BILL NUMBER: AB 12 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 1, 2007
AMENDED IN ASSEMBLY APRIL 17, 2007
AMENDED IN ASSEMBLY APRIL 9, 2007
AMENDED IN ASSEMBLY MARCH 22, 2007
AMENDED IN ASSEMBLY MARCH 13, 2007
INTRODUCED BY Assembly Member Beall
DECEMBER 4, 2006
An act to add Division 113 (commencing with Section 131500) to the
Health and Safety Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 12, as amended, Beall. The Adult Health Coverage Expansion
Program: Santa Clara County.
Existing law requires a health care service plan and a health
insurer to fairly and affirmatively offer, market, and sell its
contract or its policy, as specified, to small employers, as defined.
Existing law also provides for a local initiative, which is defined
as a prepaid health plan organized by a county government or by
stakeholders to provide comprehensive health care to eligible
Medi-Cal beneficiaries.
This bill would authorize the creation of the Adult Health
Coverage Expansion Program as a pilot program in Santa Clara County
that would be administered by the county or a local initiative in the
county if the county elects to participate in the program. The
program would provide health care coverage to eligible employees, as
specified, of a small business, as defined, that participates in the
program, not to exceed 5,000 employees in the county. The bill would
fund the program through a combination of employer contributions,
employee premiums, and any state, local,
county or federal funding made available for its purposes. The
bill would authorize the county or local initiative to determine the
amount of employer and employee contributions, subject to specified
maximum amounts. The bill would establish the amount of the
state contribution for each covered employee at $50 per month,
subject to funds being appropriated in the annual Budget Act.
The bill would provide for an evaluation of the pilot
program after 3 years.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) When a comprehensive health plan concept for the state is
adopted, there may still be some workers who lack health care
coverage.
(b) Seventy percent of the 1.7 million working uninsured are
employed by a business with fewer than 50 workers.
(c) Counties generally have a responsibility to provide a health
care safety net.
(d) A large number of small businesses would like to offer health
care coverage to their workers but have been unable to identify an
affordable, comprehensive health plan.
(e) It is therefore the intent of this act to provide health care
coverage on a pilot program basis to uninsured working adults in
California through the Adult Health Coverage Expansion Program.
SEC. 2. Division 113 (commencing with Section 131500) is added to
the Health and Safety Code, to read:
DIVISION 113. The Adult Health Coverage Expansion Program
CHAPTER 1. GENERAL PROVISIONS
131500. This division shall be known and may be cited as the
Adult Health Coverage Expansion Program.
131501. It is the intent of the Legislature that the Adult Health
Coverage Expansion Program provide health care coverage to eligible
adults employed in California who are without health care coverage on
a pilot program basis in Santa Clara County.
131502. The following definitions apply for purposes of this
division:
(a) "Local initiative" has the same meaning as set forth in
Section 12693.08 of the Insurance Code.
(b) "Program" means the Adult Health Coverage Expansion Program.
(c) "Small business" means an entity located in Santa Clara County
that employs 50 or fewer persons, with at least 35 percent of the
employees earning having a family income of
less than 300 percent of the federal poverty level, and that
has not offered health care coverage to its employees for, at
minimum, 12 consecutive months.
CHAPTER 2. ADMINISTRATION
131510. The program may be implemented as a pilot program in
Santa Clara County, at the option of the county. A maximum of 5,000
employees may be covered in the county. The county or the local
initiative shall administer the program.
131511. (a) In implementing the pilot program established
pursuant to this division, the county or the local initiative in
Santa Clara County shall not be subject to the requirements of
Article 3.1 (commencing with Section 1357) of Chapter 2.2 of Division
2, except as provided in this division, and providing that the
coverage offered to small employers complies with all the
requirements of this division relating to eligibility, benefits, and
funding. The county or local initiative may impose preexisting
condition provisions as defined in subdivision (f) of Section 1357
and shall be subject to the rating restrictions imposed under
Sections 1357.12 and 1357.13.
(b) Except in the case of a late enrollee or for satisfaction of a
preexisting condition clause in the case of initial coverage for an
eligible employee, the county or the local initiative may not exclude
any eligible employee or dependent who would otherwise be eligible
for health care coverage under this division on the basis of an
actual or expected health care condition of that employee or
dependent. The county or local initiative may not limit or exclude
coverage for any eligible employee or dependent by type of illness,
treatment, medical condition, or accident, except for preexisting
conditions as permitted under Section 1357.06.
(c) Coverage provided through the program to an eligible small
employer shall be renewable with respect to all eligible employees or
dependents at the option of the participating small employer.
CHAPTER 3. ELIGIBILITY
131520. An adult age 19 to 64 years, inclusive, employed by a
small business for a minimum of 40 hours per month is eligible to
participate in the program if he or she has a gross annual
family income that is less than 300 percent of
the federal poverty level, and his or her employer participates in
the program.
131521. A small business may apply to the county or the local
initiative that administers the program to obtain coverage for its
employees who meet the requirements of Section 131520.
131522. The program shall screen potential enrollees to determine
if they meet the eligibility requirements for the Medi-Cal program.
CHAPTER 4. BENEFITS
131530. The county or the local initiative that establishes a
program shall offer health care coverage through the program, and all
health care services shall be provided to participants by a provider
operated by the county or by a provider with whom the county has
contracted to provide health care services.
131531. The health care services provided through the program
shall be comprehensive and shall include inpatient and outpatient
services, emergency care, and coverage for prescription medications.
Participants may be charged a copayment for the health care services.
The program shall provide to eligible employees and dependents at
least all of the basic health care services included in subdivision
(b) of Section 1345 and in Section 1300.67 of Title 28 of the
California Code of Regulations.
CHAPTER 5. FUNDING
131540. The cost of the health care coverage provided through the
program shall be paid through a combination of contributions paid by
the small employer, premiums paid by participating employees, and
any state, county, county and federal
funding made available for this purpose. The county or the local
initiative may determine the amount of the employer contribution,
which shall not exceed one hundred twenty-five dollars ($125) per
month, and the amount of the employee contribution, which shall not
exceed fifty dollars ($50) per month.
131541. The state contribution shall be fifty dollars ($50) per
employee per month, subject to appropriation in the annual Budget
Act.
CHAPTER 6. EVALUATION
131550. The county or local initiative shall evaluate the pilot
program after three years, including all of the following: the number
of individuals served, the demographics of the individuals served,
the number of employees turned away due to the limitation on
enrollment in Section 131510, the number of small businesses
participating, the number of small businesses turned away due to the
limitation on enrollment of individuals, funding sources (including
employees, employers, county, state, and other
sources), and the health status of enrollees.