BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 800
Author: Lara (D)
Amended: 9/3/13
Vote: 21
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
SENATE FLOOR : 39-0, 5/29/13
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,
Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,
Jackson, Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen,
Padilla, Pavley, Price, Roth, Steinberg, Torres, Walters,
Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Vacancy
SENATE HEALTH COMMITTEE : 7-0, 9/11/13 (Pursuant to Senate Rule
29.10)
AYES: Hernandez, Anderson, Beall, DeSaulnier, Monning, Nielsen,
Wolk
NO VOTE RECORDED: De León, Pavley,
ASSEMBLY FLOOR : 53-25, 9/9/13 - See last page for vote
SUBJECT : Health care coverage programs: transition
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SOURCE : Author
DIGEST : This bill transfers specified employees of the
Managed Risk Medical Insurance Board (MRMIB) to the Department
of Health Care Services (DHCS) or the California Health Benefit
Exchange, now called Covered California, if any statute
dissolves or terminates MRMIB. Requires DHCS to provide the
Exchange, or its designee, information about parents or
caretakers of children enrolled in the Healthy Families program
(HFP) or the targeted low-income Medi-Cal program in order to
conduct outreach to potentially eligible individuals.
Assembly Amendments : (1) delete the requirement for DHCS to
provide Covered California, or its designee, with specified
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) make any permanent or
probationary civil service employee who is employed by MRMIB and
assigned to the Federal Temporary High Risk Pool whose function
ceases to immediately be transferred to the Exchange and to
retain his/her status, position, and rights pursuant to existing
law and the State Civil Service Act (SCSA); (3) require if any
statute dissolves or terminates MRMIB, any employee of MRMIB
who, immediately prior to the effective date of the dissolution
or termination of MRMIB was assigned to the federal Temporary
High Risk Pool to be transferred to Covered California and to
retain his/her status, position, and rights pursuant to existing
law and the SCSA; (4) require, if any statute dissolves or
terminates MRMIB, an employee's applicable reinstatement rights
that would have applied to MRMIB, to instead apply to DHCS; (5)
require DHCS to prepare a report on the transfer of employees
and functions upon dissolution of MRMIB, as specified; (6)
delete the urgency clause; and (7) make other clarifying and
technical changes.
ANALYSIS :
Existing law:
1. Establishes Major Risk Medical Insurance Program (MRMIP)
administered by MRMIB to provide major risk medical coverage
to California residents who have been rejected for coverage
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by at least one private health plan, or if the only private
health coverage that the applicant can secure would impose
substantial waivers or provide limited coverage or afford
coverage only at an excessive price.
2. Requires MRMIB to cease to provide coverage through the
Federal Temporary High Risk Pool on July 1, 2013, except as
required by the contract between MRMIB and the United States
Department of Health and Human Services, and at that time to
cease to operate the program except as required to complete
payments to, or payment reconciliations with, participating
health plans or other contractors, process appeals, or
conduct other necessary termination activities.
3. Creates Covered California, as an independent state entity
governed by a five-member board, to be a marketplace for
Californians to purchase affordable, quality health care
coverage, claim advanceable premium tax credits and
cost-sharing subsidies, and as a way to meet the personal
responsibility requirements of the Affordable Care Act.
4. Establishes, under state and federal law, the Medicaid
program (Medi-Cal in California) as a joint federal and state
program offering a variety of health and long-term services
to low-income women and children, low-income residents of
long-term care facilities, seniors, and people with
disabilities. Medi-Cal is administered by DHCS.
This bill:
1. Requires, in order to assist Covered California, to conduct
outreach to individuals potentially eligible for insurance
affordability programs, DHCS to provide the Exchange, 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 HFP or have been transitioned from HFP to its
replacement, the targeted low-income Medi-Cal program.
2. Makes any permanent or probationary civil service employee
who is employed by MRMIB and assigned to the Federal
Temporary High Risk Pool whose function ceases to immediately
be transferred to the Exchange and to retain his/her status,
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position, and rights pursuant to existing law and the SCSA.
3. Requires, if any statute dissolves or terminates MRMIB, any
employee of MRMIB who immediately prior to the effective date
of the dissolution or termination of MRMIB was assigned to
HFP, the Access for Infants and Mothers Program, the County
Health Initiative Matching Fund, or the MRMIP to be
transferred to DHCS and to retain his/her status, position,
and rights pursuant to existing law and the SCSA.
4. Requires if any statute dissolves or terminates MRMIB, any
employee of MRMIB who, immediately prior to the effective
date of the dissolution or termination of MRMIB was assigned
to the Federal Temporary High Risk Pool to be transferred to
the Exchange and to retain his/her status, position, and
rights pursuant to existing law and the SCSA.
