BILL ANALYSIS �
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THIRD READING
Bill No: AB 1X1
Author: John A. P�rez (D)
Amended: 6/14/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-2, 6/12/13
AYES: Hernandez, Beall, De Le�n, DeSaulnier, Monning, Pavley,
Wolk
NOES: Anderson, Nielsen
ASSEMBLY FLOOR : 54-22, 3/7/13 - See last page for vote
SUBJECT : Medi-Cal: eligibility
SOURCE : Author
DIGEST : This bill implements specified Medicaid provisions
(Medicaid is known as Medi-Cal in California) of the federal
Patient Protection and Affordable Care Act (ACA), including the
expansion of federal Medicaid coverage to low-income adults with
incomes between 0 and 138% of the federal poverty level (FPL).
Implements a number of the Medicaid Affordable Care Act
provisions to simplify the eligibility, enrollment and renewal
processes for Medi-Cal.
Senate Floor Amendments of 6/14/13 require the Medi-Cal
expansion to cease after one year if federal matching funds are
reduced to 70% or less, require the Medi-Cal expansion
population to enroll in a Medi-Cal managed care plan to receive
services under the program if a plan is available, require the
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Department of Health Care Services (DHCS) to take specified
steps in establishing income eligibility for Medi-Cal, and
define what is reasonably compatible when the information DHCS
has is different than what the person applying for coverage
reports. In addition, the amendments modify the health plan
selection process for Medi-Cal beneficiaries by deleting the
requirement that beneficiaries personally attend a presentation,
and require training for individuals assisting with selecting a
Medi-Cal managed care plan, and require DHCS to provide
information and assistance to enable Medi-Cal beneficiaries to
understand and use the services of Medi-Cal managed care plans.
Finally, the amendments delete provisions from this bill that
are in SB X1 1 (Hernandez and Steinberg), and make this
contingent upon enactment of SB X1 1.
ANALYSIS :
This bill:
Medi-Cal Expansion to Adults
1. Requires the Department of Health Care Services (DHCS) to
implement the ACA expansion of Medi-Cal coverage to adults
and parents up to 133% of the FPL (adults without minor
children are generally not eligible for Medi-Cal unless aged
or disabled, and parents applying for Medi-Cal are eligible
if they have family incomes at or below 100% of the FPL).
Implements the ACA requirement that a 5% income disregard
applies to individuals whose income eligibility is determined
based on Modified Adjusted Gross Income (MAGI), effectively
making income eligibility 138% of the FPL ($15,856 for an
individual and $26,951 for a family of 3 in 2013).
2. Requires individuals who are eligible under the Medi-Cal
expansion to enroll in a Medi-Cal managed care health plan in
those counties where a Medi-Cal managed care health plan is
available.
3. Require individuals who qualify for the Medi-Cal expansion
and who are currently enrolled in the Low Income Health
Program (LIHP) whose coverage expires January 1, 2014, to be
assigned to a Medi-Cal managed care plan that includes
his/her primary care provider, and to be informed that he/she
can choose any available Medi-Cal managed care plan and
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primary care provider.
Income
4. Requires an applicant's or beneficiary's income and
resources to be determined, counted, and valued by DHCS in
accordance with the requirement to use MAGI in determining
Medi-Cal eligibility.
5. Requires the MAGI standard to conform to federal maintenance
of effort requirements, and requires DHCS to ensure that the
financial methodology used for equivalent income threshold
preserves Medi-Cal eligibility to the extent required by law.
6. Requires DHCS to take specified steps in establishing income
eligibility for Medi-Cal, and defines what is reasonably
compatible when the information is different than what the
person applying for coverage reports.
Eligibility and enrollment process
7. Requires DHCS to retain or delegate the authority to perform
Medi-Cal eligibility determination, as set forth in this
bill. Permits Covered California (California's Health
Benefit Exchange) and DHCS, via the CalHEERS system (Covered
California's enrollment system) to determine MAGI-based
Medi-Cal eligibility for individuals who apply through an
electronic or paper application that can be processed by
CalHEERS using only the information provided and that do not
require further staff review to verify the accuracy of the
submitted information. Requires the county of residence to be
otherwise responsible for eligibility determinations and
on-going case management for Medi-Cal. Requires CalHEERS to
be jointly managed by DHCS and Covered California. Permits
Covered California to provide information on Medi-Cal managed
care health plan selection options for MAGI-eligible
individuals, and allows these individuals to choose a plan.
