BILL ANALYSIS �
AB 1233
Page 1
ASSEMBLY THIRD READING
AB 1233 (Chesbro)
As Amended April 23, 2013
Majority vote
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Logue, Ammiano, |Ayes:|Gatto, Harkey, Bigelow, |
| |Atkins, Bonilla, Bonta, | |Bocanegra, Bradford, Ian |
| |Chesbro, Gomez, Roger | |Calderon, Campos, |
| |Hern�ndez, Bocanegra, | |Donnelly, Eggman, Gomez, |
| |Maienschein, Mansoor, | |Hall, Rendon, Linder, |
| |Mitchell, Nazarian, | |Pan, Quirk, Wagner, Weber |
| |Nestande, | | |
| |V. Manuel P�rez, Wagner, | | |
| |Wieckowski, Wilk | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Authorizes participating Native American Indian
tribes, tribal organizations or subgroups to facilitate Medi-Cal
eligibility determinations using the California Healthcare
Eligibility, Enrollment, and Retention System (CalHEERS) as a
Medi-Cal Administrative Activities (MAA)-specific activity.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, 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 General Fund
involvement.
COMMENTS : According to the author this bill is needed to ensure
American Indians who are eligible for Medi-Cal and other
services can receive the care they need. This bill is also
needed to strengthen the tribal health care delivery system by
providing the tribal entities access to the 100% federal
financial participation (FFP) for providing Medi-Cal covered
services to American Indians eligible for Medi-Cal, to clarify
tribal entities can assist with Medi-Cal applications submitted
to CalHEERS and receive reimbursement through the MAA process.
There was and continues to be no cost to the state for tribal
entities that provide MAA to American Indians who are eligible
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for Medi-Cal services. In addition, the tribal entities pay the
state an administration fee. The author explains that 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 and 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.
There are 30 Tribal Health Programs (THPs) in California that
provide diagnostic, treatment, health maintenance and other
services across 37 mostly rural counties. All of the THPs
provide federal Indian Health Services and 18 of them also
participate in the Tribal MAA Program. According to research
and data sources, Native Americans suffer from significant
health disparities, including lower life expectancy, high rates
of diabetes, cardiovascular disease, pneumonia, mental health
issues, influenza, and injuries. They are more likely to die
from alcoholism (552% higher), diabetes (182% higher),
unintentional injuries (138% higher), and suicide (74% higher)
than other Americans. As a result of these substantial health
problems, the life expectancy for Native Americans is 74 years
of age, approximately four years less than the rest of the
United States population. Native Americans also have much lower
rates of employer coverage and higher rates of public coverage.
The California Health Benefit Exchange was established in 2010
by AB 1602 (John A. P�rez), 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% federal poverty level (FPL) are eligible for Advance
Premium Tax Credits (APTCs) and those up to 250% FPL are also
eligible for cost sharing reductions. The federal Affordable
Care Act (ACA) requires states to have a single streamlined
application for Exchange subsidies, their Medicaid programs and
their Children's Health Insurance Program (CHIP) programs.
Covered California and DHCS are joint program sponsors of the
CalHEERS which is the Information Technology system running both
the online application for the Exchange, Medi-Cal, and Access
for Infants and Mothers and also the phone service center
functions. CalHEERS is scheduled to take live applications
October 1, 2013, for the new coverage to begin on January 1,
2014. CalHEERS is a Web-based portal designed to be the single
streamlined resource for Californians to find out what health
program they are eligible for and to make buying health
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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. CalHEERS
Program Design Goals call for: 1) A "No Wrong Door" service
system that provides consistent consumer experiences for all
entry points; 2) Culturally and linguistically appropriate oral
and written communications which also ensure access for persons
with disabilities; 3) Seamless and timely transition between
health programs; and, 4) Minimizing the burden of establishing
and maintaining eligibility. Accenture, LLP was awarded a
contract for over $325 million for the development of CalHEERS.
Covered California is in the process of establishing an
Assister's Program that will include assister enrollment
entities (AEE) and individual entities. AEEs are entities and
organizations eligible to be trained and registered to provide
in-person assistance to consumers and help them apply for
Covered California programs, particularly entities that have
access to Covered California's targeted population. Individual
assisters are individuals who are employed, trained, certified,
and linked to AEEs to provide in-person assistance to consumers
and help them apply for Covered California programs and are
individuals who can provide assistance in culturally and
linguistic appropriate manners to consumers. According to a
recent stakeholder webinar conducted by Covered California on
the assisters program, American Indian tribe or tribal
organizations and Indian Health Service (IHS) Facilities are
proposed entities eligible to be compensated AEEs. The proposed
compensation for AEEs is $58.00 per new enrollment into Covered
California, including a person who was a modified adjusted gross
income (MAGI)-eligible Medi-Cal enrollee but upon
redetermination qualifies for Covered California and when a
currently enrolled person adds a new dependent. Compensation
for annual renewal is $25.00.
The MAA Program offers a way for Local Governmental Agencies and
Local Education Agencies to obtain federal reimbursement for the
cost of certain administrative activities necessary for the
proper and efficient administration of the Medi-Cal program.
MAA activities include: 1) Medi-Cal outreach; 2) facilitating
the Medi-Cal application; 3) Non-emergency and non-medical
transportation of Medi-Cal eligible individuals to Medi-Cal
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covered services; 4) contracting for Medi-Cal services; 5)
program planning and policy development; 6) MAA coordination and
claims administration; 7) coordination and claims
administration; 8)training; and, 9) general administration.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0000597