BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1296
                                                                  Page  1

           Date of Hearing:   May 3, 2011

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
                   AB 1296 (Bonilla) - As Amended:  April 25, 2011
           
          SUBJECT  :  Health Care Eligibility, Enrollment, and Retention 
          Act.

           SUMMARY  :  Enacts the Health Care Eligibility, Enrollment, and 
          Retention Act.  Specifically,  this bill  :  

          1)Requires, by January 1, 2012, the California Health and Human 
            Services Agency (CHHSA), in consultation with the Department 
            of Health Care Services (DHCS), Managed Risk Medical Insurance 
            Board (MRMIB), the California Health Benefit Exchange 
            (Exchange), counties, health care services plans, consumer 
            advocates, and other stakeholders to undertake a planning 
            process to develop plans and procedures to implement the 
            federal Patient Protections and Affordable Care Act (PPACA) 
            related to eligibility, enrollment, and retention with regard 
            to public health coverage programs.  

          2)Requires CHHSA to submit a report to the health committees of 
            both houses of the Legislature by April 1, 2012 regarding 
            policy changes needed to develop the eligibility, enrollment, 
            and retention system for health coverage.

          3)Defines Medi-Cal, public health coverage programs, and 
            real-time determination for the purposes of this bill.

          4)Requires that a person have the option to apply for public 
            health coverage in person, by mail, online, and by telephone. 

          5)Requires DHCS to develop, in consultation with MRMIB and the 
            Exchange, a single standardized paper, electronic, and 
            telephone application form to be used by all entities 
            authorized to make eligibility determinations and that meets 
            specified criteria as follows:

             a)   Uses simple, user friendly language and instructions;

             b)   Requires only the information necessary to determining 
               eligibility for the applicant's particular circumstances; 
               and,








                                                                  AB 1296
                                                                  Page  2


             c)   May be used for screening, but shall be an application.

          6)Requires the entity receiving the application to treat it as 
            an application for all public coverage programs and enroll the 
            applicant in the most beneficial program the applicant is 
            eligible for. 

          7)Prohibits an applicant from being required to submit new 
            information that is not necessary to determine eligibility if 
            an application is transferred to other entities for processing 
            and requires the applicant to be informed as to how to obtain 
            information regarding the status of the application.  

          8)Requires the application and process to be designed to 
            identify infants who are in the category to be deemed eligible 
            at birth and to be automatically enrolled without the 
            necessity of completing the application process.

          9)Authorizes the existing provider-based application and process 
            used for the Child Health and Disability Prevention (CHDP) 
            Gateway and presumptive eligibility for pregnant women in 
            families with income up to 200% of the federal poverty level 
            (FPL) program to be modified in the simplest possible way and 
            used as an application for ongoing coverage for Medi-Cal and 
            the Healthy Families Program (HFP) and for a program of 
            accelerated enrollment from the medical point of service.  
            Requires DHCS to adopt a process for prenatal care providers 
            to submit the application form for pregnant women online and 
            for hospitals to enroll eligible infants online immediately 
            without an application.

          10)Requires applicants or recipients seeking renewal to be 
            provided with an option that prepopulates the application 
            fields or is electronically verified in real time or both and 
            includes opportunities to provide additional information or 
            make corrections.  

          11)Requires eligibility and enrollment into a public coverage 
            program to be granted immediately if possible, and if not, 
            requires presumptive eligibility until a determination of 
            ineligibility to the fullest extent permitted under federal 
            law and also requires that prior to the online enrollment of a 
            person into the Exchange, the person is to be informed of 
            overpayment penalties and the ability to avoid them by prompt 








                                                                  AB 1296
                                                                 Page  3

            reporting, the penalty for failure to have minimum coverage, 
            and is given the option to decline immediate enrollment while 
            final eligibility is determined. 

          12)Requires the eligibility, enrollment, and retention system to 
            ensure assistance with understanding decisions to be made 
            including hardship exemptions, individual mandate, premium tax 
            credit and cost sharing reductions for the Exchange, penalties 
            for overpayments, verification, and plan choice.

