BILL ANALYSIS Ó
AB 2077
Page 1
(Without Reference to File)
ASSEMBLY THIRD READING
AB
2077 (Burke and Bonilla)
As Amended June 1, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, Chiu, | |
| | |Dababneh, Gomez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Olsen, Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-0 |Gonzalez, Bloom, | |
| | |Bonilla, Bonta, | |
AB 2077
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| | |Calderon, Daly, | |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Quirk, Santiago, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Establishes procedures to ensure eligible recipients
move from Medi-Cal and other insurance affordability programs,
like the California Health Benefit Exchange (Exchange) or
CoveredCA), without any breaks in coverage. Prohibits, for
individuals eligible to enroll in a qualified health plan (QHP)
through the Exchange, Medi-Cal benefits from being terminated
until at least 20 days after the county sends the notice of
action terminating Medi-Cal eligibility (Medi-Cal to CoveredCA
transition) and is contingent to the extent that federal
financial participation is available. Specifies procedures
counties must follow to enroll individuals in Medi-Cal who are
deemed ineligible for subsidized coverage through the Exchange
due to income that appears to make them Medi-Cal eligible
(CoveredCA to Medi-Cal transition).
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Uncertain Information Technology (IT) costs to the California
Healthcare Enrollment, Eligibility and Retention System
(CalHEERS) system (General Fund (GF)/federal/special), to the
county-administered Statewide Automated Welfare System (SAWS),
and to the Medicaid Eligibility Data System (GF/federal) to
effectuate the policy changes. There is already a "change
request" to these IT systems planned that will modify
eligibility, enrollment and notifications. This change
request could potentially be modified to accomplish the bill's
requirements at little additional cost. To the extent this
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bill would require IT changes beyond the scope of the current
request, there could be additional costs.
2)This bill's requirements could result in unknown but large
additional state cost pressure in Medi-Cal. The largest
fiscal impact is associated with the creation of a grace
period to move from Medi-Cal and enroll in a CoveredCA plan,
where the state would pay for Medi-Cal coverage for a longer
period of time in order to extend the window most consumers
have to pick a CoveredCA plan. If even a portion of this
projected 2 million stayed on Medi-Cal for an extra month
while transitioning from Medi-Cal to CoveredCA, the state
could experience cost in the millions of dollars or more
(GF/federal).
COMMENTS: 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, the
Department of Health Care Services (DHCS) selects the Medi-Cal
plan based on their QHP plan, even when networks are different.
Unlike Medi-Cal, CoveredCA coverage cannot begin until the
individual has chosen a QHP plan. According to the sponsor,
individuals 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.
Federal Poverty Level (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.
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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.
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.
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 consumer becomes newly
eligible or ineligible for help paying for their insurance.
Medi-Cal enrollment is year-round.
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.
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
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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 and the Asian Law Alliance also 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.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0003374