BILL ANALYSIS                                                                                                                                                                                                    

                                                                    AB 1231

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          1231 (Wood)

          As Enrolled  September 14, 2015

          2/3 vote

          |ASSEMBLY:  |76-0  |(June 2, 2015) |SENATE: | 40-0 |(September 9,    |
          |           |      |               |        |      |2015)            |
          |           |      |               |        |      |                 |
          |           |      |               |        |      |                 |

          |ASSEMBLY:  |80-0  |(September 10, |        |      |                 |
          |           |      |2015)          |        |      |                 |
          |           |      |               |        |      |                 |
          |           |      |               |        |      |                 |

          Original Committee Reference:  HEALTH

          SUMMARY:  Adds nonmedical transportation, as defined, to the  
          schedule of benefits in the Medi-Cal program administrated by  
          the Department of Health Care Services (DHCS) for beneficiaries  
          who receive services.  Requires DHCS to seek federal approval  


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          and conditions providing the benefit on DHCS obtaining all  
          necessary federal approvals.

          The Senate amendments:

          1)Strike the requirement for DHCS to cover nonmedical  
            transportation for beneficiaries who receive services that are  
            located more than 60 minutes or 30 miles from the  
            beneficiary's place of residence and instead insert the  
            requirement that nonmedical transportation is covered, subject  
            to utilization controls and federally permissible time and  
            distance standards.

          2)Strike "specialty care" from the definition of Medi-Cal  
            services that are covered under nonmedical transportation.

          3)Require the cost of nonmedical transportation to be paid for a  
            Medi-Cal beneficiary who can prove, in a manner to be  
            specified by DHCS, that other available resources have been  
            reasonably exhausted.

          4)Strike the provisions authorizing DHCS to seek approval of any  
            necessary state plan amendments to implement coverage for  
            nonmedical transportation, and instead requires DHCS to seek  
            any federal approvals necessary to implement this bill,  
            including, but not limited to, approval of revisions to  
            existing federal Medicaid authorities that DHCS determines are  
            necessary to implement this bill.  Prohibit this bill from  
            being implemented until all necessary federal approvals are  

          5)Make technical changes.


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          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee, this bill will have the following costs:

          1)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 (GF) and federal funds).

          2)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 (GF and federal  
            funds).  According to DHCS, 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 enrollees.  DHCS estimates the annual cost per  
            member to provide nonmedical transportation is between $0.50  
            and $2.00 per year.

          3)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.  DHCS  
            currently does not provide coverage for nonmedical  
            transportation in the fee for service system (except for  

          4)Unknown impact on overall utilization of specialty health care  
            services in the Medi-Cal program (GF 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  


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            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.

          COMMENTS:  The Western Center on Law and Poverty, the sponsor of  
          this bill, asserts access to transportation services is critical  
          for residents in rural areas where public transport is scarce  
          and low-income beneficiaries cannot afford the limited  
          transportation options available.  Although transportation to  
          and from health care services is assured through the Medicaid  
          State Plan, variation in implementation of this benefit leaves  
          uncertainty to availability and criteria for receiving such  
          benefits.  Supporters of this bill note specialty care often  
          requires multiple trips to a specialist, which can be difficult  
          for Medi-Cal beneficiaries in rural areas.  This problem is  
          exacerbated by the mandatory transition to managed care for  
          Medi-Cal consumers in 28, mostly rural, counties who are  
          reporting farther travel distances to access medically needed  
          specialty services within the plan's network.

          There is no known opposition to this bill on file.


          I am returning the following six bills without my signature;

          Assembly Bill 50

          Assembly Bill 858

          Assembly Bill 1162


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          Assembly Bill 1231

          Assembly Bill 1261

          Senate Bill 610

          These bills unnecessarily codify certain existing health care  
          benefits or require the expansion or development of new benefits  
          and procedures in the Medi-Cal program.

          Taken together, these bills would require new spending at a time  
          when there is considerable uncertainty in the funding of this  
          program. Until the fiscal outlook for Medi-Cal is stabilized, I  
          cannot support any of these measures.

          Analysis Prepared by:                                             
                          An-Chi Tsou / HEALTH / (916) 319-2097  FN: