BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1102
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|AUTHOR: |Santiago |
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|VERSION: |July 9, 2015 |
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|HEARING DATE: |July 15, 2015 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Health care coverage: Medi-Cal Access Program:
disclosures
SUMMARY : Requires the Department of Health Care Services to inform an
applicant of the Medi-Cal Access Program who is declined
coverage about the Major Risk Medical Insurance Program and
options for potential subsidized coverage through Covered
California.
Existing law:
1)Establishes the Medi-Cal Access Program, at the Department of
Health Care Services (DHCS) to provide preventive, screening,
diagnostic, and treatment services, physician services,
emergency first aid, perinatal, obstetric, radiology,
laboratory, and nutrition services, services of advanced
practice nurses or mid-level practitioners who are authorized
to perform any of the services listed in this section within
the scope of their licensure, and all services and benefits
set forth in the Medi-Cal program.
2)Establishes program eligibility for the Medi-Cal Access
Program for: a woman who is pregnant or in her postpartum
period, as specified, and who is a resident of the state; a
person who is a member of a federally recognized California
Indian tribe is a resident of the state for these purposes;
and infants up to age two who are born to woman in the
program.
3)Creates the Managed Risk Medical Insurance Board (MRMIB) which
administers the Major Risk Medical Insurance Program (MRMIP)
to provide major risk medical coverage to residents who are
unable to secure adequate private health coverage due to
chronic illness or high-risk medical conditions.
AB 1102 (Santiago) Page 2 of ?
4)Requires health plans and insurers to limit enrollment in
individual health benefit plans to open enrollment periods,
annual enrollment periods, and special enrollment periods.
5)Establishes as an open enrollment period for the policy year
beginning on January 1, 2016, from November 1, of the
preceding calendar year, to January 31, of the benefit year,
inclusive. This is the period when individuals can purchase
health insurance through Covered California and in the
commercial market. In addition, gives individuals 63 days to
enroll under one of the following special enrollment trigger
events:
a) Loss of minimum essential coverage,
as specified under federal requirements;
b) Gaining a dependent or becoming a
dependent;
c) Mandated coverage due to court
order;
d) Released from incarceration;
e) Health benefit plan substantially
violated a material provision of the contract;
f) Gained access to a new health
benefit plan as a result of a permanent move;
g) Provider no longer participating in
a plan and individual has a specified condition;
h) Misinformed about minimum essential
coverage; and,
i) Any events listed under federal
regulations.
This bill:
1)Requires DHCS to inform an applicant for the Medi-Cal Access
Program who is declined coverage about MRMIP and the coverage
options and the potential for subsidized coverage through
Covered California.
2)Requires DHCS to direct persons seeking more information to
MRMIP, Covered California, plan or policy representatives,
insurance agents, or an entity paid by Covered California to
assist with health coverage enrollment, such as a navigator or
an assister.
AB 1102 (Santiago) Page 3 of ?
FISCAL
EFFECT : This version of the bill has not been analyzed by a
fiscal committee.
PRIOR
VOTES : The prior votes are not relevant to this version of the
bill.
COMMENTS :
1)Author's statement. According to the author, in 2016,
individuals will be allowed to sign up for health insurance
within the three months designated as open enrollment.
Individuals can purchase health insurance outside this period
only when experiencing a qualifying life event such as getting
married, or having a baby. Becoming pregnant does not qualify
as a life event that triggers special enrollment. Some women
can receive health insurance outside of open enrollment
through the Medi-Cal Access Program. For women who do not
qualify for the Medi-Cal Access Program, a safety-net health
insurance program exists. The Major Risk Medical Insurance
Program (MRMIP) is not subject to open enrollment periods and
was created to ensure that those that become medically fragile
receive the healthcare they need. Unfortunately, many women
forego receiving prenatal care simply because they are unaware
of MRMIP. By requiring information about MRMIP to be given to
women who are rejected for the Medi-Cal Access Program, will
ensure pregnant women receive prenatal care and afforded the
opportunity of important preventive measures.
2)Medi-Cal Access Program. The Medi-Cal Access Program,
formerly the Access for Infants and Mothers (AIM) Program,
covers pregnant women in families with incomes between
213-322% of the federal poverty level (approximately
$25,080-$37,908 annually for an individual). These pregnant
women are subject to premiums fixed at 1.5% of their adjusted
annual income. There is no open enrollment period.
