BILL ANALYSIS                                                                                                                                                                                                    Ó


          |SENATE RULES COMMITTEE            |                       AB 1233|
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          Bill No:  AB 1233
          Author:   Chesbro (D)
          Amended:  7/2/13 in Senate
          Vote:     27 - Urgency

           SENATE HEALTH COMMITTEE  :  9-0, 6/26/13
          AYES:  Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,  
            Nielsen, Pavley, Wolk

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  77-0, 5/28/13 (Consent) - See last page for  

           SUBJECT  :    Medi-Cal:  Administrative Claiming process

           SOURCE  :     California Rural Health Board

           DIGEST  :    This bill 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 which includes, but is not  
          limited to, using the California Healthcare Eligibility,  
          Enrollment, and Retention System (CalHEERS).

           ANALYSIS  :    

          Existing law:



                                                                    AB 1233

          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  

          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  
             applications which includes, but is not limited to, using  

          2. Takes effect immediately as an urgency statute.


           MAA  .  MAA is a federal reimbursement program for the costs of  
          "administrative activities" that directly supports 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 Medi-Cal State Plan or  
          waiver service, if administering a Medicaid waiver, and is  



                                                                    AB 1233

          "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  

           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 MAA 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; 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 codifies this provision and explicitly  
          states that using CalHEERS (which did not exist in December 2008  



                                                                    AB 1233

          when the Tribal MAA plan was finished) to facilitate enrollment  
          is reimbursable through MAA.

           CalHEERS  .  Covered California was established by AB 1602 (Pérez,  
          Chapter 655, Statutes of 2010) and SB 900 (Alquist, Chapter 659,  
          Statutes of 2010).  Individuals with incomes up to 400% of the  
          federal poverty level (FPL) are eligible for advance premium tax  
          credits, and those up to 250% 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 Children's Health Insurance  

          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.  

           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.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  8/9/13)

          California Rural Indian Health Board (co-source)
          California Pan-Ethnic Health Network 
          California Primary Care Association
          California Valley Miwok Tribe
          Chapa-De Indian Health Program
          Cloverdale Rancheria of Pomo Indians of California
          Elk Valley Rancheria, California
          Karuk Tribe



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          Manchester Band of Pomo Indians
          Pala Band of Mission Indians
          Resighini Rancheria
          Tuolumne Me-Wuk Indian Health Center, Inc.

           ARGUMENTS IN SUPPORT  :    According to the author's office, 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%), diabetes (380%), accidents (240%) and  
          pneumonia/influenza (140%) than other Americans.  In addition to  
          health disparities, many Native Americans live in 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% federal  
          financial participation for providing Medi-Cal covered services  
          to American Indians eligible for Medi-Cal.

          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.  

           ASSEMBLY FLOOR  :  77-0, 5/28/13
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,  
            Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,  
            Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,  
            Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,  
            Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell,  
            Gray, Grove, Hagman, Hall, Harkey, Roger Hernández, Jones,  
            Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,  
            Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin,  
            Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,  
            V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,  
            Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,  



                                                                    AB 1233

            Williams, Yamada, John A. Pérez
          NO VOTE RECORDED:  Donnelly, Holden, Vacancy

          JL:d  8/13/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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