BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1568
A
AUTHOR: Committee on Veterans Affairs
B
AMENDED: April 23, 2009
HEARING DATE: July 15, 2009
1
CONSULTANT:
5
Dunstan/sh
6
8
SUBJECT
Veterans benefits
SUMMARY
Requires the Department of Health Care Services (DHCS) to
work in conjunction with various state and local agencies,
to use the federal public assistance and reporting
information system (PARIS) to identify veterans enrolled in
the Medi-Cal program, and to assist them in obtaining
federal veterans' health care benefits. Repeals provisions
requiring the Department of Health Care Services (DHCS) to
select three consenting counties to participate in PARIS.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Medicaid program to provide comprehensive
health benefits to low-income persons through a program
that reimburses states for Medicaid programs in the
individual states. Establishes the United States
Department of Veterans Affairs (VA) which, among its
responsibilities, operates medical centers and outpatient
clinics.
Existing state law:
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1568 (Veterans Affairs)
Page 2
Establishes the Medi-Cal program as California's Medicaid
program, administered by the Department of Health Care
Services (DHCS), which provides comprehensive health care
coverage for low-income individuals and their families;
pregnant women; elderly, blind, or disabled persons;
nursing home residents; and refugees who meet specified
eligibility criteria.
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.
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.
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, VA
benefits.
Requires DHCS, prior to commencement of the pilot program,
to do all of the following:
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;
Enter into any agreements that are required by the
federal government to utilize the PARIS system; and,
Perform any information technology activities that
are necessary to utilize the PARIS system.
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,
STAFF ANALYSIS OF ASSEMBLY BILL 1568 (Veterans Affairs)
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and continue operation of PARIS indefinitely.
Permits DHCS to implement, interpret, or make specific the
above provisions by means of written directives without
having to take further regulatory action.
Exempts contracts related to PARIS from the Public Contract
Code in order to achieve maximum cost savings through an
expedited contract process.
Authorizes each county board of supervisors to appoint a
county veteran service officer, and permits the county to
provide the officer with any assistance and facilities that
it determines to be necessary.
This bill:
Makes PARIS a permanent program by repealing provisions
making PARIS a two-year pilot program under which DHCS
selects three counties that have in operation a VA medical
center to participate in the pilot.
Repeals other language relating to the pilot project,
including provisions allowing DHCS to expand the PARIS
pilot program statewide and allowing DHCS to continue it
indefinitely if DHCS determines PARIS is cost effective.
Repeals language requiring DHCS to select three consenting
counties that have in operation a VA medical center to
participate in the pilot.
Requires DHCS to implement the program by July 1, 2010.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, there would be a one-time cost of $350,000 for
the Department of Health Care Services (DHCS) to conduct a
feasibility study report on the statewide implementation of
PARIS. The analysis also identified major one-year annual
General Fund savings, once implemented, to the extent
matches lead to increased benefits for veterans and reduced
spending. If all of the 144,000 veterans currently
enrolled in Medi-Cal shifted to VA health care, the
Legislative Analyst's Office (LAO) estimates a savings to
the Medi-Cal program of about $250 million in General Fund.
If 10 percent of veterans switched from Medi-Cal to VA
STAFF ANALYSIS OF ASSEMBLY BILL 1568 (Veterans Affairs)
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health care, reflecting a more gradual shift, the estimated
savings would be $25 million. The LAO also identified
additional non-veteran related General Fund savings of at
least $7 million. These savings would result from reducing
duplicate public program payments to out-of-state residents
and others claiming benefits from more than one state.
BACKGROUND AND DISCUSSION
According to the author, this bill is necessary to identify
veterans enrolled in the Medi-Cal program who are eligible
to receive medical benefits through the VA that would
either replace or supplement benefits available from the
Medi-Cal program. The author cites a LAO report which
recommends state implementation of PARIS and the efforts in
other states which have yielded significant savings.
According to the LAO, the ability to identify veterans
enrolled in Medi-Cal would allow DHCS to work with county
veteran services offices to promote a voluntary shift of
veterans from Medi-Cal to the VA system of health care.
