BILL ANALYSIS Ó AB 1233 Page 1 ASSEMBLY THIRD READING AB 1233 (Chesbro) As Amended April 23, 2013 Majority vote HEALTH 19-0 APPROPRIATIONS 17-0 ----------------------------------------------------------------- |Ayes:|Pan, Logue, Ammiano, |Ayes:|Gatto, Harkey, Bigelow, | | |Atkins, Bonilla, Bonta, | |Bocanegra, Bradford, Ian | | |Chesbro, Gomez, Roger | |Calderon, Campos, | | |Hernández, Bocanegra, | |Donnelly, Eggman, Gomez, | | |Maienschein, Mansoor, | |Hall, Rendon, Linder, | | |Mitchell, Nazarian, | |Pan, Quirk, Wagner, Weber | | |Nestande, | | | | |V. Manuel Pérez, Wagner, | | | | |Wieckowski, Wilk | | | |-----+--------------------------+-----+--------------------------| | | | | | ----------------------------------------------------------------- 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 AB 1233 Page 2 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. 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% 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 AB 1233 Page 3 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 AB 1233 Page 4 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