          13)Requires applicants and recipients to be given an opportunity 
            to provide information that ensures enrollment in the most 
            beneficial program for which they are eligible. 

          14)Requires seamless transition between programs at application, 
            renewal, and transition without breaks in coverage and without 
            the person being required to provide duplicative or 
            unnecessary verification, forms, or other information.

          15)Requires DHCS to develop procedures to ensure continuity at 
            specified changes in circumstances.

          16)Requires DHCS, in coordination with MRMIB and the Exchange to 
            streamline and coordinate eligibility rules and requirements 
            among the Medi-Cal, HFP, and Exchange premium tax credit and 
            reduced cost-sharing programs using the least restrictive 
            rules and requirements to ensure that applicants with family 
            income under 400% FPL obtain enrollment and that all entities 
            that are processing applications use the least restrictive 
            methodologies. 

          17)Requires renewal procedures to be coordinated across all 
            public health coverage programs so as to enable the use of 
            relevant information already in a person's or parent or 
            child's case file or electronic database, as allowable under 
            federal law, to in order to renew or transfer seamlessly and 
            without a break in coverage.  

          18)Requires renewal procedures to be as simple and user-friendly 
            as possible, requires only the provision of information that 
            has changed and allows face-to-face, telephone, and online 
            renewal.

          19)Requires, to the maximum extent permitted under federal law, 
            a recipient be allowed to update eligibility information at 








                                                                  AB 1296
                                                                  Page  4

            any point and an option to renew eligibility

          20)Requires all programs to use standardized forms and notices 
            to timely inform recipients in advance regarding the 
            information required for renewal, whether transfer to another 
            program is to occur and how the transfer will affect the 
            recipients cost, access to care, delivery system, and 
            responsibilities. 

          21)Requires the eligibility, enrollment, and retention system to 
            be transparent and accountable by requiring DHCS, CHHSA, 
            MRMIB, and the Exchange to provide a public forum on a regular 
            basis for in person feedback including public or private 
            entities providing application screening and other activities.

          22)Requires DHCS, MRMIB, and the Exchange to provide for a 
            publicly available evaluation of the information technology 
            programming by an independent expert.

          23)Requires a publicly available annual postimplementation 
            evaluation by an independent expert using data points 
            developed in consultation with stakeholders.

          24)Specifies that the duties of the CHHSA, MRMIB, DHCS and the 
            Exchange include the duty to monitor and oversee private as 
            well as public entities that are screening for eligibility.

          25)Requires that DHCS , MRMIB, and the Exchange ensure that all 
            privacy and confidentiality rights under specified state and 
            federal law are strictly incorporated and followed to ensures:

             a)   Only information strictly necessary is requested;

             b)   Verification from a third party or database is sought 
               only with regard to information required under federal law;

             c)   Applicants and recipients are given clear and complete 
               information regarding the use of the information;

             d)   Informed consent is obtained and an option to decline 
               online screening and electronic verification;

             e)   A plan to respond to any breach including notice to 
               anyone whose personal information has been the subject of 
               unauthorized access. 








                                                                  AB 1296
                                                                  Page  5


           


          EXISTING LAW  :

          1)Establishes the federal Medicaid Program, Medi-Cal in 
            California, administered by DHCS, to provide comprehensive 
            health care services and long-term care to pregnant women, 
            children, and people who are aged, blind, and disabled.

          2)Requires each state, by January 1, 2014, to establish an 
            American Health Benefit Exchange that makes qualified health 
            plans available to qualified individuals and qualified 
            employers. 

          3) Requires, under federal law, by January 2014, that states 
            offer Medicaid coverage to all adults, under age 65, with 
            income up to 133% of FPL and authorizes a phase-in.

          4)Requires, under federal law, by January 2014, that state 
            enrollment systems for persons eligible for health subsidy 
            programs meet specified standards. 

          5)Establishes MRMIB and authorizes it to administer HFP, the 
            Access for Infants & Mothers (AIM) Program, the Major Risk 
            Medical Insurance Program (MRMIP), and the Pre-Existing 
            Condition Insurance Pan (PCIP).

