BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1102 (Santiago) - Health care coverage: Medi-Cal Access
Program: disclosures
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|Version: July 9, 2015 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1102 would require the Department of Health Care
Services to notify an applicant who was denied coverage in the
Medi-Cal Access Program about options for coverage through the
Major Risk Medical Insurance Program or Covered California.
Fiscal
Impact:
Likely one-time costs in the hundreds of thousands to make
information technology changes to allow the Department of
Health Care Services and counties to provide information about
coverage options to applicants who are denied coverage through
the Medi-Cal Access Program (General Fund and federal funds).
Because much of the application and enrollment process for
Medi-Cal and related programs is automated, the Department
will need to modify its information technology systems to
include additional information about coverage options when
sending information notifying an applicant that an application
was denied.
AB 1102 (Santiago) Page 1 of
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Unknown impact on state spending on the Major Risk Medical
Insurance Program (Proposition 99 funds). By informing denied
applicants that they may be able to get health care coverage
through the Major Risk Medical Insurance Program, the bill is
likely to result in some share of those individuals seeking
and accessing coverage through the Major Risk Medical
Insurance Program. Currently, the Major Risk Medical Insurance
Program is funded through subscriber premiums and a state
subsidy using Proposition 99 funds. The state has a
maintenance of effort requirement imposed by the federal
government on this program and the program has experienced
significantly lower enrollment in recent years. Therefore, it
is uncertain whether any additional enrollment in the program
will actually increase state spending (or reduce future
savings), due to the maintenance of effort requirement.
Background: Under current law, the Department of Health Care Services
operates the Medi-Cal Access Program (formerly referred to as
the Access for Infants and Mothers or AIM Program). Under this
program, pregnant and post-partum women with incomes up to 322%
of the federal poverty level are eligible for coverage. The
program has no open enrollment periods.
Under current law, the state operates a high-risk insurance pool
for people who cannot afford or have been rejected from private
health coverage. Typically, these are people who have
pre-existing medical conditions. The Major Risk Medical
Insurance Program provides subsidized health coverage to people
who have been denied private coverage. Under the program,
participants are required to pay premiums equal to 100% of the
market equivalent premiums. The state also subsidizes premiums
(because program participants are sicker than the general
population, the actual cost to cover this group is higher than
the general population). In addition, the program has annual
benefit limits of $75,000 and lifetime benefit limits of
$750,000. The Major Risk Medical Insurance Program does not have
an open enrollment period.
Under current law, Covered California offers health care
coverage to individuals, with federal subsidies based on income
level. Covered California has an annual open enrollment period
in the fall. Individuals can acquire coverage outside of the
open enrollment period due to certain life events, such as the
AB 1102 (Santiago) Page 2 of
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birth of a child or loss of other health care coverage. Becoming
pregnant is not an event that allows for enrollment out of the
open enrollment period.
Proposed Law:
AB 1102 would require the Department of Health Care Services
to notify an applicant who was denied coverage in the Medi-Cal
Access Program about options for coverage through the Major Risk
Medical Insurance Program or Covered California.
Staff
Comments: In general, individuals can only sign up for health
care coverage through Covered California (or for private
coverage generally) during open enrollment periods or if certain
qualifying events take place. A woman who does not have health
care coverage and becomes pregnant has few options to get health
care coverage for the duration of the pregnancy if her income is
too high to qualify for Medi-Cal or the Medi-Cal Access Program.
One option in that case would be to sign up for coverage through
the Major Risk Medical Insurance Program.
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