5. Requires, if any statute dissolves or terminates MRMIB, an
employee's applicable reinstatement rights that would have
applied to MRMIB, to instead apply to DHCS.
6. Requires DHCS to prepare a report on the transfer of
employees and functions upon dissolution of MRMIB by February
1 of the year following the year in which employees are
transferred with a follow-up report each of the two years
following the submission of the report.
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
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
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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.
Comments
According to the author's office, this is a two-part bill that
seeks to ensure access to affordable care for all families,
especially for low and moderate income families. To make
coverage obtainable for families that otherwise could not afford
it and to encourage broad participation in health insurance, the
Affordable Care Act includes provisions to lower premiums and
cost-sharing obligations for people with low and modest incomes.
Families with incomes up to 250 % 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 HFP or the Medi-Cal HFP
transition. To be eligible for HFP, families' incomes must be
greater than 100 % and up to 250 % of the FPL. The first part
of this bill ensures families receive information about
obtaining health care coverage and subsidies available through
Covered California by directing DHCS to transfer information
about parents of the children enrolled in the HFP, or being
transitioned into Medi-Cal, to Covered California so that
Covered California can conduct outreach to these individuals.
Outreach for this population is essential because, by definition
of their children's participation in HFP, they are extremely
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likely to be able to access federal subsidies making health care
coverage possible.
The second part of this bill contains provisions transferring
staff of MRMIB if MRMIB is eliminated so that MRMIB can continue
to administer its existing programs, to ensure knowledgeable and
experienced staff from MRMIB are transferred to other agencies
that can make use of their skills in health program
administration, and to provide the staff with certainty as to
their employment status if MRMIB is eliminated. The
Administration has proposed to eliminate MRMIB in past budgets,
the HFP was eliminated and Pre-existing Condition Insurance
Program (PCIP) was returned to the federal government. MRMIB
continues to administer Access for Infants and Mothers Program
and MRMIP, has a small number of HFP subscribers as well as HFP
close-out activities, and will be engaged in substantial
close-out and reconciliation activities for PCIP through the end
of 2014. MRMIB management indicate its staff are seeking
opportunities elsewhere because of uncertainty regarding MRMIB's
future. When staff leave, it is difficult to maintain program
administration and attract new employees given the uncertain
future of MRMIB. This provision provides clarity and certainty
and, as such, permits MRMIB to retain the necessary continuity
of staffing and expertise to fulfill its substantial remaining
responsibilities.
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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
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Local: No
According to the Assembly Appropriations Committee, the overall
cost impact of the transfer of employees should be minor.
Employees may be reassigned to other duties after the transfer
if their functions cease. It is not clear whether workload
justifies the transfer of up to 76 employees to DHCS.
Potentially significant state Medi-Cal costs, if more
individuals enroll in Medi-Cal more quickly than would otherwise
occur, as a result of outreach provided with information
required to be transferred by this bill. If individuals are
found to be eligible for Medi-Cal under existing eligibility
rules, the cost associated with these individuals will be funded
50 % through the General Fund. Medi-Cal costs for newly
eligible individuals are 100 % federally funded through 2016.
SUPPORT : (Verified 9/11/13)
100% Campaign
American Federation of State, County and Municipal Employees,
AFL-CIO
California Pan-Ethnic Health Network
California School Employees Association
Children Now
Children's Defense Fund-California
Children's Partnership
County Welfare Directors Association of California
Health Access California
PICO California
SEIU Local 1000
SEIU-California
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.
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ASSEMBLY FLOOR : 53-25, 9/9/13
AYES: Alejo, Ammiano, Atkins, Bloom, Bocanegra, Bonilla, Bonta,
Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,
Chesbro, Cooley, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray, Hall, Roger
Hernández, Holden, Jones-Sawyer, Levine, Lowenthal, Medina,
Mitchell, Mullin, Muratsuchi, Nazarian, Pan, Perea, V. Manuel
Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone,
Ting, Weber, Wieckowski, Williams, Yamada, John A. Pérez
NOES: Achadjian, Allen, Bigelow, Chávez, Conway, Dahle,
Donnelly, Beth Gaines, Gorell, Grove, Hagman, Harkey, Jones,
Linder, Logue, Maienschein, Mansoor, Melendez, Morrell,
Nestande, Olsen, Patterson, Wagner, Waldron, Wilk
NO VOTE RECORDED: Vacancy, Vacancy
JL:d 9/11/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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