BILL ANALYSIS �
AB 1124
Page 1
Date of Hearing: April 2, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1124 (Muratsuchi) - As Introduced: February 22, 2013
SUBJECT : Medi-Cal: Public Assistance Reporting Information
System.
SUMMARY : Requires the Department of Health Care Services (DHCS)
to utilize the federal Public Assistance and Reporting
Information System (PARIS) to identify veterans and their
dependents or survivors who are enrolled in the Medi-Cal program
and assist them in obtaining federal veterans' health care
benefits statewide instead of as a two-year pilot program in
three counties. Specifically, this bill :
1)Requires DHCS to exchange information with PARIS and identify
veterans and their dependents or survivors who are receiving
Medi-Cal benefits.
2)Requires DHCS to refer identified Medi-Cal beneficiaries who
are receiving high-cost services, including long-term care
(LTC), to county veteran service officers (CVSOs) to obtain
information regarding, and assistance in obtaining, United
States Department of Veteran's Affairs (USDVA) benefits.
3)Requires DHCS to enter into an agreement with the California
Department of Veterans Affairs (CDVA) to perform CVSO outreach
services in connection with the pilot program and requires the
agreement to contain performance standards that would allow
DHCS to measure the effectiveness of the pilot program.
4)Requires DHCS to enter into any agreements that are required
by the federal government to utilize the PARIS system.
5)Requires DHCS to perform any information technology activities
that are necessary to utilize the PARIS system.
6)Authorizes DHCS to implement this bill by means of written
directives without taking further regulatory action and
provides for an expedited contracting process.
7)Repeals provisions relating to a two-year, three county pilot
project including the requirement to monitor and evaluate for
AB 1124
Page 2
outcome and savings.
8)Includes a blank appropriation from the General Fund (GF) to
CDVA to provide funding for CVSOs to identify veterans and
their dependents or survivors who are enrolled in the Medi-Cal
program and to assist them in obtaining federal veteran health
care benefits.
EXISTING LAW :
1)Establishes the federal Medicaid Program, Medi-Cal in
California, administered by DHCS, to provide comprehensive
health care services and LTC to pregnant women, children, and
people who are aged, blind, and disabled.
2)Establishes, under federal law and regulation the PARIS data
matching system to match public assistance recipients in
participating states against various state and federal public
assistance database.
3)Requires DHCS to implement by July 1, 2009 and to administer a
two-year, three-county pilot program to utilize the federal
PARIS to identify veterans and their dependents or survivors
who are enrolled in the Medi-Cal program and assist them in
obtaining federal veterans' health care benefits and
authorizes DHCS to implement the pilot project statewide if it
determines that the pilot is cost effective and continue
operation of PARIS indefinitely.
4)Establishes CDVA to aid and assist California veterans and
their families and to administer the California Veterans
Homes.
5)Establishes, under federal law, the USDVA, and within it, the
Veterans Health Administration (VA), which is responsible for
VA medical centers and outpatient clinics.
FISCAL EFFECT : This measure has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author the purpose of
this bill is to remove the pilot project nature of the
provisions in existing law and require DHCS to implement the
AB 1124
Page 3
program statewide. The author relies on an analysis by the
Legislative Analyst's Office (LAO) in 2007 stating that
implementing PARIS could save the state millions of dollars
annually in GF costs by shifting eligible veterans enrolled in
Medi-Cal who might be eligible for the USDVA health care
system. According to the LAO Report, 144,000 veterans and
dependents on Medi-Cal coverage could be eligible for
comprehensive medical care and health services through the
USDVA health care system. The author argues that connecting
only 10% of these veterans will save the state $25 million
annually. The author states that in 2008, AB 1183 (Committee
on Budget ), Chapter 758, Statutes of 2008, a budget trailer
bill, established a two year pilot project in several counties
to identify veterans enrolled in Medi-Cal who might be
eligible for USDVA health care benefits. The report states
that DHCS was able to accurately identify veterans who were
Medi-Cal beneficiaries and achieved modest success in
redirecting beneficiaries to USDVA health benefits. The
report found that this resulted in $1.63 million in total cost
avoidance and savings for the Medi-Cal program over the two
years of the pilot program. DHCS incurred costs of $150,000,
for a net cost avoidance/savings of $1.48 million. According
to the author, based on the success of the pilot, this bill
would take the program statewide. In addition, this bill
would appropriate an unspecified sum from the GF to the CDVA
to provide funding for CVSOs to identify veterans and their
dependents or survivors who are enrolled in the Medi-Cal
program and to assist them in obtaining federal veteran health
care benefits.
