Amended in Assembly September 4, 2015

Amended in Assembly September 1, 2015

Amended in Assembly July 16, 2015

Amended in Assembly July 7, 2015

Amended in Senate June 1, 2015

Amended in Senate April 28, 2015

Amended in Senate April 6, 2015

Senate BillNo. 4


Introduced by Senator Lara

(Principal coauthor: Assembly Member Bonta)

(Coauthors: Senators Hall, Hancock, Hernandez, Hill, Hueso, Mitchell, Monning, Pan, and Wolk)

(Coauthors: Assembly Members Alejo, Chiu, Gomez, Levine, Lopez, and Thurmond)

December 1, 2014


An act tobegin delete add Section 100522 to the Government Code, and toend delete amend Section 14007.8 of the Welfare and Institutions Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

SB 4, as amended, Lara. Health care coverage: immigration status.

begin delete

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.

end delete
begin delete

This bill would require the Secretary of the California Health and Human Services Agency 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, after that waiver has been granted, the California Health Benefit 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.

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. Existing law extends eligibility for full-scope Medi-Cal benefits to individuals under 19 years of age who do not have, or are unable to establish, satisfactory immigration status, commencing after the Director of Health Care Services determines that systems have been programmed for implementation of this extension, but in no case sooner than May 1, 2016. Existing law requires these individuals to enroll in a Medi-Cal managed care health plan in those counties in which a Medi-Cal managed care health plan is available.

This bill would require individuals under 19 years of age enrolled in restricted-scope Medi-Cal at the time the director makes the above-described determination to bebegin delete transitioned to full-scope Medi-Cal within 30 days of that determination.end deletebegin insert end insertbegin insertenrolled in the full scope of Medi-Cal benefits, if otherwise eligible, pursuant to an eligibility and enrollment plan, as specified.end insert The bill would also require that an individual who is eligible pursuant to these provisions enroll in a Medi-Cal managed care healthbegin delete plan if the individual would otherwise have been required to enroll in thatend delete plan.begin insert The bill would not preclude a beneficiary from being enrolled in any other children’s Medi-Cal specialty program that he or she would otherwise be eligible for.end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1

SECTION 1.  

begin delete(a)end deletebegin deleteend deleteThe Legislature finds and declares all of the
2following:

begin delete

3(1)

end delete

4begin insert(a)end insert No child in California should endure suffering and pain due
5to a lack of access to health care services.

begin delete

6(2) No individual in California should be excluded from
7obtaining coverage through the California Health Benefit Exchange
8by reason of immigration status.

end delete
begin delete

9(3)

end delete

10begin insert(b)end insert Expanding access and increasing enrollment in
11comprehensive health care coverage benefits the health and welfare
12of all Californians.

begin delete

13(b) It is the intent of the Legislature to ensure that all
14Californians are eligible to obtain health care coverage through
15the Exchange.

end delete
begin delete

16(c) It is further the intent of the Legislature to increase
17opportunities for enrollment in comprehensive coverage for adults,
18regardless of immigration status, through the enactment of this
19bill.

end delete
begin delete

20(d) It is further the intent of the Legislature that all Californians
21who are otherwise eligible for Medi-Cal, a qualified health plan
22offered through the California Health Benefit Exchange, or
23affordable employer-based health coverage, enroll in that coverage,
24and obtain the care that they need.

end delete
begin insert

25(c) Through the enactment of Senate Bill 75, the California
26Legislature has extended eligibility for full-scope Medi-Cal benefits
27to all children in California, regardless of immigration status.

end insert
begin delete
28

SEC. 2.  

Section 100522 is added to the Government Code, to
29read:

30

100522.  

(a) The Secretary of California Health and Human
31Services shall apply to the United States Department of Health
32and Human Services for a waiver authorized under Section 1332
33of the federal act as defined in subdivision (e) of Section 100501
34in order to allow persons otherwise not able to obtain coverage by
35reason of immigration status through the Exchange to obtain
P4    1coverage from the Exchange by waiving the requirement that the
2Exchange offer only qualified health plans solely for the purpose
3of offering coverage to persons otherwise not able to obtain
4coverage by reason of immigration status.

5(b) The Exchange shall offer California qualified health plans
6 that shall be subject to the requirements of this title, including all
7of those requirements applicable to qualified health plans. In
8addition, California qualified health plans shall be subject to the
9requirements of Section 1366.6 of the Health and Safety Code and
10Section 10112.3 of the Insurance Code in the same manner as
11qualified health plans.

