BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                  AB 1233
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          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  

           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. 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  


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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)  
                                                                FN: 0000597