BILL ANALYSIS �
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THIRD READING
Bill No: AB 50
Author: Pan (D)
Amended: 9/3/13 in Senate
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 7-1, 8/21/13
AYES: Hernandez, Anderson, Beall, De Le�n, DeSaulnier, Monning,
Pavley
NOES: Nielsen
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE : 6-1, 8/30/13
AYES: De Le�n, Gaines, Hill, Lara, Padilla, Steinberg
NOES: Walters
ASSEMBLY FLOOR : 54-24, 6/14/13 - See last page for vote
SUBJECT : Medi-Cal: eligibility
SOURCE : Author
DIGEST : This bill expands, effective January 1, 2014, the
benefit package to Medi-Cal-eligible pregnant women with family
incomes under 100% of the federal poverty level (FPL) to
full-scope Medi-Cal benefits. Permits the Department of Health
Care Services (DHCS) to initially implement specified Medi-Cal
provisions of the recently enacted AB X1 1 (John A. Perez,
Chapter 3, Statutes of 2013-14), and SB X1 1 (Hernandez and
Steinberg, Chapter 4, Statutes of 2013-14), by means of
all-county letters, plan letters, plan or provider bulletins, or
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similar instructions, followed by a requirement that DHCS adopt
regulations by January 1, 2015. Requires DHCS to establish a
new budgeting methodology for Medi-Cal county administrative
costs that reflect the impact of the federal Patient Protection
and Affordable Care Act (ACA) to be implemented sooner than
fiscal year 2015-16. Requires, by January 1, 2015, the
California Healthcare Eligibility, Enrollment, and Retention
System (CalHEERS) application form for Medi-Cal and Covered
California coverage, to include questions that are voluntary for
applicants to answer on applicant demographics.
ANALYSIS :
Existing law:
1.Establishes the Medi-Cal program, which is administered by
DHCS, under which qualified low-income individuals receive
health care services.
2.Requires DHCS to provide Medi-Cal eligibility to pregnant
women and infants with family incomes up to 200%, of the FPL.
The scope of Medi-Cal benefits provided to pregnant women
(full-scope benefits versus pregnancy-only benefits) depends
upon several factors, including her income, immigration
status, assets, and whether she is otherwise Medi-Cal
eligible.
3.Requires DHCS to develop and implement, in consultation with
county program and fiscal representatives, a new budgeting
methodology for Medi-Cal county administrative costs.
Requires the new budgeting methodology be used to reimburse
counties for eligibility determinations for applicants and
beneficiaries, including one-time eligibility processing and
ongoing case maintenance. Requires DHCS to provide the new
budgeting methodology to the legislative fiscal committees by
March 1, 2012, and permits inclusion of the methodology in the
May 2012 Medi-Cal Local Assistance Estimate for the 2012-13
fiscal year and each fiscal year thereafter.
4.Requires a single, accessible, standardized paper, electronic,
and telephone application for insurance affordability programs
be developed by DHCS in consultation with the Managed Risk
Medical Insurance Board and the Covered California board.
Requires the application to be used by all entities authorized
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to make an eligibility determination for any of the insurance
affordability programs and by their agents.
5.Permits the form to include questions that are voluntary for
applicants to answer regarding demographic data categories,
including race, ethnicity, primary language, disability
status, and other categories recognized by the federal
Secretary of Health and Human Services (HHS) under a specified
provision of the ACA.
This bill:
1.Allows women with income less than 100% of the FPL, eligible
for full-scope Medi-Cal benefits under a specified provision
of federal and if she meets all other eligibility
requirements. Implements this provision only if and to the
extent that federal financial participation is available and
any necessary federal approvals have been obtained.
2.Permits DHCS to implement specified provisions of the recently
enacted Medi-Cal-related provisions implementing the ACA of AB
X1 1 and SB X1 1 by means of all-county letters, plan letters,
plan or provider bulletins, or similar instructions until the
time any necessary regulations are adopted. Requires DHCS to
adopt regulations by January 1, 2017, in accordance with the
requirements of the rulemaking requirements of the
Administrative Procedure Act (APA). Requires DHCS within six
months of the effective date of these provisions, to provide a
status report to the Legislature on a semiannual basis until
regulations have been adopted.
3.Permits, rather than requires under existing law, the
budgeting methodology for county Medi-Cal eligibility
determination to include specified costs. Requires the new
budgeting methodology to be implemented no sooner than the
2015-16 fiscal year, to reflect the impact of ACA
implementation on county administrative work, and to be
provided to the legislative fiscal committees by March 1 of
the fiscal year immediately preceding the first fiscal year of
implementation.
4.Requires, by January 1, 2015, the CalHEERS application form to
include questions that are voluntary for applicants to answer
regarding demographic data categories, including race,
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ethnicity, primary language, disability status, sexual
orientation, gender identity or expression and other
categories recognized by the federal Secretary of HHS.
5.Requires the training of "individuals, including county human
services staff," (instead of "specialized county employees")
in carrying out a DHCS program, to provide information and
assistance to Medi-Cal beneficiaries to understand and
successfully use the services of Medi-Cal managed care plans.
6.Makes other clarifying changes to the recently enacted
Medi-Cal-related provisions implementing the ACA in AB X1 1
and SB X1 1.
Background
Medi-Cal benefits for low-income pregnant women . State law
requires Medi-Cal to cover pregnant women without a share of
cost with incomes below 200% of the FPL. However, the scope of
coverage a woman receives (full-scope Medi-Cal coverage versus
Medi-Cal coverage for pregnancy-only services) depends upon her
income, immigration status, assets, and whether she meets other
criteria (for example, a pregnant woman can only receive
full-scope coverage if she has "linkage" to Medi-Cal for
specified reasons). DHCS indicates a low-income pregnant woman
in her first or second trimester with income between 59% and
100% of the FPL is eligible for pregnancy-only Medi-Cal coverage
and does not qualify for full-scope Medi-Cal unless she is
otherwise linked to Medi-Cal (such as being on CalWORKS) until
she reaches her third trimester.
