BILL NUMBER: SB 4	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 28, 2015
	AMENDED IN SENATE  APRIL 6, 2015

INTRODUCED BY   Senator Lara
   (Principal coauthor: Assembly Member Bonta)
   (Coauthors: Senators  Hall,  Hancock,  Hernandez,
  Hill,  Hueso, Mitchell, Monning,  and Pan
  Pan,   and Wolk  )
   (  Coauthor:   Assembly Member 
 Levine   Coauthors:   Assembly Members
  Alejo,   Levine,   Lopez,  
and Thurmond  )

                        DECEMBER 1, 2014

   An act to add and repeal Section 100522 of, and to add and repeal
Title 22.5 (commencing with Section 100530) of, the Government Code,
to add and repeal Section 1366.7 of the Health and Safety Code, to
add and repeal Section 10112.31 of the Insurance Code, and to add
Sections 14102.1 and 14102.2 to the Welfare and Institutions Code,
relating to health care coverage, and making an appropriation
therefor.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 4, 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 individual and qualified small employers in
qualified health plans as required under PPACA.
   Existing law governs health care service plans and insurers. A
willful violation of the provisions governing health care service
plans is a crime.
   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 California Health Benefit
Exchange. The bill would require the California Health Benefit
Exchange to offer 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. These requirements would become
operative when federal approval of the waiver is granted. If federal
approval is not granted on or before January 1, 2017, the bill would
create the California Health Exchange Program  for all
  For All  Californians within state government.
   The bill would require that the California Health Exchange Program
 for   For  All Californians (Program) be
governed by the executive board that governs the California Health
Benefit Exchange. The bill would specify the duties of the board
relative to the  Program   program  and
would require the board to, by a specified date, facilitate the
enrollment into qualified health plans of individuals who are not
eligible for full-scope Medi-Cal coverage and would have been
eligible to purchase coverage through the Exchange but for their
immigration status.  The bill would require the board to
provide premium subsidies and cost-sharing reductions to eligible
individuals that are the same as the premium assistance and
cost-sharing reductions the individuals would have received through
the Exchange.  The bill would create the California Health
Trust Fund For All Californians as a continuously appropriated fund,
thereby making an appropriation, would require the board to assess a
charge on qualified health plans, and would make the implementation
of the  Program's   program's  provisions
contingent on a determination by the board that sufficient financial
resources exist or will exist in the fund. The bill would enact other
related provisions.
   The bill would require health care  services 
 service  plans and health insurers to fairly and
affirmatively offer, market, and sell in the  Program
  program  at least one product within each of the
5 levels of coverage, as specified. Because a violation of the
requirements imposed on health care service plans would be a crime,
the bill would impose a state-mandated local program.
   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.
   This bill would extend eligibility for full-scope Medi-Cal
benefits to individuals who are otherwise eligible for those benefits
but for their immigration status. 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 bill would require the State Department of Health Care
Services to develop a transition plan for individuals who are
enrolled in restricted-scope Medi-Cal as of a specified date, and who
are otherwise eligible for full-scope Medi-Cal coverage but for
their immigration status, to transition directly to full-scope
Medi-Cal coverage. The bill would require the department to notify
these individuals, as specified.
   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 with regard to certain mandates no
reimbursement is required by this act for a specified reason.
   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.
   Vote: majority. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  (a) (1) The Legislature finds and declares that
longstanding California law provides full-scope Medi-Cal to United
States citizens, lawful permanent residents, and individuals
permanently residing in the United States under color of law,
including those granted deferred action.
   (2) It is the intent of the Legislature in enacting this act to
extend full-scope Medi-Cal eligibility to California residents who
are currently ineligible for Medi-Cal due to their immigration
status, as long as they meet the other requirements of the Medi-Cal
program.
   (b) It is the intent of the Legislature that all Californians,
regardless of immigration status, have access to health coverage and
care.
   (c) It is the intent of the Legislature that all Californians who
are otherwise eligible for Medi-Cal, a qualified health plan offered
through the California Health  Benefits  
Benefit  Exchange, or affordable employer-based health coverage,
enroll in that coverage and obtain the care that they need.
   (d) It is further the intent of the Legislature to ensure that all
Californians be included in eligibility for coverage without regard
to immigration status.
  SEC. 2.  Section 100522 is added to the Government Code, to read:
   100522.  (a) The Secretary of California Health and Human Services
shall apply to the United States Department of Health and Human
Services for a waiver authorized under Section 1332 of the federal
act as defined in subdivision (e) of Section 100501 in order to allow
persons otherwise not able to obtain coverage by reason of
immigration status through the Exchange to obtain coverage from the
Exchange by waiving the requirement that the Exchange offer only
qualified health plans.
