BILL ANALYSIS �
AB 617
Page 1
Date of Hearing: April 23, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 617 (Nazarian) - As Amended: April 15, 2013
SUBJECT : California Health Benefit Exchange: appeals.
SUMMARY : Establishes an applicant's or enrollee's right to
appeal actions, inaction, or decisions made by the California
Health Benefit Exchange (known as Covered California) that
relate to enrollment, eligibility, or ineligibility for a state
health subsidy program, for advance payment of the premium tax
credits (APTC), and cost-sharing reductions, the amount of the
APTC or cost-sharing or eligibility for affordable plan options.
Includes right to appeal the determination of an exemption from
penalties for failing to meet minimum standards for obtaining
health care coverage and failure to provide timely notices as
specified. Specifically, this bill :
1)Requires Covered California to contract with the Department of
Social Services (DSS) to serve as the appeals entity to hear
appeals of enrollment, eligibility determinations, or
redeterminations for persons obtaining coverage in the
individual market. Requires, unless otherwise provided,
Medi-Cal hearing process rules to govern.
2)Requires the entity making enrollment or eligibility
determinations, including the amounts of APTC and cost-sharing
determinations to provide notice of the appeals process at the
time of enrollment, application, and determination of
eligibility.
3)Requires the entity making the enrollment or eligibility
determinations, to issue a combined eligibility notice, as
specified in federal regulations, that includes the following:
a) Information about each state health subsidy program that
the individual or other members of the household have been
determined to be eligible or ineligible for and the
effective date of eligibility and enrollment;
b) Information about eligibility for modified adjusted
gross income (MAGI)-exempt Medi-Cal and the benefits and
the services which are available, sufficient to enable the
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individual to make an informed decision as to whether to
appeal the enrollment or eligibility determination;
c) Instructions describing the right to, and process for,
appeal of an action relating to eligibility or enrollment
for any state health subsidy program, as defined by
reference to the federal Affordable Care Act (ACA), under
existing procedures applicable to the right to a fair
hearing to appeal actions regarding public benefits;
d) The right to self-representation or representation by
legal counsel or an authorized representative; and,
e) Information regarding the circumstances under which
eligibility shall be retained or reinstated pending an
appeal decision.
4)Requires DSS to allow an applicant or enrollee to request an
appeal within 90 days of the notice of an eligibility
determination, unless there is good cause as defined in
existing law relating to a fair hearing to appeal actions
regarding public benefits.
5)Requires the appeal entity to establish an expedited appeal
process where there is immediate need for health services
because a standard appeal would jeopardize the appellant's
life, health, or the ability to attain, maintain, or regain
maximum function. Requires, if an expedited appeal is
granted, the decision to be issued within three working days
or as soon as is required by the appellant's condition.
Requires, if an expedited appeal is denied, the appeals entity
shall notify the appellant within two days by telephone or
commonly available electronic means, to be followed in
writing, of the denial of an expedited appeal. Requires, if
an expedited appeal is denied, the appeal to be handled
through the standard appeal process.
6)Allows an appeal request to be submitted by telephone, by
mail, through the Internet, by commonly available electronic
means, or by facsimile.
7)Requires the staff of the Exchange, the county, and the
Managed Risk Medical Insurance Board (MRMIB) to assist the
applicant or enrollee in making the appeal request.
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8)Requires, upon receipt of an appeal request, the appeals
entity to send acknowledgement in a timely manner and to
include:
a) Information relating to the appellant's eligibility for
benefits while the appeal is pending;
b) An explanation that advance payments of the premium tax
credit while the appeal is pending are subject to
reconciliation; and,
c) An explanation that the appellant may participate in
informal resolution process, as specified.
9)Requires DSS, upon receipt of an appeals request, to notify
the Exchange and the county and, if related to the Access for
Infants and Mothers Program (AIM) to MRMIB via secure
electronic interface and requires the entity that made the
eligibility or enrollment determination to transmit the
eligibility record for use in the adjudication, as specified.
