BILL ANALYSIS Ó
AB 1869
Page 1
Date of Hearing: March 27, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1869 (John A. Pérez) - As Introduced: February 22, 2012
SUBJECT : Office of Patient Advocate: federal veterans health
benefits.
SUMMARY : Adds federal veterans health benefits to the example
of the type of information and assistance regarding public
programs that the Office of Patient Advocate (OPA) shall do in
order to assist in implementing federal health reform in
California commencing January 1, 2013.
EXISTING LAW :
1)Transfers the OPA, effective July 1, 2012, from the Department
of Managed Health Care (DMHC) to the California Health and
Humans Services Agency, to provide assistance to, and advocate
on behalf of, individuals served by health care service plans
regulated by DMHC, insureds covered by the California
Department of Insurance (CDI), and individuals who receive or
are eligible for other health care coverage in California,
including coverage available through the Medi-Cal program
administered by the Department of Health Care Services (DHCS),
the Managed Risk Medical Insurance Board, and the California
Health Benefit Exchange (Exchange).
2)Establishes duties of the OPA, including but not limited to,
developing consumer educational and information guides,
rendering assistance to consumers regarding procedures,
rights, and responsibilities related to the filing of
complaints, grievances, and appeals, making referrals to
appropriate state agencies, and coordinating and working with
other patient assistance programs.
3)Confers new responsibilities to OPA because of the enactment
of federal health care reform, including assisting consumers
in navigating both public and private health care coverage,
assisting consumers in determining which regulator regulates
the health care coverage of a particular consumer, and
providing and assisting in the provision of, outreach, and
education about health care options including information and
assistance regarding public programs such as Medi-Cal, Healthy
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Families, and Medicare.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the statute
governing the duties of the OPA does not specifically mention
providing information regarding the United States Department
of Veterans Affairs (VA) health care benefits. While it can
be assumed that the OPA would try to include information on
these benefits for veterans, the primary focus of the OPA will
probably be on providing information regarding state programs
such as Medi-Cal and health coverage offered through the
Exchange. According to UCLA's California Health Interview
Survey 2009 data, approximately 130,000 persons in California
who had served in the United States Armed Forces were
uninsured. Yet some of these individuals may be eligible for
federal VA health care benefits. On January 1, 2014,
individuals will be required to maintain health coverage under
federal health care reform. This requirement will also apply
to veterans, who will need assistance obtaining health
coverage.
The author also asserts that the UCLA 2009 survey data indicate
that 174,000 individuals who had served in the armed forces
were covered by Medi-Cal. Medi-Cal is supposed to be the
payer of last resort. So if a veteran can be covered under VA
health benefits, the veteran should be enrolled in the VA
health care program rather than in Medi-Cal. The state could
also realize General Fund savings (potentially hundreds of
millions in dollars) by shifting enrollment of veterans from
Medi-Cal to the VA since the state pays half the cost for
Medi-Cal services and the federal government pays the entire
cost for VA health benefits. Also medical benefits offered
through the VA health care system are often greater than the
benefits offered through Medi-Cal.
2)VETERANS HEALTH BENEFITS . According to the VA website,
veterans recently separated from active military service are
eligible for a wide range of health care services. VA health
services include primary care, health promotion, disease
prevention, diagnosis, palliative care, surgery, prescriptions
for medication, prosthetics, mental health care,
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rehabilitation, orthopedics, critical care, women's health
care, orthopedics, radiology and physical therapy. Generally,
veterans must be enrolled in VA's Health Care System to
receive care. Veterans may receive one-time dental treatment
if they were not provided treatment within 90 days before
separation from active duty. A 180-day from separation time
limit on dental benefits does not apply to veterans with
dental conditions resulting from service-connected wounds or
injuries.
