BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 1X1
Author: Hernandez (D)
Amended: 6/14/13
Vote: 21
SENATE HEALTH COMMITTEE : 6-1, 2/27/13
AYES: Hernandez, Beall, DeSaulnier, Monning, Pavley, Wolk
NOES: Anderson
NO VOTE RECORDED: Nielsen, Vacancy
SENATE APPROPRIATIONS COMMITTEE : 4-1, 3/4/13
AYES: De León, Hill, Lara, Steinberg
NOES: Walters
NO VOTE RECORDED: Gaines, Padilla
SENATE FLOOR : 24-7, 3/7/13
AYES: Beall, Block, Calderon, Corbett, Correa, De León,
DeSaulnier, Evans, Galgiani, Hancock, Hernandez, Hill,
Jackson, Lara, Leno, Lieu, Liu, Pavley, Price, Roth,
Steinberg, Wolk, Wright, Yee
NOES: Anderson, Berryhill, Fuller, Huff, Knight, Nielsen,
Walters
NO VOTE RECORDED: Cannella, Emmerson, Gaines, Monning, Padilla,
Wyland, Vacancy, Vacancy, Vacancy
SUBJECT : Medi-Cal: eligibility
SOURCE : Author
DIGEST : This bill establishes the existing Medi-Cal benefit
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package as the benefit package for the expansion population
eligible under the Affordable Care Act (ACA) and expands the
Medi-Cal benefit package for the existing population and newly
eligible under the ACA to include mental health services and
substance use disorder services required under the essential
health benefit (EHB) legislation adopted in 2012 that are not
currently covered by Medi-Cal. Implements a number of the
Medicaid ACA-related provisions to simplify the eligibility,
enrollment and renewal processes for Medi-Cal.
Assembly Amendments delete provisions (which remain in AB X1,
the companion bill to this measure), such as the Medi-Cal
expansion to low-income adults, delete provisions dealing with
the Low Income Health Program transition, delete the
redetermination changes and provisions dealing with the
eligibility and enrollment process for individuals applying
through CalHEERS (Covered California's enrollment system). In
addition, the amendments delete the pregnancy-related benefit
changes as these changes will be addressed in subsequent
legislation. The amendments also add a provision that requires,
if the Federal Medical Assistance Percentages (FMAP) payable to
the state under the ACA for the expansion of Medi-Cal benefits
to adults is reduced to 70 percent or less prior to January 1,
2018, the implementation of any provision of this bill
authorizing the optional expansion of Medi-Cal benefits to
adults to cease twelve months after the effective date of the
federal law or other action reducing the FMAP.
ANALYSIS :
This bill:
Medi-Cal Benefits
1.Requires Medi-Cal to cover the following additional benefits:
A. Mental health services included in the EHB package
adopted by the state (the Legislature adopted the Kaiser
Small Group Product [Kaiser Product] as the state's EHB for
the individual and small group health insurance market last
session) to be covered services under Medi-Cal to the
extent those services are not covered Medi-Cal benefits
under any state plan amendments or waivers in effect on the
effective date of this bill. Requires, to the extent that
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behavioral health treatment (BHT) services are considered
mental health services pursuant to the EHB benefit package,
those services to only be provided to individuals who
receive services through federally approved waivers or
state plan amendments pursuant to the Lanterman Development
Disability Services Act.
B. Substance abuse disorder services included in the EHB
adopted by the state (the Kaiser Product).
1.Requires the Department of Health Care Services (DHCS) to seek
approval of any necessary state plan amendments to implement
these provisions, and implement these provisions only to the
extent that federal financial participation (FFP) is available
and necessary federal approvals have been obtained.
2.Requires Medi-Cal managed care plans to provide mental health
benefits covered in the state plan, excluding those benefits
provided by county mental health plans under the Specialty
Mental Health Services Waiver. Allows DHCS to require the
managed care plans to cover mental health pharmacy benefits to
the extent provided in the contracts between DHCS and the
Medi-Cal managed care plans.
3.Requires DHCS to seek federal approval to provide adults
eligible for the Medi-Cal expansion with the alternative
benefit package authorized under federal law. Requires the
alternative benefit package to provide the same schedule of
benefits provided to full-scope Medi-Cal beneficiaries
qualifying under the Modified Adjusted Gross Income standard,
except coverage of long-term services and supports are
excluded unless otherwise required by federal law. Requires
DHCS to only provide coverage for long-term services and
supports to only those individuals who meet the asset
requirements imposed under the Medi-Cal program for receipt of
such services.
4.Requires home and community-based services be covered in
Medi-Cal to the extent FFP is available for those services
under the state plan, instead of those services being
authorized under existing law, and references an additional
provision of federal law that permits a waiver.