Under this bill, women who are citizens or legal immigrants with
family incomes below 100% of the FPL (effectively, women with
incomes between 59% and 100% of the FPL or income between
$11,523 and $19,530 for a family of three in 2013) are eligible
for full-scope Medi-Cal coverage. This addresses an anomaly in
the federal Medicaid expansion that provides single adult women
and men with broader coverage than would be provided to pregnant
women who are currently eligible for pregnancy-only services.
DHCS use of provider bulletins followed by regulations . The use
of provider bulletins in lieu of regulations has been an
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on-going issue of dispute between the Legislature and DHCS.
While the Legislature has authorized the exemption from the
rule-making provisions of the APA when urgent action is needed
(such as to immediately implement budget savings proposals) or
for ease of program implementation, the requirements set forth
in the APA are designed to provide the public with a meaningful
opportunity to participate in the adoption of state regulations
and to ensure that regulations are clear, necessary and legally
valid, and broadly available to the public. In addition, many
Medi-Cal policies and program rules are contained in statute,
all-county letters and regulations, making it difficult to
discern the complex eligibility and related requirements for
this program. This bill adopts a compromise in initially
allowing the Medi-Cal-related health reform provisions to be
adopted by all-county letters or similar instructions but
requires the adoption of regulations by July 1, 2015.
Medi-Cal county budgeting methodology changes . County social
service departments determine Medi-Cal eligibility on behalf of
the state. DHCS is responsible for determining allocation for
funding county social service costs associated with Medi-Cal
eligibility determinations. AB 102 (Committee on Budget,
Chapter 29, Statutes of 2011) required DHCS to develop and
implement a new budgeting methodology for Medi-Cal county
administrative costs. This bill makes changes to those
provisions agreed to by the County Welfare Directors Association
and DHCS, including requiring the budgeting methodology to
reflect the impact of ACA implementation on county
administrative work, and requiring the methodology be
implemented no sooner than the 2015-16 fiscal year.
Prior Legislation
SB 900 (Alquist, Chapter 659, Statutes of 2010) established
Covered California as an independent public entity within state
government, and required Covered California to be governed by a
board composed of the HSS Secretary, or his/her designee, and
four other members appointed by the Governor and the Legislature
who meet specified criteria.
AB 1602 (John A. P�rez, Chapter 655, Statutes of 2010) specified
the powers and duties of Covered California relative to
determining eligibility for enrollment in the Covered California
and arranging for coverage under qualified health plans,
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required Covered California to provide health plan products in
all five of the federal benefit levels (platinum, gold, silver,
bronze and catastrophic), required health plans participating in
Covered California to sell at least one product in all five
benefit levels in Covered California, requires health plans
participating in Covered California to sell their Covered
California products outside of Covered California, and required
health plans that do not participate in the Covered California
to sell at least one standardized product designated by the
Covered California in each of the four levels of coverage.
AB 1296 (Bonilla, Chapter 641, Statutes of 2011) the Health Care
Eligibility, Enrollment, and Retention Act, required the HSS, in
consultation with other state departments and stakeholders, to
undertake a planning process to develop plans and procedures
regarding these provisions relating to enrollment in state
health programs and federal law. AB 1296 also established the
requirements for the CalHEERS application form.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
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). This bill
extends eligibility to include all Medi-Cal benefits for this
population. DHCS has been unable to provide information on
anticipated the number of eligible women this change will
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
existing 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).
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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 Covered California to
include required demographic questions in the application
(federal funds or special funds).
SUPPORT : (Verified 9/3/13)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Communities United Institute
California Optometric Association
California Pan-Ethnic Health Network
County of Los Angeles
County Welfare Directors Association of California
Health Access California
L.A. Gay & Lesbian Center
Laborers' Locals 777 & 792
Lyon-Martin Health Services
Mental Health America of Northern California
Our Family Coalition
The Trevor Project
Transgender Law Center
OPPOSITION : (Verified 9/3/13)
California Primary Care Association
ARGUMENTS IN SUPPORT : Groups representing health care
providers, low-income consumers and women's health advocates,
such as the American Congress of Obstetricians and
Gynecologists, write in support of the expansion to 100% of the
FPL but would argue this expansion should also apply to women
with incomes up to 138% of the FPL.
ARGUMENTS IN OPPOSITION : The California Primary Care
Association writes that it is opposed unless amended because the
bill does not contain a provision entitling newly qualified
immigrants to full-scope Medi-Cal benefits, including Federally
Qualified Health Centers (FQHC) services provided at the
enhanced FQHC Medi-Cal rate.
ASSEMBLY FLOOR : 54-24, 6/14/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
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Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Chesbro, Cooley, Daly, Dickinson, Eggman, Fong,
Fox, Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray,
Hall, Roger Hern�ndez, Holden, Jones-Sawyer, Levine,
Lowenthal, Medina, Mitchell, Mullin, Muratsuchi, Nazarian,
Pan, Perea, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Salas, Skinner, Stone, Ting, Weber, Wieckowski, Williams,
Yamada, John A. P�rez
NOES: Achadjian, Allen, Ch�vez, Conway, Dahle, Donnelly, Beth
Gaines, Gorell, Grove, Hagman, Harkey, Jones, Linder, Logue,
Maienschein, Mansoor, Melendez, Morrell, Nestande, Olsen,
Patterson, Wagner, Waldron, Wilk
NO VOTE RECORDED: Bigelow, Vacancy
JL:ej 9/3/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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