BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                    AB 2077

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          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  

          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  

          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  


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            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  

             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  

             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  

             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  


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               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  

          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


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          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  


          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  


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            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  


             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  


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               consumer becomes newly eligible or ineligible for help  
               paying for their insurance.  Medi-Cal enrollment is  

             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  


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            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.  


             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."


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          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.  



          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


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          Justice in Aging

          Legal Aid Society of San Mateo

          Legal Services of Northern California

          National Health Law Program

          Project Inform


          None on file.

          Analysis Prepared by:Kristene Mapile / HEALTH / (916) 319-2097


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