BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 2352| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ THIRD READING Bill No: AB 2352 Author: John A. Perez (D) Amended: 7/15/10 in Senate Vote: 21 SENATE HEALTH COMMITTEE : 6-0, 6/23/10 AYES: Alquist, Cedillo, Leno, Negrete McLeod, Pavley, Romero NO VOTE RECORDED: Strickland, Aanestad, Cox SENATE APPROPRIATIONS COMMITTEE : 7-4, 8/12/10 AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee NOES: Ashburn, Emmerson, Walters, Wyland ASSEMBLY FLOOR : 62-12, 6/1/10 - See last page for vote SUBJECT : Medi-Cal: organ transplants: antirejection medication SOURCE : Author DIGEST : This bill requires Medi-Cal beneficiaries to remain eligible to receive Medi-Cal coverage for anti-rejection medication for up to two years following an organ transplant, unless during that time the beneficiary becomes eligible for Medicare or private health insurance that would cover the medication. ANALYSIS : CONTINUED AB 2352 Page 2 Existing federal law: 1. Establishes the Medicaid program to provide comprehensive health benefits to low-income persons. 2. Mandates states that elect to provide Medicaid benefits to cover certain eligibility groups, such as low-income children, those receiving supplemental security income (SSI) and others. 3. Allows states the option of providing Medicaid benefits to other groups, including disabled persons who are not eligible for SSI or children in families with incomes above the mandatory coverage level. Existing state law: 1. 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. 2. Establishes that the Medi-Cal program comprises a uniform schedule of health care benefits, including transplants for eligible beneficiaries, subject to utilization controls. 3. Provides limited Medi-Cal benefits for specified life-sustaining treatments, including dialysis. 4. Establishes eligibility criteria for dialysis-only benefits related to diagnosis, net worth and absence of other coverage. 5. Provides that eligible beneficiaries for dialysis benefits shall pay a share of cost based on their net worth. This bill: 1. Requires Medi-Cal beneficiaries to remain eligible to CONTINUED AB 2352 Page 3 receive Medi-Cal coverage for anti-rejection medication for up to two years following an organ transplant unless during that time the beneficiary becomes eligible for Medicare or private health insurance that would cover the medication. 2. States that DHCS may implement, interpret, or make specific this section by means of all-county letters, provider bulletins, or similar instructions, without taking any further regulatory action. Comments This bill addresses the situation of a Medi-Cal beneficiary who has received an organ transplant. The beneficiary may have gained Medi-Cal eligibility through the special treatment eligibility option for persons with end stage renal disease, or by meeting other Medi-Cal eligibility criteria. The renal disease eligibility is not full scope and covers only dialysis and related services. As the renal disease advances, the beneficiary is likely to become disabled and then become eligible for full scope Medi-Cal. Medi-Cal covers the cost of the major organ transplant procedure and the anti-rejection medication. However, as the beneficiary improves, they may lose their Medi-Cal eligibility if they no longer meet the criteria for disability, as determined by a review team. If the beneficiary no longer is considered disabled, they will lose their Medi-Cal eligibility, unless they retain eligibility by meeting other criteria. Once they have lost their eligibility, they will not have their antirejection medicines covered by Medi-Cal. While the beneficiary is enrolled in Medi-Cal, the federal government is paying its share, generally 50 percent, of the medical costs. This bill's eligibility expansion is not a mandatory or optional coverage under federal law. Because there is no federal match, the bill creates a program for which the state pays the entire costs, also known as a "state only" program. Federal matching funds would only be available if the state were to pursue what is known as a waiver. Under federal law, certain federal requirements can be waived and federal matching funds obtained. The state already has a number of waivers in its CONTINUED AB 2352 Page 4 Medi-Cal program, but these do not include the population addressed by this bill. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: No According to the Senate Appropriations Committee: Fiscal Impact (in thousands) Major Provisions 2010-11 2011-12 2012-13 Fund Medication costs $190 $400 $400General SUPPORT : (Verified 6/23/10) (prior version of bill) American Federation of State, County and Municipal Employees, AFL-CIO Astellas Pharma, U.S., Inc. California Healthcare Institute California Medical Association California Transplant Donor Network Donate Life California National Kidney Foundation Western Center on Law & Poverty ARGUMENTS IN SUPPORT : Supporters argue that that access to antirejection drugs is necessary and must be a priority in the health care delivery system for transplant patients because they help to suppress the immune system rejection of the new organ. They also note that advances in antirejection medications have decreased the incidence of adverse reactions to a donated organ significantly, but it still remains one of the gravest dangers facing transplant recipients. They argue that extending the Medi-Cal coverage period gives transplant recipients another year of guaranteed access to these products, and they can continue to recover and grow stronger. ASSEMBLY FLOOR : CONTINUED AB 2352 Page 5 AYES: Adams, Ammiano, Arambula, Bass, Beall, Bill Berryhill, Blakeslee, Block, Blumenfield, Bradford, Brownley, Buchanan, Caballero, Charles Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon, Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes, Furutani, Galgiani, Gilmore, Hall, Hayashi, Hernandez, Hill, Huber, Huffman, Jones, Lieu, Logue, Bonnie Lowenthal, Ma, Mendoza, Monning, Nava, Nestande, V. Manuel Perez, Portantino, Ruskin, Salas, Saldana, Skinner, Solorio, Swanson, Torlakson, Torres, Torrico, Tran, Villines, Yamada, John A. Perez NOES: Anderson, DeVore, Gaines, Garrick, Hagman, Jeffries, Knight, Miller, Niello, Nielsen, Norby, Smyth NO VOTE RECORDED: Tom Berryhill, Fuller, Harkey, Silva, Audra Strickland, Vacancy CTW:mw 8/16/10 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED