BILL NUMBER: AB 1580 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Bonilla
FEBRUARY 2, 2012
An act to amend Section 15926 of the Welfare and Institutions
Code, relating to public health.
LEGISLATIVE COUNSEL'S DIGEST
AB 1580, as introduced, Bonilla. Health care: eligibility:
enrollment.
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
establishes the California Health Benefit Exchange (Exchange),
pursuant to the federal Patient Protection and Affordable Care Act
(PPACA), and specifies the duties and powers of the board governing
the Exchange relative to determining eligibility for enrollment in
the Exchange and arranging for coverage under qualified health plans,
and facilitating the purchase of qualified health plans through the
Exchange. Existing law, the Health Care Reform Eligibility,
Enrollment, and Retention Planning Act, operative as provided,
requires the California Health and Human Services Agency, in
consultation with specified entities, to establish standardized
single, accessible application forms and related renewal procedures
for state health subsidy programs, as defined, in accordance with
specified requirements. Existing law provides that the application or
case of an individual screened as not eligible for Medi-Cal on the
basis of household income but who may be eligible for Medi-Cal on
another basis shall be forwarded to the Medi-Cal program for an
eligibility determination.
This bill would make technical and clarifying changes to these
provisions.
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. Section 15926 of the Welfare and Institutions Code is
amended to read:
15926. (a) The following definitions apply for purposes of this
part:
(1) "Accessible" means in compliance with Section 11135 of the
Government Code, Section 1557 of the PPACA, and regulations or
guidance adopted pursuant to these statutes.
(2) "Limited-English-proficient"
(2) "Limited English proficient"
means not speaking English as one's primary language and having a
limited ability to read, speak, write, or understand English.
(3) "State health subsidy programs" means the programs described
in Section 1413(e) of the PPACA.
(b) An individual shall have the option to apply for state health
subsidy programs in person, by mail, online, by facsimile, or by
telephone.
(c) (1) A single, accessible, standardized paper, electronic, and
telephone application for state health subsidy programs shall be
developed by the department in consultation with MRMIB and the board
governing the Exchange as part of the stakeholder process described
in subdivision (b) of Section 15925. The application shall be used by
all entities authorized to make an eligibility determination for any
of the state health subsidy programs and by their agents.
(2) The application shall be tested and operational by the date as
required by the federal Secretary of the Health and Human Services.
(3) The application form shall, to the extent not inconsistent
with federal statutes, regulations, and guidance, satisfy all of the
following criteria:
(A) Include The form shall include
simple, user-friendly language and instructions.
(B) Do The form may not
ask for information related to a nonapplicant that is not necessary
to determine eligibility in the applicant's particular circumstances.
(C) Require The form may require
only information necessary to support the eligibility and enrollment
processes for state health subsidy programs.
(D) May The form may be used for,
but shall not be limited to, screening.
(E) Ask, The form may ask
, or be used otherwise to identify, if the mother of an
infant applicant under one year of age had coverage through a state
health subsidy program for the infant's birth, for the purpose of
automatically enrolling the infant into the applicable program
without the family having to complete the application process for the
infant.
(F) Include The form may include
questions that are voluntary for applicants to answer regarding
demographic data categories, including race, ethnicity, primary
language, disability status, and other categories recognized by the
federal Secretary of Health and Human Services under Section 4302 of
the PPACA.
(d) Nothing in this section shall preclude the use of a
provider-based application form or enrollment procedures for state
health subsidy programs or other health programs that differs from
the application form described in subdivision (c), and related
enrollment procedures.
(e) The entity making the eligibility determination shall grant
eligibility immediately whenever possible and with the
consent of the applicant in accordance with the state and federal
rules governing state health subsidy programs.
(f) (1) If the eligibility, enrollment, and retention system has
the ability to prepopulate an application form for insurance
affordability programs with personal information from available
electronic databases, an applicant shall be given the option, with
his or her informed consent, to have the application form
prepopulated. Before a prepopulated renewal form or, if available,
prepopulated application is submitted to the entity authorized to
make eligibility determinations, the individual shall be given the
opportunity to provide additional eligibility information and to
correct any information retrieved from a database.
(2) All state health subsidy programs may accept self-attestation,
instead of requiring an individual to produce a document, with
respect to all information needed to determine the eligibility of an
applicant or recipient, to the extent permitted by state and federal
law.
(3) An applicant or recipient shall have his or her information
electronically verified in the manner required by the PPACA
and implementing federal regulations and guidance.
(4) Before an eligibility determination is made, the individual
shall be given the opportunity to provide additional eligibility
information and to correct information.
(5) An The eligibility of an
applicant shall not have his or her eligibility
be delayed or denied for any state health subsidy program
without being unless the applicant is
given a reasonable opportunity, of at least the kind provided for
under the Medi-Cal program pursuant to Section 14007.5 and paragraph
(7) of subdivision (d) (e) of Section
14011.2, to resolve discrepancies concerning any information provided
by a verifying entity.
