BILL ANALYSIS
AB 1269
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Date of Hearing: May 6, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 1269 (Brownley) - As Amended: April 14, 2009
Policy Committee: Health Vote:13-6
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This makes several eligibility changes to the California 250%
Working Disabled Program (CWD) to improve continuity of
coverage. Specifically, this bill:
1)Exempts consideration of Social Security income from
eligibility calculations while on CWD. Allows accumulated
savings to be exempted from future eligibility determinations
in other Medi-Cal programs. Exempts Social Security income
received by disabled individuals 65 years or older from
Medi-Cal eligibility determinations.
2)Authorizes temporarily unemployed beneficiaries up to 26 weeks
of continuation coverage like many employer-based health
policies offer under the Consolidated Omnibus Budget
Reconciliation Act (COBRA) or Cal-COBRA.
FISCAL EFFECT
1)Annual increased costs of $300,000 (50% GF) to $500,000 (50%
GF) to the extent the eligibility changes regarding income and
asset disregards increase CWD enrollment. Costs associated
with prior versions of this bill do not apply, as the CWD
program was made permanent in the budget act last year and
those provisions are no longer contained in this legislation.
2)The actual fiscal impact of this bill may be less, depending
how many enrollees transfer from other Medi-Cal programs
versus new enrollees who have either been uninsured or covered
by private insurance. Due to the low annual income ($27,000 in
2009) and assets required for eligibility, as well as the
significant disabilities of individuals in this program, most
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of the CWD beneficiaries will remain eligible for other
Medi-Cal programs, regardless of employment status. Several
provisions of this bill should reduce churning, the cycling on
and off of coverage or between coverage programs.
3)Caseload estimates over the past 10 years for this very small
Medi-Cal program have been continually overestimated as can
happen with small programs with specific and complex
eligibility criteria. In addition, small programs like CWD
often grow slowly. Initial estimates for this program in 1999
were 7,000 to 14,000 individuals enrolled annually. However,
five years after the creation of the program, only about 1,500
were enrolled. Now 10 years later, only 3,700 are enrolled.
This bill reduces enrollment barriers and should increase
caseloads, but not significantly.
COMMENTS
1)Rationale . This bill, sponsored by the World Institute on
Disability (WID), makes eligibility changes to allow
individuals to increase earnings and advance toward
self-sufficiency while maintaining access to Medi-Cal
services. WID, founded 25 years ago, provides programs to
address issues of concern to people with disabilities. For
people with disabilities, fear of losing health coverage if
they work often prevents them from entering the job market.
CWD reduces this fear by allowing working disabled individuals
to buy Medi-Cal coverage on a sliding scale premium basis.
This bill increases continuity of coverage by allowing
beneficiaries who become unemployed to continue coverage for a
period of time and allows beneficiaries receiving specified
Social Security benefits to continue working without losing
health eligibility.
2)Background . The CWD, created in 1999, allows working disabled
individuals under 250% of the federal poverty level (FPL) and
generally eligible for the Supplemental Security Income/State
Supplemental Program (SSI/SSP) to buy into the Medi-Cal
program.The current program is unique among Medi-Cal programs
in exempting Individual Retirement Accounts (IRAs) and 401K
accounts from property limits. Based on countable income,
individuals pay monthly premiums on a sliding scale from $20
to $250. This bill increases the earning and savings potential
of current CWD enrollees as well as reducing barriers to
participation. Survey results regarding such barriers indicate
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42% of potentially eligible individuals do not understand
eligibility, 22% are concerned about asset tests, and 57%
would be helped by reducing fears about losing Medi-Cal
coverage.
3)Related Legislation . AB 155 (Migden), Chapter 1088, Statutes
of 1999, established CWD. AB 1183 (Committee on Budget),
Chapter 758, Statutes of 2008 made the CWD Program permanent
by deleting the September 1, 2008 sunset date.
AB 1269 is similar to AB 851 (Brownley) in 2008 and AB 1113
(Brownley) of 2007. AB 851 was held on the Suspense File of
the Senate Appropriations Committee and AB 1113 was vetoed due
to a drafting error. The error is not contained in AB 1269.
AB 2679 (Wolk) in 2004 extended the sunset of CWD. This bill was
held on the Suspense File of the Senate Appropriations
Committee.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081