BILL ANALYSIS Ó
SB 970
Page 1
Date of Hearing: June 26, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 970 (De León) - As Amended: May 29, 2012
SENATE VOTE : 31-5
SUBJECT : Health Care Reform Eligibility, Enrollment, and
Retention Planning Act: coordination with other programs.
SUMMARY : Authorizes, upon consent of the applicant, information
provided for the single state application for health subsidy
programs to be used to meet requirements for new or continued
eligibility in the California Work Opportunity and
Responsibility to Kids (CalWORKs) and CalFresh programs.
Specifically, this bill :
1)Provides that at the time a person applies for or renews
health coverage using the single state application, the person
may also consent to have the application information used by
the county human services department to initiate an
application for CalWORKs and CalFresh programs, as well as
other human services or work support programs identified by a
workgroup.
2)Requires, upon consent of the beneficiary, if information used
to renew eligibility for a health subsidy program is
sufficient to meet requirements for a CalWORKs or CalFresh
semiannual report or annual recertification, the county human
services department shall use the information to continue or
recertify CalWORKs and CalFresh benefits for all eligible
individuals.
3)Requires the California Health and Human Services Agency
(CHHSA) to convene a work group of stakeholders, as specified,
including advocates, legislative staff, and staff from state
and county departments and agencies to consider and develop a
plan for the integration of additional human services and work
support programs into the process described in 1) above.
4)Requires implementation by December 31, 2015 and allows items
1) and 2) above to be inoperative if the CHHSA Secretary makes
a determination that to implement them would delay the
implementation of the single standardized application for
SB 970
Page 2
state health subsidy programs.
EXISTING LAW :
1)Requires the California Health Benefit Exchange (Exchange) to
inform individuals of eligibility requirements for the
Medi-Cal Program, the Healthy Families Program (HFP), or any
applicable state or local health care coverage program.
2)Requires, through screening of the application for coverage by
the Exchange, if the Exchange determines that an individual is
eligible for any such program, to enroll that individual in
the program.
3)Requires, under federal law, by January 2014, state enrollment
systems for persons eligible for health subsidy programs to
utilize a single streamlined application for Medi-Cal, HFP,
subsidized coverage through the Exchange, California Access
for Infants and Mothers Program (AIM) and the Basic Health
Plan (BHP)( if enacted).
4)Requires the Department of Health Care Services (DHCS), in
consultation with Managed Risk Medical Insurance Board (MRMIB)
and the Exchange, to develop a single, accessible,
standardized paper, electronic, and telephone application for
state health subsidy programs as part of the stakeholder
process. Requires the application to be used by all entities
authorized to make an eligibility determination for any of the
state health subsidy programs, and by their agents.
FISCAL EFFECT : According to the Senate Appropriations
Committee, unknown costs to convene a workgroup and develop a
plan to integrate social service program eligibility and
enrollment systems into the single application (mostly federal
funds).
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the goal of
this bill is to allow consumers applying for health coverage
through the new streamlined California Healthcare Eligibility,
Enrollment and Retention System (CalHEERS) to also apply for
human services programs, so they can receive needed public
benefits. The author argues that integrating human services
programs into CalHEERS increases administrative efficiency and
SB 970
Page 3
streamlines the application and renewal processes for
consumers. The author further states that additional
strategies to reach those eligible for CalFresh benefits (a
100% federally financed benefit) are needed given California's
low participation level.
2)BACKGROUND . Under the federal Patient Protection and
Affordable Care Act of 2010 (Public Law 111-48) as amended by
the federal Health Care and Education Reconciliation Act of
2010 (Public Law 111-152) (ACA), states must have a seamless,
"no wrong door" system for determining eligibility for and
enrolling people into state health subsidy programs. These
include Medi-Cal, HFP, the Exchange, AIM, and BHP(if enacted).
Pursuant to this mandate, California must implement a series
of procedures that simplify enrollment into Medi-Cal and HFP
and coordinate with the Exchange. Under the ACA and proposed
federal guidelines, applicants will initially be screened for
eligibility under a new simplified Modified Adjusted Gross
Income (MAGI) standard without regard to the amount of assets
the family or individual owns. Individuals who do not meet
the MAGI income eligibility criteria will be further screened
for eligibility under the Medi-Cal aged, blind, or disabled
category or for a premium subsidy to purchase insurance
through the Exchange.
Additional enrollment simplification and coordination procedures
include utilizing a single, streamlined application form;
establishing a Website that permits individuals to apply to,
enroll in, and renew enrollment in Medi-Cal; to consent to
enrollment or reenrollment in coverage through electronic
signatures; ensuring that individuals who seek coverage
through Medi-Cal, HFP, or the Exchange are concurrently
screened for eligibility for all three options (including
Exchange coverage subsidies and the Basic Health Program, if
enacted) and are referred to the appropriate program for
enrollment without having to submit additional or separate
applications for each program.
