SB 10, as amended, Lara. Health care coverage: immigration status.
Existing 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.
This 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.
Existing 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.
end deleteThis 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.
end deleteThe 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.
end deleteThis 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.
end deleteVote: majority.
Appropriation: no.
Fiscal committee: yes.
State-mandated local program: begin deleteyes end deletebegin insertnoend insert.
The people of the State of California do enact as follows:
(a) The Legislature finds and declares all of the
2following:
3(1) The Legislature and the Governor, through the enactment
4of the Budget Act of 2015 (Chapter 11 of the Statutes of 2015),
5expanded Medi-Cal eligibility for children to ensure that no child
6in California who is income eligible will be denied access to health
7care coverage on the basis of immigration status.
8(2) Expanding access and increasing enrollment in
9comprehensive health care coverage is of benefit to the health and
10welfare of all Californians.
11(3) Longstanding California law provides full-scope Medi-Cal
12benefits to United States citizens, lawful permanent residents, and
13individuals permanently residing in the United States under color
14of law, including those granted deferred action.
15(b) It is the intent of the Legislature in enacting this act to
16increase opportunities for enrollment in comprehensive health care
17coverage for adults, regardless of immigration status.
18(c) It is further the intent of the Legislature that all Californians
19who are otherwise eligible for Medi-Cal, a qualified health plan
20offered through the California Health Benefit Exchange, or
21affordable employer-based health coverage, enroll in that coverage,
22and obtain the care that they need.
Section 100522 is added to the Government Code,
25to read:
(a) The Secretary of California Health and Human
27Services shall apply to the United States Department of Health
28and Human Services for a waiver authorized under Section 1332
29of the federal act as defined in subdivision (e) of Section 100501
30in order to allow persons otherwise not able to obtain coverage by
31reason of immigration status through the Exchange to obtain
32coverage from the Exchange by waiving the requirement that the
33Exchange offer only qualified health plans solely for the purpose
34of offering coverage to persons otherwise not able to obtain
35coverage by reason of immigration status.
36(b) The Exchange shall offer California qualified health plans
37that
shall be subject to the requirements of this title, including all
38of those requirements applicable to qualified health plans. In
P4 1addition, California qualified health plans shall be subject to the
2requirements of Section 1366.6 of the Health and Safety Code and
3Section 10112.3 of the Insurance Code in the same manner as
4qualified health plans.
5(c) Persons eligible to purchase California qualified health plans
6shall pay the cost of coverage without federal advanced premium
7tax credit, federal cost-sharing reduction, or any other federal
8assistance.
9(d) Subdivisions (b) and (c) shall become operative upon federal
10approval of the waiver pursuant to subdivision (a).
11(e) For purposes of this section, a “California qualified
health
12plan” means a product offered to persons not otherwise eligible to
13purchase coverage from the Exchange by reason of immigration
14status and that comply with each of the requirements of state law
15and the Exchange for a qualified health plan.
Section 14102.1 is added to the Welfare and
17Institutions Code, to read:
(a) (1) Notwithstanding any other law, an individual
1919 years of age or older who meets all of the eligibility
20requirements for full-scope Medi-Cal benefits under this chapter,
21but for his or her immigration status, may be enrolled for full-scope
22Medi-Cal benefits, pursuant to paragraph (2).
23(2) When a county completes the Medi-Cal eligibility
24determination process for an individual 19 years of age or older
25who meets all of the eligibility requirements for full-scope
26Medi-Cal benefits under this chapter, but for his or her immigration
27status, the county shall transmit this information to the department
28to determine if sufficient funding is
available for this individual
29to receive full-scope Medi-Cal benefits. If sufficient funding is
30available, the individual shall be eligible for full-scope benefits.
31If sufficient funding is not available, the individual shall be eligible
32for limited scope Medi-Cal benefits.
33(b) This section shall not apply to individuals eligible for
34coverage pursuant to Section 14102.
35(c) An individual who is eligible for coverage under subdivision
36(a) shall be required to enroll into Medi-Cal managed care health
37plans to the extent required of otherwise eligible Medi-Cal
38recipients who are similarly situated.
39(d) An individual who is eligible for coverage under subdivision
40(a) shall pay copayments and premium contributions to the extent
P5 1required
of otherwise eligible Medi-Cal recipients who are similarly
2situated.
3(e) Benefits for services under this section shall be provided
4with state-only funds only if federal financial participation is not
5available for those services. The department shall maximize federal
6financial participation in implementing this section to the extent
7allowable.
8(f) Eligibility for full-scope Medi-Cal benefits for an individual
919 years of age or older pursuant to subdivision (a) shall not be an
10entitlement. The department shall have the authority to determine
11eligibility, determine the number of individuals who may be
12enrolled, establish limits on the number enrolled, and establish
13processes for waiting lists needed to maintain program expenditures
14within available funds.
15(g) Notwithstanding Chapter 3.5 (commencing with Section
1611340) of Part 1 of Division 3 of Title 2 of the Government Code,
17the department, without taking any further regulatory action, shall
18implement, interpret, or make specific this section by means of
19all-county letters, plan letters, plan or provider bulletins, or similar
20instructions until the time regulations are adopted. The department
21shall adopt regulations by July 1, 2018, in accordance with the
22requirements of Chapter 3.5 (commencing with Section 11340) of
23Part 1 of Division 3 of Title 2 of the Government Code.
24Commencing July 1, 2016, and notwithstanding Section 10231.5
25of the Government Code, the department shall provide a status
26report to the Legislature on a semiannual basis, in compliance with
27Section 9795 of the Government Code, until regulations have been
28
adopted.
If the Commission on State Mandates determines that
30this act contains costs mandated by the state, reimbursement to
31local agencies and school districts for those costs shall be made
32pursuant to Part 7 (commencing with Section 17500) of Division
334 of Title 2 of the Government Code.
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