BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB X1 1
AUTHOR: Hernandez and Steinberg
INTRODUCED: January 28, 2013
HEARING DATE: February 27, 2013
CONSULTANT: Bain
SUBJECT : Medi-Cal: eligibility.
SUMMARY : Implements the expansion of federal Medicaid coverage
in California (Medicaid is known as Medi-Cal in California) to
low-income adults with incomes between 0 and 138 percent of the
federal poverty level (FPL), establishes the Medi-Cal benefit
package for this expansion population, and requires the existing
Medi-Cal program to cover the essential health benefits (EHB)
contained in the Patient Protection and Affordable Care Act
(ACA). Implements a number of the Medicaid ACA provisions to
simplify the eligibility, enrollment and renewal processes for
Medi-Cal.
Background:
On March 23, 2010, President Obama signed the ACA into law
(Public Law 111-148), as amended by the Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152). The
ACA greatly expands health insurance coverage in California.
Beginning in 2014, millions of low- and middle-income
Californians will gain access to coverage under the expansion of
Medi-Cal through easier enrollment requirements established for
Medi-Cal, and through premium and cost-sharing subsidies offered
through the California Health Benefit Exchange (the Exchange,
which is now known as Covered California). As a result of the
coverage expansions under the ACA, between 89 and 91 percent of
non-elderly Californians are predicted to have health coverage
under the ACA, and the number of uninsured is projected to
decrease by between 1.8 and 2.7 million by 2019.
The ACA establishes new requirements for California's Medi-Cal
program, including:
Requiring Medicaid coverage of adults under age 65 who are not
currently eligible with incomes up to 138 percent of the FPL
(at or below $15,856 in 2013 for an individual);
Requiring primary care rates to be equal to Medicare rates for
2013 and 2014;
Extending Medi-Cal coverage to former foster youth up to age
Continued---
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26;
Allowing individuals to apply for Medi-Cal in person, via
phone, by mail, and through the internet or facsimile;
Eliminating the asset test for certain groups of applicants to
Medi-Cal; and,
Establishing a new methodology for counting income in
Medi-Cal, known as modified adjusted gross income (MAGI).
In addition to these ACA requirements, California has a number
of policy options in implementing the Medicaid provisions.
Options include whether to implement the Medi-Cal expansion (the
Supreme Court ruling in National Federation of Independent
Business v. Sebelius in June 2012 effectively allowed states to
opt-out of the expansion), the type of benefits and services the
expansion population will receive in Medi-Cal, and whether to
adopt options contained in the ACA to make it easier for
individuals to enroll in coverage and remain enrolled in
coverage through the use electronic verification of
eligibility-related information.
This analysis is broken down by each major policy area affected
by this bill, describes existing federal law and state law, the
proposed change to state law, gives background on existing law
(if necessary), and provides the rationale for the proposed
changes.
Medi-Cal Expansion to Low-Income Adults
Under existing federal law, prior to the enactment of the ACA,
adults were generally not eligible for Medi-Cal coverage unless
they met categorical eligibility requirements, such as being
low-income and having minor children living at home, having a
disability, being over the age of 65, or being pregnant.
Currently, Medicaid requires financial need and a categorical
relationship (family with children, aged, persons with
disability). For example, adults who are not disabled, pregnant
or who do not have minor children are not categorically eligible
for Medi-Cal. The 2014 Medicaid expansion's largest enrollment
impact will be from the expansion to non-disabled childless
adults with incomes at or below 138 percent of the FPL (for a
single adult, 138 percent of the FPL is $1,321 per month or
$15,856 per year in 2013).
Counties draw down federal Medicaid matching funds to cover
low-income adults under California's "Bridge to Reform" Section
1115 Medicaid waiver as a transition to implementation of the
ACA Medicaid expansion through the Low Income Health Program
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(LIHP). Over 500,000 individuals are covered under the LIHPs,
but not all counties have LIHPs (three counties have elected not
to implement a LIHP [Fresno, Merced and San Luis Obispo]. The
benefits in the LIHPs are more limited than in Medi-Cal, and
eligibility varies county by county. For example, eligibility
for San Francisco's LIHP is 25 percent of the FPL and Santa
Clara is 75 percent of the FPL. Coverage under the LIHPs ends
December 31, 2013. Statute establishing the LIHP requires the
state, on and after January 1, 2014, to implement comprehensive
health care reform for the populations targeted by the LIHP in
compliance with the federal ACA and subsequent amendments.
Under the ACA, starting January 1, 2014, Medi-Cal will expand
coverage to most adults who are at or below 138 percent of the
FPL. This coverage expansion applies to non-elderly,
non-pregnant adults under the age of 65. The Supreme Court
ruling in June 2012 effectively allowed states to opt-out of the
expansion by prohibiting the federal government from withholding
federal Medicaid funds for a state's entire Medicaid program if
the state failed to implement the expansion.
SB X1 1 would implement the Medicaid expansion in California. In
addition, SB X1 1 would require that individuals who qualify for
the Medicaid expansion who are currently enrolled in a LIHP be
transitioned to the Medi-Cal program in accordance with the
transition plan as approved by the federal Centers for Medicare
and Medicaid Services (CMS). SB X1 1 would require LIHP
enrollees be:
Notified which Medi-Cal health plan or plans contain his or
her existing medical home provider.
Notified that he or she can select a health plan that contains
his or her existing medical home provider.
Provided the opportunity to choose a different health plan if
there is more than one plan available in the county where he
or she resides.
Informed that if he or she does not affirmatively choose a
plan or there is only one plan in the county where he or she
resides, he or she shall be enrolled into the Medi-Cal managed
care plan that contains his or her LIHP medical home provider,
if the medical home provider contracts with a Medi-Cal managed
care plan.
In order to ensure that no persons lose health care coverage in
the course of the transition, notices of the January 1, 2014,
change must be sent to LIHP enrollees upon their LIHP
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redetermination in 2013 and again at least 90 days prior to the
transition.
Medi-Cal benefits for the current population and expansion
population
Under existing federal law (since 2006), state Medicaid programs
have had the option to provide certain groups of enrollees with
an alternative benefit package known as "benchmark" or
"benchmark-equivalent" coverage. The four benchmarks are:
(1) The Standard Blue Cross/Blue Shield Preferred Provider
Option offered through the Federal Employees Health Benefit
program;
(2) State employee coverage that is offered and generally
available to state employees;
(3) The commercial HMO with the largest insured commercial,
non-Medicaid enrollment in the state; and
(4) Secretary-approved coverage, which can include the Medicaid
state plan benefit package offered in that state.
"Benchmark-equivalent" means that the benefits include certain
specified services, and the overall benefits are at least
actuarially equivalent to one of the statutorily specified
benchmark coverage packages. California has not implemented this
federal option. The ACA requires states to select a benefit
package for the Medi-Cal expansion population using "benchmark"
or "benchmark-equivalent" coverage.