10)Prohibits a member or employee of the Exchange, a county,
MRMIB, or the appeals entity from limiting or interfering with
the applicants or enrollee's right to make an appeal.
11)Allows an applicant or enrollee to be represented by counsel
or designate an authorized representative to act on his or her
behalf.
12)Provides for the opportunity for an informal resolution prior
to the hearing by providing an opportunity for a
representative of the Exchange, the county, or MRMIB to
contact the individual and offer to discuss the case if she or
he agrees, and preserves the right to a hearing if appellant
is dissatisfied with the outcome of the informal resolution
process, unless the appellant or authorized representative
withdraws the request for hearing, or conditionally withdraws
with specified agreed upon conditions.
13)Prohibits the informal resolution process from being
mandatory, delaying the timeline for provision of a hearing,
and having an effect on the right to a hearing.
14)Requires, for enrollment or eligibility determinations for
state health subsidy programs based on MAGI, the appellant
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to initiate the informal resolution process with the entity
that made the enrollment or eligibility determination, with
the exception of the following:
a) Requires the Exchange to conduct informal resolution
involving issues related only to the Exchange, including,
but not limited to, exemption from the individual
responsibility penalty, offers of affordable employer
coverage, special enrollment periods, and eligibility for
affordable plan options;
b) Requires counties to conduct informal resolution
involving issues related to non-MAGI Medi-Cal.
c) Requires MRMIB to conduct informal resolution
involving issues related only to the AIM Program or the
Healthy Families Program.
15)Provides that if the appeal advances to a hearing, the
appellant shall not be required to provide duplicative
information or documentation that he or she previously
provided during the application, redetermination, or informal
resolution processes.
16)Requires the staff involved in the informal resolution
process to try to resolve the issue through a review of case
documents, and provide the appellant the opportunity to review
case documents, in person or through electronic means, verify
the accuracy of submitted documents, and submit updated
information or provide further explanation of previously
submitted documents.
17)Requires, by reference, the informal process established by
DSS to be used for the informal process established pursuant
to this bill.
18)Requires a position statement, if required of a public or
private agency by regulation or if the public or private
agency chooses, concerning the issues in question, to be
electronically available at least two working days before the
hearing on the appeal.
19)Requires notice of the hearing, with date, time and location,
as specified, to the appellant no later than 15 days prior to
the hearing date. Requires reasonable efforts to allow
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participation of the appellant and requires notice that the
appellant may request the hearing to be held via telephone or
video conference and instructions for submitting the request
by telephone or other commonly available electronic means.
20)Requires the format of the hearing to be in person unless the
appellant requests the hearing be held telephonically or via
video teleconference.
21)Requires the hearing to be conducted by one or more impartial
officials who have not been directly involved in the
eligibility or enrollment determination or any prior appeal
decision in the same matter.
22)Requires the appellant to be allowed the opportunity to
review his or her appeal record, case file, and all documents
to be used by the appeals entity at the hearing, at a
reasonable time before the date of the hearing, as well as
during the hearing.
23)Requires the hearing to be an evidentiary hearing where the
appellant may present evidence, bring witnesses, establish all
relevant facts and circumstances, and question or refute any
testimony or evidence, including the right to confront and
cross-examine adverse witnesses, if any.
24)Requires cases and evidence to be reviewed de novo by the
appeals entity.
25)Requires decisions to be made within 90 days from the date
the appeal is filed, and based exclusively on the application
of the applicable laws, enrollment and eligibility rules to
the information used to make decision, as well as, any other
information provided by the appellant during the course of the
appeal.
26)Requires the content of the decision of appeal to include a
decision with a plain language description of the effect of
the decision on the appellant's eligibility or enrollment, a
summary of the facts relevant to the appeal, an identification
of the legal basis for the decision, and the effective date of
the decision, which may be retroactive.
27)Requires, upon adjudication of the appeal, the appeals entity
to transmit the decision of appeal to the entity that made the
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determination of eligibility or enrollment via a secure
electronic interface.
