BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 1081
Author: Fuller (R)
Amended: 8/20/12
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 8-0, 3/28/12
AYES: Hernandez, Harman, Alquist, Anderson, Blakeslee, De
León, Rubio, Wolk
NO VOTE RECORDED: DeSaulnier
SENATE APPROPRIATIONS COMMITTEE : 7-0, 4/30/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
SENATE FLOOR : 37-0, 5/14/12 (Consent)
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Corbett, Correa, De León, DeSaulnier, Dutton,
Emmerson, Evans, Fuller, Gaines, Hancock, Harman,
Hernandez, Huff, Kehoe, La Malfa, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Simitian, Steinberg, Vargas, Walters, Wolk, Wright, Yee
NO VOTE RECORDED: Runner, Strickland, Wyland
ASSEMBLY FLOOR : 80-0, 8/27/12 - See last page for vote
SUBJECT : Public health care: Medi-Cal: demonstration
projects
SOURCE : District Hospital Leadership Forum
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DIGEST : This bill authorizes nondesignated public
hospitals (NDPH), which are hospitals owned by a local
health care district, to operate a Low Income Health
Program (LIHP) in a county that does not have a designated
public hospital if the county has previously filed an
application to operate a LIHP but has formally withdrawn
the application.
Assembly Amendments add clarifying changes.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, which is administered
by the Department of Health Care Services (DHCS), under
which qualified low-income individuals receive health
care services.
2. Requires DHCS, pursuant to federal approval of a
demonstration project, to authorize local LIHPs to
provide health care services to eligible low-income
individuals under certain circumstances. LIHPs are
established at local option, and are authorized to cover
individuals up to 200 percent of the federal poverty
level (FPL) (200 percent of the FPL is at or below
$22,340 for an individual in 2012).
3. Defines the entities authorized to operate an approved
LIHP as follows: a county, a city and county, a
consortium of counties serving a region of more than one
county, or a health authority.
This bill:
1. Requires the NDPH to provide the application to the
county at the same time it is provided to DHCS.
2. Requires DHCS to consider the application if the county
does not indicate within 30 days that it will proceed by
rescinding the withdrawal of the application.
3. Requires DHCS to seek any necessary federal approvals.
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4. States legislative intent that any NDPH that submits an
application initially establish a local stakeholder
advisory committee as specified.
5. Contains an urgency clause to ensure that the provisions
of this bill go into immediate effect upon enactment.
Background
In 2010, the Legislature passed and Governor Schwarzenegger
signed into law AB 342 (John A. Pérez), Chapter 723,
Statutes of 2010, and SB 208 (Steinberg), Chapter 714,
Statutes of 2010, a two-bill package to implement a new
federal demonstration project entitled California's "Bridge
to Reform." AB 342 authorized the LIHPs (originally called
Coverage Expansion and Enrollment Demonstration) that built
upon the Health Care Coverage Initiatives (HCCIs)
established under the 2005 demonstration project. Under the
2005 waiver, a total of $180 million in federal funds were
allotted annually to the county-based HCCIs in years three,
four, and five of the 2005 waiver (September 1, 2007
through August 31, 2010) to provide coverage to
medically-indigent adults who are not eligible for other
public programs.
AB 342 extended the 10 "legacy" HCCIs funded under the 2005
demonstration project, and authorized the expansion of the
HCCIs statewide using an early implementation option
created by the federal health care reform bill (the Patient
Protection and Affordable Care Act or ACA). The ACA
requires states, by January 1, 2014, to cover adults under
age 65 and with family incomes up to 138 percent of the FPL
(at or below $15,414 in 2012) in their Medicaid program.
Under the ACA, states have the option of drawing down
federal funds for early implementation of this provision.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee
Minor administrative costs to DHCS to seek federal
approval for this change and review applications from
hospitals to operate LIHPs. These administrative costs
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are funded by 50% federal funds, 50% local funds from
participating entities. Given the short time frame and
unique circumstances, only one county (Tulare County) is
expected to apply pursuant to this bill.
If an NDPH operated a LIHP pursuant to this bill, local
funds for health care services would also be matched by
new federal funds. According to the District Hospital
Leadership Forum, the sponsor of this bill, this could
result in an estimated increase in federal funds in
Tulare County of $2.7 million.
SUPPORT : (Verified 8/28/12)
District Hospital Leadership Forum (source)
Antelope Valley Hospital
Association of California Healthcare Districts
Coalinga Regional Medical Center
District Hospital Leadership Forum
Health Access California
Kaweah Delta Health Care District
Mountains Community Hospital
Palomar Health
Salinas Valley Memorial Healthcare System
San Benito Health Care District
Tri-City Medical Center
Western Center on Law and Poverty
ARGUMENTS IN SUPPORT : This bill is sponsored by the
District Hospital Leadership Forum (DHLF), which represents
California's health care district-operated acute-care
hospitals, to allow a public district hospital to become an
LIHP contractor in counties that are both without a county
hospital and are not interested in becoming an LIHP
contractor. DHLF states that while public district
hospitals can negotiate with an LIHP contractor to
participate in an LIHP provider network, they cannot become
an LIHP contractor under the implementing legislation.
DHLF states this restricts the flow of these federal
dollars to California and limits access to care for
uninsured Californians in counties that are without a
county hospital and that are not interested in becoming an
LIHP contractor. DHLF concludes that allowing district
hospitals to act as an LIHP contractor will result in
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expanded coverage to more areas in California without a
cost to the state General Fund
ASSEMBLY FLOOR : 80-0, 08/27/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson,
Donnelly, Eng, Feuer, Fletcher, Fong, Fuentes, Furutani,
Beth Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell,
Grove, Hagman, Halderman, Hall, Harkey, Hayashi, Roger
Hernández, Hill, Huber, Hueso, Huffman, Jeffries, Jones,
Knight, Lara, Logue, Bonnie Lowenthal, Ma, Mansoor,
Mendoza, Miller, Mitchell, Monning, Morrell, Nestande,
Nielsen, Norby, Olsen, Pan, Perea, V. Manuel Pérez,
Portantino, Silva, Skinner, Smyth, Solorio, Swanson,
Torres, Valadao, Wagner, Wieckowski, Williams, Yamada,
John A. Pérez
DLW:CTW:d 8/28/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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