BILL ANALYSIS Ó
AB 366
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ASSEMBLY THIRD READING
AB
366 (Bonta)
As Amended May 28, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+-----------------------+-------------------|
|Health |16-0 |Bonta, Maienschein, | |
| | |Burke, Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+-----------------------+-------------------|
|Appropriations |17-0 |Gomez, Bigelow, Bonta, | |
| | |Calderon, Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, Jones, | |
| | |Quirk, Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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AB 366
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SUMMARY: Requires the Department of Health Services (DHCS) to
prepare an annual report to the Legislature on the California
Medical Assistance Program (Medi-Cal) access. Requires for those
services, providers or geographic areas when DHCS identifies the
rates as inadequate, an increases in rates, to the extent money is
provided in the budget and federal funds are available.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, costs in the range of $1 million (General Fund/federal
funds) for enhanced monitoring and reporting of access and
adequacy of provider rates.
COMMENTS: According to the author, this bill would provide
critical stability to health care provider networks and ensure
access to health care services for people receiving services in
the Medi-Cal program. The author notes that with the dramatic
expansion of enrollment in California's Medi-Cal program, there is
increased concern about access to care. That concern stems from
the low rates in the program. California already pays its
Medi-Cal fee-for-service (FFS) providers some of the lowest rates
in the entire country (for primary care and obstetric care,
California ranked 48th among all states in 2012, and overall,
Medi-Cal compensated physicians at only 51 % of Medicare levels).
Having expanded Medi-Cal under the Patient Protection and
Affordable Care Act (ACA), California needs to ensure that
Medi-Cal beneficiaries have sufficient access to care.
Medi-Cal is California's version of Medicaid, a joint
federal-state program to provide health coverage to low-income
individuals. With the enactment of the ACA and California's
implementation of the Medi-Cal expansion, California has taken a
major step toward filling gaps in health coverage and removing
financial barriers that limit access to health care. Millions of
low - to moderate-income individuals have gained health benefits
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as states expand their Medicaid programs and develop their
marketplaces for private health plans. In 2010, 7.4 million
people were covered by Medi-Cal. Today, 11.9 million people -
nearly one in three Californians - are enrolled in the program.
With the Medi-Cal program projected to cover 12.2 million people
in 2015 to 2016, access to care can be a problem for those who
have coverage, particularly if Medi-Cal plan and provider rates
are below those paid by other payors.
Surveys of Californians conducted before coverage expansions
enacted under the ACA consistently showed a wide gap between
Medi-Cal enrollees and other insured populations with respect to
access to care. A 2011 survey funded by the California HealthCare
Foundation of over 1,500 Medi-Cal beneficiaries identified
difficulties in finding health care providers who accept their
coverage, as 34% of Medi-Cal beneficiaries said it was difficult
to find health care providers who accept their insurance, compared
to 13% for people with other coverage. The survey found a higher
percentage of adults with Medi-Cal say they have more difficulty
getting appointments with specialists and primary care providers
than adults with other health coverage (42% v. 24% for specialists
and 26% v. 15% for primary care providers).
Similarly, the 2012 California Health Interview Survey asked how
access to care in Medi-Cal compares to access to care in
employer-sponsored insurance (ESI) for adults with similar health
care needs. Medi-Cal had bigger gaps in access to care, including
Medi-Cal beneficiaries being less likely to have a usual source of
care other than the emergency room as compared to individuals with
ESI (21.5% v. 8.1%, Medi-Cal beneficiaries were more likely to
have used the emergency room than individuals with ESI (3.7% v.
0.5%), and Medi-Cal beneficiaries were either sometimes or never
able to get a physician appointment within two days of seeking an
appointment compared to individuals with ESI (46% v. 20.6%).
While the number of people receiving health care through Medi-Cal
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has grown dramatically, beginning in 2008, Medi-Cal payment rates
to health plans and providers in the program have been reduced to
help address the state budget deficits. In 2011, the Legislature
passed and Governor Brown signed AB 97 (Budget Committee), Chapter
3, Statutes of 2011, into law, which largely replaced prior
Medi-Cal rate reductions and which remains in effect. A court
injunction prevented DHCS from implementing many of these
reductions, however, in June 2013, the injunctions were lifted,
giving the state authority to: 1) apply the reductions to current
and future payments to providers on an ongoing basis; and, 2)
retroactively recoup the reductions from past payments that were
made to specified providers during the period in which the
injunctions were in effect (this is commonly referred to as a
"claw back").
The Legislative Analyst's Office (LAO) in their 2014-15 analysis
of health reviewed DHCS' baseline analysis and quarterly
monitoring reports. The LAO came away with numerous concerns
about the quality of the DHCS data, the soundness of the
methodologies, and the assumptions underlying the administration's
findings on FFS access. In the LAO's view, these concerns are
sufficient to render the administration's public reporting of very
limited value for the purpose of understanding beneficiary access
in the FFS system. The LAO specifically cited inflated estimates
of available FFS physicians and a flawed construction and
interpretation of enrollee-to-physician ratios that failed to take
into account physicians accepting new patients. Regarding
Denti-Cal coverage (which is primarily provided through Medi-Cal
FFS), the LAO stated that, because dental care will remain
primarily a FFS benefit for the foreseeable future, it recommended
the Legislature enact legislation that would create meaningful
standards for monitoring Denti-Cal access.
Analysis Prepared by:
Roger Dunstan / HEALTH / (916) 319-2097 FN:
0000693
AB 366
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