   (b) The Exchange shall offer qualified health benefit plans which
shall be subject to the requirements of this title, including all of
those requirements applicable to qualified health plans. In addition,
California qualified health plans shall be subject to the
requirements of Section 1366.6 of the Health and Safety Code and
Section 10112.3 of the Insurance Code in the same manner as qualified
health plans.
   (c) Persons eligible to purchase California qualified health plans
shall pay the cost of coverage without federal advanced premium tax
credit, federal cost-sharing reduction, or any other federal
assistance.
   (d) Subdivisions (b) and (c) of this section shall become
operative upon federal approval of the waiver pursuant to subdivision
(a). If subdivisions (b) and (c) of this section do not become
operative on or before January 1, 2017, Title 22.5 (commencing with
Section 100530) shall become operative, and as of that date, this
section is repealed, unless a later enacted statute, that is enacted
before January 1, 2017, deletes or extends that date. 
   (e) For purposes of this section, a "California qualified health
plan" means a product offered to those not otherwise eligible to
purchase coverage from the Exchange by reason of immigration and that
comply with each of the requirements of state law and the Exchange
for a qualified health plan. 
  SEC. 3.  Title 22.5 (commencing with Section 100530) is added to
the Government Code, to read:

      TITLE 22.5.  California Health Exchange Program for All
Californians


   100530.  (a) There is in state government the California Health
Exchange Program For All Californians, an independent public entity
not affiliated with an agency or department.
   (b) The program shall be governed by the executive board
established pursuant to Section 100500. The board shall be subject to
Section 100500.
   (c) It is the intent of the Legislature in enacting the program to
provide coverage for Californians who would be eligible  for
coverage and premium subsidies under   to enroll in
 the California Health Benefit Exchange established under Title
22 (commencing with Section 100500) but for their immigration status.

   (d) This title shall become operative only if federal approval of
the waiver described in subdivision (a) of Section 100522 is not
granted on or before January 1, 2017. If this title does not become
operative by January 1, 2017, as of that date, this title is
repealed, unless a later enacted statute, that is enacted before
January 1, 2017, deletes or extends that date.
   100531.  For purposes of this title, the following definitions
shall apply:
   (a) "Board" means the executive board described in subdivision (b)
of Section 100530.
   (b) "Carrier" means either a private health insurer holding a
valid outstanding certificate of authority from the Insurance
Commissioner or a health care service plan, as defined under
subdivision (f) of Section 1345 of the Health and Safety Code,
licensed by the Department of Managed Health Care.
   (c) "Eligible individual" means an individual who would have been
eligible to purchase coverage through the Exchange but for his or her
immigration status and who is not eligible for full-scope Medi-Cal
coverage under state law.
   (d) "Exchange" means the California Health Benefit Exchange
established by Section 100500.
   (e) "Federal act" means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), and any amendments to, or regulations or guidance issued
under, those acts.
   (f) "Fund" means the California Health Trust Fund For All
Californians established by Section 100540.
   (g) "Health plan" and "qualified health plan"  have the
same meanings as those terms are defined in Section 1301 of the
federal act.   shall be identical to "health plan" and
"qualified health plan" as defined in Title 22 (commencing with
Section 100500). 
   (h) "Medi-Cal coverage" means coverage under the Medi-Cal program
pursuant to Chapter 7 (commencing with Section 14000) of Part 3 of
Division 9 of the Welfare and Institutions Code.
   (i) "Product" means one of the following:
   (1) A health care service plan contract subject to Article 11.8
(commencing with Section 1399.845) of Chapter 2.2 of Division 2 of
the Health and Safety Code.
   (2) An individual policy of health insurance as defined in Section
106 of the Insurance Code, subject to Chapter 9.9 (commencing with
Section 10965) of Part 2 of Division 2 of the Insurance Code.
   (j) "Program" means the California Health Exchange Program For All
Californians.
   (k) "Supplemental coverage" means coverage through a specialized
health care service plan contract, as defined in subdivision (o) of
Section 1345 of the Health and Safety Code, or a specialized health
insurance policy, as defined in Section 106 of the Insurance Code.
   100532.  The board shall, at a minimum, do all of the following:
   (a) Enroll individuals into coverage who would be eligible to
enroll in the Exchange but for immigration status.
   (b) Implement procedures for the certification, recertification,
and decertification, of health plans as qualified health plans. The
board shall require health plans seeking certification as qualified
health plans to do all of the following:
   (1) Submit a justification for any premium increase before
implementation of the increase consistent with Article 6.2
(commencing with Section 1385.01) of Chapter 2.2 of Division 2 of the
Health and Safety Code and Article 4.5 (commencing with Section
10181) of Chapter 1 of Part 2 of Division 2 of the Insurance Code.
   (2) (A) Make available to the public and submit to the board
accurate and timely disclosure of the following information:
   (i) Claims payment policies and practices.
   (ii) Periodic financial disclosures.