12(c) Persons eligible to purchase California qualified health plans
13shall pay the cost of coverage without federal advanced premium
14tax credit, federal cost-sharing reduction, or any other federal
15assistance.

16(d) Subdivisions (b) and (c) of this section shall become
17operative upon federal approval of the waiver pursuant to
18subdivision (a).

19(e) For purposes of this section, a “California qualified health
20plan” means a product offered to persons not otherwise eligible to
21purchase coverage from the Exchange by reason of immigration
22status and that comply with each of the requirements of state law
23and the Exchange for a qualified health plan.

end delete
24

begin deleteSEC. 3.end delete
25begin insertSEC. 2.end insert  

Section 14007.8 of the Welfare and Institutions Code
26 is amended to read:

27

14007.8.  

(a) (1) After the director determines, and
28communicates that determination in writing to the Department of
29Finance, that systems have been programmed for implementation
30of this section, but no sooner than May 1, 2016, an individual who
31is under 19 years of age and who does not have satisfactory
32immigration status or is unable to establish satisfactory immigration
33status as required by Section 14011.2 shall be eligible for the full
34scope of Medi-Cal benefits, if he or she is otherwise eligible for
35benefits under this chapter.

36(2) Individuals under 19 years of age enrolled inbegin delete restricted-scopeend delete
37 Medi-Calbegin insert pursuant to subdivision (d) of Section 14007.5end insert at the
38time the director makes the determination described in paragraph
39(1) shall bebegin delete transitioned to full-scope Medi-Cal within 30 days of
40the director’s determination.end delete
begin insert end insertbegin insertenrolled in the full scope of Medi-Cal
P5    1benefits, if otherwise eligible, pursuant to an eligibility and
2enrollment plan. This plan shall include outreach strategies
3developed by the department in consultation with interested
4stakeholders, including, but not limited to, counties, health care
5service plans, consumer advocates, and the Legislature.end insert

6(b) To the extent permitted by state and federal law, an
7individual eligible under this section shall be required to enroll in
8a Medi-Cal managed care healthbegin delete plan if the individual would
9otherwise have been required to enroll in the plan.end delete
begin insert end insertbegin insertplan. Enrollment
10in a Medi-Cal managed care health plan shall not preclude a
11beneficiary from being enrolled in any other children’s Medi-Cal
12specialty program that he or she would otherwise be eligible for.end insert

13(c) The department shall seek any necessary federal approvals
14to obtain federal financial participation in implementing this
15section. Benefits for services under this section shall be provided
16with state-only funds only if federal financial participation is not
17available for those services.

18(d) The department shall maximize federal financial participation
19in implementing this section to the extent allowable.

20(e) This section shall be implemented only to the extent it is in
21compliance with Section 1621(d) of Title 8 of the United States
22Code.

23(f) (1) Notwithstanding Chapter 3.5 (commencing with Section
2411340) of Part 1 of Division 3 of Title 2 of the Government Code,
25the department, without taking any further regulatory action, shall
26implement, interpret, or make specific this section by means of
27all-county letters, plan letters, plan or provider bulletins, or similar
28instructions until the time any necessary regulations are adopted.
29Thereafter, the department shall adopt regulations in accordance
30with the requirements of Chapter 3.5 (commencing with Section
3111340) of Part 1 of Division 3 of Title 2 of the Government Code.

32(2) Commencing six months after the effective date of this
33section, and notwithstanding Section 10231.5 of the Government
34Code, the department shall provide a status report to the Legislature
35on a semiannual basis, in compliance with Section 9795 of the
36Government Code, until regulations have been adopted.

37(g) In implementing this section, the department may contract,
38as necessary, on a bid or nonbid basis. This subdivision establishes
39an accelerated process for issuing contracts pursuant to this section.
40Those contracts, and any other contracts entered into pursuant to
P6    1this subdivision, may be on a noncompetitive bid basis and shall
2be exempt from the following:

3(1) Part 2 (commencing with Section 10100) of Division 2 of
4the Public Contract Code and any policies, procedures, or
5regulations authorized by that part.

6(2) Article 4 (commencing with Section 19130) of Chapter 5
7of Part 2 of Division 5 of Title 2 of the Government Code.

8(3) Review or approval of contracts by the Department of
9General Services.



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