The ACA requires any Medicaid benchmark benefit package to
additionally provide coverage for the EHB. The ten EHB are
ambulatory patient services, emergency services,
hospitalization, maternity and newborn care, mental health and
substance use disorder services, including behavioral health
treatment, prescription drugs, rehabilitative and habilitative
services and devices, laboratory services, preventive and
wellness services and chronic disease management, and pediatric
services, including oral and vision care. CMS indicates a state
is not required to select the same EHB benchmark reference plan
it selects for the individual and small group market (California
designated the Kaiser Small Group product as the state's EHB
benchmark plan in legislation last session), and it could have
more than one EHB benchmark reference plan for Medicaid.
Under the ACA, the Medicaid benefits provided to the expansion
population of adults must be consistent with the federal law
benchmark authority. If the EHB benchmark reference plan
selected for Medicaid were to lack coverage within one or more
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of the ten required categories of benefits, it would need to be
supplemented to ensure that it provides coverage in each of the
ten EHB categories. This would be in addition to any other
requirements for benchmark or benchmark-equivalent plans,
including federal mental parity (known as the Mental Health
Parity and Addition Equity Act) compliance.
SB X1 1 would require the Department of Health Care Services
(DHCS) to seek federal approval to establish a benchmark benefit
package that includes the same benefits, services, and coverage
that are provided to all other full-scope Medi-Cal enrollees. In
addition, these benefits would be supplemented by any benefits,
services, and coverage included in the EHB package adopted by
the state and approved by the federal Secretary of the
Department of Health and Human Services (DHHS). In addition, SB
X1 1 would require the existing Medi-Cal benefit package for the
non-expansion population to include any benefits, services, and
coverage not otherwise described in existing law that are
included in the approved EHB package.
Medi-Cal coverage for former foster youth until age 26
Federal regulations require states to provide Medicaid to
children for whom adoption assistance or foster care maintenance
payments are made. In addition, California has adopted the
federal option that allows states to provide Medicaid coverage
for former foster children between the ages of 18 and 21. The
state does not require an income, asset test or share-of-cost
for former foster youth. In 2010, there were slightly more than
7,000 former foster youth ages 18 through 20 enrolled in
Medi-Cal.
The ACA requires states cover former foster care children who:
Are under 26 years of age;
Are not eligible or enrolled under existing Medicaid mandatory
eligibility groups (or who are described in any of the
existing Medicaid mandatory eligibility groups but have income
that exceeds the upper income eligibility limit);
Were in foster care under the responsibility of the state at
18 years of age (or such higher age as the state has elected);
and
Were enrolled in the Medicaid state plan or under a waiver
while in foster care.
The ACA also allows states to make "presumptive eligibility"
determinations for these individuals. Medicaid services rendered
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to individuals in this new mandatory eligibility group will be
matched at the state's regular federal funds matching rate,
which in California is usually 50 percent federal funds and 50
percent state funds.
This provision takes effect January 1, 2014, and mirrors a
similar provision in the ACA that allows dependents to stay on
their parents' private insurance coverage until age 26.
SB X1 1 would require, to the extent federal financial
participation (FFP) is available, DHCS to extend Medi-Cal
benefits to a foster care youth until age 26. A foster care
youth would be deemed eligible for the benefits, and would be
enrolled to receive these benefits until his or her 26th
birthday without any interruption in coverage and without
requiring a new application so long as he/she was in foster care
on his/her 18th birthday. These changes are required by the ACA.
SB X1 1 does not implement the presumptive eligibility option.
In addition to the federally required changes, DHCS would also
be required by SB X1 1 to identify and track all former
independent foster care youth who lost Medi-Cal coverage as a
result of turning age 21 in the 2013 calendar year. DHCS would
be required to develop and implement a simplified
redetermination form for these youth. A former foster youth
qualifying for the benefits would be required to fill out and
return this form only if information previously reported to DHCS
is no longer accurate, and failure to return the form alone
would not constitute a basis for termination of Medi-Cal. If the
form is returned as undeliverable and the county is otherwise
unable to establish contact, the former foster youth would
remain eligible for fee-for-service Medi-Cal until such time as
contact is reestablished or ineligibility is established, to the
extent FFP is available. These changes would take effect January
1, 2014.
The requirement in SB X1 1 that DHCS track independent foster
care adolescent who lost Medi-Cal coverage as a result of
turning age 21 in the 2013 calendar year is because these
individuals will lose Medi-Cal coverage upon the date of their
21st birthday, only to be eligible again effective January 1,
2014 under the ACA. The provisions regarding the return of
undelivered forms ensure that former foster youth are not
disenrolled because they have moved and their mail is returned
as undeliverable. Former foster youth retain their right to
Medi-Cal coverage if they move within the state, obtain a job
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and have an increase in income or obtain health insurance (in
which case Medi-Cal coverage would be the secondary payor), so
removing them from coverage to which they are entitled does not
make sense. This provision would also ensure these individuals
retain access to health care services and decrease the amount of
"churning," which occurs when a beneficiary loses coverage and
must reapply for coverage. If the redetermination form is
returned as undeliverable and the county is unable to establish
contact with the individual, SB X1 1 would shift the former
foster youth's Medi-Cal coverage to fee-for-service (if he or
she is in Medi-Cal managed care) until contact is re-established
or the person is found ineligible so the state is not making
monthly capitation payments to Medi-Cal managed care plans for
individuals who have moved out of state or are deceased.
Implementation of ACA option for attestation of
application-related information
Existing state law required DHCS, by July 1, 2007, to implement
a process that allows applicants and beneficiaries of certain
Medi-Cal programs to self-certify the amount and nature of
assets and income without the need to submit documentation. This
process is required to apply to applicants and beneficiaries in
the 1931(b) program, the FPL programs for infants, children and
pregnant women, the Medically-Indigent and Medically-Needy
Programs for children and families, and other similar programs
designated by DHCS. This process was to be implemented in two
phases. However, these provisions have not been implemented.
Federal regulations implementing the ACA allow the agency
determining eligibility (counties in California) to accept
attestation of information needed to determine the eligibility
of an individual for Medicaid (either self-attestation or
attestation by an adult who is in the applicant's household)
without requiring further information (including documentation).
Self-attestation is not permitted for citizenship status and
immigration. Federal regulations require the agency to accept
self-attestation for pregnancy unless the state has information
that is not reasonably compatible with the attestation. The
county is authorized to verify state residency, date of birth,
and household size and composition.
To determine financial eligibility, federal regulations require
the county to request specified information from other agencies
in the state, other states, and federal programs to the extent
such information is useful in verifying the financial
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eligibility of an individual. In addition, federal ACA
regulations require the Secretary of DHHS to establish an
electronic service through which states can verify information
with or obtain information from federal agencies and other data
sources (referred to as the "federal data hub"). Counties must
promptly evaluate information received or obtained to determine
whether such information may affect the eligibility of an
individual or the benefits to which he or she is entitled. If
information provided by an individual is reasonably compatible
with information obtained by the county, it must determine or
renew eligibility based on that information. CMS guidance
indicates that, if a state accepts self-attestation of income,
it must conduct post-enrollment verification with the electronic
data sources it determines useful.
Current state law authorizes state health subsidy programs to
accept self-attestation with respect to all information needed
to determine eligibility, to the extent permitted by law state
and federal law.
SB X1 1 would require state health subsidy programs (Medi-Cal,
coverage through Covered California and the Basic Health
Program, if enacted), to accept an individual's attestation,
without further documentation, for age, date of birth, family
size, household income, state residency, pregnancy, and any
other applicable eligibility criteria for which attestation is
permitted by federal law.
The purpose of this provision is to implement the ACA option, to
reduce program administrative costs, and to move the state
toward electronic verification and away from the existing
burdensome paper-based application process. The preamble of
federal regulations indicates the purpose of the proposed
federal changes was to make verification processes more
efficient, modern, and coordinated by relying on trusted
third-party electronic data sources and shifting certain
verification responsibilities to the federal government, rather
than using paperwork submitted by Medi-Cal applicants and
beneficiaries.
Prohibition on asset test for MAGI individuals, required 5
percent income disregard, and equivalent income standard
Existing state law requires each Medi-Cal applicant who is not a
recipient of aid under the California Work Opportunity and
Responsibility to Kids Act (CalWORKS) or Supplemental Security
Income/State Supplementary Payment (SSI/SSP) to file an
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affirmation setting forth such facts about his or her annual
income and other resources and qualifications for eligibility,
as may be required by DHCS.
Prior to the ACA, federal rules allowed income and asset
eligibility standards to vary across states, and different
standards to apply to different groups within states. For
example, children and pregnant women in California are eligible
for Medi-Cal without an asset test, while families under the
1931(b) coverage category have an asset test. Assets include
cash, savings, stocks, bonds, mutual funds, property, and life
insurance policies with a face value of less than $1,500.
Certain property is exempt, including a home, clothing, and the
first $4,650 value of a car. Property limits vary with family
size. For a family of two persons, the property limit is $3,000.
Effective January 1, 2014, the ACA requires states to change the
way they calculate income for purposes of determining Medi-Cal
eligibility. Under the ACA, state income disregards and asset or
resource tests would no longer apply when calculating income
eligibility (except for specified groups, such as seniors and
individuals eligible for Medicaid on a basis that does not
require determination of income by the Medicaid state agency).
In addition, the ACA prohibits the use of an asset or resource
test, except for:
Individuals eligible for Medicaid on a basis that does not
require a determination of income by the Medicaid state agency
(for example, foster care children, or individuals receiving
SSI);
Individuals who have attained age 65;
Individuals who qualify for Medicaid on the basis of being
blind or disabled regardless of whether the individual is
eligible for SSI;
Medically needy individuals;
Individuals dually eligible for Medicare and Medicaid; and
Individuals whose eligibility is being determined for purposes
of receiving nursing facility services, a level of care in any
institution equivalent to a nursing facility, home or
community-based services furnished under a Medicaid waiver or
state plan amendment.
Instead, the income eligibility for an individual or a family
would be measured based on MAGI. MAGI is defined as the Internal
Revenue Code's Adjusted Gross Income, which allows a number of
income deductions, including trade and business deductions,
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losses from the sale of property, and alimony payments. MAGI is
increased by tax-exempt interest and income earned by U.S.
citizens or residents living abroad.
SB X1 1 would conform state law to the ACA by prohibiting the
use of an asset or resource test for individuals whose financial
eligibility for Medi-Cal is determined based on MAGI. In
addition, SB X1 1 would implement the ACA requirement that a
five percent income disregard applies to individuals whose
income eligibility is determined based on MAGI.
Finally, SB X1 1 would require DHCS, effective January 1, 2014,
to implement an equivalent income level for each eligibility
group whose income level will be converted to MAGI. The
equivalent income level shall not be less than the dollar amount
of all income exemptions, exclusions, deductions, and disregards
in effect on March 23, 2010, plus the existing income level
expressed as a percent of the federal poverty level for each
eligibility group so as to ensure that the use of MAGI income
methodology does not result in populations, who would have been
eligible for either the Medi-Cal Program or the Healthy Families
Program, losing coverage. The state is awaiting further guidance
from the federal government on implementation of the equivalent
income level.
Changes to Pregnancy-Related Coverage in California
Access for Infants and Mothers Program
State law establishes the Access for Infants and Mothers (AIM)
Program, which provides prenatal care, labor and delivery and
coverage for pregnant women with family income between 200
percent and 300 percent of FPL, and for children less than 2
years of age who were born under AIM. AIM coverage continues
for 60 days postpartum. If the 60th day falls in the middle of
the month, coverage terminates as of that date.
Federal regulations for Exchanges (Covered California) require
individuals enrolling between the 1st and the 15th of a month to
have coverage the first day of the following month. For
individuals enrolling between the 16th and the last day of the
month, the Exchange must ensure a coverage effective date on the
first day of the second following month.
SB X1 1 would require, at a minimum, AIM coverage to be provided
to pregnant women during pregnancy, and until the end of the
month in which the 60th day thereafter occurs. This change would
take effect January 1, 2014.
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The purpose of this change is so that coverage does not end in
the middle of the month, to avoid a gap in coverage between when
AIM coverage ends and coverage through the Exchange begins, and
to conform to the existing Medi-Cal requirement to provide
coverage until the end of the month in which the 60th day
occurs.
Full scope coverage for pregnant women in Medi-Cal
State law requires Medi-Cal to cover pregnant women without a
share of cost with incomes below 200 percent of the FPL.
However, the type of coverage a woman receives (full scope
Medi-Cal coverage versus Medi-Cal coverage for pregnancy-only
services) depends upon her income, immigration status, assets,
and whether she meets other criteria (a pregnant woman can only
receive full scope coverage if she has "linkage" to Medi-Cal
because she has a "deprived" child in the home, is in her third
trimester, or is disabled or blind). For example, a low-income
pregnant woman in her first or second trimester with income
below 100 percent of the FPL does not qualify for full-scope
Medi-Cal unless she is otherwise linked to Medi-Cal (such as
being on CalWORKS or disabled) until she reaches her third
trimester.
If a low-income pregnant woman is not eligible for full-scope
benefits, she is eligible for pregnancy-only services without a
share of cost if her income is at or below 200 percent of the
FPL. There is no asset test for pregnancy only coverage.
Pregnancy-only coverage covers prenatal care, labor and
delivery, and care through the end of the month in which the
60th post-partum day occurs.