          6) Requires DHCS to seek federal approval of a Comprehensive 
            Medicaid Demonstration Waiver and establishes the 
            county-optional Low-Income Health Program (LIHP) and Medicaid 
            Coverage Expansion as a Demonstration Waiver. 

           FISCAL EFFECT  :  This bill has not been analyzed by a fiscal 
          committee. 

           COMMENTS  :  

           1)PURPOSE OF THIS BILL  .  According to the author, AB 1602 (John 
            A. Pérez), Chapter 655, Statues of 2010, and SB 900 (Alquist) 
            Chapter 659, Statutes of 2010, initiated the process to offer 
            health care coverage options to Californians by, among other 
            things, creating the structure and basic duties of the 
            Exchange.  The author argues that the prior bills did not 








                                                                  AB 1296
                                                                  Page  6

            establish the system required by PPACA to determine 
            eligibility for enrolling consumers in health coverage.  
            According to the author, the PPACA requires a seamless "no 
            wrong door" application system so that wherever a consumer 
            applies he/she is enrolled into the program for which he/she 
            is eligible.

          The author explains that by enacting the Health Care 
            Eligibility, Enrollment and Retention Act, this bill 
            implements the PPACA requirement to create a single statewide 
            application to be used by all entities accepting and 
            processing applications for enrolling consumers in health 
            coverage.  The author argues that the system must be available 
            to apply by phone, in person, by mail, or online for enrolling 
            into Medi-Cal, HFP, the Exchange, and county health programs.

           2)BACKGROUND  .  Under the new federal health reform law, most 
            U.S. citizens and legal residents will be required to have 
            health insurance beginning in 2014.  It is estimated that 4.7 
            million California children and adults who were uninsured 
            during some part of 2009 will be eligible for health coverage 
            under PPACA.  The new law establishes a state-based system of 
            health insurance Exchanges and expands Medicaid to make 
            coverage readily available to millions of uninsured people.  
            The PPACA requires states to change their Medicaid and State 
            Children's Health Insurance Program (SCHIP), (HFP in 
            California) eligibility rules in three fundamental ways: a) 
            states must change the way income is counted for the purpose 
            of determining eligibility; b) states must eliminate the asset 
            test for most populations; and,        c) states must make a 
            series of changes intended to improve the process for 
            determining and maintaining eligibility for their public 
            programs.  According to a Kaiser Family Foundation (KFF), 
            October 2010 Report, "Explaining Health Reform: Building 
            Enrollment Systems that Meet the Expectation of the Affordable 
            Care Act" Congress included strong provisions designed to 
            ensure that state enrollment policies and procedures and 
            supporting technology systems genuinely help individuals and 
            families enroll and stay covered, and also foster efficient 
            administration.  

           3)EXCHANGE  .  California exercised the option under PPACA to 
            establish a California Exchange.  The Exchange Board has five 
            members (four of which have been appointed) and held its first 
            meeting April 20. 2011.  The Board voted to pursue a Level II 








                                                                  AB 1296
                                                                  Page  7

            federal planning grant to support the establishment of the 
            Exchange and to submit the grant on September 30, 2011.   The 
            Board will meet next on May 11of this year and will discuss 
            health insurance markets, program integration of public health 
            care programs, public health and social services programs, the 
            Basic Health Plan option, and the Small Business Health 
            Options Program Exchange requirements.  California previously 
            received a $1 million State Planning and Establishment Grant.

           4)ENROLLMENT SIMPLIFICATION  .  The PPACA includes provisions 
            aimed at simplifying eligibility and enrollment procedures for 
            Medicaid and SCHIP, and ensuring coordination with coverage 
            available through the newly created state Exchanges.  
            According to the KFF Report, by January 1, 2014, California 
            must implement a series of procedures that simplify enrollment 
            in Medi-Cal and HFP and coordinate with the State's Exchange, 
            or risk losing federal Medi-Cal and HFP funding.  Required 
            enrollment simplification and coordination procedures include:

             a)   Utilizing a single, streamlined application form for 
               Medi-Cal, HFP, subsidies for coverage through the Exchange, 
               and the Basic Health Program;

