BILL ANALYSIS Ó SB 10 Page 1 SENATE THIRD READING SB 10 (Lara) As Amended April 28, 2016 2/3 vote. Urgency SENATE VOTE: 28-9 ------------------------------------------------------------------ |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 Page 2 | | |Quirk, Santiago, | | | | |Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------ 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 SB 10 Page 3 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 SB 10 Page 4 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. SB 10 Page 5 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