On May 31, 2012, the Exchange, in collaboration with DHCS and
MRMIB announced its intent to award a contract to Accenture
LLC to develop the Information Technology functions for this
new web-based system, referred to as CalHEERS, which will
include the design and scope of the new single point of
eligibility for individuals seeking subsidized coverage that
will be launched October 2013. CalHEERS will also offer a way
SB 970
Page 4
for individuals who are not eligible for subsidies to
comparison shop and find the best health plan for them. Small
business owners and their employees will be able to choose a
plan through the Small Employer Health Options Program. Under
new, streamlined eligibility rules, CalHEERS will make it
easier for most individuals to obtain Medi-Cal coverage and
will serve as the enrollment portal for the HFP. Some
applicants who are eligible for Medi-Cal may still have their
eligibility determined and be enrolled by the counties. As
part of the development process, vendors had been directed to
include the capability for the system to be able to take
application information and pass that along to county social
service agencies, so that they may use it to determine
eligibility for social service programs, such as CalWORKs or
CalFresh.
3)CalWORKs. The CalWORKs program provides basic needs cash
grants to very low-income families with children and work
support services for their parents. The average monthly grant
for a family of three is $471.00 which is 29.6% of the Federal
Poverty Level (FPL). Federal funding for the program comes
from the Temporary Aid to Needy Families block grant.
According to the sponsor, the program serves just 3% of the
state's population, a fraction of the 15.7% of Californians
who live below the FPL and only 65% of those who are eligible.
To be eligible for aid in CalWORKs one must be a citizen or
qualifying immigrant who meets the income and asset tests and
all adults in the household, including those not receiving aid
must be finger-imaged and comply with interview requirements.
Additionally, all adults must comply with work requirements.
4)CalFresh . CalFresh is the state's largest anti-hunger
program, serving just fewer than 4 million people with an
average weekly benefit of $145 per person. Food benefits
distributed through the program, known nationally as the
Supplemental Nutrition Assistance Program (SNAP), are 100%
federally funded. According to the United States' Department
of Agriculture, only 53% of eligible Californians participate
in the program. To be determined eligible for CalFresh
benefits, a person must be a citizen or qualifying immigrant
who meets both the gross income and net income tests and
complete an interview by phone or in person.
5)SUPPORT . According to the sponsors, Western Center on Law and
Poverty (WCLP) this bill is intended to allow people applying
SB 970
Page 5
for health coverage online to use their information to start
an application for public programs such as CalFresh and
CalWORKs. WCLP states that when someone walks into a county
office today or logs onto the internet to apply for one public
program, they have the option of applying for multiple
programs. Allowing consumers who apply for health coverage
through CalHEERS to initiate applications for human service
and work support programs is needed to ensure the state does
not move backward in providing integrated services to
low-income Californians. WCLP states this bill also better
integrates renewal processes between health and public
programs by requiring that, if the health program renewal form
has the necessary information to renew eligibility for
CalWORKs or CalFresh, that it be used to satisfy the renewal
requirement for that program, thereby reducing administrative
workload and streamlining the process for consumers. Finally,
WCLP states federal funds are available through December 31,
2015 to build the new required health coverage enrollment
system (100% federal funds for the Exchange and 90% federal
funds for Medi-Cal), and can be used for a system that
integrates public programs as well. This bill requires that
the public program integration be completed within that
timeframe.
California Food Policy Advocates and other supporters also state
that this bill would take initial steps to integrate the
process for applying for public programs such as CalWORKs and
CalFresh with the new health coverage application process.
Supporters state that this horizontal integration is an
important step towards improving CalFresh participation and
strengthening the health and well-being of low-income
Californians.
6)RELATED LEGISLATION . AB 714 (Atkins) of 2011 would have
required a notification to individuals who have ceased to be
enrolled in specified public health care coverage programs and
to individuals receiving services under specified health
programs regarding potential eligibility for health care
coverage through the Exchange. AB 714 was held in the Senate
Appropriations Committee.
7)PREVIOUS LEGISLATION . AB 1296 (Bonilla), Chapter 641,
Statutes of 2011, enacts the Health Care Eligibility,
Enrollment, and Retention Act, establishing a process for
developing a streamlined and simplified eligibility and
SB 970
Page 6
enrollment system to ensure that individuals will be able to
apply for public health coverage programs in person, by mail,
online, fax, or by telephone. AB 1296 also establishes a
stakeholder process to consult with to develop and test a
single, accessible, standardized paper, electronic, and
telephone application.
REGISTERED SUPPORT / OPPOSITION :
Support
Western Center on Law & Poverty (sponsor)
California Association of Food Banks
California Catholic Conference
California Coverage & Health Initiatives
California Food Policy Advocates
California Hunger Action Coalition
California Immigrant Policy Center
California Pan-Ethnic Health Network
California Partnership to End Domestic Violence
California Primary Care Association
California School Employees Association
Coalition of California Welfare Rights Organizations, Inc.
Consumer Federation of California
Greenlining Institute
Health Access California
Latino Coalition for a Healthy California
Santa Clara County Board of Supervisors
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097