BILL ANALYSIS Ó
SB 10
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SENATE THIRD READING
SB
10 (Lara)
As Amended April 28, 2016
2/3 vote. Urgency
SENATE VOTE: 28-9
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |12-3 |Wood, Bonilla, Burke, |Patterson, |
| | |Campos, Chiu, Gomez, |Steinorth, Waldron |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Nazarian, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-6 |Gonzalez, Bloom, |Bigelow, Patterson, |
| | |Bonilla, Bonta, |Gallagher, Jones, |
| | |Calderon, Daly, |Obernolte, Wagner |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
SB 10
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| | |Quirk, Santiago, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Requires the Secretary of California Health and Human
Services Agency (CHHSA) to apply for a waiver under Section 1332
of the Patient Protection and Affordable Care Act (ACA) to allow
persons otherwise not able to obtain coverage by reason of
immigration status to obtain coverage through California's
Health Benefit Exchange (the Exchange or Covered California).
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Minor and absorbable administrative costs to Covered
California to apply for the waiver. The CHHSA indicates
Covered California is the appropriate entity to submit the
waiver application (California Health Trust Fund).
2)Significant Information Technology (IT) costs to Covered
California, potentially in the millions. Costs include
planning, development, and testing of functionality to allow
for designation of undocumented status, and facilitate
enrollment into "California qualified health plans"
(California Health Trust Fund).
3)Potentially significant, unknown ongoing costs to Covered
California associated with additional enrollment and
maintenance of IT systems. Covered California also notes
implementation would need to include revisions to their
marketing campaign, to explain potentially confusing
differences in subsidies for families of mixed immigration
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status.
COMMENTS: The author states that this bill directs the state to
apply for a federal waiver to allow undocumented Californians to
buy health insurance with their own money through Covered
California. According to the author, this bill affirms
California's commitment to embrace and integrate our immigrant
community, to lead where the federal government has failed, and
to acknowledge the hard work and sacrifice of a community that
contributes billions of dollars to our gross domestic product.
If successful, this bill will allow 390,000 immigrants who earn
an income too high to qualify for Medi-Cal to purchase
healthcare through the Exchange under the ACA. This bill will
make California the first state in the nation to make this
petition to the federal government.
Under existing state and federal law, undocumented adults who
are otherwise income-qualified for Medi-Cal are not eligible for
full scope services, and are instead eligible for "limited
scope" Medi-Cal benefits. Limited scope services are long-term
care, pregnancy-related benefits, and emergency services.
Undocumented immigrants are also prohibited from purchasing
coverage on the Exchange under federal law, and are ineligible
for federal subsidies. However, California law requires health
plans and insurers to make the same health plans and policies
available on and off the Exchange, and currently, all
Californians can enroll off the Exchange; however, these
products would not be subsidized with advanced premium tax
credit or cost sharing reductions. The University of
California, Berkeley, Center for Labor Research and Education
indicated that more than 2.7 million Californians are expected
to remain uninsured under the ACA in 2019.
Current California law extended full-scope Medi-Cal benefits to
children. Specifically, SB 75 (Committee on Budget and Fiscal
Review), Chapter 18, Statutes of 2015, requires the Department
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of Health Care Services to provide full-scope Medi-Cal benefits
to children, under age 19, who do not have satisfactory
immigration status or are unable to establish satisfactory
immigration status. Implementation began on May 16 and
full-scope eligibility will be retroactive to May 1.
The federal ACA included a provision (Section 1332) that allows
certain ACA requirements to be waived and allows states to
pursue broad alternative approaches to expand coverage, or
targeted changes like the one proposed in this bill. Waivers
must meet several federal requirements related to affordability
and coverage and must not increase the federal deficit over 10
years. Federal guidance related to Section 1332 waivers was
released last year, and waivers can be effective as early as
January 1, 2017.
Covered California engaged stakeholders to discuss potential
Section 1332 waiver proposals and notes that a Section 1332
waiver would require considerable Covered California staff time
and resources. Covered California states that there was
significant public comment in support of expanding coverage to
additional populations such as undocumented Californians
specifically that all members of mixed immigration status
families would be able to apply for coverage directly through
Covered California. This proposal would simplify the family
health insurance shopping and enrollment experience. Covered
California also notes that there was not conclusive data
presented regarding the demand for Covered California enrollment
from undocumented Californians. Expert opinion indicated that
there could be an increase in overall enrollment in Covered
California due to mixed families being more likely to apply
through one-stop shopping and because of reduced fears related
to immigration status of undocumented family members. The
estimated potential enrollment presented to Covered California
during the stakeholder discussions was 50,000.
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This bill is supported by numerous health care, immigration,
labor, and other advocacy organizations. There is no registered
opposition on file.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0003012