Sunsets these provisions July 1, 2015.
8. Requires Covered California to implement a work-flow
transfer protocol for individuals who call the customer
service center operated by Covered California to apply for
coverage that asks questions to determine whether the
individual's household includes individuals who are
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potentially eligible for Medi-Cal. Requires Covered
California to transfer callers from a household that has an
individual who appears to be potentially Medi-Cal eligible to
the county to complete the assessment and any required
eligibility determination.
9. Requires the transfer protocol and procedures used by
Covered California to be developed and implemented in
conjunction with and subject to review and approval by DHCS.
10.Requires, during the initial open enrollment period until
June 30, 2014, Covered California to proceed with the
assessment and eligibility determination for a household that
appears to have individuals both potentially eligible for
Medi-Cal using the MAGI-income assessment and individuals who
are not Medi-Cal eligible (referred to as "mixed coverage
households").
11.Requires Covered California to transfer individuals who are
pregnant or potentially eligible for Medi-Cal on a basis
other than MAGI (disabled, 65 or older or in need on
long-term care services) to his or her county of residence.
Requires the county of residence to be responsible for final
confirmation of Medi-Cal eligibility determinations.
12.Requires Covered California to assess for eligibility if the
caller's household appears to only include individuals not
potentially eligible for Medi-Cal.
13.Requires DHCS, Covered California and county consortia to
enter into an interagency agreement which specifies the
operational parameters and performance standards pertaining
to the transfer protocol.
14.Requires the state to be responsible for providing the
administrative funding to the counties for work associated
with the above provisions, and makes funding subject to the
annual budget act.
15.Requires DHCS, in collaboration with Covered California, the
counties, consumer advocates, and the Statewide Automated
Welfare System consortia, to develop and prepare one or more
reports that are issued at least quarterly and are made
publicly available within 30 days following the end of each
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quarter, for the purpose of informing the California Health
and Human Services Agency, Covered California, the
Legislature, and the public about the enrollment process for
all insurance affordability programs.
16.Adopts the ACA requirement that requires an individual be
allowed to be accompanied, assisted, and represented in the
application and renewal process by an individual or
organization of his or her choosing.
Repeal of current semi-annual status report requirement
17.Prohibits the use of an asset or resource test for
individuals whose financial eligibility for Medi-Cal is
determined based on MAGI to conform to ACA requirements.
Requirements prior to terminating Medi-Cal coverage
18.Modifies, re-enacts and conforms existing state law
requirements for counties prior to terminating Medi-Cal
eligibility under legislation known as SB 87 (Escutia,
Chapter 1088, Statutes of 2000). Changes include:
A. Requiring counties to gather additional
eligibility-related information relevant to the Medi-Cal
beneficiary's eligibility prior to contacting the
beneficiary, rather than "making every reasonable effort"
to gather that information in existing law;
B. Requiring counties to check federal databases for
purposes of gathering information to conduct eligibility
redeterminations, and requiring the county, in cases of
annual redetermination where the county is able to make a
determination of continuing eligibility, to notify the
individual of the eligibility determination and inform the
beneficiary of his or her obligation to inform the county
if any information on the notice is inaccurate but that the
beneficiary is not required to sign and return the notice
if all information is accurate;
C. Requiring the use of a prepopulated form in annual
redeterminations in cases where the county is unable to
determine continued Medi-Cal eligibility;
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D. Establishing requirements and timeframes related to
mailing of forms and timeframes to respond.
E. Adopting the federal requirement that requires, if a
Medi-Cal beneficiary is terminated from coverage, but that
former beneficiary submits a completed form within 90 days
of termination (instead of 30 days in existing law), the
county to determine eligibility as though the form was
submitted in a timely manner;
F. Requiring a county, in the case of a redetermination due
to a change in circumstances, if a county determines that
the beneficiary remains eligible for Medi-Cal benefits, the
county to begin a new 12-month eligibility period;
G. Requiring counties, for individuals determined
ineligible for Medi-Cal, to determine eligibility for other
insurance affordability programs, and if the individual is
eligible, requiring the county, as appropriate, to transfer
the individual's electronic account to other insurance
affordability programs via a secure electronic interface;
H. Requiring any renewal form or notice to be accessible to
persons who are limited English proficient and persons with
disabilities consistent with all federal and state
requirements;
I. Requiring beneficiaries be provided with an annual
renewal form at least 60 days before the beneficiary's
annual redetermination date;
J. Requires DHCS to seek federal approval to extend the
annual redetermination date for a three-month period for
those Medi-Cal beneficiaries whose annual redeterminations
are scheduled to occur between January 1, 2014 and March
31, 2014; and
AA. Requiring, for purposes of determining whether a
Medi-Cal beneficiary whose eligibility is being terminated
during redetermination, for Medi-Cal beneficiaries subject
to the use of MAGI-based financial methods, the
determination of whether the beneficiary is eligible for
Medi-Cal benefits under any basis to include, but not be
limited to, a determination of eligibility for Medi-Cal
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benefits on a basis that is exempt from the use of
MAGI-based financial methods only if either of the
following occurs:
The county assesses the beneficiary as being
potentially eligible under a program that is exempt
from the use of MAGI-based financial methods,
including but not limited to, on the basis of age,
blindness, disability, or the need for long term care
services and supports.
