BILL ANALYSIS Ó
SB 28
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Date of Hearing: August 21, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 28 (Hernández) - As Amended: August 7, 2013
Policy Committee: HealthVote:13-5
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill contains several provisions related to implementation
of the federal Patient Protection and Affordable Care Act (ACA).
Specifically, this bill:
1)Requires the Managed Risk Medical Insurance Board (MRMIB) to
provide the California Health Benefit Exchange (Exchange) with
the name, contact information, and spoken language of Major
Risk Medical Insurance Program (MRMIP) subscribers and
applicants in order to assist the Exchange in conducting
outreach.
2)Requires the Exchange to use the information from MRMIB to
provide a notice to these individuals informing them of their
potential eligibility for coverage through the Exchange or
Medi-Cal.
3)Requires the Department of Health Care Services (DHCS) to
designate the Exchange and county human services departments
as qualified entities for determining eligibility for
accelerated enrollment (AE) under Medi-Cal for children.
FISCAL EFFECT
1)Potential cost pressure in the hundreds of thousands of
dollars on Medi-Cal county administrative costs for training
approximately 15,000 county eligibility workers on accelerated
enrollment. In practical terms, this would likely not have a
significant budgetary impact, as administrative funding is
currently provided as a lump sum to counties as part of the
annual Medi-Cal budget and this bill's requirements are not
likely to increase the sum provided. Additionally, workers
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will be retrained and the administrative funding methodology
will likely be reassessed over the next two years in light of
considerable simplification and changes in eligibility
processing for Medi-Cal.
2)Potential minor Medi-Cal benefits costs associated with some
children gaining coverage through AE sooner than would
otherwise be the case. AE allows children to receive program
benefits pending final determination of their eligibility.
Costs are not expected to be significant, as most eligibility
determinations are expected to be completed in real-time. In
addition, Medi-Cal already grants retroactive coverage,
meaning the program pays claims incurred for 90 days prior to
granting of eligibility.
The only potential benefit costs would be associated with
children who were granted AE then lost to follow-up. For
example, if a parent did not bring in needed documentation to
establish residency, the state would incur costs for AE on
behalf of that child that would otherwise not have been
occurred, and the child would not have their application
completed. This would likely occur only in a very small
minority of cases.
COMMENTS
1)Rationale . This bill makes two separate changes to prepare for
implementation of the ACA in 2014. The first change would
update the state's AE in Medi-Cal to conform to new
eligibility and enrollment systems. Specifically, this bill
would authorize the Exchange as well as counties to grant AE.
In addition, continuing AE will ensure the state will meet the
federal ACA maintenance of effort (MOE) requirement for
children's coverage that prevents states (until September 30,
2019) from having eligibility standards, methodologies, or
procedures that are more restrictive than that in effect when
ACA was enacted in 2010.
A second provision would direct MRMIB to transfer information
about individuals enrolled in the MRMIP to the Exchange so
that the Exchange can conduct outreach to these individuals.
Under federal privacy regulations, a state law is needed to
require MRMIB to transfer this information.
2)Accelerated Enrollment . Children who appear to qualify for
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Medi-Cal and whose application is sent to the existing "Single
Point of Entry" (SPE) are eligible for AE. The SPE is an
abbreviated eligibility screen conducted by a vendor in a
centralized location. AE for children offers temporary, free
Medi-Cal benefits after the child's application has been
screened by SPE and is awaiting a final Medi-Cal determination
by the county welfare department. This final determination
usually happens within 45 days of the receipt of the
application by the county. Children whose applications are
submitted to the SPE can be granted AE if they appear
eligible, pending receipt of documentation; however, counties
cannot currently offer AE if documentation is missing.
3)MRMIP . The Major Risk Medical Insurance Program (MRMIP)
provides coverage to individuals, generally with pre-existing
medical conditions, who have been rejected from individual
insurance. The federal ACA requires health insurance
companies to sell coverage at to any individual who requests
it and prohibits pricing polices based on an individual's
health status, beginning in 2014. Since most individuals who
currently receive coverage through MRMIP will be able to buy
coverage on their own in 2014, this bill requires data-sharing
such that the Exchange can contact MRMIP subscribers to alert
them to availability of new coverage.
4)Related Legislation . SB 800 (Lara) requires, in order to
assist the Exchange to conduct outreach to individuals
potentially eligible for insurance affordability programs,
DHCS provide the Exchange, or its designee, with contact
information of individuals who are not enrolled in Medi-Cal
but are the parents or caretakers of certain enrolled
children.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081