BILL ANALYSIS Ó
AB 1208
Page 1
GOVERNOR'S VETO
AB 1208 (Pan)
As Amended September 6, 2013
2/3 vote
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|ASSEMBLY: |62-12|(May 13, 2013) |SENATE: |28-5 |(September 12, |
| | | | | |2013) |
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|ASSEMBLY: |51-26|(September 12, | | | |
| | |2013) | | | |
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Original Committee Reference: HEALTH
SUMMARY : Revises the questions that may be included, but are
optional to be answered, on the California Healthcare
Eligibility, Enrollment, and Retention System (CalHEERS)
application form for Medi-Cal and Covered California coverage by
adding sexual preference and gender identity. Effective January
1, 2015, makes these questions, that also include other
demographic data categories, mandatory to be asked, but still
optional to be answered.
The Senate amendments delete the provisions of the bill and
instead make revisions regarding the CalHEERS application.
AS PASSED BY THE ASSEMBLY , this bill established the Patient
Centered Medical Home Act of 2013 which defines medical homes
and specified its characteristics.
FISCAL EFFECT : Unknown. This bill has not been analyzed by a
fiscal committee.
COMMENTS : 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
AB 1208
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Patient Protection and Affordable Care Act (ACA). The
provisions were previously in AB 50 (Pan) of the current
legislative session but deleted at the request of the
Administration. The author states that it is essential to
continue to pursue these provisions 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 category, such as gender identity 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) of 2013 and 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.
The California Health Benefit Exchange (Exchange) was
established in 2010 by AB 1602 (John A. Pérez), Chapter 655,
Statutes of 2010, and SB 900 (Alquist), Chapter 659, Statutes of
2010. Through the Exchange, now called Covered California,
people with incomes up to 400% of the federal poverty level are
eligible for advanced payment of premium tax credits, subsidies,
and cost sharing reductions, depending on their income. The ACA
requires states to have a single streamlined application for
Exchange subsidies, their Medicaid programs, and their
Children's Health Insurance Program. Covered California and the
Department of Health Care Services (DHCS) are joint program
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sponsors of CalHEERS, the information technology system running
both the online application for the Exchange, Medi-Cal, and
Access for Infants and Mothers program and also provides phone
service center functions.
The ACA establishes a number of requirements regarding the
eligibility and enrollment process with the goal of creating a
consumer-friendly, streamlined, and coordinated application
process. Implementing regulations require states to develop
online single streamlined applications, and build or modernize
their eligibility systems to implement new simplified
eligibility rules and facilitate coordination among insurance
affordability programs. Federal regulations require that
individuals must not be required to provide additional
information or documentation unless information cannot be
obtained electronically or the information obtained
electronically is not reasonably compatible with self-attested
information. Federal law does allow states the option of asking
voluntary demographic questions.
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 the
provisions relating to enrollment in state health programs and
federal law. AB 1296 also establishes the requirements for the
CalHEERS application form, including the optional collection of
demographic data revised by this bill.
GOVERNOR'S VETO MESSAGE :
AB 1208 would mandate that the single, standardized
application for health insurance affordability
programs include questions related to race, ethnicity,
primary language, disability status, sexual
orientation, gender identity and expression, so that
applicants can voluntarily report this information
beginning in 2015.
We don't need to mandate these requirements in law.
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The Department of Health Care Services and Covered
California already have the authority to modify these
types of questions on the form, and they can work
constructively with stakeholders to decide what is
necessary to change for 2015 and beyond.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0002901