3)Major Risk Medical Insurance Program. MRMIP is California's
high risk health insurance program and provides coverage to
Californians who are unable to obtain coverage, or charged
unaffordable premiums in the individual health insurance
market due to pre-existing conditions. Premiums equal 100% of
the average market cost of premiums based on the Silver level
coverage through Covered California. Premiums are subsidized
but coverage comes with an annual benefit cap of $75,000 and a
AB 1102 (Santiago) Page 4 of ?
lifetime benefit cap of $750,000. Because this program was
established prior to November 26, 2014, it is recognized as
minimum essential coverage under the Affordable Care Act
(ACA). Eligibility is not based on income and there is no
open enrollment period. With the passage of ACA, more
affordable comprehensive coverage is available through Covered
California during open or special enrollment periods.
4)ACA. The ACA makes statutory changes affecting the regulation
of and payment for certain types of private health insurance.
As of 2014, individuals are required to maintain health
insurance or pay a penalty, with exceptions for financial
hardship (if health insurance premiums exceed 8% of household
adjusted gross income), religion, incarceration, and
immigration status. Several insurance market reforms are also
required, such as prohibitions against health insurers
imposing pre-existing health condition exclusions. These
reforms impose new requirements on states related to the
allocation of insurance risk, prohibit insurers from basing
eligibility for coverage on health status-related factors,
allow the offering of premium discounts or rewards based on
enrollee participation in wellness programs, impose
nondiscrimination requirements, require insurers to offer
coverage on a guaranteed issue and renewal basis, and
determine premiums based on adjusted community rating (age,
family, geography, and tobacco use). Additionally, states
have been permitted to establish health benefit exchanges
where individuals with income below 400% of the federal
poverty level can qualify for credits toward their premium
costs and subsidies toward their cost-sharing for insurance
purchased through an exchange. California has established
Covered California, as a state-based exchange that is
operating as an independent government entity with a
five-member Board of Directors.
5)Prior legislation. AB 1180 (Pan, Chapter 441, Statutes of
2013), makes inoperative because of the ACA several provisions
in existing law that implement state health insurance laws of
the federal Health Insurance Portability and Accountability
Act of 1996 and additional provisions that provide former
employees rights to convert their group health insurance
coverage to individual market coverage without medical
underwriting. Establishes notification requirements informing
individuals affected by AB 1180 of health insurance available
in 2014.
AB 1102 (Santiago) Page 5 of ?
AB 1X 2 (Pan, Chapter 1, Statutes of 2013-14 First
Extraordinary Session), and SB 1X 2 (Hernandez, Chapter 2,
Statutes of 2013-14 First Extraordinary Session), established
health insurance market reforms contained in the ACA specific
to individual purchasers, such as prohibiting insurers from
denying coverage based on pre-existing conditions; and makes
conforming changes to small employer health insurance laws
resulting from final federal regulations.
SB 961 (Hernandez, 2012), and AB 1461 (Monning, 2012), were
identical bills that would have reformed California's
individual market similar to the provisions in SBX1 2. SB 961
and AB 1461 were vetoed by Governor Brown.
AB 1083 (Monning, Chapter 854, Statutes of 2012), established
reforms in the small group health insurance market to
implement the ACA.
AB 2244 (Feuer, Chapter 656, Statutes of 2010), required
guaranteed issue of health plan and health insurance products
for children beginning in January 1, 2011.
SB 900 (Alquist, Chapter 659, Statutes of 2010), and AB 1602
(Perez, Chapter 655, Statutes of 2010), established the
California Health Benefit Exchange.
AB 99 (Chapter 278, Statutes of 1991) established the AIM and
SB 800 (Chapter 448, Statutes of 2013) transferred the AIM
from the Managed Risk Medical Insurance Board (MRMIB) to the
Department of Health Care Services and renamed the program the
Medi-Cal Access Program.
AB 60 (Isenberg, Chapter 1168, Statutes of 1989), established
the Major Risk Medical Insurance Program administered by
MRMIB.
6)Amendments. The author and committee may wish to amend this
bill to include a requirement that Covered California and
private health insurance companies also inform an individual
who is not eligible to enroll in coverage because it is
outside an open enrollment period and he or she does not
qualify for special enrollment because of a qualifying life
event about MRMIP.
AB 1102 (Santiago) Page 6 of ?
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