BILL ANALYSIS Ó
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Date of Hearing: August 19, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
SB 4
(Lara) - As Amended July 16, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill contains two provisions related to expanding health
care coverage to undocumented immigrants. Specifically, this
bill:
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1)Requires the state to apply for a waiver of federal law that
bars undocumented immigrants from purchasing coverage through
a state health insurance exchange, in order to allow such
persons to purchase coverage through California's exchange
(also known as Covered California) using their own financial
resources.
2)Specifies a 30-day timeline for the Department of Health Care
Services (DHCS) to transition a group of undocumented
immigrant children who recently became eligible for full-scope
Medi-Cal coverage to such coverage, based on a determination
by DHCS that systems have been programmed such that
implementation may proceed.
FISCAL EFFECT:
1)Minor, absorbable costs to the California Health and Human
Services Agency (CHHSA), and costs in the range of $100,000 to
Covered California (California Health Trust Fund) to pursue a
narrow federal waiver that allows undocumented immigrants to
purchase health care coverage through Covered California.
2)Minor, absorbable ongoing administrative costs to Covered
California (California Health Trust Fund) to designate
California qualified health plans (QHPs). As this bill
specifies the California QHPs are subject to the same
standards as federal QHPs, the designation appears to be
mostly "in name only" for purposes of compliance with federal
law and does not appear to require additional workload.
3)Significant Information Technology (IT) costs to Covered
California. Potentially in the millions one-time costs, for
planning, development, and testing of functionality to allow
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for designation of undocumented status (California Health
Trust Fund). Potentially significant, unknown ongoing costs
from the same fund.
4)Negligible increased costs associated with a 30-day timeline
to transition children to full-scope Medi-Cal. The 2015-16
budget assumed transition by June 1, 2016.
COMMENTS:
1)Purpose. This bill intends to improve coverage for
undocumented immigrants in California by addressing two
separate issues. First, the author notes current federal law
excludes undocumented immigrants from being able to purchase
coverage through Covered California, even with their own
resources. He notes, for example, mixed-status families
cannot purchase coverage through Covered California as a
family unit. The author believes this policy does not reflect
our common values nor serve the common good, and proposes
seeking a federal waiver of this exclusionary federal law.
Secondly, the author also notes the Budget Act of 2015 (SB 97
(Committee on Budget and Fiscal Review), Chapter 11, Statutes
of 2015) expanded Medi-Cal eligibility for children under the
age of 19, regardless of immigration status, to ensure that no
child in California who is income-eligible will be denied
access to health care coverage. These provisions are slated
to go into effect some time on or after May 1, 2016. This
bill will make certain that children currently eligible for
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limited scope Medi-Cal are quickly transitioned to full-scope
Medi-Cal.
2)Background. Under existing state and federal law, undocumented
adults who are otherwise income-qualified for Medi-Cal are not
eligible for full scope services, and are instead eligible for
"limited scope" Medi-Cal benefits. Limited scope services are
long-term care, pregnancy-related benefits, and emergency
services.
Undocumented immigrants are also prohibited from purchasing
coverage in Covered California under federal law, and are
ineligible for federal subsidies intended to make health
insurance and the cost of care more affordable. However,
California law requires health plans and insurers to make the
same plans available inside and outside the exchange, meaning
the plans available for purchase through Covered California
are also offered outside on the non-Exchange market. The
federal Patient Protection and Affordable Care Act (ACA)
included a provision (Section 1332) that allows many ACA
requirements to be waived in order to pursue innovation.
Federal guidance related to Section 1332 waivers was recently
released. Section 1332 allows states to pursue broad
alternative approaches to expand coverage, or targeted changes
like the one proposed in this bill.
This bill has been significantly scaled down from an earlier
version, which extended full-scope Medi-Cal eligibility to all
undocumented immigrants who would have been eligible except
for their immigration status.
3)Related Legislation. SB 10 (Lara) was recently amended to
make individuals who meet all of the eligibility requirements
for full-scope Medi-Cal benefits, except for their immigration
status, eligible for full-scope Medi-Cal benefits. SB 10 was
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referred to Rules Committee July 13, 2015 and is pending in
that committee.
4)Prior Legislation. SB 1005 (Lara) of 2014, established the
California Health Exchange Program for All Californians to
facilitate the enrollment of individuals who would have been
eligible to purchase coverage through Covered California but
for their immigration status, and also extended eligibility
for full-scope Medi-Cal benefits to individuals who were
otherwise eligible for those benefits but for their
immigration status. SB 1005 was held on the Senate
Appropriations suspense file.
5)Staff Comments. Because undocumented individuals would remain
ineligible for federal subsidies that offset the significant
cost of care, and because they can purchase the same coverage
from outside the exchange, the practical impact of allowing
individuals to purchase coverage through Covered California
may be somewhat limited. Coverage will still be unaffordable
for many people, and those who can afford it can already
purchase it outside the exchange. However, Covered California
has numerous beneficial features, including shop-and-compare
functions and the ability to purchase family coverage.
Allowing undocumented individuals to purchase coverage through
the Exchange directly would allow individuals to make use of
these functions, could encourage greater enrollment, and could
benefit families of mixed immigration status.
With respect to the 30-day transition timeline for children,
it seems reasonable that children in restricted-scope Medi-Cal
aid codes should be transitioned to full-scope coverage as
quickly as possible after systems are programmed to allow
children without satisfactory immigration status to enroll in
Medi-Cal. However, staff notes administrative resources are
finite and there may be policy goals that conflict with the
goal of a 30-day transition, such as identifying and
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preserving relationships with a child's existing providers, or
expanding coverage in phases to better manage the transition
workload.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081