BILL ANALYSIS
AB 1568
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 1568 (Committee on Veterans Affairs) - As Amended: April
23, 2009
SUBJECT : Veterans: benefits.
SUMMARY : Makes the Public Assistance Reporting Information
System (PARIS) a permanent program, delays its operative date
until January 1, 2010 and repeals language requiring the
Department of Health Care Services (DHCS) to select three
consenting counties that have a United States Department of
Veterans Affairs (USDVA) medical center to participate in PARIS.
Specifically, this bill :
1)Makes PARIS a permanent program by repealing language making
PARIS a two-year pilot program where DHCS selects three
consenting counties that have in operation a USDVA medical
center to participate in the pilot.
2)Repeals language allowing DHCS to expand the PARIS pilot
program statewide and continue it indefinitely if DHCS
determines PARIS is cost effective.
3)Requires DHCS to implement the PARIS pilot program by January
1, 2010, instead of July 1, 2009 in existing law.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by DHCS, which
provides comprehensive health benefits to low-income children,
their parents or caretaker relatives, pregnant women, elderly,
blind or disabled persons, nursing home residents, and
refugees who meet specified eligibility criteria.
2)Requires DHCS, by July 1, 2009, to establish a two-year pilot
program to utilize the federal PARIS to identify veterans and
their dependents or survivors who are enrolled in the Medi-Cal
program and assist them in obtaining federal veteran health
care benefits.
3)Requires DHCS to select three consenting counties that have in
operation a USDVA medical center to participate in the pilot
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program.
4)Requires DHCS, under the pilot program, to exchange
information with PARIS and identify veterans and their
dependents or survivors who are receiving Medi-Cal benefits in
the pilot program counties.
5)Requires DHCS to refer identified Medi-Cal beneficiaries who
are receiving high-cost services, including long-term care, to
county veteran service officers (CVSOs) to obtain information
regarding, and assistance in obtaining, USDVA benefits.
6)Requires DHCS, prior to commencement of the pilot program, to
do all of the following:
a) Enter into an agreement with the California Department
of Veterans Affairs (CDVA) to perform CVSO outreach
services in connection with the pilot program. The CDVA
agreement must contain performance standards that would
allow DHCS to measure the effectiveness of the pilot
program;
b) Enter into any agreements that are required by the
federal government to utilize the PARIS system; and,
c) Perform any information technology activities that are
necessary to utilize the PARIS system.
7)Requires DHCS to monitor the two-year pilot program, evaluate
the outcomes and savings, and provide the fiscal committees of
the Legislature with a report on the findings and
recommendations. Permits DHCS, if it determines that the
pilot program is cost effective, to implement PARIS statewide,
at any time, and continue operation of PARIS indefinitely.
8)Permits DHCS to implement, interpret, or make specific the
above provisions by means of written directives without having
to take further regulatory action.
9)Exempts contracts related to PARIS from the Public Contract
Code in order to achieve maximum cost savings through an
expedited contract process.
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FISCAL EFFECT : This measure has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the Committee on Veterans
Affairs, as author, this bill would require DHCS to implement
PARIS as a permanent program, thereby allowing DHCS to
identify veterans enrolled in the Medi-Cal Program who could
receive medical benefits through the federal Veterans Health
Administration that could either replace or supplement
benefits available from the Medi-Cal Program. The author
states the PARIS system has already shown itself to be an
effective program in other states such as New York.
Additionally, the author states the cost of implementing this
legislation statewide is not much more than the cost to
implement the pilot project, and the author states the savings
statewide (as opposed to implementing in only three counties)
would be astronomical.
2)BACKGROUND ON PARIS . In 2007, as part of its analysis of the
Governor's proposed budget, the Legislative Analyst Office's
(LAO) wrote an analysis of PARIS and recommended its
implementation in California. The LAO stated PARIS is
operated by the United States Department of Health and Human
Services and is a computer data matching process that matches
public assistance recipients in participating states against
various state and federal databases on a quarterly and annual
basis. States voluntarily participate in PARIS. The three
databases compared under the PARIS match are:
a) The Veterans Administration (VA), to determine if an
individual is a veteran and whether or not the individual
is collecting VA benefits;
b) Interstate, which identifies individuals simultaneously
collecting benefits in more than one state for Medicaid,
Supplemental Security Income/State Supplementary Payment,
Temporary Assistance for Needy Families (known as TANF or
CalWORKs in California) and/or Food Stamps; and,
c) Federal, which determines whether an individual
receiving public assistance benefits is a former federal or
military employee collecting a retirement pension payment
or a current federal or military employee. The current
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DHCS computer system does not identify Medi-Cal
beneficiaries by their status as veterans.
A 2005 survey performed by the U.S. Census Bureau indicates
that approximately 144,000 veterans in California received
Medi-Cal benefits. According to the LAO, the ability to
identify veterans enrolled in Medi-Cal using PARIS would allow
DHCS to work with CVSOs to promote a voluntary shift of
veterans from Medi-Cal to the VA system of health care. The
LAO states if all of the 144,000 veterans currently enrolled
in Medi-Cal shifted to VA health care, the LAO estimates a
savings to the Medi-Cal Program of about $250 million from the
General Fund (GF). However, the LAO believes it is more
likely that there would be a more gradual shift. If 10% of
veterans switched from Medi-Cal to VA healthcare, the
estimated savings would be approximately $25 million. The LAO
also estimates savings of $6 million ($3 million GF) from
eliminating unnecessary payments to Medi-Cal managed care
plans for those beneficiaries who have moved out-of-state.
The LAO also estimates additional GF savings of $7 million ($4
million GF) by identifying duplicate public program payments
made through the CalWORKs and Food Stamps programs.
3)SUPPORT . The American Federation of State, County and
Municipal Employees, AFL-CIO (AFSCME) writes in support of the
introduced version of this bill, stating this bill continues
the medical benefit programs for veterans while saving the
state money during our current fiscal crisis. AFSCME states
the Legislature must look into all possible ways to reserve
expenditures that could be provided by the federal government.
4)PREVIOUS LEGISLATION .
a) AB 1183 (Committee on Budget), Chapter 758, Statutes of
2008 establishes the current PARIS pilot program. The
2009-10 budget for DHCS indicates it plans to implement
PARIS in 2009-10 to allow it to test the viability of
long-term savings prior to incurring costs associated with
statewide implementation. DHCS' preliminary estimate of
savings for 2009-10, on a cash basis, are $204,000
($102,000 GF).
b) AB 3082 (Committee on Veterans Affairs) would have
required DHCS to work in conjunction with designated state
and local entities in utilizing PARIS to identify veterans
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enrolled in Medi-Cal, and to assist them in obtaining
federal veterans' health care benefits. AB 3082 would have
also required DHCS to work in conjunction with CDVA to
develop a plan for the dissemination of PARIS match
results, and to establish outreach standards and
performance criteria for CVSOs that receive information
regarding veterans identified by the PARIS. AB 3082 failed
passage on the Senate Appropriations suspense file.
5)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Veterans Affairs Committee.
6)POLICY QUESTION . PARIS was established in statute by last
year's health budget trailer and DHCS is required to select
three consenting counties, with DHCS being required to
implement PARIS by July 1, 2009. DHCS is required to monitor
the pilot program and evaluate the outcomes and savings and
report on its findings and recommendations. If DHCS
determines the PARIS pilot is cost effective, it is authorized
to implement the program statewide at any time and continue
PARIS indefinitely. Should the provisions of PARIS be
expanded beyond the three counties in advance of DHCS'
evaluation of its outcomes and savings?
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
AFL-CIO (prior version)
Opposition
None on file.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097