BILL ANALYSIS Ó
AB 1114
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Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1114
(Bonilla) - As Amended April 16, 2015
SUBJECT: Health care: eligibility and enrollment.
SUMMARY: Clarifies existing law regarding the documents
necessary to retain eligibility, benefits or services from
Medi-Cal and subsidized programs under Covered California, as
defined. Specifically, this bill:
1)Defines "forms, letters, and notices" as all application,
renewal, and other forms and letters needed to obtain or
retain eligibility, benefits, or services from an insurance
affordability program, and all notices affecting the legal
rights of applicants, beneficiaries and enrollees.
2)Requires all forms, letters and notices developed pursuant to
this bill to be accessible, standardized, and in compliance
with federal and state laws, regulation, and guidance.
3)Requires all forms, letters, and notices developed pursuant to
this bill to be written in plain language, be accessible to
limited English proficient (LEP) individuals in accordance
with state and federal law, and at a minimum, provided at the
same threshold of languages as required for Medi-Cal managed
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care plans.
EXISTING LAW:
1)Requires the California Health and Human Services Agency, in
consultation with specified entities, to establish
standardized single, accessible application forms and related
renewal procedures for state subsidy programs.
2)Requires all forms and notices developed according to the
Health Care Eligibility, Enrollment, and Retention Act (Act)
be accessible and standardized, as appropriate, and must
comply with federal and state laws, regulations, and guidance
prohibiting discrimination.
3)Requires all forms and notices be developed using plain
language and provided in a manner that affords meaningful
access to LEP individuals in accordance with state and federal
law, and at a minimum, provided at the same threshold
languages as required for Medi-Cal managed care plans.
FISCAL EFFECT: None
COMMENTS:
1)PURPOSE OF THIS BILL. The author states language is a
significant barrier to health care access and coverage to
Californians. While the Health Care Eligibility, Enrollment,
and Retention Act has made progress in ensuring that
Californians are in compliance with the Patient Protection and
Affordable Care Act (ACA) and receiving the health care
coverage they need, significant challenges remain for many LEP
individuals. The author states this bill will help ensure LEP
individuals not only have access to health care for the first
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time, but also continue to renew their coverage to receive
sustained care.
2)BACKGROUND.
a) Federal and State Authority. Title VI of the Civil
Rights Act of 1964 prohibits discrimination on the basis of
race, color, and ethnic origin in all state programs that
receive federal financial assistance. Federal courts have
interpreted discrimination by national origin to include
language. The Dymally-Alatorre Bilingual Services Act of
1973 was enacted by California to ensure that individuals
who do not speak or write English still maintain access to
public services; the law specifically requires state and
local agencies to ensure they provide services and
assistance in their constituents' languages.
b) Primary Languages of Medi-Cal-Eligible Californians.
State regulations require California to define threshold
languages to help determine the need for services for
various LEP populations. Forty percent of Medi-Cal
eligible individuals statewide reported a language other
than English as their primary language, and met the
statutory criteria for a threshold language population.
Thirteen languages qualified as threshold languages.
c) Covered California and Medi-Cal Forms and Notices. The
ACA expanded private health insurance to millions of
previously uninsured Californians through its health
benefit exchange, also known as Covered California.
Medi-Cal is California's state Medicaid program, which
provides health insurance to low-income individuals with
incomes at 138% of the federal poverty level. The Covered
California and Medi-Cal application forms are currently
available in 12 languages. Renewal forms for these
programs are not currently available in these languages.
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d) Recent Litigation. On November 17, 2014, the Western
Center on Law & Poverty and other consumer advocacy groups
filed a petition for a writ of mandate against the
Department of Health Care Services (DHCS) due to the
failure of DHCS to translate 2014 Medi-Cal renewal forms
into languages other than English and Spanish. The
plaintiffs alleged DHCS was in acting in violation of Title
VI of the Civil Rights Act and California's
Dymally-Alatorre Bilingual Services Act. On February 19,
2015, the court denied part of the motion, citing that
existing law on renewal forms does not explicitly require
such translation.
3)SUPPORT. Western Center on Law & Poverty, the sponsor of this
bill, states that the lack of translated and
language-accessible renewal materials is resulting in many
consumers not understanding requests for information required
to maintain their health coverage. This has led to undue
stress and discontinued access to necessary health care
services for LEP Medi-Cal beneficiaries, following receipt of
Medi-Cal termination notices. The sponsor notes that some
counties within the state have begun to translate some of the
forms into their own threshold languages; however this is a
piecemeal solution to a statewide issue. The sponsor asserts
Californians should receive important information about their
health coverage in their primary language. The sponsor
concludes this bill is necessary to clarify which health care
forms are required to be translated for consumers, as a court
recently ruled that existing statute does not explicitly
contain translation requirements for all forms.
Supporters of this bill state that any notice to a consumer
not provided in his or her primary language is legally
insufficient to be considered proper notice in terms of a
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consumer's due process rights. Supporters note this bill is
necessary to clarify existing law and ensure Californians
better understand their healthcare coverage.
4)RELATED LEGISLATION. AB 635 (Toni G. Atkins) establishes the
Medi-Cal Medical Interpretation services program at DHCS to
provide and reimburse for certified medical interpretation
services to LEP Medi-Cal enrollees. AB 635 passed this
Committee on April 14, 2015 by a vote of 16-0 is currently
pending in the Assembly Appropriations Committee.
5)PREVIOUS LEGISLATION.
a) AB 505 (Nazarian), Chapter 788, Statutes of 2014,
requires all managed care plans contracting with the DHCS
to provide Medi-Cal services, except as specified, to
provide language assistance services, which includes oral
interpretation and translation services, to LEP Medi-Cal
beneficiaries.
b) AB 411 (Pan) of 2014 would have provided that DHCS
require all Medi-Cal managed care plans to analyze quality
performance measures, by race, ethnicity, and primary
language to identify disparities in medical treatment and
to implement strategies to reduce disparities. AB 411 was
vetoed by the Governor, in his veto message, he stated
existing law already allows DHCS to procure the additional
data, if it sees a need or benefit that justifies the cost.
c) AB 1263 (John A. Pérez) of 2013 would have established
the Medi-Cal Patient Centered Communication (CommuniCal)
program at DHCS to provide and reimburse for certified
medical interpretation services to LEP Medi-Cal enrollees.
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Would have established a certification process and registry
of CommuniCal certified medical interpreters at the
California Department of Human Resources and granted
CommuniCal certified medical interpreters collective
bargaining rights with the state. AB 1623 was vetoed by
the Governor.
d) AB 1296 (Bonilla), Chapter 641, Statutes of 2011,
establishes the Health Care Eligibility, Enrollment, and
Retention Act, and requires the California Health and Human
Services Agency, in consultation with other state
departments and stakeholders, to have undertaken a planning
process to develop plans and procedures regarding these
provisions relating to enrollment in state health programs
and federal law.
REGISTERED SUPPORT / OPPOSITION:
Support
Western Center on Law & Poverty (sponsor)
Asian Americans Advancing Justice - Los Angeles
Alameda Health Consortium
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Asian Law Alliance
California Primary Care Association
Community Health Councils, Inc.
California Pan-Ethnic Health Network
Health Access California
National Health Law Program
National Immigration Law Center
Southeast Asian Resource Action Center
Opposition
None on file.
Analysis Prepared by:An-Chi Tsou / HEALTH / (916) 319-2097
AB 1114
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