BILL ANALYSIS �
AB 1233
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Date of Hearing: May 15, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1233 (Chesbro) - As Amended: April 23, 2013
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill authorizes a participating Native American Indian
tribe or tribal organization, as specified, to facilitate
Medi-Cal eligibility determinations using the California
Healthcare Eligibility, Enrollment, and Retention System
(CalHEERS) as a Medi-Cal Administrative Activities-specific
activity.
FISCAL EFFECT
Likely minor costs to the Department of Health Care Services
(DHCS) and Covered California because there appear to be
numerous funding sources for tribes and tribal organizations to
facilitate Medi-Cal enrollment without GF involvement.
COMMENTS
1)Rationale . This bill is intended to ensure American Indians
who are eligible for Medi-Cal and other services receive the
care they need. This bill is also needed to strengthen the
tribal health care delivery system by providing tribal
entities access to the 100% federal financial participation
(FFP) where available for providing Medi-Cal covered services
to American Indians eligible for Medi-Cal. In addition, this
bill seeks to clarify tribal entities can access CalHEERS to
submit applications for Medi-Cal coverage.
According to federal data, Native Americans suffer from
significant health disparities, including lower life
expectancy, high rates of diabetes, cardiovascular disease,
pneumonia, mental health issues, influenza, and injuries. This
bill is supported by numerous tribes and tribal organizations.
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2)Federal health reform . Pursuant to the federal Affordable
Care Act (ACA), California established a health benefit
exchange to serve as a large purchasing pool for health
coverage. Rebranded as Covered California, the exchange will
begin enrollment in October 2013 for coverage starting January
1, 2014. Medi-Cal is being expanded to adults, and existing
categories for parents, pregnant women, and children are being
collapsed to enable coordinated, streamlined eligibility and
enrollment processes. Medi-Cal eligibility will be based on
modified adjusted gross income (MAGI). People with incomes
above the eligibility level (generally 138% of the federal
poverty level (FPL)) will be eligible for tax credits and
subsidies when they buy coverage. The ACA requires states to
have a single streamlined application that includes subsidies,
Medi-Cal, and other related programs.
CalHEERS, jointly sponsored by Covered California and DHCS),
is a web-based portal designed to be the single streamlined
resource for Californians to learn about health care options
and make buying health insurance as easy as possible. This
state of-the-art system will allow Californians to compare
health plans to make the purchase that best meets their
individual or small business needs and receive federal
subsidies if eligible.
3)Assisters Program and tribes . Covered California is
establishing an Assisters Program that will compensate various
entities trained and registered to provide in-person
assistance to consumers and help them apply for Covered
California programs. According to a recent stakeholder
webinar conducted by Covered California, American Indian tribe
or tribal organizations and Indian Health Service (HIS)
Facilities are identified as proposed assister entities.
According to the author, local governmental agencies (LGAs),
including federally-recognized tribes and tribal
organizations, and local educational consortia, are able to
participate in the MAA process in order to receive federal
financial participation for Medi-Cal administrative
activities. The author further states that while LGAs are
able to enroll Californians who are eligible for Medi-Cal,
related authorization overlooked tribes and tribal
organizations. The author asserts this was surprising because
there was and continues to be no cost to the state for tribal
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entities that provide MAA to American Indians who are eligible
for Medi-Cal services. In addition, the tribal entities pay
the state an administration fee. This program is known as the
Tribal MAA Program.
The author explains the federal government has developed a
number of policies to promote the use of Medicaid by tribal
entities. As a result, the federal government and the
tribal/federal partnership will each pay 50% of the costs
associated with tribal entities that enroll American Indians
who qualify for Medi-Cal into the program. The tribal/federal
partnership funds are derived from the federal government
through Indian Self Determination Act health care delivery
contracts.
4)Previous legislation . SB 308 (Figueroa), Chapter 253,
Statutes of 2003, added Native American Indian tribes, tribal
organizations, and tribal subgroups as participants in the MAA
program. The Tribal MAA program was created to address a
number of concerns. These include improving the relatively
low rate of American Indian enrollment in Medi-Cal and
assisting American Indian enrollees in accessing Medi-Cal
services, thereby helping to address Indian health disparities
by linking American Indian people with Medi-Cal in the face of
compelling health needs and inadequate IHS funding. At that
time California had 107 federally recognized tribes and about
12 tribal organizations. Only federally recognized tribes and
eligible tribal organizations may claim MAA.
The Tribal MAA program was implemented pursuant to the
provisions contained in the Tribal MAA Implementation Plan in
December of 2008 developed in consultation with the California
Rural Indian Health Board (CRIHB). DHCS, in concert with the
federal government and the participating tribes and tribal
organizations, created a strategy by which tribes and tribal
organizations can claim administrative costs, not otherwise
reimbursed, for providing services that are directly related
to the Medi-Cal program. Tribes and tribal organizations are
in a unique position to participate in this program. Due to
federal IHS policy, tribes must provide information about the
Medi-Cal program, and assist those enrolled in Medi-Cal in
gaining access to services and benefits. Through MAA, the
related administrative costs can be reimbursed at a 50% match
rate.
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Analysis Prepared by: Debra Roth / APPR. / (916) 319-2081