Coverage of recent legal immigrants
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5.Makes recent immigrant adults who do not have minor children
eligible for Medi-Cal, who would be eligible for Medicaid
except for the five-year bar under federal law, and who are
enrolled in Covered California with a tax credit also eligible
for Medi-Cal benefits not covered by their Covered California
plan, and requires DHCS to pay the individual's premium costs
and cost-sharing (referred to as a "Medi-Cal wrap").
6.Requires a recent legal immigrant adult, who is ineligible for
the Exchange because he or she is outside of an available
enrollment period for coverage, or if the Medi-Cal wrap is not
yet available, to remain eligible for state-only funded
Medi-Cal benefits if he or she is otherwise eligible for
those state-only funded benefits.
7.Makes recent legal immigrant adults ineligible for state-only
funded Medi-Cal coverage on the first day when the individual
is eligible for and does not enroll in coverage offered
through Covered California unless DHCS and the Exchange do not
have the operational capacity to implement the Medi-Cal wrap.
8.Requires DHCS to inform and assist eligible recent legal
immigrant adults with enrolling in coverage through Covered
California with the premium assistance, cost-sharing and
benefits described above.
Former Foster Youth Medi-Cal Expansion
9. Requires, to the extent FFP is available, DHCS to provide
Medi-Cal benefits to any individual who is in foster care on
his or her 18th birthday until the individual turns age 26.
Requires DHCS to adopt the federal option to provide Medi-Cal
benefits to individuals that were in foster care and enrolled
in Medicaid in any other state.
10.Requires DHCS to develop procedures to identify and enroll
individuals who meet the criteria for Medi-Cal eligibility,
including individuals who lost Medi-Cal coverage as a result
of turning 21 years of age but who are now eligible under the
ACA, requires DHCS to work with counties to identify and
conduct outreach to former foster care adolescents who lost
Medi-Cal coverage as a result of turning age 21 during 2013,
requires DHCS to develop and implement a simplified
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redetermination form, and requires DHCS to seek federal
approval to institute a renewal process that allows a
beneficiary receiving benefits to remain in fee-for-service
Medi-Cal after a redetermination form is returned as
undeliverable and the county is otherwise unable to establish
contact.
Medi-Cal streamlining provisions
11.Requires DHCS to seek any federal waivers necessary to use
the eligibility information of individuals who have been
determined eligible for the CalFRESH program who are under
the age of 65 and are not disabled, to determine their
Medi-Cal eligibility.
12.Requires DHCS to seek any federal waivers necessary to
automatically enroll parents in the Medi-Cal program that
apply for Medi-Cal benefits that have one or more children
that are eligible for Medi-Cal benefits based upon a
determined income level that is at or below the applicable
income standard for eligibility.
13.Permits DHCS to seek any federal waivers or state plan
amendments necessary to use the eligibility information of
individuals determined eligible for other state only funded
health care programs and county general assistance programs
to determine an applicant's Medi-Cal eligibility to the
extent that there is no general fund impact.
Residency
14.Requires DHCS, in determining an individual's residency, to
electronically verify an individual's state residency using
information from the federal Supplemental Nutrition
Assistance Program, the CalWORKS program, Covered California,
the Franchise Tax Board, the Department of Motor Vehicles,
the Employment Development Department, and the federal data
hub. If DHCS is unable to electronically verify an
individual's state residency using these electronic data
sources, an individual may establish state residency by
providing specified documents.
15.Outlines, for Medi-Cal eligibility, how state residency is
established, depending upon the age of the individual,
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whether he or she is capable of indicating intent, and
whether he or she resides in an institution. Allows a person
over age 21 to establish state residency by declaring under
penalty of perjury that he or she cannot produce any of
specified residency-related documents, that he or she intends
to reside in this state and does not have a fixed address, or
that the individual has entered the state with a job
commitment or is seeking employment in the state. Requires
DHCS to adopt emergency regulations to implement the
residency-related provisions.
Income Counting Changes
16.Requires DHCS to file a state plan amendment to exercise the
federal option to allow beneficiaries to use projected annual
income, and to allow applicants and beneficiaries to use
reasonably predictable annual income when determining
eligibility for Medi-Cal benefits.
Repeal of semi-annual status report
17.Repeals the semi-annual status report requirement for
individuals' whose income is determined using Modified
Adjusted Gross Income (MAGI) (state law requires adult
Medi-Cal beneficiaries to file a semi-annual status report in
order to remain eligible for Medi-Cal) to conform to ACA
requirements.
Other Changes
18.Requires DHCS to provide Medi-Cal benefits during a
presumptive eligibility (PE) period to individuals who have
determined eligible on the basis of preliminary information
(known as presumptive eligibility) by a qualified hospital.
Requires a hospital making a PE determination to be a
participating Medi-Cal provider, to make PE determinations
consistent with applicable policies and procedures, to notify
DHCS that it has elected to be a qualified provider for
making PE, and to not have been disqualified to make PE
determinations. Requires DHCS to establish a process for
determining whether a hospital should be disqualified from
making PE determinations.