             b)   Establishing a Website that permits individuals to apply 
               to, enroll in, and renew enrollment in Medi-Cal, and to 
               consent to enrollment or reenrollment in such coverage 
               through electronic signature;

             c)   Ensuring that individuals who seek coverage through 
               Medi-Cal, HFP, or the Exchange are concurrently screened 
               for eligibility for all three options (including Exchange 
               coverage subsidies and the Basic Health Program) and 
               referred to the appropriate program for enrollment, without 
               having to submit additional or separate applications for 
               each program;

             d)   Requiring development of secure electronic interfaces to 
               exchange available data to the maximum extent practicable 
               to establish, verify, and update eligibility; and,

             e)   Establishing procedures for conducting outreach to and 
               enrolling vulnerable populations, including children, 
               homeless youth, children and youth with special health care 
               needs, pregnant women, and racial and ethnic minorities.









                                                                  AB 1296
                                                                  Page  8

           5)CURRENT ELIGIBILITY AND ENROLLMENT  .  There are a multiplicity 
            of existing rules and mechanisms for the enrollment, 
            eligibility and renewal for persons covered by public programs 
            which varies depending on the program and the person's 
            individual circumstances.  Below is a non-exhaustive 
            description of the most significant:

              a)   Automatic eligibility  .  Some individuals may be eligible 
               for Medi-Cal without an application such as persons who are 
               low-income seniors or persons with disabilities.  These 
               individuals also qualify for programs such as the 
               Supplemental Security Income/State Supplementary Payment 
               (SSI/SSP) program.  Individuals or families in other cash 
               assistance programs such as Cal WORKS and Foster Care 
               children are also automatically eligible but an application 
               must be processed by the county.  

              b)   Application submission  .  Generally, those who do not get 
               Medi-Cal automatically must apply.  Applications can be 
               submitted in person, by mail, or online to the local 
               Department of Social Services.  The application process can 
               also be started over the phone with the county, though the 
               process must be completed in person or by mail.  This 
               category includes children and families and the eligibility 
               rules vary depending on the child's age and the income 
               level of the family which is expressed as a percentage of 
               FPL.  

              c)   Seniors and Persons with Disabilities not on SSI  .  
               Seniors and Persons with Disabilities, including children, 
               in addition to those receiving SSI, may be eligible for 
               Medi-Cal but must submit an application and there are 
               maximum income and property limits. 

              d)   Medi-Cal/HFP Single Point of Entry (SPE)  .  SPE screens 
               pregnant women and children for eligibility in either 
               Medi-Cal or HFP and an application may be submitted by mail 
               or online through Health-e-App.  SPE conducts an initial 
               screening for Medi-Cal and HFP.  Enrollment in HFP is 
               through a vendor.  

              e)   Non HFP children  .   For a child who appears eligible for 
               Medi-Cal after the SPE screening, the actual Medi-Cal 
               eligibility determination does not occur until the 
               application is forwarded to the county and a county 








                                                                  AB 1296
                                                                  Page  9

               eligibility worker makes the Medi-Cal eligibility 
               determination.  Children are continuously eligible for one 
               year without the requirement of a redetermination.  
               Children who appear to qualify for full-scope, no share of 
               cost Medi-Cal and whose joint application is sent to SPE 
               are eligible for Accelerated Enrollment.  Accelerated 
               Enrollment for children offers temporary, free Medi-Cal 
               benefits after the child's application has been screened by 
               SPE and is awaiting a final Medi-Cal determination by the 
               county welfare department. 

              f)   Out stationing  .  Pregnant women and children can 
               complete a short-form application at certain hospitals and 
               clinics where county eligibility workers are stationed.  
               California provides temporary Medi-Cal coverage to pregnant 
               women while their Medi-Cal applications are being 
               processed.  Pregnant women who have completed a shortened 
               application and are found to be presumptively eligible for 
               Medi-Cal receive ambulatory prenatal services.  For 
               pregnant women found to be eligible for regular Medi-Cal, 
               their presumptive eligibility period ends when the positive 
               Medi-Cal determination is made.  For those women found to 
               be ineligible for regular Medi-Cal, their presumptive 
               eligibility period ends the last day of the month in which 
               the negative Medi-Cal determination is made.  

