BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 1114 --------------------------------------------------------------- |AUTHOR: |Bonilla | |---------------+-----------------------------------------------| |VERSION: |June 15, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |June 24, 2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Scott Bain | --------------------------------------------------------------- SUBJECT : Health care: eligibility and enrollment. SUMMARY : Defines "forms and notices" for purposes of existing requirements for insurance affordability program-related application forms and notices to mean 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, thereby requiring these forms and notices to be translated in the same threshold languages as required for Medi-Cal managed care plans. Existing law: 1)Requires a single, accessible, standardized paper, electronic, and telephone application for insurance affordability programs to be developed by the Department of Health Care Services (DHCS) in consultation with the Covered California board, as part of a stakeholder process. 2)Requires the application to be used by all entities authorized to make an eligibility determination for any of the insurance affordability programs and by their agents. 3)Permits DHCS to develop and require the use of supplemental forms to collect additional information needed to determine eligibility on a basis other than Modified Adjusted Gross Income. 4)Establishes requirements for the required forms, including using simple, user-friendly language and instructions, and to only require necessary information. Requires notices developed under the above-described provisions to be accessible and standardized, as appropriate, and to comply with federal and AB 1114 (Bonilla) Page 2 of ? state laws, regulations, and guidance prohibiting discrimination, to be developed using plain language and to be provided in a manner that affords meaningful access to limited-English-proficient (LEP) individuals, in accordance with applicable state and federal law, and at a minimum, provided in the same threshold languages as required for Medi-Cal managed care plans. This bill defines "forms and notices" for purposes of existing requirements for insurance affordability program-related application forms and notices to mean 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, thereby requiring these forms and notices to be translated in the same threshold languages as required for Medi-Cal managed care plans. FISCAL EFFECT : According to the Assembly Appropriations Committee: 1)Implementation costs for translation and information technology (IT) services to Covered California/DHCS, which are joint sponsors of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), potentially in the range of $2 million (General Fund (GF)/federal funds/special funds). The vast majority of this cost is for IT. 2)Unknown, potential ongoing cost pressure to the state (GF/federal funds/special funds) for county administrative costs. Counties determine eligibility for Medi-Cal and Covered California, and would incur additional costs if additional translations are necessary beyond the standard translations included in the automated CalHEERS system. PRIOR VOTES : ----------------------------------------------------------------- |Assembly Floor: |79 - 0 | |------------------------------------+----------------------------| |Assembly Appropriations Committee: |17 - 0 | |------------------------------------+----------------------------| |Assembly Health Committee: |18 - 0 | AB 1114 (Bonilla) Page 3 of ? | | | ----------------------------------------------------------------- COMMENTS : 1)Author's statement. According to the author, language is a significant barrier to health care access and coverage for many Californians statewide. Forty percent of Medi-Cal members speak a language other than English, with 500,000 of those members speaking a language other than Spanish. This bill will help ensure that those who have limited proficiency in English will not only be able to access health care through Medi-Cal and Covered California, but can continue to renew their coverage and understand their notices to receive the care necessary for their health and well-being. 2)Background. AB 1296 (Bonilla, Chapter 641, Statutes of 2011), the Health Care Eligibility, Enrollment, and Retention Act, requires the California Health and Human Services Agency, in consultation with other state departments and stakeholders, to undertake a planning process to develop plans and procedures regarding these provisions relating to enrollment in state health programs and federal law. AB 1296 also established the existing law requirements for the application form for insurance affordability programs, which are Medi-Cal and coverage with premium or cost-sharing subsidies in Covered California. In 2014, a lawsuit was filed alleging that DHCS failed, among other requirements, to perform its duty to translate the 2014 redetermination forms in the Medi-Cal threshold languages. The petitioners contended that DHCS is responsible for ensuring languages access in the Medi-Cal program pursuant to Title VI of the federal Civil Rights Act of 1964, Government Code Section 11135, and California's Dymally-Alatorre Bilingual Services Act, and that DHCS translated redetermination forms into the eleven written Medi-Cal threshold languages in prior years. The petitioners sought an injunction preventing DHCS from terminating any Medi-Cal benefits until the 2014 redetermination forms were translated into the eleven threshold languages and sent to beneficiaries. The court denied the request for a preliminary injunction, finding that the Dymally-Alatorre Bilingual Services Act provided an alternative to translation of the redetermination AB 1114 (Bonilla) Page 4 of ? forms through the use of translation aids, translation guides or through the use of qualified bilingual individuals. The court also found that the requirements governing Medi-Cal redetermination forms were in a code section separate from the provisions of Health Care Eligibility, Enrollment, and Retention Act. The court stated that if the Legislature wanted to mandate translation of redetermination forms into threshold languages for LEP individuals, it could have included such language in the redetermination statute rather than simply requiring such redetermination forms and notices to be "accessible" to LEP individuals. 3)Support. This bill is sponsored by Western Center on Law and Poverty (WCLP) and supported by other consumer groups to clarify that Medi-Cal and Covered California renewal forms and notices must be translated into and issued in the thirteen Medi-Cal threshold languages. WCLP states California's population is incredibly diverse racially, culturally and linguistically. WCLP states Medi-Cal has a tradition of translating its vital documents including applications, renewal forms and notices of action into the Medi-Cal threshold languages to provide needed language access for its diverse LEP members. Prior to adoption of the Affordable Care Act (ACA) the Medi-Cal annual redetermination forms were translated into the Medi-Cal threshold languages. When the state developed its joint paper health care application for Medi-Cal and Covered California in 2013, that application was similarly translated into all the threshold languages. However, in 2014 neither Medi-Cal nor Covered California redetermination forms or notices nor notices of action were issued into languages other than Spanish. The 2015 Medi-Cal pre-populated renewal form was translated into the threshold languages and issued in January 2013 but it has not yet been programmed and put into use. The result is that, while the single streamlined application asks applicants what their preferred written language is and the state has a record of this language, forms and notices have not been sent in the applicants' language. WCLP believes existing law was intended to require translation of the renewal form, but neither the Medi-Cal nor Covered California renewal forms or notices were translated into the threshold languages in 2014 and DHCS has given conflicting accounts of whether it believes it is obligated to do so. WCLP is sponsoring this clarification that "forms and notices" AB 1114 (Bonilla) Page 5 of ? requiring translation include renewal forms and all forms and notices related to either eligibility or benefits as its local legal services partners have been helping consumers who cannot understand the termination notices they receive because they did not understand any of the requests for information they were sent and did not understand what they needed to do to keep their health coverage. This creates undue stress and missed appointments or prescriptions. SUPPORT AND OPPOSITION : Support: Western Center on Law and Poverty (sponsor) Alameda Health Consortium American Federation of State, County and Municipal Employees Asian Americans Advancing Justice - Los Angeles Asian Law Alliance California Pan-Ethnic Health Network California Primary Care Association Community Clinic Association of Los Angeles County Community Health Councils, Inc. Consumers Union Health Access Justice in Aging National Health Law Program National Immigration Law Center Project Inform Southeast Asian Resource Action Center Oppose: None received -- END --