BILL ANALYSIS                                                                                                                                                                                                    




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                           2352 (J. Perez)
          
          Hearing Date:  8/2/2010         Amended: 7/15/2010
          Consultant: Katie Johnson       Policy Vote: Health 6-0
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          BILL SUMMARY:  AB 2352 would require that a Medi-Cal beneficiary  
          remain eligible for Medi-Cal coverage of antirejection  
          medication for up to two years following an organ transplant,  
          unless he or she becomes eligible for other insurance that would  
          cover the medication, including Medicare.
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          ____
                            Fiscal Impact (in thousands)
           Major Provisions        2010-11      2011-12       2012-13     Fund  
          Medication costs                $190              $400  
          $400General
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          ____

          STAFF COMMENTS: This bill meets the criteria for referral to the  
          Suspense File.
          Medi-Cal currently pays for antirejection medication for  
          one-year after a transplant. This bill would require that a  
          Medi-Cal beneficiary remain eligible for Medi-Cal coverage of  
          antirejection medication for up to two years following an organ  
          transplant. Medi-Cal coverage would cease if the individual were  
          to become eligible for either Medicare or other private health  
          insurance that would cover the medication. 

          Since this bill would increase the time a beneficiary may claim  
          Medi-Cal coverage, it would increase costs to the Medi-Cal  
          program. Antirejection medication costs Medi-Cal approximately  
          $20,000 annually. Approximately 1,450 individuals receive organ  
          transplants through Medi-Cal fee-for-service coverage annually.  
          If 1 percent of individuals who had received an organ transplant  
          were to utilize services for the extra year, 15 individuals, as  
          provided for under this bill, the annual cost would be $300,000.  
          From 2005-2007, there were 45 individuals, or the 15 individuals  
          per year, who had a lapse in Medi-Cal coverage during months 13  
          - 24 post-transplant. Since 26 percent of Medi-Cal seniors and  
          persons with disabilities, the categories under which an  
          individual receiving an organ transplant would fall, are in  










          Medi-Cal managed care, it would be reasonable that the number of  
          people with lapsed coverage would be substantially lower for  
          Medi-Cal managed care than for fee-for-service. If 15  
          individuals equals 74 percent of Medi-Cal enrollees, then 5  
          individuals equals 26 percent of total enrollees and represents  
          the individuals in managed care who would likely use this bill.  
          Total costs then could be expected to be approximately $400,000  
          annually. There could be cost avoidance to the extent that the  
          provision of antirejection medication for an additional year  
          would prevent hospitalization for transplant rejection and  
          another transplant.

          This expansion of Medi-Cal benefits is not a mandatory or state  
          option under federal Medicaid law. Therefore, federal matching  
          funds would not be available to match costs related to this  
          bill. The costs incurred by Medi-Cal would be 100 percent  
          General Fund. The Department of Health Care Services (DHCS)  
          would be permitted to implement or interpret these provisions by  
          means of all-county letters, provider bulletins, or similar  
          instructions without taking any other regulatory action.