              g)   Infants  .  Infants born to a mother on Medi-Cal are 
               automatically eligible for Medi-Cal for their first year. 
               The mother is required to notify the county eligibility 
               office. 

              h)   Provider eligibility  .  Doctors can request immediate 
               temporary Medi-Cal coverage for pregnant women and children 
               while they apply for the Medi-Cal Program.

              i)   Breast and Cervical Cancer Treatment Program (BCCTP)  .   
               Women who appear to qualify for the federal BCCTP can also 
               obtain Accelerated Enrollment.  Under Accelerated 
               Enrollment, they receive temporary, full-scope Medi-Cal 
               coverage while the State's eligibility specialist makes a 
               final eligibility determination.

              j)   CHDP  .  Children receiving CHDP Program services may 
               pre-enroll in Medi-Cal or HFP through the CHDP provider 
               while they await an eligibility determination for those 








                                                                  AB 1296
                                                                  Page  10

               programs.  The temporary services are provided for two 
               months, or until the child is determined eligible for 
               Medi-Cal or HFP, whichever comes later.  

              aa)  Express Lane Eligibility  . Families who receive food 
               stamps can permit information from their Food Stamp Program 
               application to be used to determine their eligibility for 
               Medi-Cal and HFP.  Additionally, Express Lane Eligibility 
               allows schools to release information from a child's 
               National School Lunch Program application in order to 
               pre-enroll a child receiving free meals into Medi-Cal until 
               a final determination is made by the county welfare 
               department.

              bb)  Program transfer  .  A Medi-Cal beneficiary's eligibility 
               for all Medi-Cal programs must be evaluated before the 
               individual's benefits can be terminated.  If the 
               beneficiary is found eligible for another Medi-Cal program 
               an eligibility worker into that program can automatically 
               transfer the enrollee into the other program.   This 
               process should always occur without the need for a 
               beneficiary to submit a new application.  If, however, 
               continued Medi-Cal eligibility cannot be established by ex 
               parte review, then the county must attempt to contact the 
               beneficiary by telephone.  

              cc)  AIM, MRMIP and PCIP  .  MRMIB also administers AIM, MRMIP 
               and PCIP.  AIM is a subsidized insurance program for 
               mid-income pregnant women and the application is by mail.  
               Children born to AIM mothers are eligible for HFP.  MRMIP 
               and PCIP are subsidized insurance programs for persons who 
               are uninsurable due to pre-existing conditions.  There is a 
               joint application for the two programs and it is done by 
                                               mail.  

              dd)  County health programs  .  Counties are required to 
               provide medical services for medically indigent persons.  
               Each county establishes its own eligibility and application 
               process.  The Section 1115 Medi-Cal Demonstration waiver 
               "Bridge to Reform" and AB 342 (John A. Pérez), Chapter 723, 
               Statutes of 2010, establishes the county-optional LIHP and 
               Medicaid Coverage Expansion as a Demonstration Waiver to 
               cover low-income childless adults under age 65.  Counties 
               are allowed to set eligibility levels up to 200% of FPL but 
               must cover up all persons up to 133% FPL before allowing 








                                                                  AB 1296
                                                                  Page  11

               persons above 133% to enroll.  Counties set eligibility 
               income standards, methodologies, and procedures.  The 
               federal Center for Medicare and Medicaid Services (CMS) 
               required eligibility determination to be made by state or 
               local government employees. 

