BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1233
AUTHOR: Chesbro
AMENDED: June 11, 2013
HEARING DATE: June 26, 2013
CONSULTANT: Bain
SUBJECT : Medi-Cal: Administrative Claiming process.
SUMMARY : Permits American Indian tribes, tribal organizations,
or subgroups of a Native American Indian tribe or tribal
organization participating in the Medi-Cal administrative
claiming process to claim as a Medi-Cal Administrative Activity,
facilitating Medi-Cal applications using the California
Healthcare Eligibility, Enrollment, and Retention System.
Existing law:
1.Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which health
care services are provided to qualified, low-income persons.
2.Permits DHCS to contract with participating local governmental
agency (LGA) or local educational consortium (LEC) to assist
with the performance of administrative activities necessary
for the proper and efficient administration of the Medi-Cal
program. This process is known as the Medi-Cal Administrative
Activities (MAA).
3.Defines "participating local governmental agency" as a county,
chartered city, Native American Indian tribe, tribal
organization, or subgroup of a Native American Indian tribe or
tribal organization, under contract with DHCS.
4.Requires, as a condition for participation in the MAA process,
each participating LGA or LEC, for the purpose of claiming
federal Medicaid reimbursement, to enter into a contract with
DHCS and to certify to DHCS the total amount the LGA or LEC
expended on the allowable administrative activities.
This bill:
1.Permits American Indian tribes, tribal organizations, or
subgroups of a Native American Indian tribe or tribal
organization participating in the MAA process to claim, as a
Medi-Cal Administrative Activity, facilitating Medi-Cal
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applications using California Healthcare Eligibility,
Enrollment, and Retention System (CalHEERS).
2.Takes effect immediately as an urgency statute.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis of the previous version of this bill, likely
minor costs to DHCS and The California Health Benefit Exchange
(Covered California) because there appear to be numerous funding
sources for tribes and tribal organizations to facilitate
Medi-Cal enrollment without General Fund involvement.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 77- 0
COMMENTS :
1.Author's statement. According to the author, this bill seeks
to clarify that the activities conducted to assist Native
Americans in Medi-Cal applications through CalHEERS are
included within MAA. Native Americans suffer from significant
health disparities. Specifically, they are more likely to die
from alcoholism (650 percent), diabetes (380 percent),
accidents (240 percent) and pneumonia/influenza (140 percent)
than other Americans. Native Americans are more likely than
non-Hispanic Caucasians to be uninsured and problematic gaps
exist in Native American access to health care and rates of
service utilization, especially for low-income Native
Americans. In addition to health disparities many Native
Americans live in very rural areas where there is limited
access to the Internet and at times phones, making the
application process, even with CalHEERS particularly
challenging. 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 percent federal financial
participation (FFP) for providing Medi-Cal covered services to
American Indians eligible for Medi-Cal.
2.MAA. MAA is a federal reimbursement program for the costs of
"administrative activities" that directly support efforts to
identify and enroll individuals in the Medi-Cal program or
to assist those already enrolled in Medi-Cal access
services. The overarching policy for MAA is that allowable
administrative costs must be directly related to the
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Medi-Cal State Plan or waiver service, if administering a
Medicaid waiver, and is "found necessary for the proper and
efficient administration of the Medi-Cal State Plan."
Participating entities put up the state match for the
program and pay an annual participation fee to DHCS.
Examples of reimbursable administrative activities include:
� Medi-Cal outreach;
� Facilitating Medi-Cal application;
� Medi-Cal related referral;
� Medi-Cal related program planning and policy
development;
� Providing transportation to Medi-Cal services; and,
� General administrative activities.
DHCS' California Tribal Medi-Cal Administrative Activities
Implementation Plan from December 2008 is designed to be
used by the state's federally recognized tribes and tribal
organizations that participate in the Tribal MAA program.
The purpose of the Tribal MAA program is to:
� Form a partnership between DHCS and participating
federally recognized Tribes and Tribal Organizations;
� Share in the responsibility for promoting access to
Medi-Cal health care for Native American Indians/Alaskan
Natives (AI/AN); and,
� Reimburse Tribes and Tribal Organizations for performing
administrative activities allowed by Tribal MAA.
Per the Tribal MAA plan and conversations with DHCS staff,
facilitating a Medi-Cal application is currently reimbursable
through MAA. This bill would codify this provision and would
explicitly state that using CalHEERS (which did not exist in
December 2008 when the Tribal MAA plan was finished) to
facilitate enrollment is reimbursable through MAA.
1.CalHEERS. Covered California was established in 2010 by AB
1602 (P�rez), Chapter 655, Statutes of 2010, and SB 900
(Alquist), Chapter 659, Statutes of 2010. Individuals with
incomes up to 400 percent of the FPL are eligible for advance
premium tax credits, and those up to 250 percent of the FPL
are also eligible for cost sharing reductions. The ACA
requires states to have a single streamlined application for
Exchange subsidies, their Medicaid programs and their CHIP
AB 1233 | Page 4
programs.
Covered California and DHCS are the joint program sponsors of
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.
2.Prior legislation. SB 308 (Figueroa), Chapter 253, Statutes of
2003, included Native American Indian tribes, tribal
organizations, and subgroups of tribes or tribal organizations
as participating LGA for purposes of contracting with DHCS for
MAAs.
3.Support. This bill is sponsored by the California Rural
Indian Health Board (CRIHB) and supported by California
Pan-Ethnic Health Network, California Primary Care
Association, and multiple tribes and tribal organizations to
enable tribal health care clinics and other tribal government
entities to facilitate the enrollment of Native Americans who
qualify for Medi-Cal into the program at no cost to the state
using CalHEERS. California Pan-Ethnic Health Network
4.Amendment. DHCS indicates that "facilitating the Medi-Cal
application" as codifying existing authority, but that the
language in this bill (facilitating Medi-Cal applications
using the CalHEERS system) is more restrictive than CMS
guidance that allows claiming for facilitating Medi-Cal
applications without reference to any particular means of
applying. An amendment is needed to clarify that MAA claiming
for facilitating Medi-Cal applications is not limited to using
CalHEERS.
SUPPORT AND OPPOSITION :
Support: California Rural Indian Health Board (sponsor)
California Pan-Ethnic Health Network
California Primary Care Association
California Valley Miwok Tribe
Chapa-De Indian Health Program
Elk Valley Rancheria, California
Karuk Tribe
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Manchester Band of Pomo Indians
Pala Band of Mission Indians
Resighini Rancheria
Tuolomne Me-Wuk Indian Health Center, Inc.
51 Individuals
Oppose: None received.
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