   (iii) Data on enrollment.
   (iv) Data on disenrollment.
   (v) Data on the number of claims that are denied.
   (vi) Data on rating practices.
   (vii) Information on cost sharing and payments with respect to any
out-of-network coverage.
   (viii) Information on enrollee and participant rights under state
law.
   (B) The information required under subparagraph (A) shall be
provided in plain language.
   (3) Permit individuals to learn, in a timely manner upon the
request of the individual, the amount of cost sharing, including, but
not limited to, deductibles, copayments, and coinsurance, under the
individual's plan or coverage that the individual would be
responsible for paying with respect to the furnishing of a specific
item or service by a participating provider. At a minimum, this
information shall be made available to the individual through an
Internet Web site and through other means for individuals without
access to the Internet.
   (c) Provide for the operation of a toll-free telephone hotline to
respond to requests for assistance.
   (d) Maintain an Internet Web site through which enrollees and
prospective enrollees of qualified health plans may obtain
standardized comparative information on those plans.
   (e) Assign a rating to each qualified health plan offered through
the program in accordance with the criteria developed by the board.
   (f) Utilize a standardized format for presenting health benefits
plan options in the program.
   (g) Inform individuals of eligibility requirements for the
Medi-Cal program, the Exchange, or any applicable state or local
public program and, if through screening of the application by the
program, the program determines that an individual is eligible for
the state or local program, enroll that individual in that program.
   (h) Establish and make available by electronic means a calculator
to determine the actual cost of coverage.
   (i) Establish a navigator program. Any entity chosen by the board
as a navigator under this subdivision shall do all of the following:
   (1) Conduct public education activities to raise awareness of the
availability of qualified health plans through the program.
   (2) Distribute fair and impartial information concerning
enrollment in qualified health  plans, and the availability
of premium subsidies and cost-sharing reductions through the program
  plans  .
   (3) Facilitate enrollment in qualified health plans.
   (4) Provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman established under
Section 2793 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-93), or any other appropriate state agency or agencies, for
any enrollee with a grievance, complaint, or question regarding his
or her health plan, coverage, or a determination under that plan or
coverage.
   (5) Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being
served by the program.
   100533.  In addition to meeting the requirements of Section
100532, the board shall do all of the following:
   (a) Determine the criteria and process for eligibility,
enrollment, and disenrollment of enrollees and potential enrollees in
the program and coordinate that process with the state and local
government entities administering other health care coverage
programs, including the Exchange, the State Department of Health Care
Services, and California counties, in order to ensure consistent
eligibility and enrollment processes and seamless transitions between
coverage.
   (b) Develop processes to coordinate with the county entities that
administer eligibility for the Medi-Cal program.
   (c) Determine the minimum requirements a carrier must meet to be
considered for participation in the program, and the standards and
criteria for selecting qualified health plans to be offered through
the program that are in the best interests of qualified individuals.
The board shall consistently and uniformly apply these requirements,
standards, and criteria to all carriers. In the course of selectively
contracting for health care coverage offered to qualified
individuals through the program, the board shall seek to contract
with carriers so as to provide health care coverage choices that
offer the optimal combination of choice, value, quality, and service.

   (d) Provide, in each region of the state, a choice of qualified
health plans at each of the five levels of coverage contained in
Section 1302(d) and (e) of the federal act.
   (e) Require, as a condition of participation in the program,
carriers to fairly and affirmatively offer, market, and sell in the
program at least one product within each of the five levels of
coverage contained in Section 1302(d) and (e) of the federal act. The
board may require carriers to offer additional products within each
of those five levels of coverage. This subdivision shall not apply to
a carrier that solely offers supplemental coverage in the program
under paragraph (10) of subdivision (a) of Section 100534.
   (f) (1) Except as otherwise provided in this section, require, as
a condition of participation in the program, carriers that sell any
products outside the program to fairly and affirmatively offer,
market, and sell all products made available to individuals in the
program to individuals purchasing coverage outside the program.
   (2) For purposes of this subdivision, "product" does not include
contracts entered into pursuant to Chapter 7 (commencing with Section
14000) or Chapter 8 (commencing with Section 14200) of Part 3 of
Division 9 of the Welfare and Institutions Code between the State
Department of Health Care Services and carriers for enrolled Medi-Cal
beneficiaries.  "Product" also does not include a bridge
plan product offered pursuant to Section 100504.5. 
   (g) Determine when an enrollee's coverage commences and the extent
and scope of coverage.
   (h) Provide for the processing of applications and the enrollment
and disenrollment of enrollees.
   (i) Determine and approve cost-sharing provisions for qualified
health plans.
   (j) Establish uniform billing and payment policies for qualified
health plans offered in the program to ensure consistent enrollment
and disenrollment activities for individuals enrolled in the program.

