BILL ANALYSIS Ó
SB 508
Page 1
SENATE THIRD READING
SB 508 (Ed Hernandez)
As Amended August 18, 2014
Majority vote
SENATE VOTE :28-8
HEALTH 13-6 APPROPRIATIONS 12-5
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|Ayes:|Pan, Ammiano, Bonilla, |Ayes:|Gatto, Bocanegra, |
| |Bonta, Chesbro, Gomez, | |Bradford, |
| |Gonzalez, | |Ian Calderon, Campos, |
| |Roger Hernández, | |Eggman, Gomez, Holden, |
| |Lowenthal, Nazarian, | |Pan, Quirk, |
| |Ridley-Thomas, Rodriguez, | |Ridley-Thomas, Weber |
| |Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Maienschein, Chávez, |Nays:|Bigelow, Donnelly, Jones, |
| |Mansoor, Nestande, | |Linder, Wagner |
| |Patterson, Wagner | | |
| | | | |
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SUMMARY : Makes changes to the eligibility requirements for the
Medi-Cal program, to codify existing eligibility levels or
clarify changes made to the program's eligibility requirements
when the state expanded eligibility under the federal Patient
Protection and Affordable Care Act (ACA), in particular
conforming existing law to the federal requirement to use
modified adjusted gross income (MAGI) for eligibility
determination.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)This bill has four main components. The first component, the
specification in statute of income thresholds, codifies
current administrative practice under existing authority.
Therefore, placing these income thresholds in law is not
expected to increase costs. Similarly, the component related
to tuberculosis services conforms the income eligibility
methodology for these services to that used for most other
Medi-Cal categories, and should have a negligible cost impact.
SB 508
Page 2
Two other components, namely, the elimination of the
deprivation requirement in the medically needy program and the
changes related to former foster youth eligibility, may have a
minor fiscal impact. Both changes will potentially increase
state costs by expanding the number of people eligible for
Medi-Cal. Assuming average per-person costs in the medically
needy program are $10,000 annually, average per-person costs
for former foster youth are $2,000 annually, and 50
individuals enroll due to the deprivation changes and 10 new
former foster youth enroll due to the foster youth program
changes, costs would be $520,000 (50% General Fund, 50%
federal).
The former foster youth provisions appear to be necessary
pursuant to federal maintenance of effort requirements in the
ACA, under which states must maintain Medi-Cal eligibility
rules in place for children until 2019. The deprivation
change also appears to be required to maintain compliance with
federal rules, but based on how the state has chosen to
structure related programs. Since the state chose to
eliminate the deprivation requirement for a separate
eligibility category, the federal government has, according to
the author, stated the deprivation requirement must be
eliminated in the medically needy program as well. Written
verification that these specific changes are federally
required was unavailable at the time of this analysis.
2)This bill is tagged as a potential state-reimbursable mandate
because county eligibility workers conduct eligibility
screenings on behalf of the state. But no increased
administrative costs to counties are expected as a direct
result of this bill, since changes should not significantly
impact county workload and have already been incorporated into
county eligibility operations.
COMMENTS : According to the author, this bill is a follow-up
bill to SB 1 X1 (Ed Hernandez), Chapter 4, Statutes of 2013-14
First Extraordinary Session, and AB 1 X1 (John A. Pérez),
Chapter 3, Statutes of 2013-14 First Extraordinary Session, the
Medi-Cal ACA implementation bills. This bill would place into
state law the MAGI converted Medi-Cal income eligibility
standards for parents and caretaker relatives, children, and
pregnant women, would eliminate the deprivation requirement in
SB 508
Page 3
the medically needy Medi-Cal program, and would clarify
eligibility for the former foster youth Medi-Cal expansion.
When AB 1 X 1 and SB 1 X 1 were enacted, the Medi-Cal income
eligibility standards expressed in terms of MAGI were not known
but have subsequently been established administratively by the
Department of Health Care Services (DHCS). The author states
placing these amounts into state law provides greater
transparency regarding eligibility thresholds and updates
current law to reflect current income eligibility standards.
This bill also contains clean-up language to the former foster
youth Medi-Cal expansion and eliminates the deprivation
requirement in the medically needy Medi-Cal program in response
to concerns raised by the federal Centers for Medicare and
Medicaid Services to DHCS, according to the author.
Supporters state this bill codifies the new federal income
standards used by DHCS for determining Medi-Cal eligibility.
They argue this bill ensures California law accurately reflects
how DHCS has defined the new MAGI standards for purpose of
eligibility of various groups. The California Primary Care
Association supports the provisions to extend Medi-Cal benefits
to Independent foster adolescents.
Western Center on Law and Poverty states in support that this
bill finishes the job started in the special session Medi-Cal
bills of eliminating the deprivation requirement in Medi-Cal.
The deprivation test is an old welfare rules test whereby only
parents of a deprived child qualify for Medi-Cal including when
a parent is deceased, disabled, unemployed, or underemployed.
This complicated rule is no longer needed when all low-income
adults will be eligible for Medi-Cal.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097
FN: 0005022