3)BACKGROUND . On March 23, 2010, President Obama signed the
Patient Protection and Affordable Care Act (Public Law
111-148), as amended by the Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152) (together
referred to as the ACA). Among other provisions, the new law
includes a mandate for most individuals to have health
insurance or potentially pay a penalty for noncompliance,
unless an individual falls within certain exceptions, and
makes statutory changes affecting the regulation of and
payment for certain types of private health insurance. Each
state is required to establish an American Health Benefit
Exchange and a Small Business Health Options Program Exchange
by 2014 for individuals and small employers with 50 to 100
employees; after 2017, states have the option of opening the
small business exchange to employers with more than 100
employees. States can opt to provide a single exchange for
individuals and small employers. While the individual and
small-group markets will not be replaced by the exchanges, the
same market rules will apply inside and outside the exchanges.
Premium subsidies can be used only for plans purchased
through the exchanges. With the passage of AB 1602 (John A.
Pérez), Chapter 655, Statutes of 2010, the California's Health
Benefit Exchange was established as an independent public
entity within state government with a five-member board
appointed by the Governor and the Legislature.
In the fall of 2010, DMHC received a $4.1 million consumer
assistance program grant under federal health care reform. The
focus of the program is to provide assistance to consumers
with enrollment into health coverage, filing complaints and
appeals of health plan decisions, and to provide consumers
with educational materials and information about health
coverage and health care reform. According to the grant
summary, DMHC regulates 108 health plans, covering 21 million
Californians who have Health Maintenance Organization (HMO)
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and certain Preferred Provider Organization (PPO) plans.
Operating under the authority of the independently elected
Insurance Commissioner, the CDI regulates all other PPO and
indemnity health products, covering approximately 9.3 million
lives. This bifurcated regulation of the health insurance
market coupled with the administration of public programs
housed in a third agency (DHCS) often leaves consumers
confused about where to turn for help when they have questions
about heath care coverage, federal health reform, or have
complaints. The DMHC is using grant funds to enhance the
capacity of its Help Center, coordinate with existing state
consumer assistance resources, and contract with
community-based organizations that will assist consumers in
identifying coverage options and understanding health care
reform provisions. In addition the grant will also enhance
the capacity of the OPA.
4)SUPPORT . Health Access California indicates in support that
the OPA was substantially reconfigured last year to create a
central referral system for all health services. Californians
get their health coverage from many different sources,
regulated by different government entities. Even health
policy experts can be stumped by which insurance coverage or
public program is regulated or overseen by which department.
The OPA will act as a traffic cop, directing complaints to the
appropriate government program for resolution. Health Access
California indicates that research conducted jointly by Health
Access California and the University of California Berkeley,
on loss of coverage due to life transitions had identified
returning veterans as one of the populations that face a life
transition where loss of coverage is a common problem. It is
well documented that military veterans who have served our
country face greater need for health care, particularly the
broader benefits for mental health and substance abuse
treatment which will be available under health reform.
5)RELATED LEGISLATION . AB 2315 (Monning), also pending in the
Assembly Health Committee, would make a technical clean up in
the Government Code consistent with AB 922 (Monning), Chapter
552, Statutes of 2011, which transfers the DMHC and OPA to the
California Health and Human Services Agency (CHHSA), among
other provisions.
6)PREVIOUS LEGISLATION .
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a) AB 922 transfers the DMHC from the Business,
Transportation and Housing Agency to the CHHSA, transfers
the OPA from DMHC to CHHSA effective July 1, 2012 and
requires existing OPA duties to apply to health insurers
regulated by CDI and their insureds (in addition to
DMHC-regulated health plans), assigns new duties to OPA
related to assisting consumers obtain public and private
health care coverage and navigate public and private
coverage consistent with requirements under the ACA.
b) AB 1602 establishes the Exchange as an independent
public entity to purchase health insurance on behalf of
Californians, including those with incomes of between 100%
and 400% of the federal poverty level, and 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.
c) SB 900 (Alquist), Chapter 659, Statues of 2010,
establishes the Exchange and requires the Exchange to be
governed by a five-member board, as specified.
REGISTERED SUPPORT / OPPOSITION :
Support
Health Access California
National Association of Social Workers - California Chapter
Opposition
None on file.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097