BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 505 (Nazarian) - Medi-Cal: managed care: language assistance
services.
Amended: June 19, 2013 Policy Vote: Health 6-2
Urgency: No Mandate: No
Hearing Date: June 24, 2013
Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: AB 505 would require all Medi-Cal managed care
plans to provide oral interpretation services to individuals on
a 24-hour basis at key points of contact. The bill would also
require Medi-Cal managed care plans to translate certain
documents into certain languages.
Fiscal Impact:
Ongoing costs likely between $40,000 and $75,000 every
three years to determine the thresholds for translating
documents by Medi-Cal manage care plans by the Department of
Health Care Services (50% General Fund, 50% federal funds).
No significant increased costs for providing interpretation
and translation services are expected. This bill essentially
recodifies existing law and practice, see below.
Background: The state's Medi-Cal program provides health care
services to seniors, the disabled, and certain low income
children and their parents. About 5.2 million Medi-Cal
beneficiaries (about 70% of the total Medi-Cal population)
receive their health care through Medi-Cal managed care. In
addition, the state is in the process of shifting certain
populations (seniors and persons with disabilities, rural
Medi-Cal beneficiaries, and individuals eligible for both
Medi-Cal and Medicare) from fee-for-service to managed care. In
total, these initiatives are likely to shift about two million
Medi-Cal beneficiaries to managed care.
The federal Civil Rights Act of 1964 and implementing
regulations prohibit the discrimination against any person based
AB 505 (Nazarian)
Page 1
on race, color, or national origin by entities that receive
federal assistance. The federal Office for Civil Rights enforces
these requirements and has indicated through guidance that
entities receiving federal funding may be required to provide
access to translation services for limited English-speaking
program beneficiaries.
Current state law requires all licensed managed care plans to
provide interpretation services to enrollees who are limited
English proficient. Current law also requires all licensed
managed care plans to provide translation services based on the
concentration of non-English speaking enrollees. These
requirement apply to Medi-Cal managed care plans, but allow the
regulatory agencies to deem Medi-Cal managed care plans in
compliance if they meet more stringent requirements through
contractual requirements.
Proposed Law: AB 505 would require all Medi-Cal managed care
plans to provide oral interpretation services to individuals on
a 24-hour basis at key points of contact.
The bill would require Medi-Cal managed care plans to translate
certain documents into certain non-English languages.
The bill specifies the thresholds at which managed care plans
would be required to translate documents. Specifically, the bill
would require translation services to be provided to Medi-Cal
beneficiaries who have been mandatorily enrolled in managed care
and have indicated that their primary language is not English if
1) more than 3,000 live in a managed care plan service area, or
2) more than 1,000 live within a single zip code or more than
1,500 live within two contiguous zip codes.
The bill would require the Department of Health Care Services to
determine when the thresholds above are met, at least every
three years.
The requirements of the bill would not apply to mental health
plans.
Related Legislation: AB 411 (Pan) would require all Medi-Cal
managed care plans to analyze performance measures by race,
ethnicity, and primary language to identify disparities in the
delivery of services. That bill is in the Senate Health
AB 505 (Nazarian)
Page 2
Committee.
Staff Comments: The Administrative Procedure Act (beginning at
Section 11340 of the Government Code) prohibits state agencies
from issuing or enforcing any rule, regulation, order, or
standard of general application unless it has been issued as a
regulation under the Administrative Procedure Act.
Under current practice, the Department has set the translation
thresholds through letters to managed care plans. Because this
bill requires the Department to set these thresholds and does
not exempt the Department from the Administrative Procedures Act
requirements, the Department will likely have to adopt these
requirements as regulations.
As noted above, Medi-Cal managed care plans are already required
under federal and state law to provide interpretation and
translation services to enrollees. This bill generally
recodifies those requirements. The bill codifies current
contractual requirements on managed care plans by specifying the
concentrations at which translation services are required. There
is not likely to be any increased cost to the managed care plans
(and hence to the state through the capitated rates paid to
those plans) since this bill does not increase the
interpretation or translation requirements on Medi-Cal managed
care plans.