   (k) Undertake activities necessary to market and publicize the
availability of health care coverage  and subsidies 
through the program. The board shall also undertake outreach and
enrollment activities that seek to assist enrollees and potential
enrollees with enrolling and reenrolling in the program in the least
burdensome manner, including populations that may experience barriers
to enrollment, such as the disabled and those with limited English
language proficiency.
   (l) Select and set performance standards and compensation for
navigators selected under subdivision (j) of Section 100532.
   (m) Employ necessary staff. The board shall employ staff
consistent with the applicable requirements imposed under subdivision
(m) of Section 100503.
   (n) Assess a charge on the qualified health plans offered by
carriers that is reasonable and necessary to support the development,
operations, and prudent cash management of the program.
   (o) Authorize expenditures, as necessary, from the fund to pay
program expenses to administer the program.
   (p) Keep an accurate accounting of all activities, receipts, and
expenditures. Commencing January 1, 2017, the board shall conduct an
annual audit.
   (q) (1) Notwithstanding Section 10231.5, annually prepare a
written report on the implementation and performance of the program
functions during the preceding fiscal year, including, at a minimum,
the manner in which funds were expended and the progress toward, and
the achievement of, the requirements of this title.  The
report shall also include data provided by health care service plans
and health insurers offering bridge plan products regarding the
extent of health care provider and health facility overlap in their
Medi-Cal networks as compared to the health care provider and health
facility networks contracting with the plan or insurer in their
bridge plan contracts.  This report shall be transmitted to
the Legislature and the Governor and shall be made available to the
public on the Internet Web site of the program. A report made to the
Legislature pursuant to this subdivision shall be submitted pursuant
to Section 9795.
   (2) In addition to the report described in paragraph (1), the
board shall be responsive to requests for additional information from
the Legislature, including providing testimony and commenting on
proposed state legislation or policy issues. The Legislature finds
and declares that activities, including, but not limited to,
responding to legislative or executive inquiries, tracking and
commenting on legislation and regulatory activities, and preparing
reports on the implementation of this title and the performance of
the program, are necessary state requirements and are distinct from
the promotion of legislative or regulatory modifications referred to
in subdivision (c) of Section 100540.
   (r) Maintain enrollment and expenditures to ensure that
expenditures do not exceed the amount of revenue in the fund, and if
sufficient revenue is not available to pay estimated expenditures,
institute appropriate measures to ensure fiscal solvency.
   (s) Exercise all powers reasonably necessary to carry out and
comply with the duties, responsibilities, and requirements of this
title.
   (t) Consult with stakeholders relevant to carrying out the
activities under this title, including, but not limited to, all of
the following:
   (1) Health care consumers who are enrolled in health plans.
   (2) Individuals and entities with experience in facilitating
enrollment in health plans.
   (3) The executive director of the Exchange.
   (4) The State Medi-Cal Director.
   (5) Advocates for enrolling hard-to-reach populations.
   (u) Facilitate the purchase of qualified health plans in the
program by qualified individuals no later than January 1, 2016.
   (v) Require carriers participating in the program to immediately
notify the program, under the terms and conditions established by the
board when an individual is or will be enrolled in or disenrolled
from any qualified health plan offered by the carrier.
   (w) Ensure that the program provides oral interpretation services
in any language for individuals seeking coverage through the program
and makes available a toll-free telephone number for the hearing and
speech impaired. The board shall ensure that written information made
available by the program is presented in a plainly worded, easily
understandable format and made available in prevalent languages.
   100534.  (a) The board may do the following:
   (1) Collect premiums.
   (2) Enter into contracts.
   (3) Sue and be sued.
   (4) Receive and accept gifts, grants, or donations of moneys from
any agency of the United States, any agency of the state, or any
municipality, county, or other political subdivision of the state.
   (5) Receive and accept gifts, grants, or donations from
individuals, associations, private foundations, or corporations, in
compliance with the conflict-of-interest provisions to be adopted by
the board at a public meeting.
   (6) Adopt rules and regulations, as necessary. Until January 1,
2018, any necessary rules and regulations may be adopted as emergency
regulations in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2). The adoption of these regulations shall be deemed to be
an emergency and necessary for the immediate preservation of the
public peace, health and safety, or general welfare.
   (7) Collaborate with the Exchange and the State Department of
Health Care Services, to the extent possible, to allow an individual
the option to remain enrolled with his or her carrier and provider
network in the event the individual experiences a loss of eligibility
for enrollment in a qualified health plan under this title and
becomes eligible for the Exchange or the Medi-Cal program, or loses
eligibility for the Medi-Cal program and becomes eligible for a
qualified health plan through the program.
   (8) Share information with relevant state departments, consistent
with the applicable laws governing confidentiality, necessary for the
administration of the program.
