BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 800
AUTHOR: Lara
AMENDED: April 24, 2013
HEARING DATE: May 1, 2013
CONSULTANT: Bain
SUBJECT : California Health Benefit Exchange: outreach services
SUMMARY : Requires the Department of Health Care Services (DHCS)
to provide the California Health Benefit Exchange (known as
Covered California), or its designee, with the names, addresses,
e-mail addresses, telephone numbers, or other contact
information, and written and spoken languages of individuals who
are not enrolled in Medi-Cal but who are the parents or
caretakers of children enrolled in the Healthy Families Program
(HFP) or children being transitioned to the Medi-Cal program, in
order to assist Covered California to conduct outreach to
individuals potentially eligible for Medi-Cal or coverage
through Covered California.
Existing federal law:
1.Requires, under the Patient Protection and Affordable Care Act
(ACA, Public Law 111-148), as amended by the Health Care
Education and Reconciliation Act of 2010 (Public Law 111-152),
each state, by January 1, 2014, to establish an American
Health Benefit Exchange that makes qualified health plans
(QHPs) available to qualified individuals and qualified
employers. If a state does not establish an Exchange, the
federal government is required to administer the Exchange. The
ACA establishes requirements for the Exchange and for QHPs
participating in the Exchange, and defines who is eligible to
purchase coverage in the Exchange.
2.Allows, under the ACA and effective January 1, 2014, eligible
individual taxpayers, whose household income is between 100
and 400 percent of the federal poverty level (FPL) inclusive,
an advanceable and refundable premium tax credit based on the
individual's income for coverage under a QHP offered in the
Exchange. The ACA also requires a reduction in cost-sharing
for individuals with incomes below 250 percent of the FPL, and
a lower maximum limit on out-of-pocket expenses for
individuals whose incomes are between 100 and 400 percent of
the FPL. Legal immigrants with household incomes less than 100
Continued---
SB 800 | Page 2
percent of the FPL who are ineligible for Medicaid because of
their immigration status are also eligible for the premium tax
credit and the cost-sharing reductions.
Existing state law:
3.Establishes, under federal law, the Medicaid Program (Medi-Cal
in California), administered by DHCS, to provide comprehensive
health care services and long-term care to low income
populations such as pregnant women, children, and seniors, and
people with disabilities.
4.Establishes HFP, administered by Managed Risk Medical
Insurance Board (MRMIB), to provide low-cost health, dental,
and vision coverage to children who do not have health
insurance, who do not qualify for free Medi-Cal and are in
families with incomes at or below 250 percent of the FPL, and
establishes monthly premium amounts that families must pay for
HFP coverage.
5.Transitions children in the HFP to Medi-Cal, by expanding
Medi-Cal to include targeted low-income children in four
phases, beginning no sooner than January 1, 2013.
6.Establishes, under regulations implementing the federal Health
Insurance Portability and Accountability Act of 1996 (HIPAA),
requirements relating to the protection of privacy of
protected health information. Permits a HIPAA covered entity
to use or disclose protected health information to the extent
that such use or disclosure is required by law and the use or
disclosure complies with and is limited to the relevant
requirements of such law.
7.Establishes Covered California in state government, and
specifies the duties and authority of Covered California.
Requires the Covered California board, in the course of
selectively contracting for health care coverage offered to
individuals and small employers through Covered California, to
seek to contract with health plans and insurers so as to
provide health care coverage choices that offer the optimal
combination of choice, value, quality, and service.
This bill:
1.Requires DHCS to provide Covered California, or its designee,
with the names, addresses, e-mail addresses, telephone
numbers, or other contact information, and written and spoken
languages of individuals who are not enrolled in Medi-Cal but
SB 800 | Page
3
are the parents or caretakers of children enrolled in HFP or
children being transitioned to the Medi-Cal program
2.Requires the information in 1) to be transferred in order to
assist Covered California to conduct outreach to individuals
potentially eligible for Medi-Cal or coverage through Covered
California.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. I am committed to ensuring access to
affordable care for all families, especially for low and moderate
income families. Quality health insurance is expensive; however,
cost should not be a barrier. To make coverage obtainable for
families that otherwise could not afford it and to encourage broad
participation in health insurance, the ACA includes provisions to
lower premiums and cost-sharing obligations for people with low
and modest incomes. Families with incomes up to 250 percent of the
federal poverty level are eligible for reduced cost sharing (e.g.,
coverage with lower deductibles and copayments). Currently,
California serves a similar population through the Healthy
Families Program (HFP) or the Medi-Cal HFP transition. To be
eligible for HFP, families' incomes must be greater than 100
percent and up to 250 percent of the FPL.
SB 800 simply ensures these families receive information about
obtaining health care coverage and subsidies available through
Covered California. SB 800 directs DHCS to transfer information
about parents of the children enrolled in the Healthy Families
Program, or being transitioned into Medi-Cal, to Covered
California so that Covered California can conduct outreach to
these individuals. Outreach for this populations is essential
because, by definition of their children's participation in HFP,
they are extremely likely to be able to access federal subsidies
making health care coverage possible.
