BILL NUMBER: SB 4 AMENDED
BILL TEXT
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
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 to add Section 100522 to the Government Code, and
to 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.
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.
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.
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 be transitioned to
full-scope Medi-Cal within 30 days of that determination.
enrolled in the full scope of Medi-Cal
benefits, if otherwise eligible, pursuant to an eligibility and
enrollment plan, as specified. The bill would also require that
an individual who is eligible pursuant to these provisions enroll in
a Medi-Cal managed care health plan if the individual would
otherwise have been required to enroll in that plan.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The
Legislature finds and declares all of the following:
(1)
(a) No child in California should endure suffering and
pain due to a lack of access to health care services.
(2) No individual in California should be excluded from obtaining
coverage through the California Health Benefit Exchange by reason of
immigration status.
(3)
(b) Expanding access and increasing enrollment in
comprehensive health care coverage benefits the health and welfare of
all Californians.
(b) It is the intent of the Legislature to ensure that all
Californians are eligible to obtain health care coverage through the
Exchange.
(c) It is further the intent of the Legislature to increase
opportunities for enrollment in comprehensive coverage for adults,
regardless of immigration status, through the enactment of this bill.
(d) It is further the intent of the Legislature that all
Californians who are otherwise eligible for Medi-Cal, a qualified
health plan offered through the California Health Benefit Exchange,
or affordable employer-based health coverage, enroll in that
coverage, and obtain the care that they need.
(c) Through the enactment of Senate Bill 75, the California
Legislature has extended eligibility for full-scope Medi-Cal benefits
to all children in California, regardless of 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 solely for the purpose of offering coverage to
persons otherwise not able to obtain coverage by reason of
immigration status.
(b) The Exchange shall offer California qualified health plans
that 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).
(e) For purposes of this section, a "California qualified health
plan" means a product offered to persons not otherwise eligible to
purchase coverage from the Exchange by reason of immigration status
and that comply with each of the requirements of state law and the
Exchange for a qualified health plan.
SEC. 3. SEC. 2. Section 14007.8 of
the Welfare and Institutions Code is amended to read:
14007.8. (a) (1) After the director determines, and communicates
that determination in writing to the Department of Finance, that
systems have been programmed for implementation of this section, but
no sooner than May 1, 2016, an individual who is under 19 years of
age and who does not have satisfactory immigration status or is
unable to establish satisfactory immigration status as required by
Section 14011.2 shall be eligible for the full scope of Medi-Cal
benefits, if he or she is otherwise eligible for benefits under this
chapter.
(2) Individuals under 19 years of age enrolled in
restricted-scope Medi-Cal pursuant to subdivision (d)
of Section 14007.5 at the time the director makes the
determination described in paragraph (1) shall be
transitioned to full-scope Medi-Cal within 30 days of the director's
determination. enrolled in the full scope
of Medi-Cal benefits, if otherwise eligible, pursuant to an
eligibility and enrollment plan. This plan shall include outreach
strategies developed by the department in consultation with
interested stakeholders, including, but not limited to, counties,
health care service plans, consumer advocates, and the Legislature.
(b) To the extent permitted by state and federal law, an
individual eligible under this section shall be required to enroll in
a Medi-Cal managed care health plan if the individual would
otherwise have been required to enroll in the plan.
plan. Enrollment in a Medi-Cal managed care health plan
shall 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.
(c) The department shall seek any necessary federal approvals to
obtain federal financial participation in implementing this section.
Benefits for services under this section shall be provided with
state-only funds only if federal financial participation is not
available for those services.
(d) The department shall maximize federal financial participation
in implementing this section to the extent allowable.
(e) This section shall be implemented only to the extent it is in
compliance with Section 1621(d) of Title 8 of the United States Code.
(f) (1) 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 any necessary regulations are
adopted. Thereafter, the department shall adopt regulations 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.
(2) Commencing six months after the effective date of this
section, 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.
(g) In implementing this section, the department may contract, as
necessary, on a bid or nonbid basis. This subdivision establishes an
accelerated process for issuing contracts pursuant to this section.
Those contracts, and any other contracts entered into pursuant to
this subdivision, may be on a noncompetitive bid basis and shall be
exempt from the following:
(1) Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code and any policies, procedures, or regulations
authorized by that part.
(2) Article 4 (commencing with Section 19130) of Chapter 5 of Part
2 of Division 5 of Title 2 of the Government Code.
(3) Review or approval of contracts by the Department of General
Services.