BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 36|
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UNFINISHED BUSINESS
Bill No: SB 36
Author: Simitian (D), et al.
Amended: 8/26/11
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 3/23/11
AYES: Hernandez, Alquist, De León, DeSaulnier, Rubio, Wolk
NOES: Strickland, Anderson
NO VOTE RECORDED: Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 6-2, 5/26/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Runner
NO VOTE RECORDED: Emmerson
SENATE FLOOR : 26-13, 6/1/11
AYES: Alquist, Calderon, Cannella, Corbett, Correa, De
León, DeSaulnier, Evans, Hancock, Hernandez, Kehoe, Leno,
Lieu, Liu, Lowenthal, Negrete McLeod, Padilla, Pavley,
Price, Rubio, Simitian, Steinberg, Vargas, Wolk, Wright,
Yee
NOES: Anderson, Berryhill, Blakeslee, Dutton, Fuller,
Gaines, Harman, Huff, La Malfa, Runner, Strickland,
Walters, Wyland
NO VOTE RECORDED: Emmerson
ASSEMBLY FLOOR : Not available
SUBJECT : County Health Initiative Matching Fund
SOURCE : San Mateo County
CONTINUED
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DIGEST : This bill allows local County Health Initiative
Matching Fund programs to draw down federal matching funds
to provide health insurance coverage to eligible children
with family incomes at or below 400 percent federal poverty
level (FPL), instead of up to 300 percent of the FPL in
existing law, and requires 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.
Assembly Amendments add co-authors.
ANALYSIS : Existing federal law establishes the
Children's Health Insurance Program (CHIP) which provides
federal matching funds for state health insurance programs
through a block grant allotment to states. (California's
federal share of CHIP funding is currently 65 percent and
the state share is 35 percent).
Existing state law :
1. Establishes the Healthy Families Program (HFP) to
provide health, dental, and vision coverage to uninsured
children who do not qualify for free Medi-Cal and who
are generally in families at or below 250 percent of FPL
(at or below $46,325 for a family of three in 2011).
The Managed Risk Medical Insurance Board (MRMIB)
administers HFP.
2. Establishes the County Health Initiative Matching Fund
(CHIMF) program, which allows counties, county agencies,
local initiatives (LIs) and county organized health
systems (COHS) (COHS and LIs are local Medi-Cal managed
care plans) to provide funding to MRMIB for the purpose
of drawing down federal matching funds to provide
comprehensive health insurance coverage to any child or
adult who meets citizenship and immigration status
requirements for HFP, but who does not qualify for
either HFP or free Medi-Cal (income eligibility for
CHIMF for children is currently limited to children with
family incomes at or below 300 percent of FPL, at or
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below $55,875 for a family of three in 2011).
3. Coverage provided through the CHIMF programs is not an
entitlement, and existing law prohibits costs in
providing these services from accruing to the state.
All expenses incurred by MRMIB and the Department of
Health Care Services in administering CHIMF are required
to be paid from the CHIMF or directly by applicants,
except that MRMIB can accept funding from a
not-for-profit group or foundation, or from a
governmental entity providing grants for health-related
activities, to administer the CHIMF. Implementation of
the CHIMF program is subject to federal financial
participation being available and approved.
This bill:
1. Allows CHIMF programs to draw down federal matching
funds to provide health insurance coverage to eligible
children with family incomes at or below 400 percent of
the FPL ($74,120 for a family of three in 2011), instead
of up to 300 percent of the FPL in existing law.
2. Requires 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.
3. Makes implementation of the provisions of this bill, and
the existing law income eligibility provisions,
conditioned on MRMIB obtaining necessary federal
approval.
Background
AB 495 (Diaz), Chapter 648, Statutes of 2001, established
the CHIMF to allow county entities to use county funds to
draw down federal dollars from California's federal CHIP
allotment. There are three counties that provide coverage
drawing down federal funds through CHIMF to cover children
who would be eligible for HFP but who do not qualify for
HFP because of their family income. The three
participating CHIMF counties are San Mateo, San Francisco,
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and Santa Clara. San Francisco and Santa Clara cover
children with incomes at or below 300 percent of FPL, while
San Mateo covers children up to 400 percent of FPL. In the
2009-10 fiscal year, there were 1,156 subscribers in the
CHIMF. Estimated CHIMF enrollment and local and federal
CHIP funds used to support the CHIMF programs in the
2011-12 fiscal year are shown in the chart below:
----------------------------------------------------------
| | Enrollment | | | |
| County | as of June |CHIM Fund | Federal | Total |
| | 30, 2012 | | Funds | Funds |
|----------+------------+----------+-----------+-----------|
|Santa | 308 | $122,000 | $226,000 | $348,000 |
|Clara | | | | |
|----------+------------+----------+-----------+-----------|
|San Mateo | 399 | $132,000 | $246,000 | $378,000 |
|----------+------------+----------+-----------+-----------|
|San | 437 | $198,000 | $367,000 | $565,000 |
|Francisco | | | | |
|----------+------------+----------+-----------+-----------|
|Total | 1,144 | $452,000 | $839,000 |$1,291,000 |
| | | | | |
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The HFP was established in 1997 to enable California to
implement federal CHIP. CHIP provides matching funds to
states to provide health insurance for low-to
moderate-income children in families with incomes too high
to be served by state Medicaid programs (Medi-Cal in
California). HFP is for children ages 0-18 in families
with incomes between 100 percent to 250 percent FPL who are
ineligible for free Medi-Cal, and for children up to age
two in families with incomes between 250 and 300 percent
FPL who are born to women enrolled in the state AIM
Program. Subscribers must be U.S. citizens or have
qualified immigrant status. Monthly premiums are
determined by family size, net income and insurance plan
selected. Monthly premiums per child range from a low of
four dollars per child in families with an income between
100 to 150 percent of the FPL to a high of $24 per child in
families with incomes between 200 and 250 percent of the
FPL, up to a maximum of $72 per family.
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HFP services are provided through contracts with managed
care plans. At least one health plan is offered in each of
California's 58 counties. The federal government provides
funding for 65 percent of total HFP expenses (not including
subscriber premiums and cost-sharing paid by HFP
subscribers). The state covers the remaining 35 percent.
Under federal health care reform, the federal share will
increase by 23 percent starting in 2015. For individuals
with incomes at or above 300 percent of the FPL, the
federal matching rate is the state's Medicaid matching rate
(California is usually 50 percent), instead of the higher
CHIP 65 percent matching rate.
As of February 28, 2011, there were 865,480 children
enrolled in HFP, and the Governor's budget projects
enrollment of 916,029 children at the end of the budget
year. Due to a funding shortfall, MRMIB had a HFP waiting
list from July 17, 2009 to September 17, 2009.
Prior Legislation
SB 1431 (Simitian), of 2009-10 Session, was identical to
this bill. SB 1431 was vetoed by Governor Schwarzenegger.
In his veto message, the Governor cited the state of the
economy, the low participation rate in the current program,
and the new federal maintenance of effort requirements for
the HFP in arguing that expanding eligibility for this
local program was not necessary. In addition, the Governor
stated the practical impact of that measure would be
short-lived because families with eligible children will
have the opportunity to purchase subsidized insurance
through the health insurance exchange in 2014.
AB 1085 (Ruskin), of 2005-06 Session, would have enabled
CHIMF programs to draw down federal matching funds for
children in families with incomes up to 400 percent of the
FPL, instead of 300 percent of the FPL in existing law.
That bill was held on the Assembly Appropriations Suspense
file.
AB 1130 (Diaz), Chapter 687, Statutes of 2003, renames the
Children's Health Initiative Matching Fund as the County
Health Initiative Matching Fund and is the implementing
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legislation for AB 495.
AB 1524 (Richman), Chapter 866 Statutes of 2003, expands
the scope of the County Health Initiative Matching Fund to
allow these programs to draw down federal matching funds
for providing health insurance coverage for adults.
AB 495 (Diaz), Chapter 648, Statutes of 2001, establishes
the Children's Health Initiative Matching Fund to allow
local funds from counties with children's health
initiatives to be used to draw down federal dollars from
California's CHIP allotment.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
Health care for newly $91-$121
$182-$242$181-$242 Federal
eligible C-CHIP children $91-$121
$182-$242 $181-$242 Local
SUPPORT : (Verified 8/30/11)
San Mateo County Board of Supervisors (source)
Alameda County Board of Supervisors
California Association of Health Insuring Organizations
California Chapter of the American College of Emergency
Physicians
California Children's Health Initiatives
California Children's Hospital Association
California Chiropractic Association
California Communities United Institute
California District of the American Academy of Pediatrics
California Medical Association
California Optometric Association
California Psychiatric Association
California School Employees Association
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California State Association of Counties
California State PTA
Health Improvement Partnership of Santa Cruz County
Lucile Packard Children's Hospital
Peninsula Interfaith Action
San Francisco County
Santa Clara County Board of Supervisors
Urban Counties Caucus
ARGUMENTS IN SUPPORT : This bill is sponsored by San
Mateo County Board of Supervisors, which states that during
the 2009-10 budget deliberations, an enrollment cap in HFP
resulted in thousands of children statewide being placed on
a waiting list for coverage while children in higher income
brackets were able to enroll in locally funded programs.
In addition, without the statutory authority to draw down
federal funding for children between 300 and 400 percent
FPL, hundreds of children in San Mateo County and others
across the state could go without important health
coverage.
CTW:do 8/30/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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