28)Provides that an appellant may make an appeal request
regarding issues relating to the Exchange to the federal
Department of Health and Human Services (DHHS) within 30
days of the notice of the decision and provides that an
appellant may also seek judicial review to the extent
provided by law regardless of an appeal to DHHS.
29)Prohibits the contents of this bill from being construed
to limit or reduce an appellant's rights to notice,
hearing, and appeal under Medi-Cal, county indigent
programs, or any other public programs.
EXISTING LAW :
1)Establishes, under state and federal law, the Medicaid program
as a joint federal and state program offering a variety of
health and long-term services to low-income women and
children, low-income residents of long-term care facilities,
seniors, and people with disabilities.
2)Provides for Medi-Cal eligibility to be determined at a county
social service agency by an eligibility worker or
automatically in the case of a person who qualifies for other
programs such as CalWorks or is a low-income senior or person
with disabilities.
3)Under the federal ACA, effective January 1, 2014, requires an
individual to have the option to apply for state subsidy
programs, which includes the state Medicaid program, the state
Children's Health Insurance Program (CHIP), enrollment in a
qualified health plan (QHP) through a state exchange and a
Basic Health Plan (BHP), if there is one, by either in person,
mail, online, telephone, or other commonly available
electronic means.
4)Under the ACA, effective January 1, 2014, requires development
of a single, accessible standardized application for the state
subsidy programs to be used by all eligibility entities and
establishes a process for developing and testing the
application.
5)Under the ACA, effective in 2014, requires individuals to
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maintain health insurance or pay a penalty, with exceptions
for financial hardship (if health insurance premiums exceed 8%
of household adjusted gross income), religion, incarceration,
and immigration status and creates the Exchange, as an
independent state entity governed by a five-member board, to
be a marketplace for Californians to purchase affordable,
quality health care coverage, claim APTC and cost-sharing
subsidies, and as a way to meet the personal responsibility
requirements of the ACA.
6)Under the ACA, effective January 1, 2014 requires states to
extend Medi-Cal coverage to former foster youth up to age 26,
eliminate the asset test for certain groups of applicants to
Medi-Cal and establish a new methodology for counting income
in Medi-Cal, known as MAGI.
7)Under the ACA, effective January 1, 2014, provides 100%
federal matching funds to states to expand Medicaid coverage
of adults under age 65 who are not currently eligible with
incomes up to 138% of the federal poverty level (FPL),
decreasing to 95% in 2017; 94% in 2018; 93% in 2019; and 90%
thereafter.
8)Under state and federal law, provides that Medicaid coverage
and benefits are a vested, property right entitled to the
protections of due process of law, including the right to a
fair hearing when adverse action is taken.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author this bill
establishes a "no wrong door" appeals procedure for both
Exchange and MAGI eligibility and enrollment determinations.
It is also intended to establish an equitable notice procedure
by requiring the entity that made the determination, either
the Exchange or the counties, to provide to the applicant, a
notice on appeal options available. The author states that
this bill ensures the overall purpose of the ACA is achieved;
that people are enrolled and receiving benefits from
healthcare coverage programs they can afford. The author
argues, consistent with the goal of the ACA, this bill
implements a coordinated, statewide approach on appeals to
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facilitate the process and to seamlessly enroll consumers in
health coverage. This bill ensures that no matter where a
consumer decides to apply for coverage there is a defined
process in place as to next steps, should they need to appeal
a decision. The author states that this bill also includes an
informal resolution process, as specified by the ACA to avoid
going to hearing when possible.
2)BACKGROUND . The ACA increases access to health insurance
beginning in 2014 through a coordinated system of "insurance
affordability programs," including Medicaid, CHIP, APTCs for
coverage provided through new Exchanges, and optional
state-established BHPs. It also provides for coordinated,
streamlined enrollment processes for these programs.
Beginning in 2014, the ACA expands Medicaid eligibility to a
new "adult group" and collapses most existing eligibility
categories into three broad groups: parents, pregnant women,
and children under age 19. The "adult group" includes all
non-pregnant individuals ages 19 to 65 with household incomes
at or below 133% FPL. (The law includes a five percentage
point of FPL disregard making the effective limit 138% FPL).
