BILL ANALYSIS Ó
SB 1 X1
Page 1
SENATE THIRD READING
SB 1 X1 (Ed Hernandez and Steinberg)
As Amended June 14, 2013
Majority vote
SENATE VOTE : 24-7
HEALTH 13-5
--------------------------------
|Ayes:|Pan, Ammiano, Atkins, |
| |Bonilla, Bonta, Chesbro, |
| |Gomez, |
| |Roger Hernández, |
| |Lowenthal, Mitchell, |
| |Nazarian, V. Manuel |
| |Pérez, Wieckowski |
| | |
|-----+--------------------------|
|Nays:|Maienschein, Mansoor, |
| |Nestande, Wagner, Wilk |
| | |
--------------------------------
SUMMARY : Enacts, along with AB 1 X1 (John A. Pérez), statutory
changes necessary to implement the Medicaid (Medi-Cal in
California) and the California Children's Health Insurance
(CHIP) coverage expansion, eligibility, simplified enrollment,
and retention provisions of the Patient Protection and
Affordable Care Act of 2010 as amended by the Health Care and
Education Reconciliation Act of 2010 (ACA). Contains the
provisions of the ACA relating to benefits. Makes the enactment
of this bill contingent upon enactment of AB 1 X1 (John A.
Pérez). Specifically, this bill :
1)Requires the Department of Health Care Services (DHCS) to
provide assistance to any applicant or beneficiary who
requests help with an application or with the redetermination
process, and requires assistance to be available in person,
over the telephone, and online in a manner that is accessible
to individuals with disabilities or with limited English
proficiency.
2)Authorizes an individual applying for an insurance
affordability program to be accompanied, assisted, and
represented in the application and renewal process by
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individuals or organizations of his or her choice. Authorizes
specified persons to apply or renew on behalf of an individual
who is unable to apply or renew on their own behalf.
Authorizes a person who wishes to challenge an eligibility
decision to be represented by herself, himself, legal counsel,
or other specified spokespersons of his or her choice. Makes
this section effective October 1, 2013.
3)Establishes guidelines to protect individual privacy and the
integrity of the Medi-Cal program and other insurance
affordability programs by adopting requirements and safeguards
for authorized representatives (AR), effective October 1,
2013, including: a) a requirement for a completed
authorization form specifying the scope of the authority, what
notices are to be sent to the AR, and that it is effective
until canceled or modified, or the AR is otherwise replaced;
b) a requirement that an AR can be canceled or modified at any
time for any reason by the program or the enrollee; c) a
definition of AR and other relevant terms; d) a requirement
that employees or contractors of providers so disclose this
relationship; and, e) authorization for an AR at state fair
hearings, even if one has not been designated under these
provisions.
4)Provides, commencing January 1, 2014, to the extent federal
financial participation (FFP) is available, an adolescent who
is in foster care in California on his or her 18th birthday is
to be deemed eligible without interruption and without
requiring a new application; requires DHCS to develop
procedures to identify and enroll individuals under age 26 who
meet the criteria as former foster care youth, including those
who lost coverage as result of attaining the age of 21 and
those who were in foster care in another state and to work
with counties to identify and conduct outreach to former
foster care adolescents who lost coverage as a result of
attaining the age of 21, requires a simplified redetermination
form and requires the return of the form only if information
known to DHCS is no longer accurate or is materially
incomplete; and, a renewal process that allows some former
foster youth covered under this section to remain on
fee-for-service Medi-Cal after a redetermination form is
returned as undeliverable and the county is otherwise unable
to establish contact, until contact is reestablished.
5)Repeals, effective January 1, 2014, the requirement that
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adults file mandatory semiannual status reports regardless of
whether there have been any changes in income, family size, or
other factors that affect continued eligibility for the
Modified Adjusted Gross Income (MAGI)-based categories and
eliminates the requirement that a notice of action include the
requirement to file this status report.
6)Requires DHCS to seek approval to allow beneficiaries to use
projected annual income and to allow applicants and
beneficiaries to use reasonable predictable annual income when
determining eligibility if current income would render the
beneficiary ineligible. Requires a redetermination at the end
of the calendar year.
7)Requires DHCS to seek approval to use eligibility information
from the CalFresh program (formerly known as Food Stamps), to
automatically enroll parents into Medi-Cal if they have
children in Medi-Cal and are eligible based on an income level
that is at or below the maximum. Allows expedited Medi-Cal
eligibility of parents with children enrolled in Medi-Cal and
authorizes the use of eligibility information from other
specified state and county programs.
8)Codifies and revises existing regulations that define
residency by repealing the requirement that a determination of
residency is not to be granted unless the evidence supports
intent to remain indefinitely and instead provides that
residency is established by an intent to reside, regardless of
a fixed address, or if the individual has entered the state
with a job commitment or is seeking employment, effective
January 1, 2014. Establishes residency determinations for
individuals who are under 21 years of age, those without a
fixed address, and individuals, including those under age 21,
who are incapable of stating intent or who are living in an
institution.
9)Revises, reenacts, and recasts provisions relating to proof of
state residency and requires state residency to be verified
electronically using information from specified state
databases such as the Franchise Tax Board or the Department of
Motor Vehicles, effective January 1, 2014. Specifies
documentation that may be used to verify residence.
10)Allows qualified hospitals to make presumptive eligibility
determinations, effective January 1, 2014.
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11)Repeals the provisions establishing eligibility for the
Section 1931(b) program that sets the maximum income at 100%
of the federal poverty level (FPL), authorizes additional
income disregards and deductions, and requires that Medi-Cal
eligibility for these families is based on establishing
"deprivation" of a child, as defined, effective January 1,
2014.
12)Establishes a premium assistance program for legal immigrants
who would otherwise be eligible for Medi-Cal coverage under
the expansion for childless adults, but for the five-year
eligibility limitations and are eligible for advanced premium
tax credit, and provides for Medi-Cal eligibility until it is
implemented, effective January 1, 2014.
13)Requires DHCS to obtain approval from the U.S. Secretary of
Health and Human Services (HHS) 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, limits coverage for long-term services and supports
to those individuals who meet asset limit requirements, to the
extent federal approval is obtained or unless otherwise
qualify under the medically frail exemption.
14)Expands the Medi-Cal benefit package for existing and newly
eligible Medi-Cal beneficiaries to include mid-level mental
health services and substance use disorder services to conform
to the ACA definition of essential health benefits (EHBs)
(Kaiser Small Group, as designated in the individual market
and small groups in the Exchange), including group therapy,
psychology and specified substance abuse disorder services.
Limits certain behavioral health treatments to individuals who
qualify for services as developmentally disabled.
15)Makes legislative findings and declarations and states it is
the intent of the Legislature to ensure full implementation of
the ACA, including the Medi-Cal expansion for individuals with
incomes below 133% of the FPL, so that millions of uninsured
Californians can receive health care coverage.
16)Provides that implementation of the expansion of Medi-Cal to
citizens and legal immigrants between the ages of 19 and 65,
who are not eligible for other programs, is contingent: a) if
the federal medical assistance percentage (FMAP) payable to
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the state under the ACA for the optional expansion of Medi-Cal
benefits to adults is reduced below 90%, that reduction is to
be addressed in a timely manner through the annual state
budget or legislative process; and; b) if prior to January 1,
2018, the FMAP payable to the state under the ACA for the
optional expansion of Medi-Cal benefits to adults is reduced
to 70% or less, the implementation of the optional expansion
is to cease 12 months after the effective date of the federal
law or other action reducing the FMAP.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
1)The Mandatory Expansion. By simplifying the process for
determining eligibility for Medi-Cal and enrolling program
participants, this bill will increase enrollment in the
program. The Legislative Analyst's Office (LAO) projects that
the total costs due to increased enrollment of people already
eligible for the program will be about $620 million in 2014-15
($290 million General Fund (GF) at traditional cost sharing),
rising to about $1.1 billion in 2020-21 ($460 million GF).
Note that these costs will occur due to changes mandated by
federal law.
2)The Optional Expansion. By expanding Medi-Cal eligibility to
all childless adults under age 65 with household income below
138% of FPL, this bill substantially increases the eligible
population, increasing program costs. Under the ACA, FFP will
be substantially higher than current practice, starting at
100% and declining to 90% by 2020 and thereafter.
a) State Medi-Cal health care costs. The LAO projects
that, under reasonable assumptions, about 1.8 million
additional people will be eligible for Medi-Cal under this
bill and that about 65% of eligible persons will enroll in
the program. In 2014-15, total projected costs for medical
services under the optional expansion are projected to be
about $3.5 billion per year, entirely funded by the federal
government. In 2020-21, the total costs for medical
services under the optional expansion are projected to be
$6 billion per year, including about $605 million per year
in GF costs (based on the ultimate 90% federal matching
rate for the optional expansion population).
