BILL NUMBER: AB 1296	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Bonilla

                        FEBRUARY 18, 2011

   An act to add Part 3.8 (commencing with Section 15925) to Division
9 of the Welfare and Institutions Code, relating to public health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1296, as introduced, Bonilla. Health Care Eligibility,
Enrollment, and Retention Act.
   Existing law provides for various programs to provide health care
coverage to persons with limited financial resources, including the
Medi-Cal program and the Healthy Families Program. Existing law
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law, the
federal Patient Protection and Affordable Care Act (PPACA), requires
each state to, by January 1, 2014, establish an American Health
Benefit Exchange that facilitates the purchase of qualified health
plans by qualified individuals and qualified small employers, as
specified, and meets certain other requirements. Existing law, the
California Patient Protection and Affordable Care Act, creates the
California Health Benefit Exchange (Exchange), specifies the powers
and duties of the board governing the Exchange relative to
determining eligibility for enrollment in the Exchange and arranging
for coverage under qualified health plans, and requires the board to
facilitate the purchase of qualified health plans through the
Exchange by qualified individuals and qualified small employers by
January 1, 2014.
   This bill would enact the Health Care Eligibility, Enrollment, and
Retention Act, which would require the California Health and Human
Services Agency, in consultation with specified entities, to
establish a standardized single application form and related renewal
procedures for Medi-Cal, the Healthy Families Program, the Exchange,
and county programs, in accordance with specified requirements. The
bill would specify the duties of the agency and the State Department
of Health Care Services under the act, and would require the agency
to report to the Legislature by January 1, 2012, regarding policy
changes needed to implement the bill, as specified.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Part 3.8 (commencing with Section 15925) is added to
Division 9 of the Welfare and Institutions Code, to read:

      PART 3.8.  HEALTH CARE ELIGIBILITY, ENROLLMENT, AND RETENTION
ACT


   15925.  (a) This part shall be known, and may be cited, as the
Health Care Eligibility, Enrollment, and Retention Act.
   (b) (1) By January 1, 2014, the California Health and Human
Services Agency, in consultation with the State Department of Health
Care Services (department), Managed Risk Medical Insurance Board, the
California Health Benefit Exchange (Exchange), counties, health care
services plans, consumer advocates, and other stakeholders shall
undertake a planning process to develop plans and procedures to
implement this part and the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152),
related to eligibility for, and enrollment and retention in, public
health coverage programs.
   (2) The agency shall submit a report to the Legislature by January
1, 2012, regarding policy changes needed in order to develop the
eligibility, enrollment, and retention system for health coverage in
compliance with this part.
   (c) A single, standardized paper application shall be used by all
entities accepting applications for all public health care programs,
including Medi-Cal, the Healthy Families Program, the Exchange, and
county programs. An electronic application and a telephone
application shall also be developed, using the same eligibility
methodologies. All of these applications shall include simple,
user-friendly instructions, and require applicants to answer only
those questions that are necessary to determine eligibility for their
particular circumstances.
   (d) All locations, systems, portals, assistors, or entities of any
kind accepting applications for the programs identified in
subdivision (c) shall use and accept the applications described in
subdivision (c) as an application for all of the described programs.
An entity processing applications shall enroll an applicant in the
most beneficial program for which the applicant is eligible. If an
application is forwarded or transferred among entities for
processing, this process shall not impose any burden on the
applicant. The applicant shall be informed of how to get information
about the status of his or her application at any time.
   (e) An applicant shall not be required to provide any verification
that is not necessary for the purpose of evaluating eligibility or
that may be verified using reliable databases approved by the
department for the purpose of evaluating eligibility. An applicant
shall be given an opportunity to provide his or her own verifications
if he or she prefers, but shall not be required to do so. An
applicant shall not be denied eligibility for a program specified in
this section without being given an opportunity to correct any
information provided by a verifying entity.
   (f) Applications shall be evaluated so as to provide a real-time
determination of eligibility, including applicable cost sharing and
subsidies, whenever possible. When a real-time determination is not
possible, an applicant shall be granted presumptive enrollment to the
fullest extent allowed by federal law. Presumptive enrollment shall
continue until the applicant is enrolled in ongoing coverage under
Medi-Cal, the Exchange, Healthy Families, or a county health program,
or found to be ineligible for all of these programs and informed of
the denial of coverage in accordance with all applicable due process
requirements. For purposes of this part, "real-time determination of
eligibility" means an eligibility determination made at the time the
application is submitted.
   (g) The eligibility, enrollment, and retention system shall use a
consumer-mediated approach, pursuant to which consumers shall receive
assistance to understand decisions they may make, including those
concerning subsidies, plan choice, hardship exemptions, and
verifications. This approach shall provide consumers with a
meaningful opportunity to provide information that ensures their
enrollment in, and retention of, health care coverage, in the most
beneficial program for which they are eligible.
   (h) At application, renewal, or a transition due to a change in
circumstances, consumers shall move seamlessly between programs
without providing additional verification, application, or other
information.
   (i) The department shall develop procedures to ensure continuity
of coverage at specific transitions, including, but not limited to,
all of the following:
   (1) When a consumer reaches 65 years of age.
   (2) When a qualified alien reaches the five-year bar for receipt
of public benefits, as provided in Section 1613 of Title 8 of the
United States Code.
   (3) When a foster youth reaches the age upon which his or her
foster care benefits terminate.
   (4) When family income, assets, household composition, or other
circumstances change.
   (j) The department shall streamline and coordinate eligibility
rules and requirements among the programs identified in subdivision
(c) to ensure that all applicants whose income is less than 400
percent of the federal poverty level shall be eligible for one of
those programs, and all entities processing applications use the same
methodologies to determine which program is most beneficial for each
applicant. This process shall include coordination of rules for
determining income levels, assets, household size, documentation
requirements, and citizenship and identity information, so that all
applications result in coverage in the most beneficial program and
seamless transition between programs.
   (k) The department shall maximize coordination and enrollment in
other public benefits programs, including, but not limited to, the
California Work Opportunity and Responsibility to Kids (CalWORKs)
program, the California Special Supplemental Food Program for Woman,
Infants, and Children (WIC), and CalFRESH, both by accepting an
application and reporting information from those programs as an
application for health benefits, and by using health benefit
applications to initiate applications for those programs, to the
extent allowed by federal law.
   (l) Renewal procedures shall be coordinated across all programs
and entities that accept and process renewal information, so as to
use all available information to renew benefits or transfer
beneficiaries seamlessly between programs without placing a burden on
the beneficiary. Renewal procedures shall be as simple and user
friendly as possible, shall require beneficiaries to provide only
that information which has changed, and shall use all available
methods for renewal, including, but not limited to, face-to-face,
telephone, and online renewal.
   (m) All programs shall use standardized forms and notices and
notices to ensure that beneficiaries are fully informed and
understand what information is required from them for renewal, if
any, and are informed of any transfer, and how the transfer will
affect the beneficiary's costs access to care, delivery system, and
responsibilities.
   (n) (1) The requirement for submitting a report imposed under
subdivision (b) is inoperative on January 1, 2016, pursuant to
Section 10231.5 of the Government Code.
   (2) A report submitted pursuant to subdivision (b) shall be
submitted in compliance with Section 9795 of the Government Code.