BILL ANALYSIS Ó
AB 461
Page 1
ASSEMBLY THIRD READING
AB
461 (Mullin)
As Amended April 21, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
|----------------+------+-------------------------+------------------|
|Health |17-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, Chávez, | |
| | |Chiu, Gomez, Gonzalez, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Waldron, Wood | |
| | | | |
|----------------+------+-------------------------+------------------|
|Appropriations |17-0 |Gomez, Bigelow, Bloom, | |
| | |Bonta, Calderon, Chang, | |
| | |Daly, Eggman, Gallagher, | |
| | |Eduardo Garcia, Holden, | |
| | |Jones, Quirk, Rendon, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Authorizes a beneficiary receiving services through a
regional center who resides in the County of San Mateo to
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voluntarily enroll in the Cal MediConnect demonstration project
under the Coordinated Care Initiative (CCI), as specified.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, this bill has a negligible fiscal effect, given that
the impacted individuals currently incur costs as Medi-Cal
beneficiaries, and allowing them to enroll in a different delivery
system should not increase costs for their care.
COMMENTS: According to the author, in San Mateo County, Health
Plan of San Mateo (HPSM) serves about 12,000 dual eligible
beneficiaries (beneficiaries eligible for both Medicare and
Medi-Cal) through its dual-eligible special needs plan (D-SNP),
the vast majority of whom transitioned into the CCI this year.
The author states that approximately 600 dually eligible
developmentally disabled individuals remain in the D-SNP; however,
HPSM may close its D-SNP due to the costly nature of running a
program for such a small population, leaving this population
without a health plan that would integrate and maximize Medi-Cal
and Medicare benefits. The author concludes that by allowing this
population to voluntarily enroll in the CCI, HPSM will be able to
continue to provide them with the option of managed care.
1)CCI. The 2012 state budget authorized the CCI, a program
intended to integrate and coordinate the delivery of health
benefits, including behavioral health benefits and long-term
services and supports to dual eligibles and seniors and persons
with disabilities living in specified counties, including San
Mateo County. The CCI includes the Cal MediConnect Program, a
three-year demonstration project designed to coordinate medical,
behavioral health, long-term institutional, and home- and
community-based services by combining Medicare and Medi-Cal
benefits into one integrated health plan. Certain dual eligible
beneficiaries are not permitted to participate in Cal
MediConnect, including individuals with developmental
disabilities receiving services through a regional center.
2)HPSM. In certain counties, Medi-Cal managed care is operated by
a single County Organized Health System (COHS). San Mateo
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County is a COHS county, and HPSM is the single plan to serve
all Medi-Cal beneficiaries enrolled in managed care. As such,
HPSM operates the only Cal MediConnect plan called
CareAdvantage. Passive enrollment into CareAdvantage commenced
in April 2014, and as of March 2015, 10,100 dual eligibles were
actively enrolled in Cal MediConnect. San Mateo County has an
enrollment rate of 84%, with 13% of dual eligibles opting out of
Cal MediConnect, and 4% disenrolling from Cal MediConnect. The
enrollment rate is significantly higher than any other CCI
county.
HPSM also operates a D-SNP in which developmentally disabled
individuals receiving care from a regional center are enrolled.
A D-SNP is a type of Medicare Advantage plan that limits
membership to people with specific diseases or characteristics,
and tailor their benefits, provider choices, and drug
formularies to best meet the specific needs of the groups they
serve. D-SNPs serve dual eligibles, and similar to Cal
MediConnect plans, D-SNPs combine Medicare and Medicaid benefits
into one plan.
Under the CCI, D-SNPs operated by plans that also operate a Cal
MediConnect plan will be phased out. In January 2015,
beneficiaries enrolled in a D-SNP operated by a Cal MediConnect
plan were transitioned into Cal MediConnect. Additionally,
beneficiaries who are eligible for Cal MediConnect will not be
able to enroll in a D-SNP after January 2015.
SUPPORT. HPSM supports this bill stating that it serves dual
eligibles, 600 of which are developmentally disabled and receive
care through its SNP. HPSM states that the SNP is costly and
inefficient to operate for only 600 members, and it intends to
close the SNP in the next year or two, potentially leaving the 600
developmentally disabled members without a consolidated health
plan to maximize Medi-Cal and Medicare benefits. HPSM states that
this bill will correct this problem by allowing this special needs
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population to voluntarily enroll in Cal MediConnect. According to
HPSM, this bill also enjoys the support of the local San Mateo
County disability rights community.
Golden Gate Regional Center (GGRC), the regional center serving
San Mateo County, and other supporters state that persons with
developmental disabilities who are enrolled in HPSM's D-SNP should
have the option to continue with HPSM through the CCI. GGRC
states that the inability of these individuals to continue with
HPSM through the CCI would be extremely disruptive to their care,
and without the option for voluntary CCI enrollment created under
this bill, the alternative for these beneficiaries will be a
fragmented system between Medicare FFS and Medi-Cal through HPSM.
OPPISITION. There is no opposition on file.
Analysis Prepared by: Kelly Green / HEALTH /
(916) 319-2097 FN: 0000223