b) State Medi-Cal administrative costs. In addition to the
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direct costs to provide medical services to the expansion
population, there will be administrative costs to make
eligibility determinations and enroll beneficiaries in
Medi-Cal. Due to the changes to eligibility and enrollment
processes under this bill, per capita administrative costs
associated with the expansion population may be lower than
current per capita administrative costs. Administrative
costs are subject to the standard 50% federal matching
rate. By 2020-21, state GF administrative costs are likely
to be in the low tens of millions per year.
c) State savings in other health care programs and in
corrections. The LAO also indicates that the state will
see substantial savings in other state health-subsidy
programs, such as the Genetically Handicapped Persons
Program, the Breast and Cervical Cancer Treatment Program,
and other programs. As Medi-Cal eligibility increases,
some participants in these state programs will be eligible
for full scope health benefits from Medi-Cal and may no
longer need services from these specialized programs.
There is a good deal of uncertainty about the impact of the
Medi-Cal expansion on these programs, but the LAO indicates
that state savings could be in the low hundreds of millions
per year. In addition, the state could experience GF
savings up to $60 million per year due to the shift of
certain outpatient medical costs for inmates to Medi-Cal
under the expansion.
d) County health care savings. Under current law, county
governments are responsible for providing certain health
care services to medically indigent adults who do not
qualify for other public health care programs. Under the
proposed expansion of Medi-Cal, a portion of that
population would transition from county responsibility to
the Medi-Cal program. While there is a great deal of
uncertainty regarding how many people would transition from
county-provided health care coverage to Medi-Cal and the
cost savings to the counties, the LAO indicates that the
counties are likely to realize cost savings in the range of
$800 million to $1.2 billion per year. It is important to
note that under this bill, all county savings would be
retained by the counties and would not be shared with the
state.
3)Policies that will impact enrollment and costs. In addition
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to the general uncertainty in projecting future Medi-Cal
enrollment levels and health care costs, there are certain
policy issues addressed by this bill that are likely to have
impacts on enrollment levels or per capita costs. The fiscal
impacts of these policy choices are not fully known at this
time. Key policy choices made in this bill include:
a) The benefit package provided to the expansion
population. Federal law provides some flexibility to the
state to design a benefit package for the expansion
population (although the benefit package must provide the
EHBs required under the ACA).
This bill requires DHCS to seek federal approval to provide
the same benefit package to the expansion population as is
provided under the current Medi-Cal population, as well as
providing coverage required under the EHB package. In
addition, this bill requires the existing Medi-Cal
population to also receive the same EHB benchmark coverage.
In general, the existing Medi-Cal benefit package is
broader than the EHB benchmark plan the state has selected
(the Kaiser Small Group plan), particularly in coverage of
long-term services and supports. However, the Kaiser plan
provides some additional benefits such as some acupuncture
services and more generous substance abuse benefits.
The fiscal projections above assume that the expansion
population receives the existing Medi-Cal benefit package.
There may be additional costs, for both the existing
Medi-Cal eligible population and the expansion population,
by requiring both populations to receive benefits
equivalent to the Kaiser benchmark plan.
b) Self-attestation by applicants. Federal law and
regulations allow states to accept self-attestation by
applicants of certain information, such as age, date of
birth, household income, and state residency (not
immigration status). This bill requires DHCS to accept
self-attestation of this information. By allowing
applicants to self-attest (rather than requiring them to
provide documentation) this provision simplifies the
application process and is likely to increase enrollment.
c) Full scope pregnancy-related coverage. Under current
state law, pregnant women with incomes up to 200% of FPL
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are eligible for Medi-Cal. Some of these beneficiaries are
eligible for full-scope benefits during pregnancy, while
other beneficiaries are only entitled to pregnancy-related
benefits, depending on a variety of eligibility factors.
Draft federal regulations indicate that Medicaid programs
must provide full scope benefits to pregnant women, unless
the federal government specifically authorizes states to
limit such benefits. This bill requires that all pregnant
women enrolled in Medi-Cal (up to 200% of FPL) are to be
provided with full scope benefits, unless approval is
granted by the federal government to provide lesser
benefits. (The author indicates that the intent of this
bill is to require full-scope benefits to be provided to
all pregnant women enrolled in Medi-Cal.)
d) Elimination of the existing deprivation requirement.
