BILL ANALYSIS Ó
AB 1296
Page 1
ASSEMBLY THIRD READING
AB 1296 (Bonilla)
As Amended May 27, 2011
Majority vote
HEALTH 13-6 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Campos, Davis, |
| |Roger Hernández, Bonnie | |Gatto, Hall, Hill, Lara, |
| |Lowenthal, Mitchell, Pan, | |Mitchell, Solorio |
| |V. Manuel Pérez, Williams | | |
| | | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Nestande, Silva, Smyth | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Enacts the Health Care Eligibility, Enrollment, and
Retention Act and 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. Specifically, this bill :
1)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.
2)Defines Medi-Cal, public health coverage programs, and
real-time determination for the purposes of this bill.
3)Requires that a person have the option to apply for public
health coverage in person, by mail, online, or by telephone.
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4)Requires DHCS to develop, in consultation with MRMIB and the
Exchange, a single standardized paper, electronic, and
telephone application to be used by all entities authorized to
make eligibility determinations and that meets specified
criteria.
5)Requires DHCS to consult with stakeholders as to whether to
utilize the application developed by the federal Secretary of
Health and Human Services pursuant to the PPACA or a state
form and requires a state form to be tested and operational by
July 1, 2013.
6)Requires the entity receiving the application to treat it as
an application for all public coverage programs and enroll the
applicant in the 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 have the capacity to
identify infants if eligible, 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 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.
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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; requires that prior to the online enrollment of a person
into the Exchange, the person be informed of overpayment
penalties and the ability to avoid them by prompt reporting,
the penalty for failure to have minimum coverage, and be given
the option to decline immediate enrollment while final
eligibility is determined.
12)Requires that applicants who are not eligible for public
health coverage programs to be referred to county health
coverage programs.
13)Requires the eligibility, enrollment, and retention system to
ensure assistance with applications and renewals.
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, 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.
16)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.
17)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.
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18)Requires that a recipient be permitted to update eligibility
at any time and an option to renew eligibility at that time
and requires automatic renewal of eligibility for public
health coverage programs whenever any public benefits program
renewal is conducted.
19)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.
20)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.
21)Requires DHCS, MRMIB, and the Exchange to provide for a
publicly available evaluation by an independent expert,
including testing of functionality and compliance with
eligibility rules of the information technology programming.
22)Requires a publicly available annual postimplementation
evaluation by an independent expert using data points
developed in consultation with stakeholders.
23)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.
24)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 ensure
that only information strictly necessary is requested,
verification from a third party or database is sought only
with regard to information required under federal law,
applicants and recipients are given clear and complete
information regarding the use of the information, informed
consent is obtained and an option to decline online screening
and electronic verification, a plan to respond to any breach
including notice to anyone whose personal information has been
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the subject of unauthorized access.
25)Specifies that the provisions are not effective until January
1, 2014, unless otherwise specified.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs to DHCS to conduct a stakeholder planning
process and develop a report may range from $50,000 to the
hundreds of thousands of dollars, depending upon the scope and
complexity of the stakeholder process. Ongoing costs related
to specific transparency and accountability measures,
including a monthly public forum for entities operating health
programs to receive in-person feedback, estimated at $100,000
annually.
2)Significant costs for development of information technology
(IT) and business processes that meet the requirements of this
bill, potentially ranging from the tens to hundreds of
millions of dollars. Most of the significant systems changes
required by this bill are required by the federal PPACA and
existing state law governing the operation of the exchange, so
a significant systems development cost in the range specified
would be incurred regardless of the passage of this bill.
Federal grant funding and enhanced Medicaid funding (90%
federal match) is available for this purpose.
3)Unknown, potentially significant costs associated with two
provisions in the bill that go beyond strict conformity with
requirements of state and federal law: a) presumptive
eligibility for public health care coverage programs; and, b)
the requirement that recipients move seamlessly between
programs without any breaks in coverage.
COMMENTS : 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 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
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that wherever a consumer applies he/she is enrolled into the
program for which he/she is eligible.
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, (HFP in California) eligibility rules in three
fundamental ways: 1) states must change the way income is
counted for the purpose of determining eligibility; 2) states
must eliminate the asset test for most populations; and, 3)
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,
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. Currently 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.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0001122