The Supreme Court ruling on the ACA, National Federation of
Independent Business v. Sebelius , 132 S. Ct. 2566 (2012),
maintained the adult Medicaid expansion, but limited the DHHS
Secretary's authority to enforce it as mandatory on the
states, effectively making implementation of the expansion a
state choice. The Supreme Court left the requirements for
streamlining and simplification of enrollment for subsidized
coverage, as well as the individual mandate intact. As
required by the ACA, Medicaid financial eligibility for most
groups will be based on MAGI, as defined in the Internal
Revenue Code. The rule generally adopts MAGI household income
counting methods, eliminating various income disregards
currently used by states. The Centers for Medicare & Medicaid
Services (CMS) guidelines also generally align "family size"
in the current Medicaid rules with the MAGI definition of
"household" and provides household composition rules for
individuals, such as non-tax filers, who are not addressed by
MAGI methods. Certain groups are exempt from use of MAGI;
their financial eligibility will continue to be determined
using existing Medicaid rules. Eligibility for the insurance
affordability programs at the Exchange will begin with a MAGI
screen. If an individual is not found eligible for a MAGI
group, the state must collect necessary information and
determine eligibility under all other Medicaid eligibility
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categories (i.e., MAGI-exempt groups, such as disability) and
potential eligibility for APTC in an Exchange. Each state
will be required to establish timeliness and performance
standards for determining eligibility subject to an outer
limit timeliness standard of 45 days for non-disability based
eligibility determinations and 90 days for disability-based
determinations. States are also required, to the maximum
extent possible, to rely on electronic data matches with
trusted third party sources to verify information provided by
applicants.
State Medicaid agencies are to enter into one or more agreements
with an Exchange and other insurance affordability programs to
coordinate eligibility determinations and enrollment. The
state Medicaid agency must ensure that any individual who is
determined ineligible for Medicaid is screened for potential
eligibility for benefits available through an Exchange and
promptly transfer the electronic account of individuals
screened as potentially eligible to the Exchange. States also
have the option to enter into an agreement with an Exchange to
make final determinations of eligibility for APTCs for
Exchange coverage. With regard to Exchange determinations of
Medicaid eligibility, states can enter into agreements to
either have the Exchange make final Medicaid eligibility
determinations or have the Exchange make assessments of
potential Medicaid eligibility and transfer accounts to the
Medicaid agency for final determination.
3)The California Exchange . The California Exchange 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, now called Covered California,
people with incomes above Medi-Cal up to 400% FPL are eligible
for APTCs and those up to 250% FPL are also eligible for Cost
Sharing Reductions. The ACA requires states to have a single
streamlined application for Exchange subsidies, their Medicaid
programs, and their CHIP programs. Exchanges will not be
insurers but will provide eligible individuals and small
businesses with access to QHPs in a comparable way.
California has established Covered California, as a
state-based exchange that is operating as an independent
government entity with a five-member Board of Directors.
The California Healthcare Eligibility, Enrollment and Retention
System (CalHEERS) is a procurement conducted jointly by the
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Exchange, the department of Health Care Services (DHCS), and
MRMIB to build the Information Technology system to support
the consumer application and enrollment process at the
Exchange. Following extensive review and stakeholder comment
and input, Accenture was hired through a solicitation process
for the design, development, and deployment of CalHEERs. The
portal will offer eligibility determinations for both Medi-Cal
and federally subsidized Covered California coverage through
the Exchange. It will allow enrollment through multiple
access points including mail, phone, and in-person
applications. It is guided by a "no wrong door" policy that
is intended to ensure the maximum number of Californians
obtain coverage appropriate to their needs. Eligibility and
enrollment functions will be released in September of 2013 in
order to begin enrollment by October 2013, effective January
1, 2014. 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.
AB 1602 and SB 900 created the structure and basic duties of the
Exchange but did not specify particulars of an appeals process
when consumers disagreed with an eligibility determination by
the Exchange. AB 1602 stated that the Exchange should develop
an appeals process once federal guidance was issued. At
recent Exchange Board meetings Covered California discussed
their intent to promulgate eligibility and enrollment
regulations and has issued an initial draft. The section on
appeals is currently "reserved." The legislation authorizing
the Exchange gave it emergency regulatory authority until
January 1, 2016.
