BILL ANALYSIS
AB 998
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 998 (John A. Perez) - As Introduced: February 27, 2009
SUBJECT : Medi-Cal: organ transplants: anti-rejection
medication.
SUMMARY : Requires Medi-Cal beneficiaries to remain eligible to
receive Medi-Cal coverage for anti-rejection medication for up
to three years following an organ transplant, unless during that
period, the beneficiary becomes eligible for Medicare or private
health insurance that would cover the medication.
EXISTING LAW :
1)Establishes the Medi-Cal Program, administered by the
Department of Health Care Services (DHCS), under which basic
health care services are provided to qualified low-income
persons.
2)Requires organ transplants and donor surgeries to be covered
under the Medi-Cal Program when an organ transplant is
provided to a Medi-Cal beneficiary who is eligible for
full-scope benefits under the Medi-Cal Program in a medical
facility that meets the requirements of and is approved by
DHCS.
3)Requires, under federal law, the eligibility of Medicaid
(Medi-Cal in California) recipients with respect to
circumstances that may change to be re-determined at least
every twelve months, with the exception that disability can be
authorized to continue until a review team authorized under
federal regulations determines that a recipient's disability
no longer meets the definition of disability contained in the
plan.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, there are
currently some patients that qualify for Medi-Cal under a
AB 998
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federal rule allowing coverage for patients on end-stage renal
disease (on dialysis). Those patients, if they are able to
receive a kidney and have an organ transplant, will only
receive coverage for their immunosuppressive medication for
one year post-transplant. However, a person's Medi-Cal
eligibility ends when he or she no longer meets the
eligibility requirement of end-stage renal disease.
Patients in this particular group may not be eligible for
Medi-Cal under any other eligibility criteria, and they may
also be ineligible for Medicare, either because they have not
paid into Social Security for a sufficient time or because of
their immigration status. The author states if these patients
were dual-eligible for Medicare and Medi-Cal, Medicare would
pay for immunosuppressive coverage for an additional two
years, so the patient would have immunosuppressive drugs for a
total of three years post-transplant. Because patients who
have had a kidney transplant must have immunosuppressive drugs
or their body will naturally reject the organ, they have a
medical need for the anti-rejection medication to prevent
kidney failure, being placed back on dialysis or, in a
worst-case scenario, death. The author argues the state has
already paid for the organ transplant surgery (the cost of
transplant surgery is $50,000 to $100,000 according to the
author) and it makes no sense to drop Medi-Cal coverage for
these patients after only a year when many organ transplant
patients are not yet stable or ready to enter the workforce.
2)BACKGROUND . DHCS indicates fee-for-service Medi-Cal provided
coverage for 2,447 major organ transplants in 2008; 2,619 in
2007; and 2,528 in 2006. These numbers include individuals
who may also have had Medicare coverage. Of these transplant
recipients, the number of beneficiaries who had 36 months of
continuous Medi-Cal eligibility was 271 in 2008; 298 in 2007
and 346 in 2006. Current federal law requires the eligibility
of Medicaid recipients be re-determined at least every twelve
months, with the exception that disability can be authorized
to continue until a review team determines that a recipient's
disability no longer meets the definition of disability. In
addition, state law requires a mid-year status report for
adults and an annual reaffirmation of Medi-Cal eligibility.
For those Medi-Cal beneficiaries whose disability (and
therefore Medi-Cal eligibility) ends but who have an on-going
need for anti-rejection medication, Medi-Cal coverage ends
unless the person is otherwise eligible under another Medi-Cal
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eligibility provision. By requiring that Medi-Cal
beneficiaries remain eligible to receive Medi-Cal coverage for
anti-rejection medication for up to three years following an
organ transplant (unless the beneficiary becomes eligible for
Medicare or private health insurance that covers the
medication), this bill would establish a state-only Medi-Cal
Program (meaning federal funds would not be available) for
anti-rejection medication for these individuals.
3)SUPPORT . The National Kidney Foundation of Northern
California and Nevada writes in support that access to
anti-rejection drugs is necessary and must be a priority in
the health care delivery system because immunosuppressants are
a vital tool for the care of kidney transplant patients, and
anti-rejection drugs help to suppress the immune system
rejection of the new organ. The California Medical
Association writes in support that this bill will conform
Medi-Cal to Medicare for anti-rejection medication treatments
and will hopefully provide patients with a sufficient amount
of time for their bodies to heal and accept their new organs.
REGISTERED SUPPORT / OPPOSITION :
Support
California Medical Association
National Kidney Foundation of Northern California and Nevada
Opposition
None on file.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097