BILL ANALYSIS Ó
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CONSENT
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
vote
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:
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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
applications which includes, but is not limited to, using
CalHEERS.
2. Takes effect immediately as an urgency statute.
Comments
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
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"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 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
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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
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.
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,
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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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