   (9) Require carriers participating in the program to make
available to the program and regularly update an electronic directory
of contracting health care providers so that individuals seeking
coverage through the program can search by health care provider name
to determine which health plans in the program include that health
care provider in their network. The board may also require a carrier
to provide regularly updated information to the program as to whether
a health care provider is accepting new patients for a particular
health plan. The program may provide an integrated and uniform
consumer directory of health care providers indicating which carriers
the providers contract with and whether the providers are currently
accepting new patients. The program may also establish methods by
which health care providers may transmit relevant information
directly to the program, rather than through a carrier.
   (10) Make available supplemental coverage for enrollees of the
program to the extent permitted by available funding. Any
supplemental coverage offered in the program shall be subject to the
charge imposed under subdivision (n) of Section 100533. 
   (11) Make available premium subsidies and cost-sharing reductions
to the extent funding is available. 
   (b) (1) An applicant for health care coverage shall be required to
provide only the information strictly necessary to authenticate
identity, determine eligibility, and determine the amount of the
credit or reduction.
   (2) Any person who receives information provided by an applicant
pursuant to paragraph (1), whether directly or by another person at
the request of the applicant, or otherwise obtains information about
the applicant through the program process shall do both of the
following:
   (A) Use the information only for the purposes of, and to the
extent necessary in, ensuring the efficient operation of the program,
including verifying the eligibility of an individual to enroll
through the program.
   (B) Not disclose the information to any other person except as
provided in this section.
   (c) The board shall have the authority to standardize products to
be offered through the program.
   100535.  The board shall establish and use a competitive process
to select participating carriers and any other contractors under this
title. Any contract entered into pursuant to this title shall be
exempt from Chapter 1 (commencing with Section 10100) of Part 2 of
Division 2 of the Public Contract Code, and shall be exempt from the
review or approval of any division of the Department of General
Services.
   100536.  (a) The board shall establish an appeals process for
prospective and current enrollees of the program.
   (b) The board shall not be required to provide an appeal if the
subject of the appeal is within the jurisdiction of the Department of
Managed Health Care pursuant to the Knox-Keene Health Care Service
Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of
Division 2 of the Health and Safety Code) and its implementing
regulations, or within the jurisdiction of the Department of
Insurance pursuant to the Insurance Code and its implementing
regulations.
   100537.  (a) Notwithstanding any other law, the program shall not
be subject to licensure or regulation by the Department of Insurance
or the Department of Managed Health Care.
   (b) Carriers that contract with the program shall have a license
or certificate of authority from, and shall be in good standing with,
their respective regulatory agencies.
   100538.  (a) Records of the program that reveal the deliberative
processes, discussions, communications, or any other portion of the
negotiations with entities contracting or seeking to contract with
the program, entities with which the program is considering a
contract, or entities with which the program is considering or enters
into any other arrangement under which the program provides,
receives, or arranges services or reimbursement shall be exempt from
disclosure under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1).
   (b) The following records of the program shall be exempt from
disclosure under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1) as follows:
   (1) (A) Except for the portion of a contract that contains the
rates of payments, contracts with participating carriers entered into
pursuant to this title on or after the date the act that added this
subparagraph becomes effective, shall be open to inspection one year
after the effective dates of the contracts.
   (B) If contracts with participating carriers entered into pursuant
to this title are amended, the amendments shall be open to
inspection one year after the effective date of the amendments.
   (c) Three years after a contract or amendment is open to
inspection pursuant to subdivision (b), the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
   (d) Notwithstanding any other law, entire contracts with
participating carriers or amendments to contracts with participating
carriers shall be open to inspection by the Joint Legislative Audit
Committee. The committee shall maintain the confidentiality of the
contracts and amendments until the contracts or amendments to a
contract are open to inspection pursuant to subdivisions (b) and (c).

   100539.  (a) No individual or entity shall hold himself, herself,
or itself out as representing, constituting, or otherwise providing
services on behalf of the program unless that individual or entity
has a valid agreement with the program to engage in those activities.

   (b) Any individual or entity who aids or abets another individual
or entity in violation of this section shall also be in violation of
this section.
   100540.  (a) The California Health Trust Fund For All Californians
is hereby created in the State Treasury for the purpose of this
title. Notwithstanding Section 13340, all moneys in the fund shall be
continuously appropriated without regard to fiscal year for the
purposes of this title. Any moneys in the fund that are unexpended or
unencumbered at the end of a fiscal year may be carried forward to
the next succeeding fiscal year.
   (b) The board of the program shall establish and maintain a
prudent reserve in the fund.
   (c) The board or staff of the program shall not utilize any funds
intended for the administrative and operational expenses of the
                                     program for staff retreats,
promotional giveaways, excessive executive compensation, or promotion
of federal or state legislative or regulatory modifications.
   (d) Notwithstanding Section 16305.7, all interest earned on the
moneys that have been deposited into the fund shall be retained in
the fund and used for purposes consistent with the fund.