19.Requires a person who wishes to apply for an insurance
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affordability program to be allowed to file an application on
his or her own behalf or on behalf of his or her family.
Permits an 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 (known as an authorized representative).
Requires DHCS to implement policies and prescribe forms,
notices and other safeguards to ensure the privacy and
protection of the rights of applicants who appoint an
authorized representative.
20.Adopts the ACA option and current DHCS practice to include
individuals under 19 years of age (or under 21 in the case of
full-time students) in the household for purposes of
determining Medi-Cal eligibility.
21.Adopts the ACA option to repeal the "deprivation"
requirement under which at least one parent in the family
must be absent, deceased or disabled, or the principal wage
earner must be unemployed or underemployed in order to
receive Medi-Cal coverage.
22.Requires DHCS to meet the ACA requirement to provide
assistance to any Medi-Cal applicant or beneficiary that
requests help with the application or redetermination process
to the extent required by federal law. Requires the
assistance provided to be available in person, over the
telephone, and online and in a manner that is accessible to
individuals with disabilities and those who have limited
English proficiency.
23.Requires a person who wishes to apply for an insurance
affordability program to be allowed to file an application on
his or her own behalf or on behalf of his or her family.
Permits an 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 (known as an authorized representative).
Requires DHCS to implement policies and prescribe forms,
notices and other safeguards to ensure the privacy and
protection of the rights of applicants who appoint an
authorized representative
24.Makes this bill operative only if SB X1 1 (Hernandez and
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Steinberg) is enacted and takes effect.
25.Makes the implementation of the expansion of Medi-Cal
benefits to adults under the ACA contingent upon the
following:
A. Requires, if the federal medical assistance percentage
(the FMAP is the percentage of Medi-Cal paid by the federal
government) payable to the state under the ACA for the
expansion of Medi-Cal benefits to adults is reduced below
90 percent, that reduction to be addressed in a timely
manner through the annual state budget or legislative
process. Requires notification to the Legislature of any
reduction.
B. Requires, if the FMAP payable to the state under the ACA
for the expansion of Medi-Cal benefits to adults is reduced
to 70% or less prior to January 1, 2018, the implementation
of any provision of this bill authorizing the optional
expansion of Medi-Cal benefits to adults to cease twelve
months after the effective date of the federal law or other
action reducing the FMAP.
Comments
This bill and AB X1 1 implements the expansion of federal
Medicaid coverage in California. Major provisions of this bill
including establishing the Medi-Cal benefit package for the
expansion population as the same benefit package for the current
Medi-Cal population. In addition, this bill requires the
existing Medi-Cal program to cover additional mental health and
substance abuse benefits that are provided under the Kaiser
Product EHB. This bill will also provide coverage to former
foster youth and makes a number of changes to make the
enrollment process easier.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
The contents of this bill have been discussed in both
Appropriations and Budget Committee and the 2013-14 budget bill
contains funding for the provisions of the bill.
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SUPPORT : (Verified 6/14/13)(unable to reverify at time of
writing)
AARP
Advancement Project
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
American Heart Association
The Arc and United Cerebral Palsy California Collaboration
Asian Pacific American Legal Center
Binational Center for the Development of Oaxacan Indigenous
Communities
Cal-Islanders Humanitarian Association
California Association of Addiction Recovery Resources
California Association of Alcoholism and Drug Abuse Counselors
California Association of Public Hospitals and Health Systems
California Black Health Network
California Chiropractic Association
California Family Resource Association
California Hospital Association
California Immigrant Policy Center
California Labor Federation
California Latino Legislative Caucus
California Medical Association
California Nurse-Midwives Association
California Nurses Association
California Pan-Ethnic Health Network
California Primary Care Association
California School Employees Association, AFL-CIO
California School Health Centers Association
California State Council of the Service Employees International
Union
California State Parent Teacher Association
California Teachers Association
Californians for Safety and Justice
Child and Family Center
Chinese Progressive Association of San Francisco
Consumers Union
County of Santa Clara Board of Supervisors
County Welfare Directors Association of California
Department of Insurance
Friends of the Family
Greenlining Institute
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Guam Communications Network
Health Access California
Health Officers Association of California
Hillview Mental Health Center, Inc
Junior Blind
Latino Health Alliance
March of Dimes Foundation
National Association of Social Workers
National Health Law Program
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino Counties
Planned Parenthood of Santa Barbara
Private Essential Access Community Hospitals
Six Rivers planned Parenthood
Street Level Health Project
United Nurses Associations of California/Union of Health Care
Professionals
Urban Counties Caucus
ARGUMENTS IN SUPPORT : This bill and AB X1 1 are supported by
consumer, low-income and health care provider groups.
Generally, proponents argue these bills are 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 these bills 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, the additional benefits provided as part of
Medi-Cal coverage, the elimination of the deprivation and asset
tests, and the program simplification provisions.
JL:nl 6/14/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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