Draft federal regulations released in January 2013 revise the
Medicaid exemption for pregnancy-related services so that all
services provided to pregnant women must be considered
pregnancy-related unless specifically identified in the state
plan as not pregnancy-related. In addition, the most recent
proposed Internal Revenue Service regulations that define
minimum essential coverage for purposes of meeting the
requirement that individual maintain such coverage (known as the
"individual mandate") states that pregnancy-related services
under Medicaid do not provide minimum essential coverage.
SB X1 1 would require that pregnant women enrolled in Medi-Cal
be provided with all medically necessary services, and not just
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pregnancy-only coverage, unless federal approval is granted to
provide fewer benefits during pregnancy. SB X1 1 would define
"pregnancy-related services" to mean, at a minimum, all services
required under the Medi-Cal program unless federal approval is
granted to provide fewer benefits during pregnancy. This
requirement would take effect January 1, 2014.
The purpose of providing full scope coverage to pregnant women
is to help prevent premature delivery and low birth weight
infants, and to promote women's overall health, well-being, and
financial security and that of their families.
Repeal of semi-annual status reports
Existing state law requires adult Medi-Cal beneficiaries to file
a semi-annual status report in order to remain eligible for
Medi-Cal. Existing state law also requires information about the
semi-annual status report to be included in a notice used by
counties for Medi-Cal beneficiaries.
Regulations implementing the Medicaid ACA changes require
individuals' whose income is determined using MAGI to be renewed
once every 12 months but not more frequently than once every 12
months, thus prohibiting the semi-annual status report
requirement.
SB X1 1 would conform state law to the federal regulation by
repealing the semi-annual status report requirement.
Authorized representative to assist in application and renewal
process
Regulations implementing the ACA Medicaid changes require
agencies to allow individual(s) of the applicant or
beneficiary's choice to assist in the application process or
during a renewal of eligibility.
DHCS indicates it does not have statute or regulation that
defines authorized representatives.
SB X1 1 would require a person who wishes to apply for a state
health subsidy program to be allowed to file an application on
his or her own behalf or on behalf of his or her family. The
individual also would have the right to be accompanied,
assisted, and represented in the application and renewal process
by an individual or organization of his or her choosing. If the
individual for any reason is unable to apply or renew on his or
her own behalf, any of the following persons may file the
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application for the applicant:
The individual's guardian, conservator, or executor;
A public agency representative; or
The individual's legal counsel, relative, friend, or
other spokesperson of his or her choice.
SB X1 1 would give a person, who wishes to challenge a decision
concerning his or her eligibility for or receipt of benefits
from a state health subsidy program, the right to represent
himself or herself or use legal counsel, a relative, a friend,
or other spokesperson of his or her choice.
The purpose of this provision of the bill is to meet the ACA
requirement, and to address an issue raised during the Medi-Cal
managed care stakeholder workgroup process regarding individuals
who are authorized representatives in the federal Social
Security System are not recognized as authorized representatives
by the state Medi-Cal computer system (known as MEDS).
Repeal of deprivation requirement
Under existing state law, the Medi-Cal 1931(b) program covers
children up through age 18 (and up to age 19 if they are
expected to graduate) and parents and caretaker relatives who
are "deprived" of full parental support. Deprivation means at
least one parent in the family must be absent, deceased or
disabled, or the principal wage earner must be unemployed or
underemployed.
The ACA allows states to eliminate the deprivation requirement.
SB X1 1 adopts the ACA option to repeal the deprivation
requirement.
The purpose of eliminating the deprivation requirement is there
is no longer a need for an administratively burdensome and
outdated welfare-based rule when individuals are subject to an
individual mandate and are eligible for coverage.
Requirements prior to terminating Medi-Cal coverage
Existing state law establishes requirements for counties prior
to terminating eligibility for Medi-Cal under legislation known
as SB 87 (Escutia), Chapter 1088, Statutes of 2000. Under SB 87,
counties must make "every reasonable effort" to gather
information available to the county that is relevant to the
beneficiary's Medi-Cal eligibility prior to contacting the
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beneficiary. This includes Medi-Cal, CalWORKS, and CalFresh case
files of the beneficiary or any of his or her immediate family
members.
Federal regulations require the county to make a redetermination
of eligibility without requiring information from the individual
if able to do so based on reliable information contained in the
individual's account, or other more current information
available to the county. If the county is able to renew
eligibility based on such information, the county must notify
the individual of the eligibility determination, basis, and that
the individual must inform the county, through any of the modes
permitted for submission of applications (by telephone, in
person, mail, or through other commonly available electronic
means) if any of the information contained in such notice is
inaccurate. The individual is not required to sign and return
such notice if all information is accurate. If the county cannot
renew eligibility, the county must provide the individual with a
renewal form containing specified information.
SB X1 1 would eliminate the provision that limits the
requirement that counties "make every reasonable effort" to
gather information, thereby requiring counties to gather the
information. It would also require counties to check federal and
state databases to verify financial and non-financial
information.
SB X1 1 would require the county, if it is able to renew
eligibility based on information in the databases, to notify the
individual of the eligibility determination and basis, and that
the individual is required to inform the county if any
information contained in the notice is inaccurate. Under SB X1
1, the individual would not be required to sign and return the
notice if all information provided on the notice is accurate so
as to conform to federal regulations. Counties would be required
to make all reasonable efforts not to send multiple notices
during the same time period about eligibility, and the notice of
eligibility renewal must contain other related information, such
as if the individual is in a new Medi-Cal program.
Under existing state law, if a county cannot obtain information
necessary to redetermine eligibility, counties have to attempt
to reach the beneficiary by telephone. SB X1 1 would also
require the county to attempt to reach the beneficiary through
other commonly available electronic means (for example, email or
text) in counties where such electronic means are available.
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Under existing state law, if a county's efforts to obtain the
information necessary to redetermine eligibility have failed,
the county is required to send to the beneficiary a form which
highlights the information needed to complete the eligibility
determination. SB X1 1 would repeal this requirement and instead
require the county to send a form containing information
available to the county needed to renew eligibility, and would
require the form to advise the individual to provide any
necessary information to the county via internet, telephone,
mail, in person or through other commonly available electronic
means, and to sign the renewal form. This bill would prohibit a
county from requesting information from non-applicants necessary
to make an eligibility determination.
Under existing state law, if a beneficiary submits an incomplete
form, counties must attempt to contact the beneficiary by
telephone.
SB X1 1 would require counties to attempt to contact the
beneficiary in writing and other commonly available electronic
means in counties where such electronic communication is
available.
Federal regulations implementing the Medicaid ACA-related
changes extend this 30-day timeframe. These regulations require,
for individuals whose income is determined based on MAGI, annual
eligibility redeterminations to be reconsidered if an individual
whose eligibility has been terminated for failure to submit the
renewal form or necessary information submits the required
information within 90 days , or a longer period elected by the
state, without requiring a new application.