The beneficiary requests that the county
determine whether he/she is eligible for Medi-Cal
benefits on a basis that is exempt from the use of
MAGI-based financial methods.
Other Changes
1. Requires DHCS, when determining whether an individual is
eligible for Medi-Cal benefits, to verify the accuracy of the
information provided as part of the application process by
obtaining information about an individual that is available
electronically for other state and federal agencies and
programs in determining eligibility for Medi-Cal or Covered
California coverage prior to requesting additional
verification from an applicant or beneficiary for information
he/she provides as part of the application or redetermination
process. Specifies the sources of information, including
state and federal agencies.
2. Requires DHCS and governmental agencies determining
eligibility for Medi-Cal or other DHCS administered programs
to share information with each other to enable them to
perform their statutory and regulatory duties under state and
federal law.
3. Requires DHCS to develop and update a verification plan
describing the verification policies and procedures adopted
by DHCS to verify eligibility information. Requires the
development of the verification plan be undertaken in
consultation with specified stakeholders.
4. Requires DHCS to develop, by January 1, 2015, pre-populated
renewal forms for use with beneficiaries whose eligibility is
determined using non-MAGI-based methods (federal regulations
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require a prepopulated form for MAGI eligibility
redeterminations).
5. Requires DHCS to adopt the federal eligibility determination
options to: (a) consider blindness as continuing until the
reviewing physician determines that a beneficiary's vision
has improved beyond the definition of blindness contained in
the state's Medicaid State Plan; and (b) consider disability
as continuing until the review team determines that a
beneficiary's disability no longer meets the definition of
disability contained in the plan. DHCS indicates these
provisions adopt its current policy.
6. Adopts the ACA option to include domestic partners within
the definition of caretaker relatives for Medi-Cal
eligibility purposes.
7. Permits the use of old Medi-Cal applications until January
1, 2016, and continues to allow the use of a joint
application for insurance affordability programs (such as
Medi-Cal and subsidized Exchange coverage), CalWORKS, and
CalFresh.
8. Requires Medi-Cal managed care plans, when it learns of a
Medi-Cal beneficiary's updated contact information, to ask
the beneficiary to provide the plan with approval of the plan
providing this information to the appropriate county.
Requires counties to attempt to verify the information it
receives from the Medi-Cal managed care health plan is
accurate, which could include making contact with the
beneficiary. Requires the contact to first be attempted to be
made using the method of contact identified by the
beneficiary as the preferred method of contact. Repeals the
requirement that DHCS develop a consent form to be used by
counties to record the beneficiary's consent to use the
information received from the plan to update the
beneficiary's file.
9. Extends the duration of coverage through the Access for
Infants and Mothers Program (AIM) by requiring coverage to be
provided until the end of the month in which the 60th day
occurs, rather than terminating coverage mid-month 60 days
following the end of the pregnancy.
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10.Modify the health plan selection process for Medi-Cal
beneficiaries by deleting the requirement that beneficiaries
personally attend a presentation, and requires training for
individuals assisting with selecting a Medi-Cal managed care
plan.
11.Requires DHCS to provide information and assistance to
enable Medi-Cal beneficiaries to understand and use the
services of Medi-Cal managed care plans.
12.Requires any person that assists a Medi-Cal beneficiary who
is eligible for the program based on MAGI to select a
Medi-Cal managed care plan via CalHEERS (Covered California
enrollment system) to complete a training program, and
requires any person that assists a Medi-Cal beneficiary who
is not eligible for Medi-Cal on the basis of MAGI to select a
Medi-Cal managed care plan to complete a training program.
13.Makes this bill operative only if SB X1 1 (Hernandez and
Steinberg) is enacted and takes effect.