Under current state law, the Medi-Cal program covers
children and caretaker relatives who are "deprived" of full
parental support (i.e., one parent is absent, deceased,
disabled, unemployed, or underemployed). Federal law allows
states to eliminate this requirement and this bill does so.
It is not clear whether eliminating this requirement would
actually increase the number of eligible individuals for
the program.
e) Projection of annual income. Federal guidance to date
indicates that projected annual income (rather than an
applicant's current monthly income) can be used to
determine income eligibility. This bill requires DHCS to
allow applicants to use projected annual income to
determine income eligibility. The counties (who currently
perform eligibility determinations) have indicated that
they already allow some projection of income when making
eligibility determinations, so it is not clear whether this
would actually increase overall enrollment in Medi-Cal.
COMMENTS : On January 24, 2013, Governor Brown issued a
proclamation to convene the Legislature in Extraordinary Session
to consider and act upon legislation necessary to implement the
ACA in: a) the areas of California's private health insurance
market, rules and regulations governing the individual and small
group market; b) California's Medi-Cal program and changes
necessary to implement federal law; and, c) options that allow
low-cost health coverage through Covered California,
California's Exchange, to be provided to individuals who have
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income up to 200% of the FPL. This bill, along with AB 1 X1
(John A. Pérez), address the second of the three areas
identified in the Governor's proclamation, that is to adopt the
provisions of the ACA related to changes in Medi-Cal.
Specifically, this bill adopts the state option of expanding
Medi-Cal coverage to non-disabled citizens and qualified
resident childless adults between the ages of 19 and 65 who are
not currently eligible for other full-scope Medi-Cal programs
and provides a full scope benefit package, as allowable under
federal law. This category is limited to individuals with
income under 138% of the FPL and who meet other citizenship and
immigration status requirements. This bill also enacts the ACA
requirement that the state Medicaid program extend coverage to
former foster youth until age 26, without regard to income or
assets. The ACA establishes a new simplified income standard
for families, children, and the new expansion population based
on the MAGI-standard as defined under the Internal Revenue Code
(IRC). It does not apply to seniors or person with
disabilities. This bill includes provisions necessary to
convert to the new MAGI methodology and income standard.
Finally this bill includes a number of provisions that implement
the goal of the ACA, to reduce the number of uninsured by
streamlining and simplifying eligibility determinations and
increasing reliance on electronically available data.
Starting in calendar year 2014, the ACA replaces many of the
complex categorical groupings and limitations in the Medicaid
program and provides eligibility to all nondisabled,
non-pregnant individuals between the ages of 19 and 65 with
family income at or below 133% FPL, provided that the individual
meets certain non-financial eligibility criteria, such as
citizenship. Also beginning in 2014, the ACA requires MAGI to
be used in determining eligibility for this new Medi-Cal
population, as well as for families, children, and caretaker
relatives and for subsidized coverage through Covered
California. The MAGI is based on the federal IRC. The ACA
generally adopts MAGI as a way to count household income and
eliminates the existing variety of income disregards and
deductions currently used by states. In addition, there are no
resource or assets limits under MAGI. Using MAGI methods,
household income will be the sum of the income of every
individual who is in the household, minus a standard income
disregard of five percentage points of the FPL for the
applicable household size. The MAGI rule also aligns family
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size under Medicaid rules with the IRC's MAGI definition. As a
result, there are a small number of situations in which the
transition from current rules to MAGI rules will result in
different household compositions than under the old rules.
According to a model of California insurance markets known as
the California Simulation of Insurance Markets, 5.6 million
Californians, or 16% of the population under age 65, were
without health insurance in 2012. A recent study estimates that
when California implements the Medi-Cal provisions, more than
1.4 million of these individuals will be newly eligible, of
which between 750,000 and 910,000 are expected to be enrolled at
any point in time by 2019. This study, "Medi-Cal Expansion
under the Affordable Care Act: Significant Increase in Coverage
with Minimal Cost to the State," published by UC Berkeley Center
for Labor Research and Education and UCLA Center for Health
Policy Research in January 2013, also finds that about 2.5
million Californians are already eligible for Medi-Cal but not
enrolled, and between 240,000 and 510,000 of them are expected
to be enrolled at any point in time by 2019 as a result of
implementing the ACA.