Under existing state law, if a Medi-Cal beneficiary is
terminated from coverage, but that former beneficiary submits a
completed form within 30 days of termination, the county is
required to determine eligibility as though the form was
submitted in a timely manner. If the beneficiary is found
eligible, existing law requires the termination to be rescinded.
SB X1 1 would conform state law to the federal regulation by
codifying the 90-day federal requirement, but would not extend
it beyond 90 days.
SB X1 1 would also require the county, if it has enough
SB X1 1 | Page 16
information available to it to renew eligibility with respect to
all eligibility criteria, to begin a new 12-month eligibility
period. For individuals determined ineligible for Medi-Cal, SB
X1 1 would require the county to determine eligibility for other
state health subsidy programs, and comply with specified
procedures in existing law. SB X1 1 would also require any
renewal form or notice to accessible to persons who are limited
English proficient and persons with disabilities consistent with
all federal and state requirements.
Blindness and disability
Federal regulations allow counties determining eligibility to
consider blindness as continuing until the reviewing physician
determines that a beneficiary's vision has improved beyond the
definition of blindness contained in the state's Medicaid State
Plan. In addition, the Medicaid ACA-related changes allow the
county to consider disability as continuing until the review
team determines that a beneficiary's disability no longer meets
the definition of disability contained in the plan.
SB X1 1 would adopt the two federal options outlined above. DHCS
indicates this provision adopts its current policy.
Redetermination of Medi-Cal eligibility
Existing state law requires Medi-Cal redetermination to be filed
annually. Existing law permits redetermination to be required at
other times in accordance with general standards established by
DHCS.
Federal regulations implementing the Medicaid ACA changes
prohibit an individual whose income is determined using the MAGI
methodology to be renewed once every 12 months but not more
frequently than once every 12 months, thus prohibiting the
semi-annual status report requirement.
SB X1 1 eliminates the semi-annual status report requirement to
conform to federal requirements.
Implementation of Income Option
Federal regulations implementing the ACA require, for applicants
and new enrollees, financial eligibility to be based on current
monthly household income and family size. For current
beneficiaries, individuals who have been determined financially
eligible for Medicaid using the MAGI-based methods, a state may
elect to base financial eligibility either on current monthly
household income and family size or income based on projected
SB X1 1 | Page
17
annual household income and family size for the remainder of the
current calendar year.
SB X1 1 would require DHCS to adopt procedures to take into
account projected future changes in income and family size, for
individuals whose Medi-Cal income eligibility is determined
using MAGI-based methods, in order to grant or maintain
eligibility for those individuals who may be ineligible or
become ineligible if only the current monthly income and family
size are considered.
For current beneficiaries, SB X1 1 would require DHCS to base
financial eligibility on projected annual household income for
the remainder of the current calendar year if the current
monthly income would render the beneficiary ineligible due to
fluctuating income. For applicants, DHCS would be required to
base an initial determination of eligibility on the projected
annual household income and family size for the upcoming year if
considering the current monthly income and family size in
isolation would render an applicant ineligible.
SB X1 1 would require DHCS to implement a reasonable method to
account for a reasonably predictable decrease in income and
increase in family size, as evidenced by a history of
predictable fluctuations in income or other clear indicia of a
future decrease in income and increase in family size. SB X1 1
would prohibit DHCS from assuming potential future increases in
income or decreases in family size to make an applicant or
beneficiary ineligible in the current month.
The MC 210 application for Medi-Cal instructs individuals to
list how much income they receive. The MC 210 instructs
individuals, who know that their family's income will fluctuate
in the next few months, to explain this on a separate sheet of
paper. The provision in allowing the use of projected annual
income SB X1 1 provides individuals the option to still enroll
in Medi-Cal by using their annual income if they have knowledge
their annual income is likely to be lower than their current
income in the month they apply for Medi-Cal.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, SB X1 1 expands
SB X1 1 | Page 18
Medi-Cal eligibility up to 138 percent of the FPL to adults who
are not currently Medi-Cal eligible. This expansion is estimated
to result in more than 1.4 million Californians being newly
eligible for Medi-Cal, of whom between 750,000 and 910,000 are
expected to be enrolled at any point in time by 2019. There are
multiple policy and fiscal reasons for implementing the expansion,
including:
Reducing the number of uninsured in California;
Improving the health status of the newly eligible Medi-Cal
recipients;
Providing significantly enhanced federal funding for
California;
Providing enhanced funding for safety-net health care
providers to serve the 3.1 to 4 million remaining uninsured;
Reducing health care providers' uncompensated care costs;
and
Preventing lower income individuals from being without
access to affordable health care coverage when higher income
individuals have access to tax credits that reduce premium and
cost-sharing costs in Covered California.
The policy and fiscal reasons for using the Medi-Cal benefit
package for the expansion population and the current eligible
population are to:
Provide a consistent benefit package across both existing
and expansion Medi-Cal population;
Make the program easier to administer for health plans,
providers, counties and the state;
Eliminate the incentive to shift from benchmark coverage to
the existing Medi-Cal benefit package for enhanced benefits not
available to expansion population at higher state cost;
Provide an economic stimulus benefit from enhanced federal
funding from a broader benefit package; and
Avoid having to oversee costly and administratively
difficult exemptions from the benchmark benefit packages.
Finally, SB X1 1 implements a number of the Medicaid ACA
provisions to simplify the eligibility, enrollment, and
renewal processes for Medi-Cal coverage.
1.Should the state adopt the Medicaid expansion? The policy and
fiscal reasons for implementing the federal Medicaid expansion
include:
The Medicaid expansion would reduce the number of
uninsured in California . According to a California
SB X1 1 | Page
19
HealthCare Foundation's December 2012 publication on
California's uninsured, California had the largest total
number of people under 65 years of age without health
insurance - 7.1 million - of any state in the nation.
Implementing the Medi-Cal expansion would allow hundreds of
thousands of currently uninsured adults to obtain medically
needed services through the Medi-Cal program.
Medicaid reduces mortality, improves access to health
care, improves financial security and improves
self-reported health status . According to data from UC
Berkeley-UCLA CalSIM model, Version 1.8, 31 to 36 percent
of individuals projected to enroll in Medi-Cal who are in
the expansion population rate their health status as "fair"
or "poor." A UCLA Center for Health Policy Research 2012
Fact Sheet reported that 68.5 percent of uninsured adults
with mental health needs, who were between the ages of 18
to 65, received no treatment. The UCLA Fact Sheet indicated
that 254,000 individuals or 47 percent of the 541,000
uninsured individuals with mental health needs would be
eligible for the Medi-Cal expansion.
