BILL ANALYSIS Ó AB 505 Page 1 ASSEMBLY THIRD READING AB 505 (Nazarian) As Amended April 17, 2013 Majority vote HEALTH 18-0 APPROPRIATIONS 17-0 ----------------------------------------------------------------- |Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Harkey, Bigelow, | | |Bonilla, Bonta, Chesbro, | |Bocanegra, Bradford, Ian | | |Gomez, | |Calderon, Campos, | | |Roger Hernández, | |Donnelly, Eggman, Gomez, | | |Lowenthal, Maienschein, | |Hall, Ammiano, Linder, | | |Mansoor, Mitchell, | |Pan, Quirk, Wagner, Weber | | |Nazarian, Nestande, | | | | |V. Manuel Pérez, Wagner, | | | | |Wieckowski, Wilk | | | |-----+--------------------------+-----+--------------------------| | | | | | ----------------------------------------------------------------- SUMMARY : Requires the Department of Health Care Services (DHCS) to require all Medi-Cal managed care (MCMC) plans (MCPs) contracted to provide Medi-Cal services to provide language assistance to limited-English-proficient (LEP) enrollees as specified. Specifically, this bill : 1)Requires interpretation services to be provided by the MCPs on a 24 hour basis at all points of service. 2)Requires translation services to be provided to the language groups identified by DHCS. 3)Requires DHCS to determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds: a) Three thousand LEP persons eligible for Medi-Cal reside in the plan's service area, or 1,000 LEP persons eligible for Medi-Cal reside in a single zip code; or, b) Two contiguous zip codes with 1,500 LEP persons eligible for Medi-Cal are in a health plan's service. FISCAL EFFECT : According to the Assembly Appropriations AB 505 Page 2 Committee, this bill has minor and absorbable costs to DHCS, as this bill essentially codifies current practice. COMMENTS : According to the author, this bill is intended to codify language assistance requirements in current contracts between DHCS and MCPs, in order to strengthen these access standards. The author points out more than 40% of Californians speak a language other than English at home, and an estimated six to seven million people (one in five) are LEP, meaning they speak English less than "very well." The author states that for over a decade, DHCS has required MCPs to provide language assistance to LEP members. MCPs must provide oral interpretation services, in all languages, on a 24 hour basis. Currently, by contract, translation services of written documents, such as application for enrollment or notice of benefits, must be provided when the LEP population meets one of the numeric thresholds specified in this bill. According to the author, the following languages meet the current threshold required for translation services: Arabic; Armenian; Cambodian; Cantonese; Farsi; Hmong; Korean; Mandarin; Russian; Spanish; Tagalog; and, Vietnamese. The author explains that DHCS instructs the MCPs on how to provide both the oral interpretation and written translation services through policy letters and contract requirements. The author states that in 2003, language assistance requirements were codified for commercial plans licensed by the Department of Managed Health Care or at the California Department of Insurance, but not for MCPs. Currently MCMC in California serves about 5.2 million enrollees in 30 counties, or about 69% of the total Medi-Cal population. DHCS has embarked upon an ambitious array of initiatives that could result in over two million new enrollees into MCPs in 2012 and 2013. These program changes include all age groups and all geographic regions. For example, DHCS is currently in the process of transitioning approximately 860,000 Healthy Families Program children statewide into the Medi-Cal program in four phases throughout 2013. In November of 2010, California obtained federal approval for a Section 1115(b) Medicaid Demonstration Waiver from the Centers for Medicare and Medicaid Services entitled "A Bridge to Reform Waiver." Among other provisions, this waiver authorized mandatory enrollment into MCPs of over 600,000 low-income seniors and persons with disabilities (SPDs) who are eligible for Medi-Cal only (not AB 505 Page 3 Medicare) in the 14 two-plan and two Geographic Managed Care (GMC) counties. Enrollment was phased in over a one-year period in the affected counties beginning on June 1, 2011. Prior to this, mandatory enrollment was limited to children and their families for 30 counties and SPDs in the 14 counties served by the County Operated Health System (COHS). In eight counties, DHCS will begin adding Long-Term Services and Supports, previously carved out of managed care and largely provided through fee-for-service, as services provided through the MCPs. The counties include two COHS counties, one GMC county, and the other five are two-plan model. In addition, under the Federal Patient Protections and Affordable Care Act, states must expand Medicaid eligibility up to 138% of the federal poverty level (FPL) for families, pregnant women, and children. States also have the option to cover childless adults between ages 19 and 65 with incomes under 138% of the FPL who are not currently Medi-Cal eligible. This expansion is estimated to result in between one million and 1.4 million more Californians enrolling in Medi-Cal by 2019. Most of these newly eligible will be enrolled in MCMC. According to the sponsors, the thresholds were developed as part of a MCMC work group convened by DHCS in the early '90s when California was planning to transition the majority of their Medi-Cal beneficiaries into managed care. Work group members, in partnership with the Office of Multicultural Health, reviewed Medi-Cal data on the language needs of the beneficiaries and determined that setting the threshold at 3,000 in a county would provide translated materials to two-thirds of the beneficiaries whose primary language is other than English. This threshold has been codified for purposes of Steven M. Thompson Physician Corps Loan Repayment Program and the Steven M. Thompson Medical School Scholarship Program. Both programs require priority consideration to applicants who speak a Medi-Cal threshold language, along with those coming from an economically disadvantaged background or having experience in a medically underserved area or with medically underserved populations. Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097 FN: 0000441 AB 505 Page 4