BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1114
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|AUTHOR: |Bonilla |
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|VERSION: |June 15, 2015 |
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|HEARING DATE: |June 24, 2015 | | |
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|CONSULTANT: |Scott Bain |
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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 :
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|Assembly Floor: |79 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |18 - 0 |
AB 1114 (Bonilla) Page 3 of ?
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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
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