BILL ANALYSIS Ó
AB 2077
Page 1
Date of Hearing: April 5, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2077
(Burke) - As Amended March 18, 2016
SUBJECT: Health Care Eligibility, Enrollment, and Retention
Act.
SUMMARY: Establishes procedures to ensure eligible recipients
move from Medi-Cal and other insurance affordability programs,
like the California Health Benefit Exchange (Exchange), without
any breaks in coverage. Specifically, this bill:
1)Prohibits, for individuals eligible to enrollee in a qualified
health plan (QHP) through the Exchange, Medi-Cal benefits from
being terminated until at least 30 days after the county sends
the notice of action terminating Medi-Cal eligibility.
2)Requires the notice of action to inform an individual of the
date by which he or she must select and enroll in a QHP to
avoid being uninsured. Specifies that if an individual
enrolls in a QHP before the notice of action termination date,
Medi-Cal eligibility will be terminated at the QHP enrollment
date.
3)Requires an individual's case to be run through the California
Healthcare Eligibility, Enrollment, and Retention System
(CalHEERS) when a QHP enrollee reports a change in
circumstances, goes through the renewal process, or is
reevaluated for eligibility and there is a change affecting
AB 2077
Page 2
his or her eligibility for any insurance affordability
program. Requires CalHEERS to send an individual's case file
to his or her county of residence within three business days
if CalHEERS receives information indicating that an individual
enrolled in a QHP is newly eligible for Medi-Cal. Specifies
that the county:
a) Cannot treat the individual as a new Medi-Cal
application;
b) Must process case files received before the 15th of the
month for final Medi-Cal eligibility by the end of that
month and case files received after the 15th of the month
by the 15th day of the following month;
c) Issue a notice at least 15 days before the individual's
QHP enrollment ends that advises the following: he or she
will be Medi-Cal enrolled; instructions on how to select a
Medi-Cal managed care plan; right to appeal QHP
eligibility; and, instructions on how to request continued
enrollment in a QHP pending the outcome of his or her
appeal;
d) Verify income, as specified;
e) Must follow procedures for newly eligible Medi-Cal
individuals. For Medi-Cal counties under the two-plan
model or the geographic managed care plan model, the
individual will be enrolled to either the available
Medi-Cal managed care plan that has the same or
substantially similar provider network to the QHP plan or
to a plan using the usual Medi-Cal managed care default
algorithm;
f) Issue a 15 day notice to the individual and include:
the assigned Medi-Cal managed care plan if the individual
does not take any action; the individual choice of any
available plan; description of available Medi-Cal managed
care plans; and, instructions on how to change Medi-Cal
AB 2077
Page 3
managed care plans; and,
g) For counties under a county organized health system
(COHS) to enroll an individual on the first date of
Medi-Cal coverage and send the provider directory to the
individual.
EXISTING LAW:
a)Establishes various programs to provide health care coverage
to persons with limited financial resources, including the
Medi-Cal program and the state's children's health insurance
program (CHIP).
b)Establishes the Medi-Cal program which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income persons receive health care benefits.
Governs and funds the Medi-Cal program, in part, by federal
Medicaid program provisions. Allows DHCS to exercise a
specified federal option to extend continuous Medi-Cal
eligibility to children 19 years of age and younger.
c)Establishes the Exchange, also referred to as Covered
California (CoveredCa) within state government, as an
independent public entity not affiliated with an agency or
department, and requires the Exchange to compare and make
available through selective contracting health insurance for
individual and small business purchasers as authorized under
the federal Patient Protection and Affordable Care Act (ACA).
Specifies the powers and duties of the board governing the
Exchange, and requires the board to facilitate the purchase of
qualified health plans though the Exchange by qualified
individuals and small employers.
d)Requires the board to determine the criteria and process for
eligibility, enrollment, and disenrollment of enrollees and
potential enrollees in the Exchange and coordinate that
process with state and local government entities administering
other specified health care coverage programs, as specified
AB 2077
Page 4
e)Requires an individual to be provided the option to apply for
insurance affordability programs in person, by mail, online,
by telephone, or by other commonly available electronic means.
f)Defines "insurance affordability programs" to include the
Medi-Cal program, CHIP, and a program that makes available to
qualified individuals coverage in a QHP through the Exchange
with advance payment of the premium tax credit established
under the Internal Revenue Code and cost-sharing reduction
under federal law.
g)Requires an entity making eligibility determination for an
insurance affordability program to ensure than an eligible
applicant and recipient of the program meets all program
eligibility requirements and complies with all necessary
requirements for information without any breaks in coverage
and without being required to provide any forms, documents, or
other information or undergo verification that is duplicative
or otherwise unnecessary.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The sponsor, Western Center on Law and
Poverty (WCLP), states that under the existing presumptive
eligibility process, most people do not have a break in
coverage during which they are uninsured. However, a change
in policy at the state level may result in individuals being
required to stay in CoveredCa until they have their Medi-Cal
eligibility determined while paying premiums for commercial
coverage. Furthermore, DHCS selects the Medi-Cal plan based
on their QHP plan, even when networks are different and
without giving the individual a choice of plan. Unlike
Medi-Cal, CoveredCa coverage cannot begin until the individual
has chosen a QHP plan. According to the sponsor, individuals
AB 2077
Page 5
whose Medi-Cal coverage are ending are not told to choose a
CoveredCa plan before the end of the month to avoid a break in
coverage.
