BILL NUMBER: SB 36 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 29, 2011
INTRODUCED BY Senator Simitian
( Principal coauthor: Senator
Leno )
( Coauthor: Senator Alquist
)
( Coauthors: Assembly Members
Ammiano, Fong, Gordon, and Hill
)
DECEMBER 6, 2010
An act to amend Section 12699.53 of the Insurance Code, relating
to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 36, as amended, Simitian. County Health Initiative Matching
Fund.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which health care
services are provided to qualified low-income recipients. Existing
law also creates the Healthy Families Program, administered by the
Managed Risk Medical Insurance Board (MRMIB), to arrange for the
provision of health care services to children less than 19 years of
age who meet certain eligibility requirements.
Existing law, the County Health Initiative Matching Fund,
establishes a fund that is administered by MRMIB in collaboration
with the department to accept intergovernmental transfers to be used
to increase the state's ability to use federal funds for programs to
improve and expand access to health care. Under existing law, a
county, a county agency, a local initiative, or a county organized
health system that will provide an intergovernmental transfer may
apply to MRMIB for funding to provide health care coverage to
eligible children whose family income is at or below 300% of the
federal poverty level or eligible adults whose family income does not
exceed 200% of the federal poverty level. Existing law requires that
persons receiving this coverage be ineligible for the Healthy
Families Program and no share of cost Medi-Cal coverage.
This bill would allow persons who are eligible for but
unable to enroll in the Healthy Families Program as a result of
enrollment policies initiated by MRMIB due to insufficient funding to
receive this coverage and would also allow a county, a
county agency, a local initiative, or a county organized health
system that will provide an intergovernmental transfer to apply to
MRMIB for funding to provide health care coverage to eligible
children whose family income is at or below 400% of the federal
poverty level , as specified, and would require
persons receiving this coverage be ineligible for no share of cost
Medi-Cal coverage and either ineligible for the Healthy Families
Program or unable to enroll in the program as a result of specified
enrollment policies due to insufficient funds . The bill would
specify that implementation of these provisions is conditioned on
MRMIB obtaining necessary federal approval thereof.
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 12699.53 of the Insurance Code is amended to
read:
12699.53. (a) (1) An applicant that will
provide an intergovernmental transfer may submit a proposal to the
board for funding for the purpose of providing comprehensive health
insurance coverage to any child or adult who meets citizenship and
immigration status requirements that are applicable to persons
participating in the program established by Title XXI of the Social
Security Act, and in case of a child, whose family income is at or
below 300 percent of the federal poverty level or, at the option of
the applicant, at or below 400 percent of the federal
poverty level, or in case of an adult, whose family income does not
exceed 200 percent of the federal poverty level, in specific
geographic areas, as published quarterly in the Federal Register by
the Department of Health and Human Services, and which child or adult
meets both of the following requirements:
(1)
(A) Does not qualify for the Healthy Families Program
(Part 6.2 (commencing with Section 12693)) or qualifies for the
program but is unable to enroll in the program as a result of
enrollment policies initiated by the board due to insufficient funds.
(2)
(B ) Does not qualify for Medi-Cal with no
share of cost pursuant to the Medi-Cal Act (Chapter 7 (commencing
with Section 14000) of Part 3 of Division 9 of the Welfare and
Institutions Code).
(2) In its application, the applicant shall specify the income
level at or below 400 percent of the federal poverty level for which
it will provide coverage and whether the applicant will cover
individuals who qualify for the Healthy Families Program but are
unable to enroll in the program as a result of enrollment policies
initiated by the board due to insufficient funds.
(b) The proposal shall guarantee at least one year of
intergovernmental transfer funding by the applicant at a level that
ensures compliance with the requirements of any applicable approved
federal waiver or state plan amendment as well as the board's
requirements for the sound operation of the proposed project, and
shall, on an annual basis, either commit to fully funding the
necessary intergovernmental amount or withdraw from the program. The
board may identify specific geographical areas that, in comparison to
the national level, have a higher cost of living or housing or a
greater need for additional health services, using data obtained from
the most recent federal census, the federal Consumer Expenditure
Survey, or from other sources. The proposal may include an
administrative mechanism for outreach and eligibility.
(c) The applicant may include in its proposal reimbursement of
medical, dental, vision, or mental health services delivered to
children who are eligible under the State Children's Health Insurance
Program (Subchapter 21 (commencing with Section 1397aa) of Chapter 7
of Title 42 of the United States Code), if these services are part
of an overall program with the measurable goal of enrolling served
children in the Healthy Families Program.
(d) If a child is determined to be eligible for benefits for the
treatment of an eligible medical condition under the California
Children's Services Program pursuant to Article 5 (commencing with
Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health
and Safety Code, the health, dental, or vision plan providing
services to the child pursuant to this part shall not be responsible
for the provision of, or payment for, those authorized services for
that child. The proposal from an applicant shall contain provisions
to ensure that a child whom the health, dental, or vision plan
reasonably believes would be eligible for services under the
California Children's Services Program is referred to that program.
The California Children's Services Program shall provide case
management and authorization of services if the child is found to be
eligible for the California Children's Services Program. Diagnosis
and treatment services that are authorized by the California Children'
s Services Program shall be performed by paneled providers for that
program and approved special care centers of that program and
approved by the California Children's Services Program. All other
services provided under the proposal from the applicant shall be made
available pursuant to this part to a child who is eligible for
services under the California Children's Services Program.
(e) An applicant may submit a proposal for reimbursement of
medical, dental, or vision services delivered to adults as specified
in subdivision (a).
(f) (1) If a proposal from an applicant for coverage of an adult
includes state funds or funds derived from county sources, the
applicant shall, to the extent feasible, include participation by
health care service plans licensed by the Department of Managed
Health Care or health insurers regulated by the Department of
Insurance that contract with the board to provide services to Healthy
Families Program subscribers in the geographic area.
(2) This subdivision shall not apply if the population to be
served by the applicant's proposal is less than 1,000 persons.
(g) Notwithstanding any other provision of this section, an
applicant may submit a proposal to the board for the purposes of
providing comprehensive health insurance coverage to children whose
coverage is not eligible for funding under Title XXI of the Social
Security Act, or to a combination of children whose coverage is
eligible for funding under Title XXI of the Social Security Act and
children whose coverage is not eligible for that funding. To be
approved by the board, these proposals shall comply with both of the
following requirements:
(1) Meet all applicable requirements for funding under this part,
except for availability of funding through Title XXI of the Social
Security Act.
(2) Provide for the administration of children's coverage by the
board through the administrative infrastructure serving the Healthy
Families Program, and through health, dental, and vision plans
serving the Healthy Families Program.
(h) Implementation of this section is conditioned on the board
obtaining necessary federal approval of these provisions.