BILL ANALYSIS �
AB 1233
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CONCURRENCE IN SENATE AMENDMENTS
AB 1233 (Chesbro)
As Amended July 2, 2013
2/3 vote. Urgency
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|ASSEMBLY: |77-0 |(May 28, 2013) |SENATE: |38-0 |(August 15, |
| | | | | |2013) |
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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
enactment.
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)
319-2097
FN: 0001706
AB 1233
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