BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 50 (Pan) - Medi-Cal: eligibility: pregnancy-related and
postpartum services.
Amended: August 15, 2013 Policy Vote: Health 7-1
Urgency: Yes Mandate: No
Hearing Date: August 30, 2013
Consultant: Brendan McCarthy
SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Bill Summary: AB 50 would make pregnant women with incomes below
100% of the federal poverty level eligible for full-scope
Medi-Cal benefits. The bill would also make several changes to
recently enacted laws relating to Medi-Cal and the Affordable
Care Act
Fiscal Impact (as proposed to be amended):
Unknown costs to provide full-scope benefits to pregnant
women with household incomes between 60% and 100% of the
federal poverty level (General Fund and federal funds).
Under current law and practice, pregnant women with incomes
from 59% to 100% of the federal poverty level are eligible
for Medi-Cal benefits limited to pregnancy-related services.
This bill would extend eligibility to include all Medi-Cal
benefits for this population. The Department of Health Care
Services has been unable to provide information on
anticipated the number of eligible women this change would
impact or the marginal increase in spending to provide
full-scope Medi-Cal benefits.
Likely one-time costs in the hundreds of thousands to low
millions to adopt regulations for various provisions of
current law implementing changes to the Medi-Cal program
under the federal Affordable Care Act (General Fund and
federal funds).
Likely one-time costs in the hundreds of thousands to
develop a new methodology for reimbursing county governments
for their costs to perform Medi-Cal eligibility
determinations (General fund and federal funds).
AB 50 (Pan)
Page 1
One-time costs of $100,000 to $150,000 to modify
information technology systems to allow the health care
coverage application system for Medi-Cal and the California
Health Benefit Exchange to include required demographic
questions in the application (federal funds or special
funds).
Background: Under state and federal law, the Department of
Health Care Services operates the Medi-Cal program, which
provides health care coverage to pregnant women, children and
their parents with incomes below 100% of the federal poverty
level, as well as blind, disabled, and certain other
populations. In addition, pregnant women with incomes up to 200%
of the federal poverty level are eligible for Medi-Cal.
Generally, the federal government provides a 50% federal match
for state Medi-Cal expenditures.
The benefits that a pregnant woman is entitled to depend on
income, immigration status, and other criteria. Women with
income below 200% of the poverty level are eligible for full
scope Medi-Cal benefits in their third trimester. In the first
and second trimesters, if a pregnant woman is not otherwise
eligible for Medi-Cal (for example, because she has Medi-Cal
eligible children), Medi-Cal provides full scope benefits for
women with incomes up to 59% of the federal poverty level. For
women with incomes between 60% and 200% of the federal poverty
level, Medi-Cal generally provides coverage for
pregnancy-related care only.
The federal Affordable Care Act allows states to expand Medicaid
(Medi-Cal in California) eligibility to persons under 65 years
of age, who are not pregnant, not entitled to Medicare Part A or
enrolled in Medicare Part B, and whose income does not exceed
133% of the federal poverty level (effectively 138% of the
federal poverty level as calculated under the Affordable Care
Act). California has opted to expand eligibility for Medi-Cal up
to 138% of the federal poverty level.
The Affordable Care Act provides a significantly enhanced
federal match for the Medicaid expansion. Under the law, the
federal government will pay for 100% of the cost of the Medicaid
expansion in 2013-14 declining to a 90% federal match in the
2020 federal fiscal year and thereafter.
AB 50 (Pan)
Page 2
AB X1 1 (J. Perez, Statutes of 2013) and SB X1 1 (Hernandez and
Steinberg, Statutes of 2013) implement the expansion of Medi-Cal
and include a number of changes to the eligibility and
enrollment process for the Medi-Cal program.
Under current law, counties perform eligibility determinations
for applicants to Medi-Cal. County administrative costs are
reimbursed by the state according to a defined methodology. AB
102 (Committee on Budget, Statutes of 2011) requires the
Department of Health Care Services to develop a new methodology
to reimburse counties.
Proposed Law: AB 50 would make pregnant women with incomes below
100% of the federal poverty level eligible for full-scope
Medi-Cal benefits. The bill would also make several changes to
recently enacted laws relating to Medi-Cal and the Affordable
Care Act.
Specific provisions of the bill would:
Make pregnant women with incomes below 100% of the federal
poverty level eligible for full-scope Medi-Cal benefits,
provided federal funding is available.
Authorize the Department of Health Care Services to
implement various changes to the Medi-Cal program
implementing the Affordable Care Act through all-county
letters or similar instructions. The bill would require the
Department to subsequently adopt regulations by July 1,
2015.
Delay the required implementation of a new methodology for
paying county administrative costs to perform Medi-Cal
eligibility determinations and make changes to the
requirements of the new methodology.
Require the application for Medi-Cal and health care
coverage through the California Health Benefit Exchange to
include certain demographic questions. (Answering the
questions would be optional for applicants.)
Related Legislation: AB X1 1 (J. Perez, Statutes of 2013) and SB
X1 1 (Hernandez and Steinberg, Statutes of 2013) implement the
expansion of Medi-Cal authorized in the Affordable Care Act and
include a number of changes to the eligibility and enrollment
process for the Medi-Cal program.
Staff Comments: Under current law and practice, pregnant women
AB 50 (Pan)
Page 3
with incomes between 59% and 200% of the federal poverty level
(who are not otherwise eligible for Medi-Cal) are eligible for
limited-scope Medi-Cal that only provides coverage for
pregnancy-related care. In practice, it is not clear how this
requirement limits the care that is provided to pregnant women
and the Department has been unable to provide information
regarding the difference in services that are being provided and
the cost to the state by expanding eligibility to provide
full-scope Medi-Cal benefits to this population.
Proposed author's amendments: would limit the pregnancy-related
benefit provisions of the bill to women with income below 100%
of the federal poverty level. These amendments were agreed to in
the Senate Health Committee.