BILL ANALYSIS Ó
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THIRD READING
Bill No: SB 28
Author: Hernandez (D)
Amended: 5/13/13
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/24/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : 5-0, 5/6/13
AYES: De León, Hill, Lara, Padilla, Steinberg
NO VOTE RECORDED: Walters, Gaines
SUBJECT : California Health Benefit Exchange
SOURCE : Author
DIGEST : This bill requires the Managed Risk Medical Insurance
Board (MRMIB) to provide the California Health Benefit Exchange
(known as Covered California) with specified information of
Major Risk Medical Insurance Program (MRMIP) and Pre-Existing
Condition Insurance Program (PCIP) subscribers and applicants to
assist Covered California in conducting outreach. Requires
Covered California to provide a specified notice, informing
these subscribers and applicants of their potential eligibility
for coverage through Covered California or Medi-Cal. Requires
the Department of Health Care Services (DHCS) to designate
Covered California and county human services departments as
qualified entities for determining eligibility for accelerated
enrollment (AE) under Medi-Cal for children.
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ANALYSIS :
Existing law:
1.Requires DHCS to exercise the federal Medicaid option to
implement a program for AE of children. Requires DHCS to
designate a single point of entry (SPE) as the qualified
entity for determining Medi-Cal eligibility.
2.Establishes MRMIP, which is administered by MRMIB, to provide
major risk medical coverage to California residents who have
been rejected for coverage by at least one private health
plan, or if the only private health coverage that the
applicant can secure would impose substantial waivers or
provide limited coverage or afford coverage only at an
excessive price.
3.Requires, under the Patient Protection and Affordable Care Act
(ACA), the federal Secretary of the Department of Health and
Human Services (DHHS) to establish a temporary high-risk
health insurance pool program to provide health insurance
coverage for eligible individuals until January 1, 2014 (known
as the Pre-Existing Condition Insurance Program or PCIP).
Existing state law requires PCIP to be managed by MRMIB.
4.Requires, under the ACA, the Secretary of DHHS to develop
procedures to provide for the transition of eligible
individuals enrolled in health insurance coverage offered
through a high-risk pool into qualified health plans offered
through Covered California.
5.Establishes, under regulations implementing the federal Health
Insurance Portability and Accountability Act of 1996 (HIPAA),
requirements relating to the protection of privacy of
protected health information. Permits a HIPAA-covered entity
to use or disclose protected health information.
6.Establishes Covered California in state government and
requires the Covered California board to seek to contract with
health plans and insurers so as to provide health care
coverage choices that offer the optimal combination of choice,
value, quality, and service.
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This bill:
1.Requires MRMIB to provide Covered California or its designee
with the name, addresses, email addresses, telephone numbers,
other contact information, and written and spoken language of
MRMIP and PCIP subscribers and applicants in order to assist
Covered California in conducting outreach to MRMIP and PCIP
subscribers and applicants.
2.Requires Covered California to use the information from MRMIB
to provide a notice to individuals informing the individual
that he/she may be eligible for reduced-cost coverage through
Covered California or no-cost coverage through Medi-Cal.
Requires the notice to include information on obtaining
coverage under those programs.
3.Requires DHCS, commencing October 1, 2013, to designate
Covered California and its agents, and county human services
departments as qualified entities for determining eligibility
for AE for children under Medi-Cal under the SPE. Requires a
qualified entity to grant AE if a complete eligibility
determination cannot be made for a child at the time of the
initial application. Clarifies that the qualified entity
shall grant AE only to children who are eligible.
Background
This bill makes two separate changes to prepare for
implementation of the ACA in 2014. The first change updates the
state's AE in Medi-Cal to conform to the new enrollment systems
being established under the ACA. Specifically, this bill
broadens the entities authorized to grant AE to include counties
and Covered California so that children applying through either
entity can receive AE. The second change made by this bill
directs MRMIB to transfer information about individuals enrolled
in MRMIP and PCIP to Covered California to conduct outreach.
Under HIPPA, a state law is needed to require MRMIB to transfer
this information. PCIP is scheduled to terminate at the end of
2013 when Covered California opens, and the nearly 16,000
individuals enrolled in PCIP will need a new health coverage
option. This bill requires Covered California to use the
information from MRMIB to provide a notice to individuals
informing the individual that he/she may be eligible for
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reduced-cost coverage through Covered California, or no-cost
coverage through Medi-Cal.
AE and the SPE. AB 430 (Cardenas, Chapter 171, Statutes of
2001), and AB 442 (Assembly Budget Committee, Chapter 1161,
Statutes of 2002), established the SPE and AE for children in
Medi-Cal. The SPE and AE were established in part because the
state provides two separate children's health insurance programs
(the Healthy Families Program and Medi-Cal) with different
entities making eligibility determinations for each program.
The purpose of AE is to accelerate temporary, fee-for-service,
full-scope, Medi-Cal coverage for children under the age of 19
who are new to Medi-Cal, who applied for Medi-Cal through the
SPE and are likely eligible for Medi-Cal based on screening by
the SPE. AE is temporary coverage while the county human
services department makes a final determination of Medi-Cal
eligibility. Coverage under AE begins the first day of the
month of the date the SPE receives the application. Once the
county makes an eligibility determination, a notice of action
either approving or denying the application is sent.
HIPAA and MRMIP and PCIP. A HIPAA-covered entity is prohibited
from using or disclosing protected health information without an
authorization that is valid, with specified exceptions. One
exception to this HIPAA prohibition against the disclosure of
protected health information is if a HIPAA-covered entity is
required to use or disclose protected health information by law,
and the use or disclosure complies with and is limited to the
relevant requirements of such law. This bill places such a
requirement on MRMIB to transfer information about PCIP and
MRMIP subscribers and applicants to the Covered California for
purposes of having the Covered California conduct outreach to
these individuals.
Prior Legislation
AB 714 (Atkins, 2011-12), would have required notices of health
care eligibility be sent to individuals who are enrolled in, or
who cease to be enrolled in, publicly-funded state health care
programs. AB 714 was held on the Senate Appropriations
Committee suspense file.
AB 792 (Bonilla, Chapter 851, Statutes of 2012), establishes
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notification requirements about the availability of reduced-cost
coverage available in the Covered California and no-cost
coverage available in Medi-Cal to an individual, as specified.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 5/13/13)
100% Campaign
California Coverage and Health Initiatives
California Primary Care Association
Children Now
Children's Defense Fund-California
The Children's Partnership
United Ways of California
Western Center on Law and Poverty
ARGUMENTS IN SUPPORT : California Children's Health Coverage
Coalition, comprised of the 100% Campaign (a collaborative
effort of The Children's Partnership, Children Now, and
Children's Defense Fund-California), California Coverage and
Health Initiatives, and United Ways of California, supports this
bill to update the state's AE program for children applying for
coverage to conform to the new enrollment systems being
established to implement the ACA. Supporters argue this bill
preserves a critical access point for children entering Medi-Cal
by broadening the entities authorized to grant AE and by
requiring the state to make necessary changes in order to offer
more affordable coverage through Covered California.
(JL:nl):ej 5/14/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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