Effective January 1, 2014, states will use the MAGI-based
methodology for determining the income of an individual and the
individual's household, as applicable, for purposes of
eligibility for Medicaid or CHIP where a determination of income
is required. Pursuant to the ACA, the federal Centers for
Medicare and Medicaid Services (CMS) issued regulations that
consolidated eligibility groups currently included in multiple
statutory provisions into three simplified groups and
established a new group for the low-income adult expansion
group. The consolidated groups are: 1) Parents and Other
Caretaker Relatives; 2) Pregnant Women; and, 3) Children under
19. According to CMS, to promote coordination and avoid gaps or
overlaps in coverage, the new methodology is aligned with the
one that will be used to determine eligibility for the premium
tax credits and cost sharing reductions available to certain
individuals purchasing coverage on the Exchanges starting in
2014. Under the ACA, MAGI-based income methodologies will not
apply to determinations of Medicaid eligibility for elderly and
disabled populations. As interpreted by CMS regulations, the
new MAGI-based methodology includes certain unique income
counting and household composition rules.
Currently, states' methodologies for determining Medicaid and
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CHIP income eligibility vary widely, primarily due to
differences in the application of income disregards. To
determine eligibility, the state first determines an
individual's (or family's) gross income using a combination of
state and federal rules on household or family composition, and
then applies deductions, or disregards, which are income amounts
that are not considered countable, such as childcare expenses.
These income deductions or disregards can vary by state, type of
income, and by eligibility group. The resulting net income is
then compared to an income eligibility threshold (referred to as
the net income standard), expressed as a percentage of the FPL
to determine whether the individual is income-eligible for
Medicaid or CHIP. By converting to the MAGI rules and
collapsing most existing eligibility into three broad
categories, this methodology has an impact on how household
income is counted. For example, a stepparent with no financial
obligation for a child is not counted in the household income
under existing rules, but may be under MAGI.
Effective January 1, 2014, the ACA envisions a streamlined,
simplified, and seamless enrollment system that employs minimal
use of paper documentation and relies on modern technology to
the greatest extent possible for all the state subsidy programs.
For example, CMS states in the Preamble to the March 23, 2012,
Rules and Regulations, as follows: whether conducted by a
public or private entity, it is anticipated that eligibility
determinations using MAGI-based standards will be highly
automated, utilizing business rules developed by the State
Medicaid agency. In the most simplified cases, which can be
determined without human intervention or discretion, we are
clarifying that automated systems can generate Medicaid
eligibility determinations, without suspending the case and
waiting for an eligibility worker to finalize the
determinations.
Except for certain specified information such as citizenship and
immigration status, the CMS Regulations allow states to accept
attestation of needed information. CMS further states that this
applies to both financial and non-financial verification and
that if self-attestation is not accepted, states must access
available electronic databases prior to requiring additional
information or documentation in verifying all factors of
eligibility. With regard to forms, the HHS Secretary is
required to develop a single streamlined application. A state
may develop its own single, streamlined form, but it must be
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approved by the HHS Secretary and meet the HHS
Secretary-established standards. The ACA also requires that an
individual determined to be ineligible for the Medicaid program
or the state's CHIP program is to be screened for eligibility
for enrollment in the Exchange, and if applicable, premium
assistance without being required to submit an additional or
separate application. Supplemental forms may only be required
for individuals whose eligibility cannot be determined through
the application of the MAGI standard. States are required to
establish procedures that enable individuals to enroll and renew
through an Internet Website and to consent to enrollment or
reenrollment through an electronic signature. States are also
required to ensure that the Medicaid program, the CHIP program,
and the Exchange utilize a secure electronic interface
sufficient to allow for a determination of eligibility for
coverage or enrollment, as appropriate. CMS has directed states
to analyze current verification procedures to determine the
policy and systems modifications that will be needed in order
for the state to achieve this streamlined verification process.
The California Healthcare Eligibility, Enrollment, and Retention
System (CalHEERS) is a procurement conducted jointly by the
Exchange, DHCS, and the Managed Risk Medical Insurance Board to
build the Information Technology system to support the consumer
application and enrollment process at the Exchange. The portal
will offer eligibility determinations for both Medi-Cal and
federally subsidized Covered California coverage through the
Exchange. It will allow enrollment through multiple access
points including mail, phone, and in-person applications. It is
guided by a "no wrong door" policy that is intended to ensure
the maximum number of Californians obtain coverage appropriate
to their needs. Eligibility and enrollment functions will be
released in September of 2013. The CalHEERS business functions
include interfacing with the Medi-Cal eligibility data system.
