BILL ANALYSIS Ó
AB 2077
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
2077 (Burke and Bonilla)
As Amended August 19, 2016
Majority vote
--------------------------------------------------------------------
|ASSEMBLY: |80-0 |(June 2, 2016) |SENATE: | 39-0 | (August 25, |
| | | | | |2016) |
| | | | | | |
| | | | | | |
--------------------------------------------------------------------
Original Committee Reference: HEALTH
SUMMARY: Prohibits Medi-Cal benefits from being terminated
until at least 20 days after the county sends the notice of
action (NOA) terminating Medi-Cal eligibility if the individual
is eligible to enroll in a qualified health plan (QHP) through
Covered California, to the extent federal financial
participation is available. Establishes application processing
timelines for counties for individuals who were enrolled in
California's Health Benefit Exchange (also known as Covered
California) and who are determined newly eligible for Medi-Cal
through the application processing system known as the
California Healthcare Eligibility, Enrollment and Retention
System (CalHEERS).
The Senate amendments:
1)Delete language specifying that individuals who effectuated
AB 2077
Page 2
enrollment in a QHP prior to the termination date specified in
the NOA, then Medi-Cal eligibility will be terminated as of
the QHP enrollment date.
2)Delete language specifying that for individuals enrolled in a
QHP and newly eligible for Medi-Cal, cases received by the
county prior to the 15th day of the month be processed for
final Medi-Cal eligibility by the end of the month and cases
received by the county after the 15th of the month be
processed for final Medi-Cal eligibility by the 15th day of
the following month.
3)Add language specifying that for referrals of a Modified
Adjusted Gross Income Medi-Cal eligible individual, the county
is required to prioritize the referral for processing to
ensure the individual's Medi-Cal eligibility is effective
according to either of the following timelines, as applicable:
a) Requires the county to prioritize the referral for
processing to ensure the individual's Medi-Cal eligibility
is effective on the first day of the following month if the
referral is received with at least five business days
remaining in the month; and,
b) Requires the county to prioritize the referral for
processing to ensure the individual's eligibility is
effective no later than the first day of the second month
following receipt of the referral if the referral is
received with less than five business days remaining in the
month.
4)Add language requiring the county to prioritize the referral
for processing to ensure the individual's Medi-Cal eligibility
is effective no later than the first day of the second month
following receipt of the referral if the referral requires
follow-up to establish Medi-Cal eligibility.
AB 2077
Page 3
5)Delete the Medi-Cal enrollment procedure requirements for
newly eligible Medi-Cal individuals, specifically:
a) For individuals previously enrolled through Covered
California and the QHP is available as a Medi-Cal managed
care plan in the same county and the health plan has the
same or substantially similar provider network;
b) For individuals assigned to a health plan using the
usual Medi-Cal managed care default algorithm; and,
c) For individuals enrolled into the county organized
health system plan.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)One-time costs in the hundreds of thousands, for the
Department of Health Care Services (DHCS) to change internal
processes, revise regulations, and seek any necessary federal
approvals (General Fund and federal funds).
2)One-time costs in the hundreds of thousands to make system
changes to several information technology systems used to
determine eligibility for Medi-Cal and Covered California
coverage and to manage Medi-Cal enrollment (General Fund and
federal funds). In order to facilitate the requirements of
this bill, system changes will be needed to CalHEERS (the
system used to process applications for Medi-Cal and Covered
California coverage) and MEDS (the system used to managed
Medi-Cal enrollment). It is possible that those costs would
be eligible for enhanced federal matching rate of 90%.
3)One-time costs of $2.5 million to make system changes to the
AB 2077
Page 4
SAWS (the systems used by counties to determine eligibility
for Medi-Cal) (General Fund and federal funds).
4)Ongoing costs of $3 million to $5 million per year from
extended Medi-Cal eligibility during transitions to Covered
California coverage (General Fund and federal funds). Under
current practice, when an individual loses eligibility for
Medi-Cal (generally because of an increase in income), the
individual is given 10 days notice before coverage is
terminated. This bill would require individuals to be given
20 days notice before coverage is terminated. Medi-Cal
coverage would be terminated before 20 days, if the individual
enrolls in coverage through Covered California. Because
Medi-Cal enrollment is granted monthly, extending the
transition period from 10 to 20 days will result in roughly a
third of transitioning individuals receiving an additional
month of coverage. According to data published by DHCS, there
are 5,000-6,000 individuals per month who transition from
Covered California to Medi-Cal. Staff assumes that a roughly
similar number of individuals transition from Medi-Cal to
Covered California each month.
5)Ongoing costs, potentially in the low millions due to
increased enrollment in Medi-Cal of individuals transitioning
from Covered California coverage to Medi-Cal (General Fund and
federal funds). This bill would impose new deadlines on
counties to determine Medi-Cal eligibility for individuals who
have lost their Covered California coverage. By imposing such
deadlines, this bill may result in earlier Medi-Cal
enrollment. If 10% of individuals in that situation become
eligible for Medi-Cal for one extra month under this bill, the
annual cost would be about $3 million.
COMMENTS: According to the author, this bill eases the
transition between plans for those moving from Covered
California plans to Medi-Cal and vice versa. For individuals
moving from Medi-Cal to Covered California, they will have 20
days before their Medi-Cal benefits expire. Those moving from
Covered California to Medi-Cal will also have additional time to
AB 2077
Page 5
select a plan, and receive guidance on how to select a plan. By
providing a coverage bridge for Californians transitioning
between plans, we can make sure that no one falls through a
coverage gap.
DHCS concerns. The problems with transitions between Covered
California and Medi-Cal has been discussed with DHCS and Covered
California, and the improved notices regarding the need to
promptly pick a plan for new Covered California enrollees are
currently scheduled to take effect in the CalHEERS release in
September 2016. With regard to the 20 day NOA (instead of the
current 10 day NOA), DHCS indicates this change would treat
individuals in a transition differently than new applicants for
Medi-Cal coverage. This change would require changes to DHCS'
existing infrastructure for a subset of individuals, and is
counter to DHCS' desire to treat individuals the same. If the
NOA timeframe were changed to 20 days for all Medi-Cal
beneficiaries, DHCS indicates this would have an impact on
Medi-Cal costs as more individuals would remain on the program
an additional month.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0004758