   (e) Effective January 1, 2018, if at the end of any fiscal year,
the fund has unencumbered funds in an amount that equals or is more
than the board approved operating budget of the program for the next
fiscal year, the board shall reduce the charges imposed under
subdivision (n) of Section 100533 during the following fiscal year in
an amount that will reduce any surplus funds of the program to an
amount that is equal to the agency's operating budget for the next
fiscal year.
   100541.  (a) The board shall ensure that the establishment,
operation, and administrative functions of the program do not exceed
the combination of state funds, private donations, and other
non-General Fund moneys available for this purpose.
   (b) The implementation of the provisions of this title, other than
this section, Section 100530, and paragraphs (4) and (5) of
subdivision (a) of Section 100534, shall be contingent on a
determination by the board that sufficient financial resources exist
or will exist in the fund.  The determination shall be based
on at least the following:  
   (1) Financial projections identifying that sufficient resources
exist or will exist in the fund to implement the program. 

   (2) A comparison of the projected resources available to support
the program and the projected costs of activities required by this
title.  
   (3) The financial projections demonstrate the sufficiency of
resources for at least the first two years of operation under this
title.  
   (c) The board shall provide notice to the Joint Legislative Budget
Committee and the Director of Finance that sufficient financial
resources exist in the fund to implement this title. 

   (d) 
    (c)  If the board determines that the level of resources
in the fund cannot support the actions and responsibilities
described in subdivision (a), it shall provide the Department of
Finance and the Joint Legislative Budget Committee a detailed report
on the changes to the functions, contracts, or staffing necessary to
address the fiscal deficiency along with any contingency plan should
it be impossible to operate the program without the use of General
Fund moneys. 
   (e) 
    (d) The board shall assess the impact of the program's
operations and policies on other publicly funded health programs
administered by the state and the impact of publicly funded health
programs administered by the state on the program's operations and
policies. This assessment shall include, at a minimum, an analysis of
potential cost shifts or cost increases in other programs that may
be due to program policies or operations. The assessment shall be
completed on at least an annual basis and submitted to the Secretary
of California Health and Human Services and the Director of Finance.
  SEC. 4.  Section 1366.7 is added to the Health and Safety Code, to
read:
   1366.7.  (a) For purposes of this section, the following
definitions shall apply:
   (1) "Federal act" means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), and any amendments to, or regulations or guidance issued
under, those acts.
   (2) "Health plan" has the same meaning as that term is defined in
subdivision (g) of Section 100530 of the Government Code.
   (3) "Program" means the California Health Exchange Program For All
Californians established in Title 22.5 (commencing with Section
100530) of the Government Code.
   (b) Health care service plans participating in the program shall
fairly and affirmatively offer, market, and sell in the program at
least one product within each of the five levels of coverage
contained in Section 1302(d) and (e) of the federal act. The
executive board established under Section 100530 of the Government
Code may require plans to sell additional products within each of
those levels of coverage. This subdivision shall not apply to a plan
that solely offers supplemental coverage in the program under
paragraph (10) of subdivision (a) of Section 100534 of the Government
Code.
   (c) (1) Health care service plans participating in the program
that sell any products outside the program shall fairly and
affirmatively offer, market, and sell all products made available to
individuals in the program to individuals purchasing coverage outside
the program.
   (2) For purposes of this subdivision, "product" does not include
contracts entered into pursuant to Chapter 8 (commencing with Section
14200) of Part 3 of Division 9 of the Welfare and Institutions Code
between the State Department of Health Care Services and health care
service plans for enrolled Medi-Cal beneficiaries.
   (d) Commencing January 1, 2015, a health care service plan shall,
with respect to plan contracts that cover hospital, medical, or
surgical benefits, only sell the five levels of coverage contained in
Section 1302(d) and (e) of the federal act, except that a health
care service plan that does not participate in the program shall,
with respect to plan contracts that cover hospital, medical, or
surgical benefits, only sell the four levels of coverage contained in
Section 1302(d) of the federal act.
   (e) Commencing January 1, 2015, a health care service plan that
does not participate in the program shall, with respect to plan
contracts that cover hospital, medical, or surgical benefits, offer
at least one standardized product that has been designated by the
program in each of the four levels of coverage contained in Section
1302(d) of the federal act. This subdivision shall only apply if the
executive board of the program exercises its authority under
subdivision (c) of Section 100534 of the Government Code. Nothing in
this subdivision shall require a plan that does not participate in
the program to offer standardized products in the small employer
market if the plan only sells products in the individual market.
Nothing in this subdivision shall require a plan that does not
participate in the program to offer standardized products in the
individual market if the plan only sells products in the small
employer market. This subdivision shall not be construed to prohibit
the plan from offering other products provided that it complies with
subdivision (d).
