BILL ANALYSIS �
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THIRD READING
Bill No: AB 50
Author: Pan (D)
Amended: 9/5/13 in Senate
Vote: 21
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 : Health care coverage: Medi-Cal: eligibility
SOURCE : Author
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to adopt regulations implementing the provision
that a woman is eligible for full-scope Medi-Cal benefits if her
income is less than 100% of the federal poverty level (FPL) as
determined, counted, and valued in accordance with federal law,
by January 1, 2017, and to provide semiannual status reports to
the Legislature until that time.
Senate Floor Amendments of 9/5/13 delete provisions in the bill
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that permit DHCS to implement Medi-Cal related health care
reform administratively, followed by the adoption of
regulations; that modify provisions regarding the budgeting
methodology for county Medi-Cal eligibility determination; and
that require the California Healthcare Eligibility, Enrollment,
and Retention System application form for Medi-Cal and Covered
California coverage to include additional demographic questions
that are voluntary for applicants.
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.
This bill:
1.Requires, effective January 1, 2014, a woman to be eligible
for full-scope Medi-Cal benefits, as defined, if her income is
less than 100 % of the FPL.
2.Requires DHCS, without taking any further regulatory action,
to implement, interpret, or make specific this provision by
means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions until the time regulations
are adopted.
3.Requires DHCS to adopt regulations by January 1, 2017, as
specified.
4.Requires, beginning six months after the effective date of
these provisions, DHCS to provide a status report to the
Legislature on a semiannual basis, until regulations have been
adopted.
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5.Authorizes implementation of these provisions only if and to
the extent that federal financial participation is available
and any necessary federal approvals have been obtained.
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
on-going issue of dispute between the Legislature and DHCS.
While the Legislature has authorized the exemption from the
rule-making provisions of the Administrative Procedure Act (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,
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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 January
1, 2017.
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.
SUPPORT : (Verified 9/6/13)
California Primary Care Association
ASSEMBLY FLOOR : 54-24, 6/14/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
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 9/6/13 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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