It will also have the capacity to be a secure interface with
federal and state databases in order to obtain and verify
information necessary to determine eligibility.
The ACA goal of reducing the number of uninsured by creating
continuum of a coverage options for individuals with family
incomes up to 400% FPL and the increased reliance on
electronically available data has implications for how states
process renewals and redeterminations. For instance, unless the
individual provides information regarding a change in
circumstances, renewal for individuals whose eligibility is
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based on MAGI can be no more frequently than once every 12
months. Since the individual is obligated to report changes in
circumstances, this requires the elimination of semiannual
reporting for adults in California. The state agency must have
procedures in place to ensure that beneficiaries make timely and
accurate reports of any change in circumstances and that enable
beneficiaries to report these changes online, by phone, in
person, or through other electronic means. For non-MAGI groups,
such as those who are blind or disabled, the rule retains the
existing provision that eligibility be re-determined at least
every 12 months, but allows states to assume that blindness and
disability continue until there is a determination otherwise.
For MAGI groups, state agencies will first seek to renew
eligibility by evaluating information from the individual's
electronic account or from other more current reliable data
sources. If the available information is sufficient to
determine continued Medicaid eligibility, the state is required
to renew coverage based on that information and send an
appropriate notice without requiring the individual to sign and
return the notice. Enrollees must correct any inaccurate
information in the notice online, in person, by telephone, or by
mail. If it cannot be determined that the individual remains
eligible based on available information, the individual must be
provided with a pre-populated form containing the information
relevant to renewal that is available to the agency and a
reasonable period of time of at least 30 days to provide the
necessary information and correct any inaccuracies online, in
person, by telephone, or by mail. The state has the option to
allow self-attestation and then use information available
through electronic data sources for verification. The state
cannot require an in-person interview as part of the
redetermination process. AB 1296 (Bonilla), Chapter 641,
Statutes of 2011, adopted many of these requirements, and this
bill makes additional conforming changes. This bill also
implements the provisions that are designed to reduce multiple
unnecessary applications by allowing a reconsideration period
for individuals who are terminated due to failure to submit a
renewal form or information. In such a case, if the individual
subsequently submits within 90 days after the date of
termination, the state is required to redetermine the
individual's eligibility without requiring a new application.
Supporters, such as Western Center on Law and Poverty (Western
Center), state that this bill is truly a historic piece of
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legislation which will transform the Medi-Cal program by
covering all low-income Californians and modernizing and
simplifying the eligibility rules to realize the "no wrong door
visions" of the ACA. According to Western Center, many complain
that Medi-Cal administration and eligibility determinations are
too cumbersome and complicated and states in support that this
bill would achieve a more modern, efficient, and streamlined
program, as well as align the Medi-Cal rules with the rules in
the Exchange. Western Center also points out in support that
this bill provides the same scope of benefits to the adult
expansion population as to the existing population and also adds
the 10 categories of EHBs. The County Welfare Directors
Association of California (CWDA), also in support, states that
this bill moves California closer to the promise of affordable,
accessible coverage by implementing a new federal income
standard based on tax filings, eliminating the asset test for
parents, children, and the newly eligible population,
eliminating mid-year status reports, and providing a structure
for those enrolled in the Low-Income Health Program (LIHP) to
transition seamlessly into ongoing Medi-Cal coverage. CWDA
points out that many of these simplifications have been long
sought by county human services departments and that reducing
the burden for clients and the amount of time county staff must
spend, as well as increasing the use of information
electronically, will help ensure quick and accurate eligibility
determinations. The California Labor Federation states that
this bill will enact a central component of the ACA to
complement the establishment of the state Exchange by expanding
Medi-Cal to ensure that the lowest-income Californians have
access to subsidized coverage. The California Labor Federation
further argues in support that not only will individuals and
families benefit, but the expansion has the possibility of
improving public health by increasing access to preventive care
and reducing the use of emergency rooms and charity care. These
supporters and others also point to the fact that this bill will
bring in an estimated $2.1 to $3.5 billion in federal funds due
to the 100% federal funding for the newly eligible. Health
Access California, also in support, points to an analysis
conducted by the University of California that found that most
of the costs associated with the Medi-Cal expansion and program
changes would be offset by increased GF revenues and other
savings.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
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319-2097 FN:
0001211