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 individuals 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.end delete
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.
begin delete These requirements would become operative when federal approval of the waiver is granted.end delete
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.
begin delete 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 delete
This bill would extend eligibility for full-scope Medi-Cal benefits to individuals under 19 years of age who are otherwise eligible for those benefits but for their immigration status. The bill would also extend eligibility for either limited scope Medi-Cal benefits or 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. 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 delete
This bill would require the State Department of Health Care Services to develop a transition plan for individuals under 19 years of age who are enrolled in restricted-scope Medi-Cal as of the effective date of the bill, 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.end delete
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.end delete
This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.end delete
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.end delete
Fiscal committee: yes.
State-mandated local program:
begin deleteyes end delete.
The people of the State of California do enact as follows:
(a) The Legislature finds and declares all of the
3(1) No child in California should endure suffering and pain due
4to a lack of access to health care services.
P4 1(2) No individual in California should be excluded from
2obtaining coverage through the California Health Benefit Exchange
3by reason of immigration status.
4(3) Expanding access and increasing enrollment in
5comprehensive health care coverage benefits the health and welfare
6of all Californians.
7(4) Longstanding California law provides full-scope Medi-Cal
8to United States citizens, lawful permanent residents, and
9individuals permanently residing in the United States under color
10of law, including those granted deferred action.
11(b) It is the intent of the Legislature in enacting
this act to extend
12full-scope Medi-Cal eligibility to every child in California who is
13currently ineligible for Medi-Cal due to his or her immigration
14status, as long as he or she meets the other requirements of the
17 It is
begin delete furtherend delete the intent of the Legislature to ensure that all
18Californians are eligible to obtain health care coverage through
begin delete exchange.end delete
21 It is further the intent of the Legislature to increase
22opportunities for enrollment in comprehensive coverage for adults,
23regardless of immigration status, through the enactment of this
26 It is further the intent of the Legislature that all Californians
27who are otherwise eligible for Medi-Cal, a qualified health plan
28offered through the California Health Benefit Exchange, or
29affordable employer-based health coverage, enroll in that coverage,
30and obtain the care that they need.
Section 100522 is added to the Government Code, to
(a) The Secretary of California Health and Human
34Services shall apply to the United States Department of Health
35and Human Services for a waiver authorized under Section 1332
36of the federal act as defined in subdivision (e) of Section 100501
37in order to allow persons otherwise not able to obtain coverage by
38reason of immigration status through the Exchange to obtain
39coverage from the Exchange by waiving the requirement that the
40Exchange offer only qualified health plans.
3(b) The Exchange shall offer qualified health
begin delete benefitend delete
4 plans that shall be subject to the requirements of this title, including
5all of those requirements applicable to qualified health plans. In
6addition, California qualified health plans shall be subject to the
7requirements of Section 1366.6 of the Health and Safety Code and
8Section 10112.3 of the Insurance Code in the same manner as
9qualified health plans.
10(c) Persons eligible to purchase California qualified health plans
11shall pay the cost of coverage without federal advanced premium
12tax credit, federal cost-sharing reduction, or any other federal
14(d) Subdivisions (b) and (c) of this section shall become
15operative upon federal approval of the waiver pursuant to
purposes of this section, a “California qualified health
18plan” means a product offered to those not otherwise eligible to
19purchase coverage from the Exchange by reason of immigration
20status and that comply with each of the requirements of state law
21and the Exchange for a qualified health plan.
Section 14102.1 is added to the Welfare and
23Institutions Code, to read:
(a) (1) Notwithstanding any other law, an individual
25under 19 years of age who meets all of the eligibility requirements
26for full-scope Medi-Cal benefits under this chapter, but for his or
27her immigration status, shall be eligible for full-scope Medi-Cal
29(2) Notwithstanding any other law, an individual 19 years of
30age or older who meets all of the eligibility requirements for
31full-scope Medi-Cal benefits under this chapter, but for his or her
32immigration status, may be enrolled for full-scope Medi-Cal
33benefits, pursuant to paragraph (3).
34(3) When a county completes the Medi-Cal eligibility
35determination process for an individual 19 years of age or older
36who meets all of the eligibility requirements for full-scope
37Medi-Cal benefits under this chapter, but for his or her immigration
38status, the county shall transmit this information to the department
39to determine if sufficient funding is available for this individual
40to receive full-scope Medi-Cal benefits. If sufficient funding is
P6 1available, the individual shall be eligible for full-scope benefits.
2If sufficient funding is not available, the individual shall be eligible
3for limited scope Medi-Cal benefits.
4(b) This section shall not apply to individuals eligible for
5coverage pursuant to Section 14102.