A study published in the September 2012 edition of the New
England Journal of Medicine (NEJM) compared three states
that have substantially expanded adult Medicaid eligibility
since the year 2000 (New York, Maine, and Arizona) with
neighboring states without expansions. The study reported
that Medicaid expansions were associated with a significant
reduction in mortality, decreased rates of uninsurance,
decreased rates of delayed care due to costs, and increased
rates of self-reported health status of "excellent" or
"very good." The NEJM study concluded that "[S]tate
Medicaid expansions to cover low-income adults were
significantly associated with reduced mortality as well as
improved coverage, access to care, and self-reported
health."
Another study published in the August 2011 edition of the
NEJM examined Oregon's use of a lottery in 2008 to allocate
a limited number of Medicaid spots for low-income adults
(19 to 64 years of age) to people on a waiting list for
Medicaid. The study found people with Medicaid had improved
access to medically needed health care, including being 70
SB X1 1 | Page 20
percent more likely to have a regular place of care and 55
percent more likely to report having a usual doctor.
Medicaid coverage also increased the use of preventive care
such as mammograms (by 60 percent) and cholesterol
monitoring (by 20 percent). Medicaid coverage also provided
improved financial protection, reducing by 40 percent the
probability that people report having to borrow money or
skip payment on other bills because of medical expenses and
decreasing by 25 percent the probability that they will
have unpaid medical bills that are sent to a collection
agency. Finally, the study found Medicaid coverage improves
self-reported health as compared with being uninsured.
Medicaid enrollees were 25 percent more likely to indicate
they are in good, very good or excellent health, and 25
percent less likely to screen positive for depression.
The Medicaid expansion provides significantly enhanced
federal funding for California . Under the ACA, the cost of
Medicaid benefits for the expansion population are 100
percent federally funded for the first three years
(2014-2016), 95 percent federally funded in 2017, 94
percent federally funded in 2018, 93 percent federally
funded in 2019 and 90 percent federally funded in 2020 and
thereafter. States will be able to offer a significant
benefit to some of their residents while bearing only a
small fraction of the costs. The UC Berkeley Labor
Institute and the UCLA Center for Health Policy Research
estimate the Medi-Cal expansion and enrollment growth among
those already eligible is predicted to bring between $2.1
and $3.5 billion in new federal Medi-Cal dollars to
California in 2014, growing to between $3.4 and $4.5
billion in 2019.
Increased funding for health care safety net . The
Medi-Cal expansion will provide more funding for safety net
health care providers that currently care for Medi-Cal
beneficiaries, the uninsured and low-income populations,
and will reduce health care providers' uncompensated care
costs. While the ACA will make a significant reduction in
the number of uninsured in California, an estimated 3.1 to
4 million individuals will remain uninsured in 2019
following implementation of the ACA. These "residual
uninsured" will continue to access safety net providers for
their care, and the Medi-Cal expansion will assist these
providers by providing additional revenue through Medi-Cal
and by reducing the amount of uncompensated care from
SB X1 1 | Page
21
expansion-eligible individuals who were previously
uninsured.
Failure to expand Medi-Cal is inequitable to the
lowest-income adults . The ACA provides refundable and
advanceable tax credits that reduce premium costs for
individuals with incomes between 100 and 400 percent of the
FPL, and legal immigrants who are ineligible for Medicaid
with incomes below 100 percent of the FPL up to 400 percent
of the FPL who purchase coverage through Covered
California. In addition, individuals with incomes up to 250
percent of the FPL purchasing coverage in the silver tier
through Covered California and legal immigrants below 100
percent of FPL who are ineligible for Medicaid are eligible
for reduced cost-sharing (e.g., coverage with lower
deductibles and co-payments).
If California fails to enact the Medicaid expansion, premium
and cost-sharing subsidies will be provided to Californians
with incomes between 100 and 400 percent of the FPL but
California adults who are not immigrants without children
with incomes below 100 percent of the FPL will not be
eligible for any public program or premium subsidies.
States costs of covering increased enrollment of people
who are already Medi-Cal eligible will occur whether or not
the state expands Medi-Cal . According to the UC Labor
Institute and the UCLA Center for Health Policy Research,
about 2.5 million Californians are already eligible for
Medi-Cal but not enrolled. Between 240,000 and 510,000 of
these eligible but not yet enrolled Californians are
expected to be enrolled in Medi-Cal coverage at any point
in time by 2019.
A state will have to incur certain costs under the ACA even
if it does not expand Medicaid. The ACA's requirement to
purchase insurance (known as the individual mandate), its
required simplification of Medicaid eligibility procedures,
and the significant outreach and education that will be
aimed at encouraging individuals to apply for subsidized
coverage in the Exchanges will increase Medicaid
participation among individuals who are currently eligible
but are not enrolled, even if a state rejects the Medicaid
SB X1 1 | Page 22
expansion. A state will incur some additional costs for
covering some of these individuals regardless of whether it
expands Medicaid, and such costs cannot be attributed to
the Medicaid expansion.
Failure to provide Medicaid expansion is projected to
increase private insurance rates . According to a Decision
Brief by the American Academy of Actuaries, states'
decisions to expand Medicaid eligibility will affect not
only access to coverage and costs to the federal government
and the states, but also the premiums for private insurance
coverage. For example, the ACA provides premium subsidies
to individuals purchasing coverage in the Exchange if they
have income between 100 percent and 400 percent of FPL and
who are not eligible for Medicaid or are not offered
employer-sponsored coverage that meets minimum value and
affordability requirements. Individuals below 100 percent
of FPL who are not eligible for Medicaid are not eligible
for subsidies in the Exchange.
If a state opts not to extend Medicaid eligibility to 138
percent of FPL, then individuals 100 percent to 138 percent
of FPL who otherwise would have been eligible for Medicaid
will have access to premium subsidies in the Exchange. This
population can be expected to have higher health care needs
than higher-income Exchange enrollees. The Congressional
Budget Office (CBO) estimates that, due to the likely
higher health spending among lower-income enrollees,
average individual market premiums will be 2 percent higher
than projections made under the assumption that all states
expand Medicaid to 138 percent of FPL. This CBO estimate
reflects the increase in average premiums overall,
including not only states that opt out of the Medicaid
expansion but also those that expand Medicaid. Therefore,
premium increases would be even higher among those states
that do not expand Medicaid. Premium increases would be
borne by nonsubsidized purchasers and by the federal
government for subsidized enrollees.
States cannot enact partial expansions and receive
enhanced federal funding . In December 2012, the federal CMS
indicated that states cannot enact partial Medicaid
expansions and still receive the enhanced federal funding
available under the ACA. Congress directed that the
enhanced Medicaid matching rate be used to expand coverage
SB X1 1 | Page
23
to 138 percent of the FPL, and the law does not provide for
a phased-in or partial expansion. As such, CMS indicated it
will not consider partial expansions for populations
eligible for the 100 percent matching rate in 2014 through
2016. CMS indicates that if a state that declines to expand
coverage to 138 percent of FPL, and would like to propose a
demonstration project that includes a partial expansion,
CMS would consider such a proposal to the extent that it
furthers the purposes of the program, subject to the
regular federal matching rate (which in California is
usually 50 percent state funds, 50 percent federal funds).
