BILL ANALYSIS Ó
SB 1341
Page 1
SENATE THIRD READING
SB 1341 (Mitchell)
As Amended May 6, 2014
Majority vote
SENATE VOTE :35-0
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bigelow, |
| |Bonilla, Bonta, Chávez, | |Bocanegra, Bradford, Ian |
| |Chesbro, Gomez, Gonzalez, | |Calderon, Campos, |
| |Roger Hernández, | |Donnelly, Eggman, Gomez, |
| |Lowenthal, Mansoor, | |Holden, Jones, Linder, |
| |Nazarian, Waldron, | |Pan, Quirk, |
| |Ridley-Thomas, Rodriguez, | |Ridley-Thomas, Wagner, |
| |Wagner, Wieckowski | |Weber |
| | | | |
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SUMMARY : Requires the Statewide Automated Welfare System (SAWS)
to be the system of record for Medi-Cal and to contain all
Medi-Cal eligibility rules and case management functionality.
EXISTING LAW requires the Office of Systems Integration to
implement a statewide automated system for the California Work
Opportunity and Responsibility to Kids program, CalFresh,
Medi-Cal, foster care, refugee program, and county medical
services programs. The statewide automated system that was
eventually developed is now known as SAWS.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill would have:
1)Information technology costs, likely in the range of several
million dollars (50% General Fund (GF)/50% federal or 10%
GF/90% federal if federal approval is granted for enhanced
matching funds) to program functionality related to notices of
action (NOAs) into the relevant computer systems.
2)Significant reduced administrative cost pressure, potentially
exceeding $10 million GF ongoing, for county eligibility work.
SB 1341
Page 2
County eligibility workers conduct eligibility screenings and
interface with beneficiaries on behalf of the state. Counties
are funded by the Department of Health Care Services to process
Medi-Cal eligibility, and are currently reimbursed on a
historical and negotiated basis, not on a time basis or per-case
basis. Thus, county administrative costs and state GF costs are
highly correlated, but do not correspond exactly.
According to county eligibility workers, the current system of
issuing NOAs using the California Healthcare Eligibility,
Enrollment and Retention System (CalHEERS) system has resulted
in a high degree of confusion and has led to unnecessary
increased administrative workload. The County Welfare
Director's Association (CWDA), the sponsor of this bill,
estimates the status quo is resulting in additional workload of
$260 million in 2014-15 and $155 million ongoing (likely 25%
GF). Relieving this workload pressure would translate into a
significant reduction in state cost pressure. Inaccurate and
vague notices appear to be generating significant additional
workload because workers have to spend additional time
researching cases, responding to questions, and handling
appeals. The CWDA estimate may be slightly overstated because
county workers would incur additional costs to verify the
accuracy and appropriately annotate NOAs to avoid beneficiary
confusion, which would offset some of the projected savings.
However, CWDA also asserts various assumptions were fairly
conservative, and the unnecessary increased administrative
workload imposed by the status quo costs may actually be higher
than they calculated. On balance, the estimates appear
reasonable in magnitude, even if they are not completely
accurate due to the data quality of several assumptions used to
make the estimate.
Practically speaking, the actual costs incurred statewide on
eligibility functions in a given time period are constrained by
the capacity of county workforce. Thus, the effect of this
additional time spent on cases is not an immediate direct cost
to the state, but results in cost pressure to increase
administrative funding to counties and prevents the state from
conducting eligibility and enrollment functions in a timely way.
If the state does not correct the notices and counties continue
to incur this higher level of costs on an ongoing basis, there
will be significant cost pressure to increase funding for
eligibility work in future years.
SB 1341
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COMMENTS : According to the author, this bill will clarify the
respective roles of SAWS and CalHEERS in order to minimize
confusion and errors related to Medi-Cal eligibility under the
Patient Protection and Affordable Care Act. This bill will also
ensure that NOAs are able to be tailored in an accurate manner
and consistent with legal requirements.
This bill is jointly sponsored by CWDA and the Service Employees
International Union. They argue, in light of the decision to
build CalHEERS, an agreement was reached between the
Administration, Covered California, and the counties that
reflected existing statute naming SAWS as the system of record
for Medi-Cal and requiring Medi-Cal eligibility functions to be
in SAWS. Per the agreement, CalHEERS would serve as the system
that applies the new modified adjusted gross income rules, and
SAWS was to proceed with all other eligibility and enrollment
case functions. The sponsors state the intent of SAWS serving
as the system of record is to ensure program efficiency,
efficacy, continuity, and cohesiveness via multi-program case
management, and to allow for ease of access to Medi-Cal while
providing a more simplified process. This bill would codify the
agreed upon automation approach designed to comprehensively and
seamlessly serve families' needs for both their health care and
human service needs. The sponsors conclude this approach allows
families and individuals to obtain coordinated services, both
when they initially apply and as their circumstances change.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097
FN: 0004902