   (f) A health care service plan participating in the program shall
charge the same rate for the same product whether that product is
offered through the program or in the outside market notwithstanding
any charge imposed by the program pursuant to subdivision (n) of
Section 100533 of the Government Code.
   (g) This section shall become operative only if Title 22.5
(commencing with Section 100530) of the Government Code becomes
operative on or before January 1, 2017. If this section does not
become operative by January 1, 2017, as of that date, this section is
repealed, unless a later enacted statute, that is enacted before
January 1, 2017, deletes or extends that date.
  SEC. 5.  Section 10112.31 is added to the Insurance Code, to read:
   10112.31.  (a) For purposes of this section, the following
definitions shall apply:
   (1) "Federal act" means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), and any amendments to, or regulations or guidance issued
under, those acts.
   (2) "Health plan" has the same meaning as that term is defined in
subdivision (g) of Section 100530 of the Government Code.
   (3) "Program" means the California Health Exchange Program For All
Californians established in Title 22.5 (commencing with Section
100530) of the Government Code.
   (b) Health insurers participating in the program shall fairly and
affirmatively offer, market, and sell in the program at least one
product within each of the five levels of coverage contained in
Section 1302(d) and (e) of the federal act. The executive board
established under Section 100530 of the Government Code may require
insurers to sell additional products within each of those levels of
coverage. This subdivision shall not apply to an insurer that solely
offers supplemental coverage in the program under paragraph (10) of
subdivision (a) of Section 100534 of the Government Code.
   (c) (1) Health insurers participating in the program that sell any
products outside the program shall fairly and affirmatively offer,
market, and sell all products made available to individuals in the
program to individuals purchasing coverage outside the program.
   (2) For purposes of this subdivision, "product" does not include
contracts entered into pursuant to Chapter 8 (commencing with Section
14200) of Part 3 of Division 9 of the Welfare and Institutions Code
between the State Department of Health Care Services and health
insurers for enrolled Medi-Cal beneficiaries.
   (d) Commencing January 1, 2015, an insurer shall, with respect to
policies that cover hospital, medical, or surgical benefits, only
sell the five levels of coverage contained in Section 1302(d) and (e)
of the federal act, except that an insurer that does not participate
in the program shall, with respect to policies that cover hospital,
medical, or surgical benefits, only sell the four levels of coverage
contained in Section 1302(d) of the federal act.
   (e) Commencing January 1, 2015, an insurer that does not
participate in the program shall, with respect to policies that cover
hospital, medical, or surgical benefits, offer at least one
standardized product that has been designated by the program in each
of the four levels of coverage contained in Section 1302(d) of the
federal act. This subdivision shall only apply if the board of the
program exercises its authority under subdivision (c) of Section
100534 of the Government Code. Nothing in this subdivision shall
require an insurer that does not participate in the program to offer
standardized products in the small employer market if the insurer
only sells products in the individual market. Nothing in this
subdivision shall require an insurer that does not participate in the
program to offer standardized products in the individual market if
the insurer only sells products in the small employer market. This
subdivision shall not be construed to prohibit the insurer from
offering other products provided that it complies with subdivision
(d).
   (f) An insurer participating in the program shall charge the same
rate for the same product whether that product is offered through the
program or in the outside market notwithstanding any charge imposed
by the program pursuant to subdivision (n) of Section 100533 of the
Government Code.
   (g) This section shall become operative only if Title 22.5
(commencing with Section 100530) of the Government Code becomes
operative on or before January 1, 2017. If this section does not
become operative by January 1, 2017, as of that date, this section is
repealed, unless a later enacted statute, that is enacted before
January 1, 2017, deletes or extends that date.
  SEC. 6.  Section 14102.1 is added to the Welfare and Institutions
Code, to read:
   14102.1.  (a) Notwithstanding any other law, individuals who meet
all of the eligibility requirements for full-scope Medi-Cal benefits
under this chapter, but for their immigration status, shall be
eligible for full-scope Medi-Cal benefits.
   (b) This section shall not apply to individuals eligible for
coverage pursuant to Section 14102.
   (c) Individuals who are eligible under subdivision (a) shall be
required to enroll into Medi-Cal managed care health plans to the
extent required of otherwise eligible Medi-Cal recipients who are
similarly situated.
   (d) Individuals who are eligible under subdivision (a) shall pay
copayments and premium contributions to the extent required of
otherwise eligible Medi-Cal recipients who are similarly situated.
   (e) Benefits for services under this section shall be provided
with state-only funds only if federal financial participation is not
available for those services. The department shall maximize federal
financial participation in implementing this section to the extent
allowable.
   (f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted. The
department shall adopt regulations by July 1, 2018, in accordance
with the requirements of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code. Commencing
July 1, 2016, and notwithstanding Section 10231.5 of the Government
Code, the department shall provide a status report to the Legislature
on a semiannual basis, in compliance with Section 9795 of the
Government Code, until regulations have been adopted  pursuant to
Section 14102.2  .