2)BACKGROUND . Under federal law, the Medicaid Program is
intended to be the payer of last resort, meaning that all
other available sources for a beneficiary's provision of care,
such as private insurance or other federal programs (such as
the VA), must be exhausted before Medi-Cal can provide
services. Although county welfare workers are supposed to
screen for veterans when processing Medi-Cal applications, a
2005 survey performed by the US Census Bureau indicated that
approximately 144,000 veterans in California received Medi-Cal
benefits. The LAO estimated the cost of such benefits totals
approximately $500 million ($250 million GF). The LAO further
assumed that because approximately 90,000 of the 144,000
veterans served in World War II, the Korean War, and the
Vietnam War, they likely fall into the aged and disabled
category of beneficiaries. The costs to treat the aged and
AB 1124
Page 4
disabled are generally higher than costs to treat other groups
of beneficiaries, such as children. The LAO concluded that if
some portion of these veterans received medical services
through the VA, the state could potentially save many tens of
millions of dollars.
Participation in the VA health care system provides veterans
with access to a wide range of coordinated health care
services. Once enrolled in the VA healthcare system, veterans
may also have greater access to some medical benefits, such as
mental health counseling and treatment for alcohol and
substance abuse, than they would have under Medi-Cal. For
example, the VA does not place a cap on the cost of dental
services or limit the number of days a patient can be
hospitalized for inpatient stays on a yearly basis. Unlike
Medi-Cal, the VA system does not require that a beneficiary
pay down his or her assets until they become "medically needy"
before covering the costs of LTC. The VA also has no
requirement for repayment of LTC services as in the Medi-Cal
Program.
3)PARIS . PARIS is an information sharing system, operated by
the US Department of Health and Human Services, Administration
for Children and Families, which allows states and federal
agencies to verify public assistance client circumstances.
The PARIS system includes three different data matches. The
PARIS-Veterans (PARIS-V) match allows states to compare their
beneficiary information with the USDVA. The PARIS-Federal
match allows states to compare their beneficiary information
with the US Department of Defense and the US Office of
Personnel Management. The PARIS-Interstate match allows
states to compare their beneficiary information with other
states.
4)PILOT PROJECT . As authorized by AB 1183, DHCS conducted a
two-year PARIS pilot program to improve the identification of
Medi-Cal beneficiaries who are veterans (or their dependents
or survivors) receiving high-cost services, and assist them in
obtaining health benefits provided by the United States
Department of Veterans Affairs (USDVA). The rationale for
conducting this pilot was two-fold: veterans may have access
to enhanced health benefits and greater asset protection by
using USDVA health benefits and the state may improve the
cost-effectiveness of the Medi-Cal program. The pilot
project, in partnership with CDVA, began operations in July
AB 1124
Page 5
2009, and for purposes of the report to the Legislature,
concluded in June 2011. Counties were selected for the pilot
based on those having USDVA medical centers. The pilot
started with three counties - Fresno, San Bernardino, and San
Diego in the first year. According to DHCS, in addition to
having a USDVA medical center, these three selected counties
had a track record of successfully performing veteran benefit
facilitation services as reported by CDVA. Over the course of
the second year, the pilot efforts were expanded to seven
additional counties at their request to participate (Alameda,
Orange, Sacramento, San Mateo, San Francisco, Santa Clara, and
Solano).
DHCS sent CDVA referrals. CVSOs contacted the veteran and
performed the outreach services and in some cases, assisted
them in applying for such benefits. According to DHCS, during
the contacts made with individuals, CVSOs explained to
beneficiaries the benefits of switching from Medi-Cal to USDVA
health benefits, including offering specific services that may
best meet their needs as a veteran. For example, USDVA
services could include specific therapies that focus on
physical and psychosocial injuries incurred during deployment.
CVSOs also ensured that the veteran understood Medi-Cal
estate recovery requirements. During the pilot, approximately
16,000 positive data matches were found among the submitted
records. Of the positive data matches, DHCS focused on those
beneficiaries who may have had high Medi-Cal expenditures
(based on several criteria including those with a service
connected disability), those who could have veteran benefits
restored, and survivors who appeared eligible for Civilian
Health and Medical Program of the USDVA. Based on the overall
analysis of the pilot, DHCS was able to accurately identify
veterans who were Medi-Cal beneficiaries and achieved modest
success in redirecting utilization to USDVA health benefits.
