BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 1208
Author: Pan (D)
Amended: 9/6/13 in Senate
Vote: 21
PRIOR VOTES NOT RELEVANT
SENATE HEALTH COMMITTEE : 6-2, 9/11/13 (Pursuant to Senate Rule
29.10)
AYES: Hernandez, Beall, De León, Monning, Pavley, Wolk
NOES: Anderson, Nielsen
NO VOTE RECORDED: DeSaulnier
SENATE APPROPRIATIONS COMMITTEE : 5-1, 9/12/13 (Pursuant to
Senate Rule 29.10)
AYES: De León, Hill, Lara, Padilla, Steinberg
NOES: Walters (Vice Chair)
NO VOTE RECORDED: Gaines
SUBJECT : Insurance affordability programs: application form
SOURCE : Equality California
DIGEST : This bill authorizes the application form for
insurance affordability programs form to include questions that
are voluntary for applicants to answer regarding sexual
orientation and gender identity or expression. This bill,
effective January 1, 2015, requires the form to include
questions that are voluntary for applicants to answer regarding
the demographic data categories specified.
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Senate Floor Amendments of 9/6/13 delete the prior contents of
this bill dealing with medical homes, and instead include
provisions in this bill that were previously included in AB 50
(Pan) that require, by January 1, 2015, the California
Healthcare Eligibility, Enrollment, and Retention System
application form for Medi-Cal and Covered California coverage
include additional questions that are voluntary for applicants
to answer on demographic data categories.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, which is administered by
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care
services.
2. Requires a single, accessible, standardized paper,
electronic, and telephone application for insurance
affordability programs be developed by DHCS in consultation
with the Managed Risk Medical Insurance Board and the Covered
California board. Requires the application to be used by all
entities authorized to make an eligibility determination for
any of the insurance affordability programs and by their
agents.
3. Permits the form to include questions that are voluntary for
applicants to answer regarding demographic data categories,
including race, ethnicity, primary language, disability
status, and other categories recognized by the federal
Secretary of Health and Human Services (HHS) under a
specified provision of the Affordable Care Act (ACA).
This bill:
1. Authorizes, until January 1, 2015, the application form for
insurance affordability program coverage to include
additional questions that are voluntary for applicants to
answer on sexual orientation and gender identity or
expression.
2. Requires, by January 1, 2015, the application form to include
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questions that are voluntary for applicants to answer
regarding demographic data categories, including race,
ethnicity, primary language, disability status, sexual
orientation, gender identity or expression and other
categories recognized by the federal Secretary of the DHHS.
Background
The ACA makes numerous changes to simplify enrollment in public
health coverage programs. ACA requires that an enrollment
system be created that allows state residents to apply for
enrollment, receive an eligibility determination, and renew
participation in state health subsidy programs. In addition,
ACA requires the Secretary of DHHS to develop and provide to
each state a single, streamlined form that:
May be used to apply for all applicable state health subsidy
programs (Medi-Cal, Healthy Families Program, and through
Covered California);
May be filed online, in person, by mail, or by telephone;
May be filed with Covered California or with state officials
operating one of the other applicable state health subsidy
programs; and,
Is structured to maximize an applicant's ability to complete
the form satisfactorily, taking into account the
characteristics of individuals who qualify for applicable
state health subsidy programs.
Comments
According to the author's office, this bill contains provisions
related to the collection of demographic data on the simplified
application for insurance affordability programs that is
required by the federal Patient Protection and ACA. The
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provisions were previously in AB 50 (Pan) but deleted at the
request of the Administration. The author's office states that
it is essential to continue to pursue this provision as a
stand-alone bill.
The collection of this demographic data is needed for two
reasons. The first is to assess and evaluate application and
program enrollment data to determine whether a particular
demographic category is underrepresented. This could be a
geographic region or a particular language or ethnic group.
Trends could be identified that would allow tailored outreach
strategies to target these underrepresented groups or areas.
Secondly, this data is needed to identify health disparities by
region and other demographic categories, such as gender identify
and language spoken. Currently only language spoken, gender and
ethnicity are being collected by the Medi-Cal program. This
bill is also a companion bill to AB 411(Pan) will provide for a
more detailed analysis of disparities among these categories in
the Medi-Cal managed care program. With regard to Covered
California, in order to meet the requirements of the ACA and for
the new system to be operational by October 1, 2013, a decision
was made to omit these items from the initial system design.
Therefore, this bill does not mandate the collection until
January 1, 2015. However, this demographic information will be
crucial and therefore should begin to be collected in the
future. It is not sufficient to defer the collection of the
data to the health plans as there is no guarantee that it will
be collected and analyzed in order to identify and reduce health
disparities.
Prior/Related Legislation
AB 50 (Pan) originally contained the provisions of this bill,
among other changes. The provisions contained in this bill was
amended out of AB 50 through amendments adopted on the Senate
Floor on September 6, 2012, which deleted the previous contents
of AB 1208 that dealt with medical homes.
AB 1296 (Bonilla, Chapter 641, Statutes of 2011), the Health
Care Eligibility, Enrollment, and Retention Act, requires the
HHS 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
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established the existing law requirements for the application
form for insurance affordability programs.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, 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 Covered California to include required
demographic questions in the application (federal funds or
special funds).
SUPPORT : (Verified 9/12/13)
Equality California (source)
California Lesbian, Gay, Bisexual, and Transgender Health Human
Services
Network
California Pan-Ethnic Health Network
Transgender Law Center
ARGUMENTS IN SUPPORT : This bill is sponsored by Equality
California (EC), which states a number of studies have indicated
that members of the lesbian, gay, bisexual and transgender
(LGBT) population continue to experience worse health outcomes
than their non-LGBT counterparts. Due to factors like low rates
of health insurance coverage, high rates of stress from
systematic harassment and discrimination, and a lack of cultural
competency in the health care system, LGBT people are at a
higher risk for cancer, mental illnesses, and other diseases,
and are more likely to smoke, drink alcohol, use drugs, and
engage in other risky behaviors. EC states it can only estimate
the full extent of LGBT health disparities due to a consistent
lack of data collection on sexual orientation and gender
identity.
EC writes that "this bill will significantly help to address
this problem by requiring that data on sexual orientation and
gender identity that is voluntarily given be collected for the
purposes of various health insurance programs in the state.
This information will allow researchers and advocates to get a
fuller and more accurate accounting of LGBT health outcomes and
needs-and ultimately to close the gap between the health and
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well-being of LGBT people and the non-LGBT population."
The California Pan-Ethnic Health Network (CPEHN) writes that
"health disparities are prevalent and pervasive. To address
these disparities experienced by California's diverse
communities." CPEHN argues "our state's health care programs
must improve the way in which we collect and analyze data by
enrollee demographics, including race, ethnicity, language and
sexual orientation." CPEHN argues "this bill will help in this
effort by updating applications to include voluntary questions
on certain enrollee demographics."
JL:d 9/12/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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