6(c) Individuals who are eligible under subdivision (a) shall be
7required to enroll into Medi-Cal managed care health plans to the
8extent required of otherwise eligible Medi-Cal recipients who are
10(d) Individuals who are eligible under subdivision (a) shall pay
11copayments and premium contributions to the extent required of
12otherwise eligible Medi-Cal recipients who are similarly situated.
13(e) Benefits for services under this section shall be provided
14with state-only funds only if federal financial participation is not
15available for those services. The department shall maximize federal
16financial participation in implementing this section to the extent
18(f) Eligibility for full-scope benefits for an individual 19 years
19of age or older pursuant to subdivision (a) shall not be an
20entitlement. The department shall have the authority to determine
21eligibility, determine the number of individuals who may be
22enrolled, establish limits on the number enrolled, and establish
23processes for waiting lists needed to maintain program expenditures
24within available funds.
25(g) Notwithstanding Chapter 3.5 (commencing with Section
2611340) of Part 1 of Division 3 of Title 2 of the Government Code,
27the department, without taking any further regulatory action, shall
28implement, interpret, or make specific this section by means of
29all-county letters, plan letters, plan or provider bulletins, or similar
30instructions until the time regulations are adopted. The department
31shall adopt regulations by July 1, 2018, in accordance with the
32requirements of Chapter 3.5 (commencing with Section 11340) of
33Part 1 of Division 3 of Title 2 of the Government Code.
34Commencing July 1, 2016, and notwithstanding Section 10231.5
35of the Government Code, the department shall provide a status
36report to the Legislature on a semiannual basis, in compliance with
37Section 9795 of the Government Code, until regulations have been
38adopted pursuant to Section 14102.2.
Section 14102.2 is added to the Welfare and
40Institutions Code, to read:
(a) (1) Except as provided in subdivision (c),
2individuals under 19 years of age who are enrolled in restricted
3scope Medi-Cal as of December 31, 2015, and who are eligible
4under Section 14102.1, shall be transitioned directly to full-scope
5coverage under the Medi-Cal program in accordance with the
6requirements of this section. The department shall develop a
7transition plan for those individuals under 19 years of age who are
8enrolled in restricted scope Medi-Cal as of the effective date of
9the act adding this section.
10(2) For purposes of this section, an “emergency care provider”
11is defined as a hospital in the county of the individual’s residence
12 where he or she received emergency care, if any.
13(b) Except as provided in subdivision (c), with respect to
14managed care health plan enrollment, a restricted-scope enrollee
15who is under 19 years of age and who applies and is determined
16eligible before October 1, 2015, shall be notified by the department
17at least 60 days before January 1, 2016, in accordance with the
18department’s transition plan of all of the following:
19(1) Which Medi-Cal managed care health plan or plans contain
20his or her existing emergency care provider, if the department has
21this information and the emergency care provider is contracted
22with a Medi-Cal managed care health plan.
23(2) That the restricted scope enrollee who is under 19 years of
24age, subject to his or her ability to change as described in paragraph
25(3), will be assigned to a health plan that includes his or her
26emergency care provider and enrolled effective January 1, 2014.
27If the enrollee who is under 19 years of age wants to keep his or
28her emergency care provider, no additional action shall be required
29if the emergency care provider is contracted with a Medi-Cal
30managed care health plan.
31(3) That the restricted scope enrollee who is under 19 years of
32age may choose any available Medi-Cal managed care health plan
33and primary care provider in his or her county of residence before
34January 1, 2016, if more than one such plan is available in the
35county where he or she resides, and he or she will receive all
36provider and health plan information required to be sent to new
37enrollees and instructions on how to choose or change his or her
38health plan and primary care provider.
39(4) That in
counties with more than one Medi-Cal managed care
40health plan, if the restricted scope enrollee who is under 19 years
P8 1of age does not affirmatively choose a plan within 30 days of
2receipt of the notice, he or she shall be enrolled into the Medi-Cal
3managed care health plan that contains his or her emergency care
4provider as part of the Medi-Cal managed care contracted network,
5if the department has this information about the emergency care
6provider, and the emergency care provider is contracted with a
7Medi-Cal managed care health plan. If the emergency care provider
8is contracted with more than one Medi-Cal managed care health
9plan, then the restricted scope enrollee who is under 19 years of
10age shall be assigned to one of the health plans containing his or
11her emergency care provider in accordance with an assignment
12process established to ensure the linkage.