  SEC. 7.  Section 14102.2 is added to the Welfare and Institutions
Code, to read:
   14102.2.  (a) (1) Except as provided in subdivision (c),
individuals who are enrolled in restricted scope Medi-Cal as of
December 31, 2015, who are eligible under Section 14102.1 shall be
transitioned directly to full-scope coverage under the Medi-Cal
program in accordance with the requirements of this section. The
department shall develop a transition plan for those currently
enrolled in restricted scope Medi-Cal.
   (2) For purposes of this section, an "emergency care provider" is
defined as a hospital in the county of his or her residence where the
individual received emergency care, if any.
   (b) Except as provided in subdivision (c), with respect to managed
care health plan enrollment, a restricted-scope enrollee who applies
and is determined eligible before October 1, 2015, shall be notified
by the department at least 60 days before January 1, 2016, in
accordance with the department's transition plan of all of the
following:
   (1) Which Medi-Cal managed care health plan or plans contain his
or her existing emergency care provider, if the department has this
information and the emergency care provider is contracted with a
Medi-Cal managed care health plan.
   (2) That the restricted scope enrollee, subject to his or her
ability to change as described in paragraph (3), will be assigned to
a health plan that includes his or her emergency care provider and
enrolled effective January 1, 2014. If the enrollee wants to keep his
or her emergency care provider, no additional action shall be
required if the emergency care provider is contracted with a Medi-Cal
managed care health plan.
   (3) That the restricted scope enrollee may choose any available
Medi-Cal managed care health plan and primary care provider in his or
her county of residence before January 1, 2016, if more than one
such plan is available in the county where he or she resides, and he
or she will receive all provider and health plan information required
to be sent to new enrollees and instructions on how to choose or
change his or her health plan and primary care provider.
   (4) That in counties with more than one Medi-Cal managed care
health plan, if the restricted scope enrollee does not affirmatively
choose a plan within 30 days of receipt of the notice, he or she
shall be enrolled into the Medi-Cal managed care health plan that
contains his or her emergency care provider as part of the Medi-Cal
managed care contracted network, if the department has this
information about the emergency care provider, and the emergency care
provider is contracted with a Medi-Cal managed care health plan. If
the emergency care provider is contracted with more than one Medi-Cal
managed care health plan, then the restricted scope enrollee shall
be assigned to one of the health plans containing his or her
emergency care provider in accordance with an assignment process
established to ensure the linkage.
   (5) That the enrollee subject to this section shall receive all
provider and health plan information required to be sent to new
enrollees. If the restricted scope enrollee is not assigned to two
 Medi-Cal managed care health plans    pursuant to
paragraph (2), and does not affirmatively select one of the available
Medi-Cal managed care health plans within 30 days of receipt of the
notice, he or she shall automatically be assigned a plan through the
department-prescribed auto-assignment process.
   (6) That the restricted scope enrollee does not need to take any
action to be transitioned to full-scope Medi-Cal or to retain his or
her emergency care provider, if the emergency care provider is
available pursuant to paragraph (2).
   (7) That the restricted scope enrollee may choose not to
transition to the full-scope Medi-Cal program, and what this choice
will mean for his or her health care coverage and access to health
care services.
   (c) Individuals who qualify under subdivision (a) and who apply
and are determined eligible for restricted scope after the date
identified by the department, that is not later than October 1, 2015,
shall be considered late enrollees. Late enrollees shall be notified
in accordance with subdivision (b), except according to a different
timeframe, but will transition to full-scope Medi-Cal coverage on
January 1, 2016. Late enrollees after the date identified in this
subdivision shall be transitioned pursuant to the department's
restricted scope transition plan process.
   (d) Emergency care providers that receive reimbursement for
restricted scope coverage shall work with the department and its
designees during the 2015 and 2016 calendar years to facilitate
enrollment and data sharing for the purposes of delivering Medi-Cal
services in the 2016 calendar year.
  SEC. 8.  The Legislature finds and declares that  Section 3
of this act, which adds Section 100538  to
  of  the Government Code,  as added by Section
3 of this act,  imposes a limitation on the public's right of
access to the meetings of public bodies or the writings of public
officials and agencies within the meaning of Section 3 of Article I
of the California Constitution. Pursuant to that constitutional
provision, the Legislature makes the following findings to
demonstrate the interest protected by this limitation and the need
for protecting that interest:
   In order to ensure that the California Health Exchange Program For
All Californians is not constrained in exercising its fiduciary
powers and obligations to negotiate on behalf of the public, the
limitations on the public's right of access imposed by Section 3 of
this act are necessary.
  SEC. 9.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for
certain costs that may be incurred by a local agency or school
district because, in that regard, this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
   However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code.