4)Federal regulations . In addition to having a streamlined
eligibility and enrollment application system, the ACA and its
implementing regulations require states to have coordinated
notice and appeal procedures. CMS issued proposed regulations
governing exchanges on January 22, 2013 and requested comments
be submitted by February 13, 2013. These proposed regulations
covered, among other things, fair hearing and appeals
processes for Medicaid and Exchange eligibility and enrollment
appeals. An individual is not eligible for APTCs if they are
eligible for Medi-Cal and eligibility for APTCs starts exactly
where eligibility for Medi-Cal ends. The preamble notes that
the proposed regulations are intended to maximize coordination
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of appeals involving the different insurance affordability
programs and minimize burden on consumers and states.
Specifically, it proposes that the Medicaid agency treat an
appeal of a determination of eligibility for enrollment in a
QHP in the Exchange and for APTC or cost-sharing reductions as
a request for a fair hearing of the denial of Medicaid. The
preamble further states that this is intended to avoid the
need for an individual to request multiple appeals. The major
options the proposed regulations leave up to states is: a)
whether and which entity to designate as an "exchange appeals
entity;" b) what entity issues the combined notices and (3)
whether and which entity should engage in an informal
resolution process to try to resolve the case before it
reaches the hearing. States that exercise the option to
delegate authority to conduct Medicaid fair hearings to an
Exchange must give the individual the option to opt for a fair
hearing before the Medicaid agency. Furthermore, the preamble
makes clear the same due process rights apply when delegated
to the Exchange and the Medicaid agency would continue to
exercise appropriate oversight authority and take corrective
actions if necessary. The proposed regulations also require,
to ensure coordination across the entire eligibility,
enrollment and appeals process, that a Medicaid application is
automatically reinstated if an individual is found potentially
ineligible for Medicaid and files an appeal related to the
determination or their eligibility for enrollment in a QHP,
for APTC or cost-sharing reductions and reinstatement would be
effective as of the date the application was initially
received.
5)DUE PROCESS AND MEDI-CAL FAIR HEARINGS. The right to an
administrative fair hearing stems from the Due Process Clause
of the US Constitution as interpreted by the US Supreme Court
in Goldberg v. Kelly , 397 U.S. 254 (1970) (Goldberg v. Kelly).
Federal law requires that the hearing be conducted at a
reasonable time, date, and place, after adequate notice, and
by an impartial official who was not directly involved in the
initial determination of the action in question. Medi-Cal
hearings are heard by Administrative Law Judges (ALJ) from the
State Hearings Division of the DSS. The hearings are held
during regular business hours, in at least one location per
county. During the hearing, the claimant must be allowed to
present witnesses, evidence, arguments, and confront and
cross-examine adverse witnesses. Medi-Cal hearings include
giving testimony under oath and submitting evidence into the
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record. The process is designed to be fair to unrepresented
laypersons and is therefore more relaxed than a formal court
proceeding. Formal rules of evidence do not apply, but
evidence is admitted "if it is the sort of evidence on which
responsible persons are accustomed to rely in the conduct of
serious affairs." The issues are limited to those reasonably
related to the request for a hearing, as well as any that both
sides have agreed to prior to or at the hearing.