According to the DHCS evaluation because CVSOs were provided
no funding for these contacts, and experienced staffing
shortages and workload pressures, only 24% of referrals were
acted on by CVSOs. Although the pilot ended June 30, 2011,
DHCS continues conducting PARIS-V in the 10 counties.
DHCS was required to monitor the pilot program, evaluate the
outcomes and savings, and report to the Legislature on the
findings and recommendations. DHCS has broad authority to
implement the program statewide at any time and continue
operation of PARIS indefinitely if it determines that the
AB 1124
Page 6
pilot program is cost effective.
DHCS concluded that given the limited contact that resulted in
$1.634 million in GF savings and cost avoidance, it is
reasonable to assume that PARIS-V effectiveness has not been
fully realized, and increased communication and outreach with
veterans, their family members and surviving dependents, would
result in increased success in utilization of USDVA health
benefits. According to the DHCS report, going forward, the
state can continue its current path in redirecting limited
resources to maintain the level of effort put forth in the
pilot. The state can also consider directing more resources
for the pilot, or consider additional or alternative measures
to increase utilization of USDVA benefits. By implementing
one or more of the following recommendations, DHCS could
achieve additional Medicaid cost reductions:
a) Direct more dedicated resources to DHCS, CDVA, and CVSOs
to act upon referrals;
b) Initiate direct contact between DHCS and beneficiaries
by increasing awareness through efforts such as posting
information on its web site to educate veterans or
contacting veterans directly; and,
c) Assist CVSOs to educate veteran Medi-Cal beneficiaries
of the advantage of USDVA health benefits over Medi-Cal.
5)OTHER STATES . DHCS reviewed best practices from other states.
According to DHCS other states have more aggressively
maximized the PARIS-V data match and have shown substantial
cost avoidance/savings results. For example Pennsylvania has
participated in PARIS-V since its inception. Pennsylvania
estimated annualized cost avoidance/savings of approximately
$27.8 million from a period covering nine PARIS-V quarters.
In Washington State, the Washington Department of Social and
Health Services (WDSHS) paid the Washington Department of
Veterans Affairs (WDVA) a yearly sum of $225,000 through an
interagency contract with performance-based metrics. WDVA
received 10% of the actual savings verified by WDSHS. Because
of this success, the performance contract was no longer needed
as the Washington State Legislature appropriated $1 million
and four staff to WDVA to work exclusively on PARIS-V.
6)SUPPORT . The National Association of Social Workers,
AB 1124
Page 7
California Chapter, writes they support expanding the pilot
statewide and providing funding to CVSOs because it will help
veterans obtain the benefits they have earned.
7)PREVIOUS LEGISLATION .
a) AB 1223 (Committee on Veterans Affairs) of 2011 would
have required the DHCS to utilize the federal PARIS to
identify veterans and their dependents or survivors who are
enrolled in the Medi-Cal program and assist them in
obtaining federal veterans' health care benefits statewide
instead of as a two-year pilot program in three counties.
Governor Brown vetoed AB 1223 stating that while he
supported efforts to inform veterans about the health care
options that best meet their needs, current law already
requires screening of Medi-Cal beneficiaries for veteran
status and allows for expansion of the PARIS data match
project beyond the current pilot counties. Rather than
requiring the PARIS pilot project to be implemented
statewide, more effort should go into understanding which
health care benefits work best for veterans, and how that
outreach can be most effective before expending additional
resources statewide.
b) AB 1568 (Committee on Veterans Affairs) of 2009 would
have made PARIS pilot project a permanent, statewide
program. AB 1568 was amended into a different subject
matter.
c) AB 3082 (Committee on Veterans Affairs) of 2008 would
have required any state or public assistance agency using
PARIS to identify veterans enrolled in the Medi-Cal Program
for the purpose of assisting them in obtaining federal
health care benefits. Required CDVA to develop a plan for
handling data-match information given to a CVSO. AB 3082
died on the Senate Appropriations Suspense File.
d) AB 1183 required DHCS to establish a two-year pilot
program for the use of PARIS by July 1, 2009, and to report
to the Legislature the effectiveness of the program and
included authority for DHCS to make PARIS a permanent
program if the program was deemed effective.
8)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
AB 1124
Page 8
the Assembly Veterans Affairs Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
National Association of Social Workers, California Chapter
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097