BILL ANALYSIS Ó
AB 1124
Page 1
ASSEMBLY THIRD READING
AB 1124 (Muratsuchi)
As Amended May 24, 2013
Majority vote
HEALTH 18-0 VETERANS AFFAIRS 10-0
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|Ayes:|Pan, Logue, Ammiano, |Ayes:|Muratsuchi, Chávez, |
| |Atkins, Bonilla, Bonta, | |Atkins, Brown, Eggman, |
| |Chesbro, Gomez, Roger | |Fox, Grove, Melendez, |
| |Hernández, Gordon, | |Salas, Yamada |
| |Maienschein, Mansoor, | | |
| |Nazarian, Nestande, V. | | |
| |Manuel Pérez, Wagner, | | |
| |Wieckowski, Wilk | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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APPROPRIATIONS 17-0
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|Ayes:|Gatto, Harkey, Bigelow, | | |
| |Bocanegra, Bradford, Ian | | |
| |Calderon, Campos, | | |
| |Donnelly, Eggman, Gomez, | | |
| |Hall, Ammiano, Linder, | | |
| |Pan, Quirk, Wagner, Weber | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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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 and repeals provisions relating to a two-year,
three county pilot project including the requirement to monitor
and evaluate for outcome and savings.
EXISTING LAW :
1)Requires DHCS to exchange information with PARIS and identify
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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 Veterans Affairs (VA) benefits.
3)Requires DHCS to enter into an agreement with the California
Department of Veterans Affairs (CDVA) to perform CVSO outreach
services requires the agreement to contain performance
standards that would allow DHCS to measure the effectiveness
of the program.
4)Requires DHCS to enter into any agreements that are required
by the federal government to utilize the PARIS system and to
perform any information technology activities that are
necessary to utilize the PARIS system.
5)Authorizes DHCS to implement this bill by means of written
directives without taking further regulatory action and
provides for an expedited contracting process.
6)Requires DHCS monitor the two-year pilot program, evaluate the
outcomes and savings, provide the fiscal committees of the
Legislature with a report on findings and recommendations.
Provides, if DHCS determines the pilot program is
cost-effective, it may implement the program statewide at any
time and continue operation of PARIS indefinitely.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, approximately $150,000 in state General Fund (GF)
costs to administer the program, offset by unknown but likely
significant cost savings and avoidance as veterans are
identified and health costs are shifted away from Medi-Cal to
the federal veterans' health care system.
COMMENTS : 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 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
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eligible veterans enrolled in Medi-Cal who might be eligible for
the VA health care system. According to the LAO Report, 144,000
veterans and dependents with Medi-Cal coverage could be eligible
for comprehensive medical care and health services through the
VA 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 (Budget Committee),
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
VA health care benefits. According to the author, based on the
success of the pilot, this bill would take the program
statewide.
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 United
States (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 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
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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.
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 VA. 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.
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 VA. The pilot project, in partnership with CDVA,
began operations in July 2009, and for purposes of the report to
the Legislature, concluded in June 2011. Counties were selected
for the pilot based on those having VA 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 VA 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 VA health benefits,
including offering specific services that may best meet their
needs as a veteran. For example, VA 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.
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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 the Civilian Health and Medical Program of the VA. 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 VA 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 has broad authority
to implement the program statewide at any time and continue
operation of PARIS indefinitely if it determines that the 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 VA 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 National Association of Social Workers, 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.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0000991
AB 1124
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