BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1233
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          ASSEMBLY THIRD READING
          AB 1233 (Chesbro) 
          As Amended May 23, 2013
          2/3 vote. Urgency 

           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.   
          Contains an urgency clause to ensure that the provisions of this  
          bill take effect immediately upon enactment.

           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 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.   


          Through the California Health Benefit Exchange, now called  
          Covered California, people with incomes up to 400% federal  
          poverty level are eligible for Advance Premium Tax Credits.  The  
          federal Patient Protection and Affordable Care Act requires  
          states to have a single streamlined application for Exchange  
          subsidies, their Medicaid programs and their Children's Health  
          Insurance Program 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 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"  








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          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.  

          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 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-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  
          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 








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