BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
SB 249 (Leno) - Public Health: health records: confidentiality.
Amended: April 16, 2013 Policy Vote: Health 9-0, Judic.
7-0
Urgency: No Mandate: No
Hearing Date: May 13, 2013 Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 249 would permit the Department of Public
Health to share records with specified entities relating to the
diagnosis or care of beneficiaries enrolled in health care
programs for HIV positive individuals. The bill also makes other
changes to statute relating to the sharing of information
related to HIV positive individuals.
Fiscal Impact:
Likely administrative costs in the hundreds of thousands to
develop agreements with other state agencies and health
plans by the Department of Public Health (federal funds).
Unknown potential information technology costs by the
Department of Public Health (federal funds). The Department
indicates that it may need to make changes to its
information technology systems to share information with
other entities. At this time, the Department does not know
whether such changes are necessary or what they would cost.
Potential increase in Medi-Cal costs in the low millions
(federal funds). See below.
Unknown potential savings to programs administered by the
Department of Public Health because the bill would help
ensure that other sources of health care coverage pay for
services (federal funds). See below.
Background: Under current law, the Department of Public Health
manages several federally-funded programs to provide limited
health care coverage to individuals who are HIV positive and do
not have other health care coverage or need additional services
not covered by their current insurance (referred to as Ryan
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White-funded programs). About 75,000 individuals receive
services from these programs.
Current law places certain restrictions on the disclosure or use
of information relating to a person's HIV status.
Current law also requires health care providers and laboratories
to report HIV cases to local health officers, who are required
to report that information to the Department of Public Health.
The federal Affordable Care Act allows states to expand Medicaid
(Medi-Cal in California) eligibility to persons under 65 years
of age, who are not pregnant, not entitled to Medicare Part A or
enrolled in Medicare Part B, and whose income does not exceed
133 percent of the federal poverty level (effectively 138
percent of the federal poverty level as calculated under the
Affordable Care Act).
The Affordable Care Act provides a significantly enhanced
federal match for the Medicaid expansion. Under the law, the
federal government will pay for 100 percent of the cost of the
Medicaid expansion in 2013-14 declining to a 90 percent federal
match in the 2020 federal fiscal year and thereafter.
Proposed Law: SB 249 would permit the Department of Public
Health to share records relating to the diagnosis or care of
beneficiaries enrolled in health care programs for HIV positive
individuals with the Department of Health Care Services, the
California Health Benefit Exchange, Medi-Cal managed care plans,
health plans offering coverage through the Exchange, and the
Department of Managed Health Care.
The bill authorizes laboratories to report cases of HIV
infection to the Department of Public Health, upon request. The
bill also makes other technical changes to statutes relating to
the sharing of information related to HIV positive individuals.
Related Legislation:
SB 28 (Hernandez) would require notification of subscribers
of two state-run health plans about coverage options that
will be available through the state's Health Benefit
Exchange. That bill is on the Senate Floor.
SB 800 (Lara) would require the Department of Health Care
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Services to provide contact information to the California
Health Benefit Exchange for parents and caretakers of
children enrolled in the Healthy Families Program. That bill
will be heard in this committee.
Staff Comments: The intention of the bill is to assist with the
transition of individuals with HIV from existing programs to
subsidized coverage through the Exchange or to an expanded
Medi-Cal.
Under current law, individuals up to 400% of the federal poverty
level will be eligible for subsidized coverage through the
Exchange. In addition, the state is considering expanding the
eligibility for Medi-Cal to 138% of the federal poverty level.
Should the state decide to expand Medi-Cal eligibility, a
significant number of the participants in Ryan White-funded
programs may qualify for Medi-Cal.
To the extent that this bill results in those individuals
learning of their eligibility for expanded Medi-Cal, enrollment
could increase, increasing costs. However, given that
participants in these programs are currently receiving care for
a serious condition, it is likely that most program participants
are aware of new options for coverage that will be available
after January 1, 2014. Thus, this bill is not likely to
significantly increase enrollment in Medi-Cal, should the state
decide to expand the program. To the extent that enrollment does
increase, those costs would be borne entirely by the federal
government, since the Medi-Cal expansion will be funded entirely
with federal funds initially.
The Ryan White-funded programs that would be impacted by this
bill generally require any other form of health care coverage to
pay for services before the program will provide payment (i.e.
these programs are payers of last resort). After January 1,
2014, it is anticipated that many enrollees in these programs
will be able to access health care coverage through Medi-Cal or
the Exchange. In those cases, the Ryan White-funded programs
would only be required to pay for services or costs not borne by
those other programs. By allowing the Department to share
information with the Exchange and other entities, this bill will
increase the likelihood that costs are appropriately paid by
other programs before Ryan White-funded program funds are used.
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