SB 10, as amended, Lara. Health care coverage: immigration status.
begin insertExisting law, the federal Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, and meets certain other requirements. PPACA specifies that an individual who is not a citizen or national of the United States or an alien lawfully present in the United States shall not be treated as a qualified individual and may not be covered under a qualified health plan offered through an exchange. Existing law creates the California Health Benefit Exchange for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA.
end insertbegin insertThis bill would require the Secretary of California Health and Human Services to apply to the United States Department of Health and Human Services for a waiver to allow individuals who are not eligible to obtain health coverage because of their immigration status to obtain coverage from the Exchange. The bill would require, after that waiver has been granted, the Exchange to offer California qualified health benefit plans, as specified, to these individuals. The bill would require that individuals eligible to purchase California qualified health plans pay the cost of coverage without federal assistance.
end insertExisting law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. The federal Medicaid Program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.
This bill would extend eligibility for full-scope Medi-Cal benefits to individuals 19 years of age and older who are otherwise eligible for those benefits but for their immigration status if the department determines that sufficient funding is available, or for limited scope Medi-Cal benefits if funding for full-scope benefits is not available. The bill would require these individuals to enroll into Medi-Cal managed care health plans, and to pay copayments and premium contributions, to the extent required of otherwise eligible Medi-Cal recipients who are similarly situated. The bill would require that benefits for those services be provided with state-only funds only if federal financial participation is not available. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
(a) The Legislature finds and declares all of the
2following:
P3 1(1) The Legislature and the Governor, through the enactment
2of the Budget Act of 2015 (Chapter 11 of the Statutes of 2015),
3expanded Medi-Cal eligibility for children to ensure that no child
4in California who is income eligible will be denied access to health
5care coverage on the basis of immigration status.
6(2) Expanding access and increasing enrollment in
7comprehensive health care coverage is of benefit to the health and
8welfare of all Californians.
9(3) Longstanding California law provides full-scope Medi-Cal
10benefits to United States citizens, lawful permanent residents, and
11individuals permanently residing in the United States under color
12of law, including those granted deferred action.
13(b) It is the intent of the Legislature in enacting this act to
14increase opportunities for enrollment in comprehensive health care
15coverage for adults, regardless of immigration status.
16(c) It is further the intent of the Legislature that all Californians
17who are otherwise eligible for Medi-Cal, a qualified health plan
18offered through the California Health Benefit Exchange, or
19affordable employer-based health coverage, enroll in that coverage,
20and obtain the care that they need.
begin insertSection 100522 is added to the end insertbegin insertGovernment Codeend insertbegin insert, to
22read:end insert
(a) The Secretary of California Health and Human
24Services shall apply to the United States Department of Health
25and Human Services for a waiver authorized under Section 1332
26of the federal act as defined in subdivision (e) of Section 100501
27in order to allow persons otherwise not able to obtain coverage
28by reason of immigration status through the Exchange to obtain
29coverage from the Exchange by waiving the requirement that the
30Exchange offer only qualified health plans solely for the purpose
31of offering coverage to persons otherwise not able to obtain
32coverage by reason of immigration status.
33(b) The Exchange shall offer California qualified health plans
34that shall be subject to the requirements of this title, including all
35of those
requirements applicable to qualified health plans. In
36addition, California qualified health plans shall be subject to the
37requirements of Section 1366.6 of the Health and Safety Code and
38Section 10112.3 of the Insurance Code in the same manner as
39qualified health plans.
P4 1(c) Persons eligible to purchase California qualified health
2plans shall pay the cost of coverage without federal advanced
3premium tax credit, federal cost-sharing reduction, or any other
4federal assistance.
5(d) Subdivisions (b) and (c) shall become operative upon federal
6approval of the waiver pursuant to subdivision (a).
7(e) For purposes of this section, a “California qualified health
8plan” means a product offered to persons not otherwise eligible
9to purchase coverage from the Exchange by reason of immigration
10status and that comply with each of the
requirements of state law
11and the Exchange for a qualified health plan.
Section 14102.1 is added to the Welfare and Institutions
14Code, to read:
(a) (1) Notwithstanding any other law, an individual
1619 years of age or older who meets all of the eligibility
17requirements for full-scope Medi-Cal benefits under this chapter,
18but for his or her immigration status, may be enrolled for full-scope
19Medi-Cal benefits, pursuant to paragraph (2).
20(2) When a county completes the Medi-Cal eligibility
21determination process for an individual 19 years of age or older
22who meets all of the eligibility requirements for full-scope
23Medi-Cal benefits under this chapter, but for his or her immigration
24status, the county shall transmit this information to the department
25to determine if sufficient funding is
available for this individual
26to receive full-scope Medi-Cal benefits. If sufficient funding is
27available, the individual shall be eligible for full-scope benefits.
28If sufficient funding is not available, the individual shall be eligible
29for limited scope Medi-Cal benefits.
30(b) This section shall not apply to individuals eligible for
31coverage pursuant to Section 14102.
32(c) An individual who is eligible for coverage under subdivision
33(a) shall be required to enroll into Medi-Cal managed care health
34plans to the extent required of otherwise eligible Medi-Cal
35recipients who are similarly situated.
36(d) An individual who is eligible for coverage under subdivision
37(a) shall pay copayments and premium contributions to the extent
38required
of otherwise eligible Medi-Cal recipients who are similarly
39situated.
P5 1(e) Benefits for services under this section shall be provided
2with state-only funds only if federal financial participation is not
3available for those services. The department shall maximize federal
4financial participation in implementing this section to the extent
5allowable.
6(f) Eligibility for full-scope Medi-Cal benefits for an individual
719 years of age or older pursuant to subdivision (a) shall not be an
8entitlement. The department shall have the authority to determine
9eligibility, determine the number of individuals who may be
10enrolled, establish limits on the number enrolled, and establish
11processes for waiting lists needed to maintain program expenditures
12within available funds.
13(g) Notwithstanding Chapter 3.5 (commencing with Section
1411340) of Part 1 of Division 3 of Title 2 of the Government Code,
15the department, without taking any further regulatory action, shall
16implement, interpret, or make specific this section by means of
17all-county letters, plan letters, plan or provider bulletins, or similar
18instructions until the time regulations are adopted. The department
19shall adopt regulations by July 1, 2018, in accordance with the
20requirements of Chapter 3.5 (commencing with Section 11340) of
21Part 1 of Division 3 of Title 2 of the Government Code.
22Commencing July 1, 2016, and notwithstanding Section 10231.5
23of the Government Code, the department shall provide a status
24report to the Legislature on a semiannual basis, in compliance with
25Section 9795 of the Government Code, until regulations have been
26
adopted.
If the Commission on State Mandates determines that
29this act contains costs mandated by the state, reimbursement to
30local agencies and school districts for those costs shall be made
31pursuant to Part 7 (commencing with Section 17500) of Division
324 of Title 2 of the Government Code.
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