BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1102|
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THIRD READING
Bill No: AB 1102
Author: Santiago (D)
Amended: 7/9/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 7/15/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth,
Wolk
NO VOTE RECORDED: Nielsen
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/27/15
AYES: Lara, Beall, Hill, Leyva, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 66-10, 6/4/15 - See last page for vote
SUBJECT: Health care coverage: Medi-Cal Access Program:
disclosures
SOURCE: Author
DIGEST: This bill 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.
ANALYSIS:
Existing law:
1)Establishes the Medi-Cal Access Program, at the Department of
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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 within the scope of their
licensure, and all services and benefits set forth in the
Medi-Cal program.
2)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.
3)Requires health plans and insurers to limit enrollment in
individual health benefit plans to open enrollment periods,
annual enrollment periods, and special enrollment periods.
4)Establishes California's health benefit exchange (Covered
California), authorized under the federal Affordable Care Act
(ACA), as a marketplace for individuals and small business to
purchase health insurance, and for eligible individuals to
obtain premium and cost sharing subsidies.
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 specified special enrollment trigger events such
as a move, marriage or birth of a child.
This bill:
1)Requires DHCS to inform an applicant for the Medi-Cal Access
Program who is declined coverage, about MRMIP 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
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assist with health coverage enrollment, such as a navigator or
an assister.
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. 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. 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 are 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. 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 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 ACA. Eligibility is not based on income
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and there is no open enrollment period, however there is a
three month preexisting condition exclusionary period. With
the passage of ACA, more affordable comprehensive coverage is
available through Covered California during open or special
enrollment periods.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)Likely one-time costs in the hundreds of thousands to make
information technology changes to allow DHCS 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, DHCS 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.
2)Unknown impact on state spending on MRMIP (Proposition 99
funds). By informing denied applicants that they may be able
to get health care coverage through MRMIP, the bill is likely
to result in some share of those individuals seeking and
accessing coverage through MRMIP. Currently, MRMIP 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.
SUPPORT: (Verified8/28/15)
Health Access California
March of Dimes
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OPPOSITION: (Verified8/28/15)
None received
ARGUMENTS IN SUPPORT: The March of Dimes writes that this
bill will help provide increased information about health
coverage options for pregnant women. Lack of health coverage is
a significant barrier to accessing prenatal care and puts both
mom and baby at risk. Maternal mortality is three to four times
higher among women who do not receive prenatal care according to
the American College of Obstetricians and Gynecologists.
ASSEMBLY FLOOR: 66-10, 6/4/15
AYES: Achadjian, Alejo, Baker, Bloom, Bonilla, Bonta, Brough,
Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu,
Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman,
Frazier, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Roger Hernández, Holden, Irwin,
Jones-Sawyer, Kim, Levine, Linder, Lopez, Low, Maienschein,
Mathis, McCarty, Medina, Mullin, Nazarian, O'Donnell, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NOES: Travis Allen, Bigelow, Beth Gaines, Gallagher, Harper,
Lackey, Mayes, Melendez, Olsen, Patterson
NO VOTE RECORDED: Grove, Hadley, Jones, Obernolte
Prepared by:Teri Boughton / HEALTH /
8/31/15 16:37:05
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