BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                            Senator Kevin de León, Chair


          AB 1208 (Pan) - Insurance affordability programs: application  
          form.
          
          Amended: September 6, 2013      Policy Vote: Health 6-2
          Urgency: No                     Mandate: No
          Hearing Date: September 12, 2013                        
          Consultant: Brendan McCarthy    
          
          This bill does not meet the criteria for referral to the  
          Suspense File.
          
          This bill was referred to this committee pursuant to Senate Rule  
          29.10(c). 

          
          Bill Summary: AB 1208 would permit the application form for  
          insurance affordability programs (including Medi-Cal and health  
          care coverage through the California Health Benefit Exchange) to  
          include questions on sexual orientation and gender identity.  
          After January 1, 2015, the bill would require the application to  
          include specified demographic questions. 

          Fiscal Impact: 
              One-time costs of $100,000 to $150,000 to modify  
              information technology systems to allow the health care  
              coverage application system for Medi-Cal and the California  
              Health Benefit Exchange to include required demographic  
              questions in the application (federal funds or special  
              funds).

          Background: Under state and federal law, the Department of  
          Health Care Services operates the Medi-Cal program, which  
          provides health care coverage to pregnant women, children and  
          their parents with incomes below 100% of the federal poverty  
          level, as well as blind, disabled, and certain other  
          populations. 
          
          The federal Affordable Care Act allows states to expand Medicaid  
          (Medi-Cal in California) eligibility to persons under 65 years  
          of age, who are not pregnant, not entitled to Medicare Part A or  
          enrolled in Medicare Part B, and whose income does not exceed  
          133% of the federal poverty level (effectively 138% of the  








          AB 1208 (Pan)
          Page 1


          federal poverty level as calculated under the Affordable Care  
          Act). California has opted to expand eligibility for Medi-Cal up  
          to 138% of the federal poverty level.

          The Affordable Care Act provides a significantly enhanced  
          federal match for the Medicaid expansion. Under the law, the  
          federal government will pay for 100% of the cost of the Medicaid  
          expansion in 2013-14 declining to a 90% federal match in the  
          2020 federal fiscal year and thereafter.

          AB X1 1 (J. Perez, Statutes of 2013) and SB X1 1 (Hernandez and  
          Steinberg, Statutes of 2013) implement the expansion of Medi-Cal  
          and include a number of changes to the eligibility and  
          enrollment process for the Medi-Cal program. AB X1 1 and SB X1 1  
          require a single application paper, electronic, or telephone  
          application for Medi-Cal and health care coverage through the  
          California Health Benefit Exchange. Current law authorizes the  
          single application to include questions about the applicant's  
          demographic characteristics. Those questions are voluntary for  
          the applicant to answer.

          Proposed Law: AB 1208 would permit the application form for  
          insurance affordability programs (including Medi-Cal and health  
          care coverage purchased through the California Health Benefit  
          Exchange) to include questions on sexual orientation and gender  
          identity. 

          After January 1, 2015, the bill would require the application  
          for to include specified 
          demographic questions - including questions regarding the  
          applicant's race, ethnicity, primary language, disability  
          status, sexual orientation, gender identity or expression. 

          Applicants would not be required to answer those demographic  
          questions to complete the application.

          Related Legislation: AB 50 (Pan) formerly included language  
          identical to this bill. Those provisions were amended out of  
          that bill. That bill has been enrolled.