           6)SUPPORT  .  Western Center on Law and Poverty (WCLP), sponsor of 
            this bill, states in support that in today's health care 
            market the onus is largely on the consumer to figure out what 
            health coverage program to apply for and to submit a new 
            application when moving from one health coverage program for 
            another.  For example, a consumer who applies for California's 
            high risk pools but is eligible for Medi-Cal would have to 
            submit a separate application to Medi-Cal.  According to WCLP, 
            there is currently no mechanism for the state to transfer an 
            adult's application for one program to initiate an application 
            for another program.  WCLP further argues that the PPACA 
            changes that - requiring that for example if someone applies 
            for Medi-Cal but is eligible for the Exchange they are 
            enrolled into the Exchange, and vice versa.  According to 
            WCLP, California does have a joint application for children 
            for Medi-Cal and HFP, but will now have to integrate the 
            process for applying for the Exchange and county health 
            coverage programs with applying for Medi-Cal.  This will 
            require a new level of coordination among agencies and 
            departments including CHHSA, DHCS which administers the 
            Medi-Cal Program, MRMIB which administers HFP, the new 
            California Exchange Board, and counties which determine 
            eligibility for Medi-Cal and administer their own county 
            health programs.  WCLP further states that it is important 
            both that these entities coordinate on developing and 
            implementing the eligibility, enrollment, and retention system 
            and that if a particular department or entity has overall 
            responsibility for a particular component of the system that 
            that is explicitly laid out.  Clear lines of authority are 
            needed so that if problems arise stakeholders know what entity 
            has responsibility for what pieces of the system.

           7)RELATED AND PRIOR LEGISLATION  .

             a)   AB 714 (Atkins) of 2011 requires a notification to 
               individuals who have ceased to be enrolled in specified 
               public health care coverage programs and to individuals 
               receiving services under specified health programs 
               regarding potential eligibility for health care coverage 








                                                                  AB 1296
                                                                  Page  12

               through the Exchange.  AB 714 is pending in the Assembly 
               Appropriations Committee.

             b)   AB 792 (Bonilla) of 2011 requires the disclosure of 
               information on health care coverage through the Exchange, 
               under specified circumstances, by health care service 
               plans, health insurers, employers, employee associations, 
               the Employment Development Department, upon an initial 
               claim for disability benefits, or by the court, upon the 
               filing of a petition for dissolution of marriage, nullity 
               of marriage, legal separation, or adoption.  AB 792 is 
               pending in the Assembly Appropriations Committee. 

             c)   AB 43(Monning) of 2011 expands Medi-Cal coverage to 
               persons with income that does not exceed 133% FPL, 
               effective January 1, 2014.  AB 43 is pending in the 
               Assembly Appropriations Committee.

             d)   AB 1066 (John A. Pérez) of 2011 enacts technical and 
               conforming statutory changes necessary to conform to the 
               Special Terms and Conditions required by CMS in the 
               approval of the Bridge to Reform Demonstration, including 
               changing the name of the LIHP from Coverage Expansion and 
               Enrollment Projects to Medi-Cal Coverage Expansion and the 
               Health Care Coverage Initiative.  AB 1066 is pending in the 
               Assembly Appropriations Committee. 

             e)   AB 342 (John A. Pérez), Chapter 723, Statutes of 2010, 
               enacted the LIHP and Coverage Expansion and Enrollment 
               Projects to provide health care benefits to uninsured 
               adults up to 200% of the FPL, at county option through a 
               Medi-Cal waiver demonstration project.

             f)   SB 208 (Steinberg), Chapter 714, Statutes of 2010, 
               implemented provisions of the 2010 Section 1115 replacement 
               waiver including the Delivery System Reinvestment and 
               Improvement Pool, authorized DHCS to require the mandatory 
               enrollment of seniors and people with disabilities in a 
               Medi-Cal managed care plan and required DHCS to implement 
               pilot projects to provide coordinated care to children in 
               the California Children's Services and to persons who are 
               eligible for Medi-Cal and Medicare.

             g)   AB 1595 (Jones) of 2010, would have required DHCS to 
               expand Medi-Cal eligibility to individuals with family 








                                                                  AB 1296
                                                                  Page  13

               income up to 133% of FPL without regard to family status by 
               January 1, 2014.  AB 1595 died on suspense in the Assembly 
               Appropriations Committee.

             h)   AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010, 
               establishes the Exchange as an independent public entity to 
               purchase health insurance on behalf of Californians with 
               incomes of between 100% and 400% FPL and employees of small 
               businesses.  Clarifies the powers and duties of the board 
               governing the Exchange relative to the administration of 
               the Exchange, determining eligibility and enrollment in the 
               Exchange, and arranging for coverage under qualified 
               carriers

             i)   SB 900 (Alquist), Chapter 659, Statutes of 2010, 
               establishes the Exchange.  Requires the Exchange to be 
               governed by a five-member board, as specified.  

