BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1114|
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THIRD READING
Bill No: AB 1114
Author: Bonilla (D)
Amended: 9/1/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 6/24/15
AYES: Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan,
Roth, Wolk
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/1/15 - See last page for vote
SUBJECT: Health care: eligibility and enrollment
SOURCE: Western Center on Law and Poverty
DIGEST: This bill defines forms and notices for purposes of
existing requirements for insurance affordability
program-related application forms and notices to mean
application and renewal forms and notices of action needed to
obtain or retain eligibility, benefits, or services from an
insurance affordability program, thereby requiring these forms
and notices to be translated in the same threshold languages as
required for Medi-Cal managed care plans.
ANALYSIS:
Existing law:
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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
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 and renewal
forms and notices of action needed to obtain or retain
eligibility, benefits, or services from an insurance
affordability program, thereby requiring these forms and notices
to be translated in the same threshold languages as required for
Medi-Cal managed care plans.
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
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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
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.
Comments
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
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Covered California, but can continue to renew their coverage and
understand their notices to receive the care necessary for their
health and well-being.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:NoLocal: No
According to the Senate Appropriations Committee, unknown costs
to make programmatic changes to information technology systems
(General Fund, federal funds, special fund). Through the
California Healthcare Eligibility, Enrollment, and Retention
System (CalHEERS) system, eligibility determinations and
notifications for Medi-Cal and Covered California are largely
automated. Currently, CalHEERs has only been programmed to issue
redetermination forms or notices of action in English or Spanish
(depending on the applicant's stated language preference). In
order to issue redetermination forms, notices of action, and
other documents in the applicant/enrollee's language of
preference, the CalHEERs system will need programming changes.
SUPPORT: (Verified8/31/15)
Western Center on Law and Poverty (source)
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
OPPOSITION: (Verified8/31/15)
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Department of Finance
ARGUMENTS IN 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. WCLP states 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" 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 for beneficiaries and missed appointments or
prescriptions.
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ARGUMENTS IN OPPOSITION: The Department of Finance (DOF)
writes in opposition to the prior version of this bill that this
bill would result in costs not included in the current fiscal
plan and because of its impact on the CalHEERS and the Statewide
Automated Welfare System systems (CalHEERS and SAWs are the
Covered California and Medi-Cal eligibility computer systems).
DOF argues introducing new requirements to CalHEERS and SAWS is
not prudent at this time given the significant workload to
update these systems for requirements related to the ACA.
ASSEMBLY FLOOR: 79-0, 6/1/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Wagner
Prepared by:Scott Bain / HEALTH /
9/1/15 21:20:00
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