After a fair hearing, a decision will be sent to the claimant
and their representative. The hearing decision must be in
writing and completed within 90 days of the fair hearing
request. It can be based only on the evidence presented at
the hearing. The decision must summarize the facts, identify
the regulations supporting the decision, and inform the
individual of the reason for the decision and the right to
request a rehearing or judicial review. The decision issued
by the ALJ in a Medi-Cal hearing is a proposed decision, which
within 75 days is filed with the Director of DHCS who reviews
the proposed decision. The proposed decision is adopted,
changed, or set for further hearing. If the Director takes no
action within 30 days of receiving the proposed decision, it
is deemed adopted. If the Director decides the matter
differently, that decision is served on the claimant and the
county. If the decision is favorable to the claimant or if
the agency decides in his or her favor prior to the hearing,
the county must comply with the decision within 30 days. If
applicable, corrective payments must be made retroactive to
the date that the incorrect action was taken. If the decision
rules against the claimant, the county can stop aid
immediately. The state may also recover the costs of
continued benefits or of "aid paid pending" from the
beneficiary. However, the counties rarely pursue these
claims. If the claimant loses at the fair hearing level, she
or he has two options. First, within 30 days of receiving the
ALJ's proposed decision, she or he may request a rehearing.
The second option after receiving an adverse decision is to
ask for judicial review, by filing a petition in the Superior
Court within one year after receiving the Director's final
decision.
6)SUPPORT . Western Center on Law and Poverty (WCLP), sponsor of
this bill, writes in support that the ACA requires a new
seamless and coordinated eligibility and enrollment system for
Medi-Cal, the Exchange, and AIM. DHCS and the Exchange are
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working to realize this vision - overseeing the building of
CalHEERS to be the online application for public health
coverage programs as well as providing for in-person, phone,
and mail application venues. Just as the application
processes must be coordinated, federal law also requires that
notices and appeals for the Exchange, "MAGI Medi-Cal," and AIM
be coordinated. According to WCLP, federal regulations, also
require that Exchange appeals conform to Medicaid fair hearing
requirements. WCLP argues that legislation is needed to
specify those notice and appeals procedures. WCLP further
states that while Covered California is working on eligibility
and enrollment regulations which it has the authority to
promulgate under its authorizing legislation, it feels
something as important as due process rights belong in
statute. Moreover, because the appeals process for the new
combined application affects both Medi-Cal and AIM in addition
to the Exchange, that Medi-Cal and AIM notices and appeals
should not be governed by Exchange regulations. The National
Health Law Program (NHeLP) writes in support that the
requirements of due process are well-established. NHeLP
points out that notice and the right to a fair hearing upon
denial of a Medicaid application are of course required by the
due process provisions of the Constitution under the Supreme
Court's ruling in Goldberg v. Kelly. NHeLP further states
that the ACA requires a new seamless and coordinated
eligibility and enrollment system for Medicaid and the
Exchange. In addition, in keeping with the fundamental due
process rights outlined above, recently proposed federal
Medicaid and Exchange regulations have laid-out clear
requirements for integrated notices and a well-coordinated
appeals system. Because both Medicaid and the Exchange
(including the tax subsidies and cost sharing reductions) will
be utilizing the new MAGI rules, the impact of determining
eligibility for the Medi-Cal program will directly impact
Exchange coverage, as an applicant cannot be eligible for tax
credits in the Exchange if he/she is Medi-Cal eligible.
According to NHeLP, this significant overlap requires a highly
coordinated, and preferably integrated, notice and appeals
system that is provided by this bill. Disability Rights
California, Health Access, the 100% Campaign,
California/Nevada Community Action Partnership, the Asian Law
Alliance, California Advocates for Nursing Home Reform, and
the Coalition of California Welfare Rights Organizations also
write in support of this bill because of the coordinated
notices that are important to avoid confusion, use of the same
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fair hearing process as currently used for Medi-Cal,
provisions allowing an informal resolution, expedited appeals,
and the ability to retain coverage pending an appeal.
7)RELATED LEGISLATION .
a) AB 2 X1 (Pan) and SB 2 X1 (Ed Hernandez) enact
substantially similar provisions to implement the ACA
insurance provisions related to health insurance regulated
under the Insurance Code and the Health and Safety Code,
respectively. Ties both bills together so that they both
have to be enacted.
b) AB 1 X1 (John A. P�rez) and SB 1 X1 (Ed Hernandez and
Steinberg) implement various provisions of the ACA
regarding Medi-Cal eligibility and program simplification
including the use of MAGI and expansion of eligibility in
the Medi-Cal program.