Background
PARIS is a computer data matching process to help states
share information with one another about individuals
enrolled in state and federal health and social services
programs. It identifies public assistance recipients in
participating states who are eligible for federal benefits,
including VA benefits. The process also identifies
individuals who are simultaneously enrolled in, and
receiving benefits from, Medicaid, Supplemental Security
Income/State Supplementary Payment, Temporary Assistance
for Needy Families (known as TANF or CalWORKs in
California) and Food Stamps in more than one state.
In 2007, as part of its analysis of the Governor's proposed
budget, the LAO wrote an analysis of PARIS and recommended
its implementation in California. The LAO stated that
PARIS is operated by the United States Department of Health
and Human Services and is a computer data system 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:
The Veterans Administration (VA), to determine if
STAFF ANALYSIS OF ASSEMBLY BILL 1568 (Veterans Affairs)
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an individual is a veteran and whether or not the
individual is collecting VA benefits;
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,
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 DHCS computer system does not identify Medi-Cal
beneficiaries by their status as veterans.
As part of the regular Medi-Cal eligibility screening
process, workers in county welfare offices are required to
ask applicants whether they have served in the armed forces
and have veteran's status. If a county eligibility worker
determines that an applicant is a veteran, the eligibility
worker has the applicant fill out a form, which is then
forwarded to a county veteran services office where a case
worker will contact the VA to determine the benefits to
which the applicant is entitled. The referral process is
intended to ensure that all possible outside sources of
income are obtained and available to help reduce costs to
the Medi-Cal program. Medi-Cal currently reimburses county
veterans' offices approximately $800,000 annually for these
activities. Although county welfare workers are required
to screen for veterans when processing Medi-Cal
applications, a 2005 survey performed by the U.S. Census
Bureau indicates that approximately 144,000 veterans in
California received Medi-Cal benefits.
Many of California's veterans have not claimed money they
are eligible for, or have been unable to get money they are
eligible for because of the backlog of claims at the
federal level. Many of the backlogged claims are due to
rejected claims that may be legitimate claims, but are
rejected on technicalities, such as an improperly filled
out form. Once a form is filled out correctly, the process
starts all over again.
STAFF ANALYSIS OF ASSEMBLY BILL 1568 (Veterans Affairs)
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To help with this problem states fund County Veteran
Service Officers (CVSO) to, among other things, help
veterans with paperwork and expediting claims. CVSOs are
county departments that provide assistance and advocacy to
all veterans and dependents in their attempts to obtain
benefits from the federal government. These offices are a
joint venture of different levels of government to help
veterans claim their benefits. The state pays a portion of
the costs of the offices.
Prior legislation
AB 1183 (Committee on Budget), Chapter 758, Statutes of
2008, the health budget trailer bill for the 2008-2009
budget, required, among its other provisions, DHCS to
establish a two-year pilot program in three counties to
utilize PARIS to identify veterans and their dependants or
survivors who are enrolled in the Medi-Cal Program and
assist them in obtaining federal veteran health care
benefits.
AB 3082 (Salas) of 2008) requires DHCS to work in
conjunction with various state and local agencies, to use
the federal public assistance and reporting information
system (PARIS) to identify veterans enrolled in the
Medi-Cal program, and to assist them in obtaining federal
veterans' health care benefits. This bill was held on the
Senate Appropriations suspense file.
Supplemental report language to the Budget Act of 2007
required DHCS to file two reports regarding the
implementation of PARIS.
PRIOR ACTIONS
Senate Veterans Affairs: 6-0
Assembly Floor: 79-0
Assembly Appropriations: 17-0
Assembly Health: 18-0
COMMENTS
STAFF ANALYSIS OF ASSEMBLY BILL 1568 (Veterans Affairs)
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1. County veterans offices are facing budget cuts.
The state has not increased funding for CVSOs for some
years, and is slated to cut their budgets further.
Counties provide the majority of the funding and
county budgets are under significant fiscal stress.
Since the CVSOs are an important element in the
implementation of this program, this may limit the
success of the program.
2. Bill would end pilot project well before its
completion.
This bill would end the pilot project which is
slated to begin this month. This action comes less
than a year after the Legislature authorized a
two-year pilot program and would make the program
permanent. The author points to studies of efforts in
other states that have concluded that use of PARIS has
saved significant funds, and that in this fiscal
environment, the state cannot afford to wait for the
results of the pilot project.
POSITIONS
Support: None received
Oppose: None received
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