BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 1263 (J. Perez) - Medi-Cal: CommuniCal.
Amended: July 10, 2013 Policy Vote: PE&R 3-2, Health
7-2
Urgency: No Mandate: No
Hearing Date: August 30, 2013
Consultant: Brendan McCarthy
SUSPENSE FILE.
Bill Summary: AB 1263 would require the Department of Health
Care Services to establish a program to provide for and
reimburse for medical interpretation services provided to
Medi-Cal enrollees with limited English proficiency. The bill
would grant collective bargaining rights to interpreters
providing services through the program.
Fiscal Impact:
One-time costs of $1.4 million to develop program
guidelines, seek necessary federal approvals, and develop
billing systems (50% General Fund, 50% federal funds).
One-time costs of about $50,000 to develop regulations
relating to collective bargaining of translators by the
Public Employment Relations Board (General Fund).
One-time costs of about $90,000 and ongoing costs of about
$50,000 to oversee an election by translators to choose a
collective bargaining agent by the Public Employment
Relations Board (General Fund).
Periodic costs up to $1 million for negotiating a
memorandum of understanding with the established bargaining
unit and overseeing the implementation by the Department of
Human Resources (General Fund).
Ongoing costs of about $30 million per year to provide
translation services in fee-for-service Medi-Cal (General
Fund and federal funds).
Unknown costs in Medi-Cal managed care (General Fund and
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federal funds). Under current law, health plans are required
to provide interpretation services, including managed care
plans that contract with the Department of Health Care
Services. It is unclear whether the bill's requirement to
provide "certified medical interpretation services" at
reimbursement rates subject to collective bargaining would
increase costs for translation services, above the costs
already being incurred.
The federal financial participation rate for the costs
above may vary. For interpretive services provided to
children and their family members, the state can claim a 75%
federal financial participation rate. However, those costs
are only eligible for a 75% federal cost share if they are
billed as administrative costs (as opposed to benefits). For
childless adults, the rate is generally 50%.
Background: The state's Medi-Cal program provides health care
services to seniors, the disabled, and certain low income
children and their parents. About 5.2 million Medi-Cal
beneficiaries (about 70% of the total Medi-Cal population)
receive their health care through Medi-Cal managed care. In
addition, the state is in the process of shifting certain
populations (seniors and persons with disabilities, rural
Medi-Cal beneficiaries, and individuals eligible for both
Medi-Cal and Medicare) from fee-for-service to managed care. In
total, these initiatives are likely to shift about two million
Medi-Cal beneficiaries to managed care.
The federal Civil Rights Act of 1964 and implementing
regulations prohibit the discrimination against any person based
on race, color, or national origin by entities that receive
federal assistance. The federal Office for Civil Rights enforces
these requirements and has indicated through guidance that
entities receiving federal funding may be required to provide
access to translation services for limited English-speaking
program beneficiaries.
Current state law requires all licensed managed care plans to
provide interpretation services to enrollees who are limited
English proficient. Current law also requires all licensed
managed care plans to provide translation services based on the
concentration of non-English speaking enrollees. These
requirement apply to Medi-Cal managed care plans, but allow the
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regulatory agencies to deem Medi-Cal managed care plans in
compliance if they meet more stringent requirements through
contractual requirements.
Despite these requirements in law, there are indications that
not all Medi-Cal beneficiaries are receiving care in a
linguistically appropriate manner. According to the California
Health Interview Survey, about 8% of adults in Medi-Cal had
difficulty understanding their doctor or required another person
to help them understand their doctor. Similarly, about 7% of the
parents of children enrolled in Medi-Cal had difficulty
understanding their doctor or needed another person to help them
understand their doctor.
Proposed Law: AB 1263 would require the Department of Health
Care Services to establish a program to provide for and
reimburse for medical interpretation services provided to
Medi-Cal enrollees with limited English proficiency. The bill
would grant interpreters providing services through the program
with collective bargaining rights.
Major provisions of the bill would:
Require the Department of Health Care Services to establish
the "CommuniCal" program for interpretation services to
Medi-Cal beneficiaries;
Permit Medi-Cal health care providers, in both
fee-for-service and managed care, to use CommuniCal;
Require CommuniCal to be administered by an independent
broker;
Require participating interpreters to be certified by the
Department;
Require certified interpreters to have specified
qualifications;
Grant CommuniCal interpreters the right to be represented
by a labor organization, which would be responsible for
state-wide collective bargaining for the interpreters;
Provide the procedures under which interpreters may select
a labor organization and the responsibilities of the
Department of Human Resources and the Public Employment
Relations Board in bargaining with such a labor
organization.
Related Legislation:
AB 2392 (J. Perez, 2012) was substantially similar to this
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bill. That bill was moved to the Assembly Inactive File on
concurrence in Senate amendments.
AB 505 (Nazarian) would codify current practice regarding
language assistance in the Medi-Cal program. That bill is on
the Senate Floor.
Staff Comments: The availability of enhanced federal financial
participation for translation services indicates that there may
be opportunities to improve access to care for non-English
proficient Medi-Cal beneficiaries at a reduced cost to the
state. On the other hand, it is not clear whether the program to
provide certified translation services, as required under the
bill, would be a more economical method of providing translation
services than the current methods used by health care providers.
If a centralized system managed by the Department is more costly
than the methods currently in use, cost savings may be minimal.
Improving translation services for people with limited English
proficiency would likely have mixed impacts on Medi-Cal costs.
By improving enrollees' ability to communicate with providers,
the bill is likely to enable enrollees to more easily access
care, increasing utilization and costs. On the other hand,
better communication between a patient and a provider may
improve the patient and the provider's ability to manage the
patient's health, potentially reducing long-term costs.