2)BACKGROUND.
a) Federal Poverty Level (FPL). FPL is a measure of income
level issued annually by the Department of Health and Human
Services to determine eligibility for certain programs and
benefits. Medi-Cal is available to all individuals who
qualify on the basis of income up to 138% of the FPL and
all children (up to age 19) whose family's income is at or
under 266% of the FPL. Families who enroll in the Exchange
with income below 266% of the FPL must enroll their
children in Medi-Cal or enroll their children into a
separate commercial plan.
b) CoveredCa. The Exchange does not change how existing
state health care coverage programs are administered.
Medi-Cal continues to be administered by the DHCS. Federal
law requires state exchanges to perform the function of
screening for and enroll individuals in Medi-Cal. The
Exchange coordinates with DHCS and California counties to
ensure that individuals are seamlessly transitioned between
coverage programs if their eligibility changes.
c) CalHEERS. CalHEERS is the computer system behind the
Exchange and is sponsored by CoveredCa and DHCS. It is a
computer program that allows prospective consumers to enter
their personal and income data and receive information
about plans they are eligible for and what they cost. It
also determines preliminary eligibility for Advanced
Premium Tax Credits, Modified Adjusted Gross Income (MAGI)
Medi-Cal, and Non-MAGI Medi-Cal.
d) Enrollment. Consumers who experience a qualifying life
event can enroll in a CoveredCa health insurance plan even
outside of the open-enrollment period. This is called
special enrollment and includes income changes in which a
AB 2077
Page 6
consumer becomes newly eligible or ineligible for help
paying for their insurance. Medi-Cal enrollment is
year-round.
e) Existing transition procedures. While existing law
already requires transitions between CoveredCa and Medi-Cal
without a break in coverage, this bill provides for
specificity with respect to notice requirements for newly
eligible members. Unlike Medi-Cal, CoveredCa coverage
cannot begin until the individual has chosen a QHP, however
it appears as if current notices are insufficient to advise
individuals that they need to choose a QHP before the end
of the month to avoid a break in health coverage. This
bill also requires CalHEERS to send an individual's case
file within a specific time if CalHEERS receives
information indicating that an individual is newly eligible
for Medi-Cal.
3)SUPPORT. WCLP, the sponsor of this bill, states that while
existing law requires transitions between Medi-Cal and
CoveredCa without a break in coverage, there needs to be more
specific processes to ensure that the transitions work. WCLP
writes that the state is changing its current processes and
even when someone loses their job and reports it to CoveredCa,
they would have to stay on and keep paying for their current
coverage, rather than moving over to Medi-Cal. WCLP contend
that individuals should be informed of their option to choose
their own plan instead of Medi-Cal enrolling individuals into
a Medi-Cal plan based on their QHP plan. Additionally, WCLP
notes that this bill would give consumers notice at least 30
days before Medi-Cal termination to allow time for consumers
to choose and enroll in a QHP plan. Finally, WCLP and the
Asian Law Alliance contend that this bill will put policies in
place to ensure that when someone's income fluctuates they
could move into their new program without becoming uninsured.
The California Black Health Network states that this bill will
AB 2077
Page 7
ease the transition for consumers and will ensure that no
Californian falls through the coverage gap. The California
Immigrant Policy Center contends that while the transitions
between Medi-Cal and CoveredCa are supposed to happen without
a break in coverage, many people are ending up uninsured which
means that low and moderate income Californians who are
eligible for health coverage are going without care.
4)RELATED LEGISLATION. AB 1839 (Patterson) allows families in
which adults are eligible for subsidized coverage via the
Exchange to enroll children eligible for Medi-Cal coverage in
the same Exchange product. AB 1839 is pending in Assembly
Health Committee.
5)PREVIOUS LEGISLATION.
a) AB 1296 (Bonilla), Chapter 641, Statutes of 2011, enacts
the Health Care Reform Eligibility, Enrollment, and
Retention Planning Act (Act), which would require the
California Health and Human Services Agency (CHHSA), in
consultation with specified entities, to establish
standardized single, accessible application forms and
related renewal procedures for state health subsidy
programs, as defined, in accordance with specified
requirements. AB 1296 specifies the duties of the CHHSA
and DHCS under the Act, and requires CHHSA to provide
specified information to the Legislature by July 1, 2012,
regarding policy changes needed to implement the Act.
b) SB 970 (De León) of 2012 would have provided for a
workgroup of county staff, advocates, legislative staff,
and other specified representatives to consider the
feasibility, costs, and benefits of integrating application
and renewal processes for additional human services and
work support programs with the single stated application.
SB 970 was vetoed by the Governor who indicated that "this
bill is well-intentioned but overly prescriptive in its
requirements. Codifying another workgroup and requiring
another report are not necessary."
AB 2077
Page 8
6)POLICY COMMENT. Currently, CoveredCa and DHCS are conducting
stakeholder workgroups to address concerns with QHP and
Medi-Cal transitions. This bill will assist with codifying
specific requirements with respect to timing issues and notice
language to ensure that eligibility requirements are met
without any break in coverage.
REGISTERED SUPPORT / OPPOSITION:
Support
Western Center on Law and Poverty (sponsor)
Advancing Justice California
Asian Law Alliance
California Black Health Network
California Immigrant Policy Center
Central California Legal Services, Inc.
Consumers Union
Health Access California
AB 2077
Page 9
Justice in Aging
Legal Aid Society of San Mateo
Legal Services of Northern California
National Health Law Program
Project Inform
Opposition
None on file.
Analysis Prepared by:Kristene Mapile / HEALTH / (916) 319-2097
AB 2077
Page 10