c) SB 3 X1 (Ed Hernandez) requires Covered California to
establish a "bridge" plan product by contracting with
Medi-Cal managed care plans for individuals losing Medi-Cal
coverage (for example, because of an increase in income),
the parents of Medi-Cal children, and individuals with
incomes below 200% FPL.
d) SB 18 (Ed Hernandez) establishes legislative intent to
enact legislation to reform the individual health care
coverage market consistent with the ACA.
e) SB 28 (Ed Hernandez and Steinberg) implements various
provisions of the ACA regarding Medi-Cal eligibility and
program simplification including the use of the MAGI and
expansion of eligibility in the Medi-Cal program.
f) AB 50 (Pan) requires DHCS to establish a process to
implement the ACA provision that allows hospitals to make a
preliminary determination of a person's eligibility for
Medi-Cal, requires DHCS to revise the existing process used
for Medi-Cal enrollees to choose a managed care plan,
requires DHCS, in consultation with the Exchange, and
stakeholders, establish a new more coordinated process that
is consistent with the ACA and allows applications for
renewal of a person's Medi-Cal eligibility to be
streamlined by prepopulating the form with existing
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available information.
8)PREVIOUS LEGISLATION .
a) AB 43 (Monning) of 2012 would have expanded Medi-Cal
coverage to persons with income that does not exceed 133%
FPL, effective January 1, 2014 and would have required a
transition plan for persons enrolled in a Low Income Health
Program (LIHP). AB 43 died on the Senate Inactive File.
b) SB 677 (Ed Hernandez) of 2012 would have required DHCS
to implement the provisions of the ACA relating to
eligibility and benefits in the Medi-Cal program. SB 677
died on the Assembly Inactive File.
c) SB 1487 (Ed Hernandez) of 2012 would have required DHCS
to extend Medi-Cal eligibility to youth who were formerly
in foster care and who are under 26 years of age, subject
to federal financial particiapation being available and to
the extent required by federal law. SB 1487 would have
also made legislative findings and declarations regarding
the ACA, stated legislative intent to ensure full
implementation of the ACA, and to enact into state law any
provision of the ACA that may be struck down by the US
Supreme Court. SB 1487 was held on the Senate
Appropriations Committee suspense file.
d) AB 342 (John A. P�rez), Chapter 723, Statutes of 2010,
enacts the LIHP and Coverage Expansion and Enrollment
Projects to provide health care benefits to uninsured
adults up to 200% of the FPL, at county option through a
Medi-Cal waiver demonstration project.
e) AB 1296 (Bonilla), Chapter 641, Statutes of 2011, the
Health Care Eligibility, Enrollment, and Retention Act,
requires the California Health and Human Services Agency,
in consultation with other state departments and
stakeholders, to undertake a planning process to develop
plans and procedures regarding these provisions relating to
enrollment in state health programs and federal law. AB
1296 also requires that an individual would have the option
to apply for state health programs through a variety of
means.
f) AB 1595 (Jones) of 2010, would have required DHCS to
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expand Medi-Cal eligibility to individuals with family
income up to 133% of FPL without regard to family status by
January 1, 2014. AB 1595 died on suspense in the Assembly
Appropriations Committee.
g) AB 1602 establishes the Exchange as an independent
public entity to purchase health insurance on behalf of
Californians with incomes of between 100% and 400% FPL and
employees of small businesses. Clarifies the powers and
duties of the board governing the Exchange relative to the
administration of the Exchange, determining eligibility and
enrollment in the Exchange, and arranging for coverage
under qualified carriers.
h) SB 900 establishes the Exchange. Requires the Exchange
to be governed by a five-member board, as specified.
REGISTERED SUPPORT / OPPOSITION :
Support
Western Center on Law and Poverty (sponsor)
100% Campaign
Asian Law Alliance
California Advocates for Nursing Home Reform
California/Nevada Community Action Partnership
Children Now
Children's Defense Fund California
Children's Partnership
Coalition of California Welfare Rights Organizations
Disability Rights California
Greenlining Institute
Health Access California
National Health Law Program
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
AB 617
Page 17