In 2017, when the 100 percent federal funding is slightly
reduced, further demonstration opportunities will become
available to states under State Innovation Waivers with
respect to the Exchanges, and the law contemplates that
such demonstrations may be coupled with section 1115
Medicaid demonstration projects. This demonstration
authority offers states significant flexibility while
ensuring the same level of coverage, affordability, and
comprehensive coverage at no additional costs for the
federal government. CMS indicated it will consider section
1115 Medicaid demonstrations, with the enhanced federal
matching rates, in the context of these overall system
demonstrations.
Hospitals in states that do not enact Medicaid expansion
will still receive reduced "disproportionate share"
hospital payments . Federal disproportionate share hospital
(DSH) payments provide additional federal funds to those
hospitals that serve a significantly disproportionate
number of low-income and Medi-Cal patients. The annual DSH
allotment is calculated by federal law.
Beginning in federal fiscal year 2014, the ACA dramatically
decreases the amount of funding that will be provided under
both DSH programs, based on the premise that the ACA
coverage expansions will result in fewer individuals
receiving uncompensated care. Under the ACA, the federal
Secretary of DHHS is required to develop a methodology that
will reduce the DSH payments by $14.1 billion during the
period 2014 to 2019, pursuant to a schedule set out in the
ACA. These reductions increase over time, and by 2019
represent an approximate 50 percent reduction over baseline
SB X1 1 | Page 24
projections. These reductions will occur even if states do
not expand Medicaid.
California's DSH allotment for 2013-14 is estimated to be
$1.132 billion. The DHCS' 2013-14 budget assumes a
reduction of 4.4 percent will be applied in 2013-14. This
will result in reductions in DSH payments to private
hospitals (known as "virtual DSH") of $31.9 million ($15.9
million state funds/$15.9 million federal funds) and $69.4
million to public DSH hospitals ($24 million non-federal
funds/$45.4 million federal funds).
If California does not expand Medi-Cal up to 138 percent of
FPL, the need for funding to address uncompensated care
will continue, while the amount of DSH funds that were
previously used to subsidize some of the costs of that care
will decrease substantially. This may lead some hospitals
to provide less uncompensated care or pursue higher
payments from health plans or other third-party payors to
offset additional uncompensated care costs.
1.Arguments for Medi-Cal having the same benefit package. The
policy and fiscal reasons for using the Medi-Cal benefit
package for the expansion population and the EHB for the
currently eligible population are as follows:
Consistent benefit package across both existing and
expansion Medi-Cal population . Requiring the expansion
population and the current Medi-Cal population to receive
the same benefit package will ensure coverage is available
and affordable for this population which has virtually no
ability to afford private individual coverage at these
income levels. Aligning benefits received by the existing
Medi-Cal population will provide a consistent benefit
package to both the currently eligible and the expansion
population, and will ensure continuity of care by
eliminating the need to shift benefit packages if Medi-Cal
beneficiaries move into a different eligibility category
because of a change in eligibility.
Ease of administration for providers and state . One
uniform benefit package for both the newly eligible
expansion population and current Medi-Cal program will be
administratively simpler for the state, counties, health
plans, and health care providers to administer.
Eliminates incentive to shift from benchmark coverage to
SB X1 1 | Page
25
the existing Medi-Cal benefit package for enhanced benefits
not available to expansion population at higher state cost .
Aligning benefits would simplify the eligibility and
enrollment processes for the counties by eliminating the
need for additional levels of eligibility determination if
a person is in need of services covered under the existing
Medi-Cal benefit package, but not under the benchmark
benefit package provided to the expansion population if the
current Medi-Cal benefit package is not chosen for the
expansion population. For example, if an individual is
eligible under the Medi-Cal expansion, but also eligible
for the current Medi-Cal program because he or she is
disabled or in need of long-term services and support
services (such as In-Home Supportive Services) that are not
covered by the more narrow benchmark benefit packages, such
an individual will seek coverage under the existing
Medi-Cal program to obtain these additional services. Such
an individual would have to go through an additional
eligibility determination, and the state may only receive
the regular 50 percent federal matching rate (instead of
the enhanced matching rate in the ACA).
Economic stimulus benefit of enhanced federal funding
from broader benefit package . States have an economic
incentive to provide an enhanced benefit package for the
expansion population because the broader benefit package
will draw additional federal Medicaid funds into the
California economy because the expansion population is
eligible for 100 percent federal financing for the first
three years of the expansion. As noted previously, the
enhanced federal funding reduces to 95 percent in 2017, 94
percent in 2018, 93 percent in 2019 and 90 percent in 2020
and thereafter.
Exemptions from benchmark benefit packages would be
costly to administer . Federal Medicaid law prevents certain
groups from being required to enroll in benchmark or
benchmark equivalent benefits. For example, pregnant women,
individuals who are blind or disabled, individuals dually
eligible for Medicare and Medicaid, terminally ill
individuals receiving hospice care under Medi-Cal,
medically frail individuals and other groups (known as
"exempt individuals" in federal regulation) can be offered
benchmark or benchmark-equivalent coverage, but are not
required to enroll. Federal regulations require states to
SB X1 1 | Page 26
offer exempt individuals the option to enroll in benchmark
or benchmark equivalent coverage but require states to
inform individuals that enrollment is voluntary, and that
they may disenroll at any time. Federal regulations also
require states to inform individuals of the difference in
the benefit packages prior to enrollment, and to document
that the individual was informed prior to enrollment in the
individual's eligibility file.
1.Legislative Analyst's Office (LAO) Report. In February 2013,
the LAO released a report entitled "Examining the State and
County Roles in the Medi-Cal Expansion." The LAO states the
expansion would likely have significant policy benefits,
including improved health outcomes for the newly eligible
Medi-Cal population. In the short term, fiscal savings to the
state as a whole would far outweigh the nonfederal costs
associated with providing health care to the expansion
population. After a decade, when the enhanced federal matching
rate is reduced from 100 percent to 90 percent, the LAO
estimates that overall savings to the state as a whole (state
and local governments) would likely continue to outweigh
costs. Despite the significant uncertainty about the long-term
costs and savings associated with the expansion, on balance,
the LAO believes the policy merits of the expansion and the
fiscal benefits that are likely to accrue to the state as a
whole outweigh the costs and potential fiscal risks. The LAO
recommends the state adopt the optional expansion.
The LAO also states that it finds that the state is in a better
position than the counties to effectively organize and
coordinate the delivery of health services to the newly
eligible population-potentially resulting in improved health
outcomes and administrative efficiencies. As a practical
matter, the LAO also believes the state is better positioned
than the counties to successfully implement an expansion by
January 1, 2014. The LAO recommends the Legislature adopt a
state-based expansion, shifting the fiscal and programmatic
responsibility of providing health care to the expansion
population from counties to the state. Given this shift of
responsibility, the LAO further finds that implementation of a
state-based approach results in the need for a reexamination
of state-county funding arrangements for indigent health care.
