BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session AB 1231 (Wood) - Medi-Cal: nonmedical transportation ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: June 19, 2015 |Policy Vote: HEALTH 9 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: AB 1231 would require the Department of Health Care Services to provide nonmedical transportation as a covered benefit in the Medi-Cal program. Fiscal Impact: One-time costs, likely about $150,000 to $300,000 for one to two years to develop program requirements, amend the state's Medicaid plan, and adopt regulations to implement the bill (General Fund and federal funds). Ongoing costs of $1.5 million to $6.5 million to provide nonmedical transportation to Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans that do not already provide nonmedical transportation as a covered benefit (General Fund and federal funds). According to the Department of Health Care Services, 17 out of 21 Medi-Cal managed care plans already provide coverage for nonmedical transportation, covering between 50% and 70% of all existing Medi-Cal managed care plan AB 1231 (Wood) Page 1 of ? enrollees. The Department estimates the annual cost per member to provide nonmedical transportation is between $0.50 and $2.00 per year. Ongoing costs of $1.5 million to $3.0 million per year to provide coverage for nonmedical transportation to Medi-Cal beneficiaries not enrolled in Medi-Cal managed care. The Department currently does not provide coverage for nonmedical transportation in the fee for service system (except for children). Unknown impact on overall utilization of specialty health care services in the Medi-Cal program (General Fund and federal funds). By ensuring that Medi-Cal beneficiaries have access to nonmedical transportation to specialty care, the bill is likely to allow for increased access to specialty care by Medi-Cal beneficiaries, particularly those in rural areas of the state. This is likely to increase utilization of those services. On the other hand, timely access to specialty services may allow beneficiaries and their providers to better manage serious medical conditions, potentially reducing future needs for additional specialty services or hospitalization. The net impact of these factors is unknown. Background: Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. Medi-Cal provides coverage to childless adults and parents with household incomes up to 138% of the federal poverty level and to children with household incomes up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary. Federal regulations require state Medicaid programs to provide coverage for "necessary transportation for recipients to and from providers". Under the state's Medicaid State Plan, Medi-Cal provides coverage for emergency medical transportation (e.g. ambulance transportation to an emergency department), nonemergency medical transportation (e.g. ambulance transportation from a hospital to a skilled nursing facility), and nonmedical transportation (e.g. reimbursement of travel in a private car or taxi to a specialist's office) for children and dual eligibles enrolled in the Coordinated Care Initiative. AB 1231 (Wood) Page 2 of ? Current state policy does not require nonmedical transportation to be provided to other Medi-Cal beneficiaries. However, many Medi-Cal managed care plans do provide nonmedical transportation as a covered benefit, but with differing requirements and authorization procedures. In recent years, the state has dramatically expanded enrollment in Medi-Cal managed care (due both to the expansion of Medi-Cal eligibility under the Affordable Care Act and state policy to shift Medi-Cal beneficiaries from fee-for-service into managed care). A significant change in the Medi-Cal program in recent years has been the expansion of Medi-Cal managed care to rural counties. Given the low population density in some of those counties, there are a limited number of medical specialists who participate in the Medi-Cal program. In some counties, the design of Medi-Cal managed care specialty networks has resulted in Medi-Cal beneficiaries needing to travel significant distances to obtain specialty care. Proposed Law: AB 1231 would require the Department of Health Care Services to provide nonmedical transportation as a covered benefit in the Medi-Cal program. Specific provisions of the bill would: Require nonmedical transportation to be covered, subject to utilization controls, to allow a beneficiary obtain covered specialty care if those services are more than 60 minutes or 30 miles from the beneficiary's residence; Define nonmedical transportation; State legislative intent that the intent of the bill is to affirm existing federal requirements, rather than to create a new benefit in the Medi-Cal program; Require implementation of the bill only to the extent that federal financial participation is available and federal approvals have been obtained; Authorize the Department of Health Care Services to implement the bill through all county letters or other means, until implementing regulations are adopted. AB 1231 (Wood) Page 3 of ? -- END --