BILL ANALYSIS �
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
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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.
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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FN: 0000679