14.Makes the implementation of the expansion of Medi-Cal
benefits to adults under the ACA contingent upon the
following:
A. Requires, if the federal medical assistance percentage
(the FMAP is the percentage of Medi-Cal paid by the federal
government) payable to the state under the ACA for the
expansion of Medi-Cal benefits to adults is reduced below
90%, that reduction to be addressed in a timely manner
through the annual state budget or legislative process.
Requires notification to the Legislature of any reduction.
B. Requires, if the FMAP payable to the state under the ACA
for the expansion of Medi-Cal benefits to adults is reduced
to 70% or less prior to January 1, 2018, the implementation
of any provision of this bill chapter authorizing the
optional expansion of Medi-Cal benefits to adults to cease
twelve months after the effective date of the federal law
or other action reducing the FMAP.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
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The contents have been discussed in both Appropriations and
Budget Committee and the 2013-14 budget bill contains funding
for the provisions of the bill.
SUPPORT : (Verified 6/14/13)(unable to reverify at time of
writing)
AARP
Advancement Project
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
American Heart Association
The Arc and United Cerebral Palsy California Collaboration
Asian Pacific American Legal Center
Binational Center for the Development of Oaxacan Indigenous
Communities
Cal-Islanders Humanitarian Association
California Association of Addiction Recovery Resources
California Association of Alcoholism and Drug Abuse Counselors
California Association of Public Hospitals and Health Systems
California Black Health Network
California Chiropractic Association
California Family Resource Association
California Hospital Association
California Immigrant Policy Center
California Labor Federation
California Latino Legislative Caucus
California Medical Association
California Nurse-Midwives Association
California Nurses Association
California Pan-Ethnic Health Network
California Primary Care Association
California School Employees Association, AFL-CIO
California School Health Centers Association
California State Council of the Service Employees International
Union
California State Parent Teacher Association
California Teachers Association
Californians for Safety and Justice
Child and Family Center
Chinese Progressive Association of San Francisco
Consumers Union
County of Santa Clara Board of Supervisors
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County Welfare Directors Association of California
Department of Insurance
Friends of the Family
Greenlining Institute
Guam Communications Network
Health Access California
Health Officers Association of California
Hillview Mental Health Center, Inc
Junior Blind
Latino Health Alliance
March of Dimes Foundation
National Association of Social Workers
National Health Law Program
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino Counties
Planned Parenthood of Santa Barbara
Private Essential Access Community Hospitals
Six Rivers planned Parenthood
Street Level Health Project
United Nurses Associations of California/Union of Health Care
Professionals
Urban Counties Caucus
ARGUMENTS IN SUPPORT : This bill and SB X1 1 are supported by
consumer, low-income and health care provider groups. Generally,
proponents argue these bills are the largest expansion of
Medi-Cal since 1966, will make 1.4 million Californians eligible
for coverage and draw down an estimated $2.1 to $3.5 billion in
federal funds in 2014 alone. This will help create jobs in the
health care workforce, improve worker productivity, and increase
local and state tax revenues. Proponents argue expanding
Medi-Cal will extend lifesaving health coverage to millions,
provide preventive care and improve health outcomes for those
who receive coverage. Proponents cite specific provisions of
these bills and federal law that they support, including the
enhanced federal matching rate for the expansion population, the
Medi-Cal coverage expansion to former foster youth and
low-income adults, the additional benefits provided as part of
Medi-Cal coverage, the elimination of the deprivation and asset
tests, and the program simplification provisions.
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ASSEMBLY FLOOR : 54-22, 3/7/13
AYES: Achadjian, 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, Gordon,
Gray, Hall, Roger Hern�ndez, Holden, Hueso, Jones-Sawyer,
Levine, Lowenthal, Medina, Mitchell, Mullin, Muratsuchi,
Nazarian, Pan, Perea, V. Manuel P�rez, Quirk, Quirk-Silva,
Rendon, Salas, Skinner, Ting, Torres, Weber, Wieckowski,
Williams, Yamada, John A. P�rez
NOES: Allen, Bigelow, Ch�vez, Conway, Donnelly, Gorell, Grove,
Hagman, Harkey, Jones, Linder, Logue, Maienschein, Mansoor,
Melendez, Morrell, Nestande, Olsen, Patterson, Wagner,
Waldron, Wilk
NO VOTE RECORDED: Alejo, Dahle, Beth Gaines, Stone
JL:nl 6/14/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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