(6) To the extent federal financial participation is available, an
applicant shall be provided benefits in accordance with the rules of
the state health subsidy program, as implemented in federal
regulations and guidance, for which he or she otherwise qualifies
until a determination is made that he or she is not eligible and all
applicable notices have been provided. Nothing in this section
shall be interpreted to grant presumptive eligibility if it is not
otherwise required by state law, and , if so
required, then only to the extent permitted by federal law.
(g) The eligibility, enrollment, and retention system shall offer
an applicant and recipient assistance with his or her application or
renewal for a state health subsidy program in person, over the
telephone, and online, and in a manner that is accessible to
individuals with disabilities and those who are limited English
proficient.
(h) (1) During the processing of an application, renewal, or a
transition due to a change in circumstances, an entity making
eligibility determinations for a public health coverage
state health subsidy program shall ensure that
an eligible applicant and recipient of state health subsidy programs
that meets all program eligibility requirements and complies with all
necessary requests for information moves between programs without
any breaks in coverage and without being required to provide any
forms, documents, or other information or undergo verification that
is duplicative or otherwise unnecessary. The individual shall be
informed about how to obtain information about the status
of his or her application, renewal, or transfer to another program at
any time, and the information shall be promptly provided when
requested.
(2) An The application or case of an
individual screened as not eligible for Medi-Cal on the basis of
Modified Adjusted Gross Income (MAGI) household income but who may be
potentially eligible for Medi-Cal on
another basis on the basis of being
65 years of age or older, or on the basis
of blindness or disability , shall
have his or her application or case be
forwarded to the Medi-Cal program for an eligibility determination.
During the period this application or case is processed for a
non-MAGI Medi-Cal eligibility determination, if the applicant or
recipient is otherwise eligible for a state health subsidy program,
he or she shall be determined eligible for that program.
(3) Renewal procedures shall include all available methods for
reporting renewal information, including, but not limited to,
face-to-face, telephone, and online renewal.
(4) An applicant who is not eligible for a state health subsidy
program for a reason other than income eligibility, or for any reason
in the case of applicants and recipients residing in a county that
offers a health coverage program for individuals with income above
the maximum allowed for the Exchange premium tax credits, shall be
referred to the county health coverage program in his or her county
of residence.
(i) Notwithstanding subdivisions (e), (f), and (j), before an
online applicant who appears to be eligible for the Exchange with a
premium tax credit or reduction in cost sharing, or both, may be
enrolled in the Exchange, both of the following shall occur:
(1) The applicant shall be informed of the overpayment penalties
under the federal Comprehensive 1099 Taxpayer Protection and
Repayment of Exchange Subsidy Overpayments Act of 2011 (Public Law
112-9), if the individual's annual family income increases by a
specified amount or more, calculated on the basis of the individual's
current family size and current income, and that penalties are
avoided by prompt reporting of income increases throughout the year.
(2) The applicant shall be informed of the penalty for failure to
have minimum essential health coverage.
(j) The department shall, in coordination with MRMIB and the
Exchange board, streamline and coordinate all eligibility rules and
requirements among state health subsidy programs using the least
restrictive rules and requirements permitted by federal and state
law. This process shall include the consideration of methodologies
for determining income levels, assets, rules for household size,
citizenship and immigration status, and self-attestation and
verification requirements.
(k) (1) Forms and notices developed pursuant to this section shall
be accessible and standardized, as appropriate, and shall comply
with federal and state laws, regulations, and guidance prohibiting
discrimination.
(2) Forms and notices developed pursuant to this section shall be
developed using plain language and shall be provided in a manner that
affords meaningful access to limited-English-proficient individuals,
in accordance with applicable state and federal law, and at a
minimum, provided in the same threshold languages as required
for Medi-Cal managed care plans .
(l) The department, the California Health and Human Services
Agency, MRMIB, and the Exchange board shall establish a process for
receiving and acting on stakeholder suggestions regarding the
functionality of the eligibility systems supporting the Exchange,
including the activities of all entities providing eligibility
screening to ensure the correct eligibility rules and requirements
are being used. This process shall include consumers and their
advocates, be conducted no less than quarterly, and include the
recording, review, and analysis of potential defects or enhancements
of the eligibility systems. The process shall also include regular
updates on the work to analyze, prioritize, and implement corrections
to confirmed defects and proposed enhancements, and to monitor
screening.
(m) In designing and implementing the eligibility, enrollment, and
retention system, the department, MRMIB, and the Exchange board
shall ensure that all privacy and confidentiality rights under the
PPACA and other federal and state laws are incorporated and followed,
including responses to security breaches.
(n) Except as otherwise specified, this section shall be operative
on and after January 1, 2014.