           8)TECHNICAL AMENDMENTS  .  The author is proposing the following 
            technical amendments:

             a)   Page 3 line 16:
             (b) An individual shall have the option to apply for public 
               health coverage programs in person, by mail, online,  and   or 
                by telephone.

             b)   Page 3 line 22:
             (c) A single, standardized paper, electronic, and telephone 
               application form for public health coverage programs shall 
               be developed by the department in consultation with MRMIB 
               and the Exchange Board and shall be used by all entities 
               authorized to make an eligibility determination for any of 
               the public health coverage programs and by their agents.  
                The department shall consult with stakeholders including 
               counties and consumer advocates in the development of the 
               application.  The application shall be tested and 
               operational by July 1, 2013.  The application forms:

             c)   Page 3 line 28:
             screening. The application form  instead  shall be an 
               application

             d)   P. 5 line 6:
             electronically verified in real time, or both, using person  al









                                                                 AB 1296
                                                                  Page  14


              e)   Page 5 line 25:  
              (2) An applicant or recipient who chooses electronic 
               real-time verification shall be permitted to provide 
               additional eligibility information and to correct 
               information retrieved from a database any time before or 
               after a final eligibility determination is made.  An 
               applicant shall not be denied eligibility for any public 
               health coverage program without being given a reasonable 
               opportunity, of at least the kind provided for in Medi-Cal 
               for citizenship documentation, to resolve discrepancies 
               concerning any information provided by a verifying entity.  
               Applicants shall receive  the  benefits  for which they 
               otherwise qualify  pending this reasonable opportunity 
               period.  

              f)   Page 6 line 17:  
              (i) The Eligibility, Enrollment, and Retention system shall 
               ensure that applicants and recipients receive assistance 
                with their application or renewal for public health 
               coverage programs  t  o understand decisions they may make  , 
               including but not limited to those concerning hardship 
               exemptions from the individual mandate, the premium tax 
               credit and cost-sharing reductions for the Exchange and 
               penalties for overpayments, verifications, and plan choice. 
               Applicants and recipients shall also be given a meaningful 
               opportunity to provide information on their applications 
               and renewal forms that ensures their enrollment in, and 
               retention of, health care coverage, in the most beneficial 
               program for which they are eligible.  

              g)   Page 7 line 32:  
             (1)    To the maximum extent allowed under federal law, a   A 
                recipient shall be permitted to update her or his 
               eligibility information at any point  and thereby  restart 
               the period for her or his annual redetermination  .   A 
               recipient providing an update to his or her eligibility 
               information in-between renewal dates shall be given the 
               option to renew eligibility at the time of the update.

             (2)   Eligibility for public health coverage programs shall be 
               automatically renewed whenever any public benefits program 
               renewal  with sufficient information to renew health 
               coverage  is conducted.  
             








                                                                  AB 1296
                                                                  Page  15

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          Western Center on Law and Poverty (sponsor) 
          100% Campaign 
          American Federation of State, County and Municipal Employees, 
          AFL-CIO
          California Academy of Family Physicians
          California Children's Health Initiative
          California Communities United Institute
          California Mental Health Directors Association
          California Pan-Ethnic Health Network
          California Rural Legal Assistance Foundation
          California School Health Centers Association
          California State Association of Counties
          Children Now
          Children's Defense Fund
          Contra Costa County Board of Supervisors
          County Health Executives Association of California
          County Welfare Directors Association
          Health Access California
          National Alliance on Mental Illness, California
          PICO California
          The Children's Partnership
          United Nurses Association of California/Union of Health Care 
          Professionals
          United Way
          Urban Counties Caucus
          Youth Law Center
           
          Opposition 

           None on file.


           Analysis Prepared by  :    Marjorie Swartz / HEALTH / (916) 
          319-2097