Accordingly, the LAO recommends the Legislature redirect a
portion of funding currently allocated to counties under 1991
realignment for indigent health.
SB X1 1 | Page
27
2.Related legislation
AB X1 1 (John A. Pérez) is identical to this measure. ABX1 1 was
heard in the Assembly Health Committee on February 19, 2013, and
passed on a 13-6 vote.
SB X1 3 (Hernandez) establishes legislative intent to create a
bridge option that allows low-cost health coverage to be
provided to individuals within Covered California. SBX1 3 is
pending referral in the Senate Rules Committee.
SB 28 (Hernandez and Steinberg) implements various provisions of
the ACA regarding Medi-Cal eligibility and program
simplification including the use of the MAGI and expansion of
eligibility in the Medi-Cal program and is substantially similar
to SB X1 1. SB 28 is currently in the Senate Health Committee.
AB 50 (Pan) implements various provisions of the ACA related to
allowing hospitals to make a preliminary determination of
Medi-Cal eligibility, allows forms for renewal to be
prepopulated with existing available information and requires
the process for Medi-Cal enrollees to choose a plan to be
coordinated with the Exchange. AB 50 is currently in the
Assembly Health Committee.
3.Prior legislation
AB 43 (Monning) and SB 677 (Hernandez) of the 2011-2012 session
were substantially similar to SB 28 of this session. SB 677 died
on the Assembly Inactive File and AB 43 died on the Senate
Inactive File.
SB 1487 (Hernandez) also from the 2011-2012 session would have
required DHCS to extend Medi-Cal eligibility to youth who were
formerly in foster care and who are under 26 years of age,
subject to FFP being available and to the extent required by
federal law. SB 1487 would have also made legislative findings
and declarations regarding the ACA, stated legislative intent to
ensure full implementation of the ACA, and to enact into state
law any provision of the ACA that may be struck down by the
United States Supreme Court. SB 1487 was held on the Senate
Appropriations Committee suspense file.
4.Support. This bill is supported by Consumers Union, Health
Access California, Western Center on Law & Poverty, the
Congress of California Seniors, the California Labor
SB X1 1 | Page 28
Federation, the California Primary Care Association, the
California Academy of Family Physicians, the American Cancer
Society Cancer Action Network, and the American Heart
Association, among others. Generally, proponents argue this
bill is the largest expansion of Medi-Cal since 1966, will
make 1.4 million Californians eligible for coverage and draw
down an estimated $2.1 to $3.5 billion in federal funds in
2014 alone. This will help create jobs in the health care
workforce, improve worker productivity, and increase local and
state tax revenues. Proponents argue expanding Medi-Cal will
extend lifesaving health coverage to millions, provide
preventive care and improve health outcomes for those who
receive coverage. Proponents cite specific provisions of the
bill and federal law that they support, including the enhanced
federal matching rate for the expansion population, the
Medi-Cal coverage expansion to former foster youth and
low-income adults, the extension of full scope benefits to
pregnant women, the addition of the EHB to Medi-Cal coverage,
the elimination of the deprivation and asset tests, and the
program simplification provisions. Los Angeles County writes
in support that there are 2.2 million uninsured people in Los
Angeles County, and half of these individuals will be eligible
for Medi-Cal benefits, including many of the 240,000
participants in its LIHP.
5.Support in concept. The California State Council of the
Service Employees International Union (SEIU) supports this
bill in concept as it supports full implementation of the ACA.
SEIU states it would like to continue discussions aimed at
ensuring there will be increased access to high quality
affordable health care and raise provider rates, which are
presently inadequate. SEIU supports finding new revenue
sources to ensure adequate long term financing for expanded
access to high quality health care and ensuring the state
maintains funding for the public and private safety-net health
care systems. SEIU states it will continue working with the
Legislature and Governor on developing clear protocols and
coordination between county Medi-Cal eligibility operations
and Covered California that supports all Californians seeking
coverage.
6.Support and request amendments. Organizations including the
California Pan-Ethnic Health Network, the Latino Health
Alliance, the California Immigrant Policy Collaborative, PICO
California, California School Health Centers, Latino Coalition
for a Healthy California, the Alliance for Boys and Men of
SB X1 1 | Page
29
Color Health Policy Work Group, the Children's Defense Fund,
PolicyLink, the California Health Advocates, and the
California Primary Care Association write in support but ask
that this bill be amended to include within the Medi-Cal
expansion all legal permanent resident adults with incomes
less than 138 percent of the FPL. These groups argue refusing
to act will result in many low-income immigrants being denied
access to affordable coverage in 2014, and immigrants earning
less than $15,856 a year will be required to pay monthly
premiums and out-of-pocket expenses that are unaffordable.
Children Now writes in support and requests amendments to
specify that DHCS work with community-based organizations and
other stakeholders to design an effective outreach plan and
that the former foster youth expansion be implemented
immediately for people aging out of Medi-Cal so as to achieve
parity with young adults who have not been in foster care.
The California Association of Public Hospitals writes in support
of this bill and also suggests amendments to help maintain
continuity of care, minimize confusion for enrollees, and
conform to with the Administration's LIHP transition plan.
The California Opioid Maintenance Providers (COMP) write in
support but also requests that language in this bill
specifically states that all current Medi-Cal benefits,
including the optional benefits delivered through Drug
Medi-Cal must be covered. COMP states ensuring coverage of
those services provided through the Drug Medi-Cal Program will
yield significant outcomes and savings.
SUPPORT AND OPPOSITION :
Support: Alliance for Boys and Men of Color
American Cancer Society Cancer Action Network
American Federation of State, County, and Municipal
Employees
American Heart Association
California Academy of Family Physicians
California Association of Public Hospitals and Health
Systems
California Coverage and Health Initiatives
California Health Advocates
California Hospital Association
California Immigrant Policy Center
California Labor Federation
SB X1 1 | Page 30
California Mental Health Directors Association
California Nurses Association
California Opioid Maintenance Providers
California Pan-Ethnic Health Network
California Primary Care Association
California School Employees Association, AFL-CIO
California School Health Centers Association
California State Association of Counties
Californians for Patient Care
Children Now
Children's Defense Fund California
Congress of California Seniors
Consumers Union
County Welfare Directors Association of California
Epilepsy California
Health Access California
Latino Health Alliance
Los Angeles County Board of Supervisors
March of Dimes Foundation - California Chapter
National Association of Social Workers - California
chapter
National Health Law Program
PICO California
Planned Parenthood
San Mateo County Central Labor Council
Service Employees International Union
The Children's Partnership
The Greenlining Institute
Transgender Law Center
United Ways of California
Western Center on Law and Poverty
100% Campaign
Oppose: None received
-- END --