13(5) That the enrollee who is under 19 years of age shall receive
14all provider and health plan information required to be sent to new
15enrollees. If the restricted scope enrollee who is under 19 years of
16age is not assigned to two Medi-Cal managed care health plans
17pursuant to paragraph (2), and does not affirmatively select one
18of the available Medi-Cal managed care health plans within 30
19days of receipt of the notice, he or she shall automatically be
20assigned a plan through the department-prescribed auto-assignment
22(6) That the restricted scope enrollee who is under 19 years of
23age does not need to take any action to be transitioned to full-scope
24Medi-Cal or to retain his or her emergency care provider, if the
25emergency care provider is available pursuant to paragraph (2).
26(7) That the restricted scope enrollee who is under 19 years of
27age may choose not to transition to the full-scope Medi-Cal
28program, and what this choice will mean for his or her health care
29coverage and access to health care services.
30(c) Individuals who
are under 19 years of age, who qualify under
31subdivision (a), and who apply and are determined eligible for
32restricted scope after the date identified by the department, which
33is not later than October 1, 2015, shall be considered late enrollees.
34Late enrollees shall be notified in accordance with subdivision (b),
35except according to a different timeframe, but will transition to
36full-scope Medi-Cal coverage on January 1, 2016. Late enrollees
37after the date identified in this subdivision shall be transitioned
38 pursuant to the department’s restricted scope transition plan
P9 1(d) Emergency care providers that receive reimbursement for
2restricted scope coverage shall work with the department and its
3designees during the 2015 and 2016 calendar years to facilitate
4enrollment and data sharing for the purposes of delivering
5Medi-Cal services in the 2016 calendar year.
No reimbursement is required by this act pursuant to
7Section 6 of Article XIII B of the California Constitution for certain
8costs that may be incurred by a local agency or school district
9because, in that regard, this act creates a new crime or infraction,
10eliminates a crime or infraction, or changes the penalty for a crime
11or infraction, within the meaning of Section 17556 of the
12Government Code, or changes the definition of a crime within the
13meaning of Section 6 of Article XIII B of the California
15However, if the Commission on State Mandates determines that
16this act contains other costs mandated by the state, reimbursement
17to local agencies and school districts for those costs shall be made
18pursuant to Part 7 (commencing with Section 17500) of Division
194 of Title 2 of the Government Code.
(a) After the director determines, and
23communicates that determination in writing to the Department of
24Finance, that systems have been programmed for implementation
25of this section, but no sooner than May 1, 2016, an individual who
26is under 19 years of age and who does not have satisfactory
27immigration status or is unable to establish satisfactory immigration
28status as required by Section 14011.2 shall be eligible for the full
29scope of Medi-Cal benefits, if he or she is otherwise eligible for
30benefits under this chapter.
35(b) To the extent permitted by state and federal law, an
36individual eligible under this section shall be required to enroll in
37a Medi-Cal managed care health plan
begin delete in those counties in
38a Medi-Cal managed care health plan is available.end delete
P10 1(c) The department shall seek any necessary federal approvals
2to obtain federal financial participation in implementing this
3section. Benefits for services under this section shall be provided
4with state-only funds only if federal financial participation is not
5available for those services.
6(d) The department shall maximize federal financial participation
7in implementing this section to the extent allowable.
8(e) This section shall be implemented only to the extent it is in
9compliance with Section 1621(d) of Title 8 of the United States
11(f) (1) Notwithstanding Chapter 3.5 (commencing with Section
1211340) of Part 1 of Division 3 of Title 2 of the Government Code,
13the department, without taking any further regulatory action, shall
14implement, interpret, or make specific this section by means of
15all-county letters, plan letters, plan or provider bulletins, or similar
16instructions until the time any necessary regulations are adopted.
17Thereafter, the department shall adopt regulations in accordance
18with the requirements of Chapter 3.5 (commencing with Section
1911340) of Part 1 of Division 3 of Title 2 of the Government Code.
20(2) Commencing six months after the effective date of this
21section, and notwithstanding Section 10231.5 of the Government
22Code, the department shall provide a status report to the Legislature
23on a semiannual basis, in compliance with Section 9795 of the
24Government Code, until regulations have been adopted.
25(g) In implementing this section, the department may contract,
26as necessary, on a bid or nonbid basis. This subdivision establishes
27an accelerated process for issuing contracts pursuant to this section.
28Those contracts, and any other contracts entered into pursuant to
29this subdivision, may be on a noncompetitive bid basis and shall
30be exempt from the following:
31(1) Part 2 (commencing with Section 10100) of Division 2 of
32the Public Contract Code and any policies, procedures or
33regulations authorized by that part.
34(2) Article 4 (commencing with Section 19130) of Chapter 5
35of Part 2 of Division 5 of Title 2 of the Government Code.
36(3) Review or approval of contracts by the Department of