BILL ANALYSIS Ó AB 1114 Page 1 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 AB 1114 Page 2 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 AB 1114 Page 3 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. AB 1114 Page 4 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 AB 1114 Page 5 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. AB 1114 Page 6 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 AB 1114 Page 7 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 Page 8