BILL ANALYSIS                                                                                                                                                                                                    

                                                                  AB 1233
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          AB 1233 (Chesbro)
          As Amended July 2, 2013
          2/3 vote. Urgency
          |ASSEMBLY:  |77-0 |(May 28, 2013)  |SENATE: |38-0 |(August 15,    |
          |           |     |                |        |     |2013)          |
           Original Committee Reference:    HEALTH  

           SUMMARY  :  Authorizes participating Native American Indian  
          tribes, tribal organizations or subgroups to facilitate Medi-Cal  
          applications, including but not limited to 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  

           The Senate amendments  clarify the MAA activity is to facilitate  
          Medi-Cal applications. 

           FISCAL EFFECT  :  According to the Senate Appropriations  
          Committee, pursuant to Senate Rule 28.8, negligible state costs.

           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  
          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.   


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          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 the  
          Department of Health Care Services are joint program sponsors of  
          the CalHEERS which is the Information Technology system running  
          both the online application for Covered California, 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" 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.  


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          Covered California is in the process of establishing an  
          Assister's Program that will include Certified Enrollment  
          Entities (CEE) and individual entities, Certified Enrollment  
          Counselors (CEC) and an In-Person Assistance (IPA) Program.   
          CEEs are entities or individuals registered by the Exchange to  
          provide one-on-one consumer assistance to help them apply for  
          Covered California programs, particularly entities that have  
          access to Covered California's targeted population.  CECs are  
          individuals who are certified by the Exchange to provide  
          face-to-face one-on-one consumer assistance.  IPAs are CECs  
          employed, trained, certified, and linked to CEEs and registered  
          in the IPA Program.  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 CEEs.  The proposed compensation for CEEs 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)  

          FN: 0001706  


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