BILL ANALYSIS �
AB 50
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 50 (Pan)
As Amended September 5, 2013
Majority vote
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|ASSEMBLY: |54-24|(June 14, 2013) |SENATE: |33-5 |(September 9, |
| | | | | |2013) |
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Original Committee Reference: HEALTH
SUMMARY : Expands full-scope Medi-Cal to cover pregnant women with
income up to 100% of the federal poverty level (FPL).
The Senate amendments delete the provisions of the bill as passed by
the Assembly and instead expand full-scope Medi-Cal coverage to
pregnant women with income up to 100% FPL.
AS PASSED BY THE ASSEMBLY , this bill enacted provisions relating to
the federal Patient Protection and Affordable Care Act (ACA)
regarding presumptive eligibility by hospitals, enrollment in
Medi-Cal managed care plans, and the collection of demographic data
on the standardized application for state health subsidy programs.
This bill also contained an urgency clause to ensure that the
provisions of this bill go into immediate effect upon enactment.
FISCAL EFFECT : According to the Senate Appropriations Committee,
based on the prior version of this bill:
1)Unknown costs to provide full-scope benefits to pregnant women
with household incomes between 60% and 100% of FPL [General Fund
(GF) and federal funds]. Under current law and practice, pregnant
women with incomes from 59% to 100% of FPL 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 (DHCS)
has been unable to provide information on the anticipated number
of eligible women this change would impact or the marginal
increase in spending to provide full-scope Medi-Cal benefits.
2)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 ACA (GF and
federal funds).
AB 50
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3)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 (GF and federal
funds).
4)One-time costs of $100,000 to $150,000 to modify Information
Technology (IT) systems to allow the health care coverage
application system for Medi-Cal and the California Health Benefit
Exchange (Exchange) to include required demographic questions in
the application (federal funds or special funds).
COMMENTS : According to the author, this bill is necessary for
enactment of provisions needed to implement the ACA, but had to be
deleted from the final versions of SB 1 X1(Ed Hernandez and
Steinberg), Chapter 4, Statutes of 2013-14 First Extraordinary
Session, and AB 1 X1 (John A. P�rez), Chapter 3, Statutes of 2013-14
First Extraordinary Session.
The Exchange, now known as Covered California, was established in
2010 by AB 1602 (John A. P�rez), Chapter 655, Statutes of 2010, and
SB 900 (Alquist), Chapter 659, Statutes of 2010. Through the
Exchange people with incomes up to 400% FPL are eligible for
advanced payment of premium tax credits, subsidies, and cost sharing
reductions, depending on their income. The ACA also requires states
to have a single streamlined application for Exchange subsidies,
their Medicaid programs, and their Children's Health Insurance
Program. Covered California and DHCS are joint program sponsors of
the California Health and California Healthcare Eligibility,
Enrollment, and Retention System (CalHEERS), which is the IT system
running both the online application for the Exchange, Medi-Cal, and
Access for Infants and Mothers program and also the phone service
center functions. The portal will offer eligibility determinations
for both Medi-Cal and federally subsidized coverage through the
Exchange. It will allow enrollment through multiple access points
including mail, phone, and in-person applications. The CalHEERS
business functions include interfacing with the Medi-Cal eligibility
data system. It will also have the capacity to be a secure
interface with federal and state databases in order to obtain and
verify information necessary to determine eligibility.
On August 16, 2012, Governor Brown submitted a letter to the
President Pro Tempore of the Senate and the Speaker of the Assembly
informing them of his plan to call a Special Session in the
beginning of the next legislative session to continue the work of
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implementing the ACA. On January 24, 2013, Governor Brown issued a
proclamation to convene the Legislature in Extraordinary Session
(also known as Special Session) to consider and act upon legislation
necessary to implement the ACA in the areas of California's private
health insurance market, rules and regulations governing the
individual and small group market, California's Medi-Cal program,
changes necessary to implement federal law, and options that allow
low-cost health coverage through Covered California to be provided
to individuals who have income up to 200% of the FPL. AB 2 X1
(Pan), Chapter 1, Statutes of 2013-14 First Extraordinary Session
and SB 2 X1 (Ed Hernandez) Chapter 2, Statutes of 2013-14 First
Extraordinary Session address the insurance market reforms, and SB 3
X1 (Ed Hernandez) Chapter 5, Statutes of 2013-14 First Extraordinary
Session addresses the option of low-cost health coverage.
AB 1 X1 and SB 1 X1 implement provisions of the ACA regarding
Medi-Cal eligibility and program simplification including the use of
Modified Adjusted Gross Income and expansion of eligibility in the
Medi-Cal program to address the second of the three areas identified
in the Governor's Special Session proclamation. At the time AB 1 X1
and SB1 X1 were heard in the policy committees both bills provided
full scope Medi-Cal coverage to pregnant women up to 200% FPL. In
the meantime, the Brown Administration proposed an alternative with
regard to women with income over 100% FPL who are eligible to
purchase a Qualified Health Plan (QHP) through the Exchange. As a
result, the provisions relating to pregnancy coverage were amended
out of AB1 X1 and SB1 X1 before they were sent to the Governor and
these provisions are now amended into this bill. This alternative
would have provided for all cost-sharing, including premiums and
co-payments to be paid by the Medi-Cal program and for the benefits
provided by the QHP to be supplemented with Medi-Cal
pregnancy-related benefits. However, agreement could not be reached
with stakeholders and the provisions relating to the affordability
wrap were deleted from this bill.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097
FN: 0002623