2. Shift of HFP children to Medi-Cal. AB 1494 (Committee on
Budget), Chapter 28, Statutes of 2012, a health budget trailer
bill, required the transition of children in HFP to Medi-Cal.
HFP provides low-cost health, dental and vision coverage to
uninsured children, until the age 19, in working families. HFP
covers children who meet all of the following criteria:
SB 800 | Page 4
a. Children under the age of 19;
b. Uninsured children with no employer-sponsored health
insurance in the last three months;
c. California resident;
d. Not eligible for or are enrolled in no-cost Medi-Cal;
e. Children must meet citizenship or immigration rules;
and,
f. A families' income must be greater than 100 percent and
below 250 percent, inclusive, of the Federal Income
Guideline which, varies depending on the age of the child.
The state is currently in the middle of transitioning children
enrolled in HFP into Medi-Cal. The first phase of the
transition began January 1, 2013, and included children in a
HFP health plan that matches a Medi-Cal managed care (MCMC)
health plan. Phase 2 began April 1, 2013, and affects children
in an HFP health plan that is a subcontractor of a MCMC health
plan. Phase 3 is scheduled to begin no sooner than August 1,
2013, and transitions children enrolled in an HFP plan that is
not a MCMC plan and does not contract or subcontract with a
MCMC plan into a MCMC plan in that county. The final phase
begins no earlier than September 1, 2013, and transitions
children in HFP residing in a county that is not MCMC into the
Medi-Cal fee-for-service delivery system.
Depending upon their income, the parents of children enrolled
in Medi-Cal will be eligible for either Medi-Cal or premium
and cost-sharing subsidies in Covered California.
1.HIPAA and HFP. Under federal HIPAA privacy regulations, a
HIPAA covered entity is prohibited from using or disclosing
protected health information without an authorization that is
valid, with specified exceptions. One exception to this HIPAA
SB 800 | Page
5
prohibition against the disclosure of protected health
information is if a HIPAA covered entity is required to use or
disclose protected health information by law, and the use or
disclosure complies with and is limited to the relevant
requirements of such law. SB 800 would place such a
requirement on MRMIB to transfer information about the parents
and caretaker relatives of HFP subscribers and applicants to
Covered California for purposes of having Covered California
conduct outreach to these individuals.
2.Related legislation. SB X1 1 (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.
SB X1 1 is currently in the Assembly Health Committee. AB X1 1
(John A. Pérez) is identical to SB X1 1. AB X1 1 is currently
in the Senate Health Committee.
SB 249 (Leno) permits DPH to share health records involving the
diagnosis, care, and treatment of a beneficiary enrolled in
federal Ryan White Act-funded programs who may be eligible for
services under the ACA, with "qualified entities," as defined.
Permits qualified entities to share health records relating
to persons diagnosed with HIV/AIDS with DPH for the purpose of
enrollment without disruption in Medi-Cal, the bridge program,
Medicaid expansion programs, and any insurance plan certified
by Covered California. SB 249 passed the Senate Health
Committee by a vote of 9-0 on April 24, 2013.
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 Covered California. AB 50 is currently in
the Assembly Health Committee.
SB 28 (Hernandez) requires MRMIB to provide Covered California
with the name, contact information and spoken language of
Major Risk Medical Insurance Program and Pre-Existing
Condition Insurance Program (PCIP) subscribers and applicants
in order to assist Covered California in conducting outreach.
SB 28 also requires Covered California to use the information
from MRMIB to provide a notice to these individuals informing
them of their potential eligibility for coverage through
SB 800 | Page 6
Covered California or Medi-Cal. SB 28 passed the Senate Health
Committee by a Vote of 9-0.
3.Prior legislation. AB 714 (Atkins) of the 2011-12 session
would have required notices of health care eligibility be sent
to individuals who are enrolled in, or who cease to be
enrolled in, publicly-funded state health care programs. AB
714 was held on the Senate Appropriations Committee suspense
file.
AB 792 (Bonilla), Chapter 851, Statutes of 2012 establishes
notification requirements about the availability of
reduced-cost coverage available in the Covered California and
no-cost coverage available in Medi-Cal to an individual filing
a dissolution or nullity of marriage, divorce or separation,
or petitioning for adoption, and for an individual who ceases
to be enrolled in health coverage through a health plan or
health insurer.
4.Support. Health Access, a statewide health care consumer
advocacy coalition, and Western Center on Law and Poverty
write in support of this bill. Proponents argue this bill
would require DHCS Services to provide information about
parents of Health Family eligible-children to Covered
California, and Covered California would then facilitate
outreach to them about new coverage options.
SUPPORT AND OPPOSITION :
Support: Health Access California
Western Center on Law and Poverty
Oppose: None received
-- END --