BILL ANALYSIS Ó
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THIRD READING
Bill No: SB 800
Author: Lara (D)
Amended: 5/28/13
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 9-0, 5/1/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : California Health Benefit Exchange: outreach
services
SOURCE : Author
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to provide the California Health Benefit
Exchange (known as Covered California), or its designee, with
specified 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.
ANALYSIS :
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Existing federal law:
1. Requires, under the Patient Protection and Affordable Care
Act (ACA), 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 % of the FPL, and a
lower maximum limit on out-of-pocket expenses for individuals
whose incomes are between 100 and 400% of the FPL. Legal
immigrants with household incomes less than 100 % 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:
1. 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.
2. Establishes the 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% of the FPL, and
establishes monthly premium amounts that families must pay
for HFP coverage.
3. Transitions children in the HFP to Medi-Cal, by expanding
Medi-Cal to include targeted low-income children in four
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phases, beginning no sooner than January 1, 2013.
4. 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.
5. 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, email addresses, telephone
numbers, or other contact information, and written and spoken
languages of individuals who are not enrolled in Medi-Cal but
are the parents or caretakers of children enrolled in the 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.
Comments
Shift of HFP children to Medi-Cal . AB 1494 (Assembly Budget
Committee, Chapter 28, Statutes of 2012) a health budget trailer
bill, requires the transition of children in HFP to Medi-Cal.
The state is currently in the middle of transitioning children
enrolled in the 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
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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.
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
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. This bill places 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.
Prior Legislation
AB 714 (Atkins, of 2011) 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.
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FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Minor administrative costs to DHCS and/or the MRMIB to
provide contact information (General Fund).
Likely costs in the low hundreds of thousands for the
Covered California to contact parents and caretakers (federal
funds).
Potential increased costs in the Medi-Cal program in the
millions to low tens of millions (federal funds) for one
year.
SUPPORT : (Verified 5/24/13)
Autism Deservers Equal Coverage
California Pan Ethnic Health Network
California Welfare Directors Association
Health Access California
SEIU Local 1000
Western Center on Law and Poverty
ARGUMENTS IN 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 requires DHCS services to provide information about parents
of HFP eligible-children to Covered California, and Covered
California would then facilitate outreach to them about new
coverage options.
JL:d 5/28/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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