduced by Liz Ortega

AB 636 would make diapers a Medi-Cal covered benefit for children over 3 with medically related incontinence (and under 21 via EPSDT), subject to federal approval and funding.

In committee: Held under submission.
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Bill Summary · AB 636

AB 636 — Medi‑Cal: diapers (Ortega)

Main purpose

AB 636 would add diapers as an explicit covered Medi‑Cal benefit for certain children and youth with medically related incontinence. The intent is to ensure Medi‑Cal pays for diapers when they are medically necessary to treat or ameliorate incontinence tied to a diagnosed condition.

Key provisions

  • Adds Welfare & Institutions Code section 14132.33.
  • Coverage rules:
    • Diapers are a Medi‑Cal covered benefit for any child greater than 3 years of age who has a diagnosed physical, mental, neurological, or behavioral health condition that contributes to incontinence.
    • Diapers are also covered for any individual under 21 years of age when necessary to correct or ameliorate a condition under federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) standards (W&I §14059.5(b); 42 U.S.C. §1396d(r)).
  • Supply limits: Diapers provided under this section are limited to an “appropriate supply” based on the beneficiary’s diagnosed condition and age.
  • Implementation conditions:
    • The Department of Health Care Services (DHCS) must seek any required federal approvals.
    • Implementation is contingent on obtaining required federal approvals, availability of federal financial participation, and a legislative appropriation.
    • DHCS must update the Medi‑Cal provider manual as applicable.

Who would be affected

  • Primary beneficiaries: Medi‑Cal‑enrolled children older than 3 with medically related incontinence and Medi‑Cal enrollees under 21 when EPSDT standards support the service.
  • Providers and Medi‑Cal plans: would need to adopt administrative, billing, and documentation practices; DHCS to update provider guidance.
  • State and potentially federal budgets: if implemented, costs may increase depending on utilization; federal matching funds may apply if CMS approves coverage.

Procedural status & timeline

  • Introduced: February 13, 2025.
  • Key committee actions: Referred to Health Committee (Feb–Mar 2025); amended and re‑referred; passed out of Health (April 1, 2025) and re‑referred to Assembly Appropriations (April 2); set on suspense and held under submission (April–May 2025).
  • Current status (as of 2025‑05‑23): In committee — Held under submission.

Notes on fiscal and federal issues

  • The bill expressly requires federal approval and conditions implementation on availability of federal financial participation and a legislative appropriation, indicating potential costs and need for CMS sign‑off (since diapers may be treated differently under Medicaid rules than other incontinence supplies).
  • No specific appropriation amount is included in the bill text.

Compiled from official sources — confirm details with the bill’s official record.

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