BILL ANALYSIS Ó
SB 4
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Date of Hearing: September 9, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
SB
4 (Lara) - As Amended September 4, 2015
SENATE VOTE: Not relevant
SUBJECT: Health care coverage: immigration status.
SUMMARY: Requires children enrolled in restricted scope
Medi-Cal be enrolled in full-scope Medi-Cal if otherwise
eligible when 2015 Budget bill language making undocumented
children under the age of 19 eligible for full-scope Medi-Cal
benefits is implemented. Specifically, this bill:
1)Requires, when 2015 Budget bill language is implemented to
make undocumented children under the age of 19 eligible for
full scope Medi-Cal benefits, that children enrolled in
restricted scope Medi-Cal at that time to be enrolled in full
scope Medi-Cal if otherwise eligible, pursuant to an
eligibility and enrollment plan.
2)Requires the eligibility and enrollment plan to include
outreach strategies developed by the Department of Health Care
Services (DHCS) in consultation with stakeholders including,
but not limited to, counties, health care service plans,
consumer advocates, and the Legislature.
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3)Requires an individual made eligible for full-scope Medi-Cal
under these provisions to enroll in a Medi-Cal managed care
(MCMC) plan if the individual would otherwise have been
required to enroll in the plan.
4)Specifies that enrollment in a MCMC health plan does 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.
5)Requires DHCS to seek any necessary federal approvals to
obtain federal financial participation (FFP) in implementing
these provisions, and requires benefits for services under
these provisions to be provided with state-only funds only if
federal financial participation is not available for those
services.
6)Requires DHCS to implement these provisions by means of
all-county letters, plan letters, plan or provider bulletins,
or similar instructions until the time any necessary
regulations are adopted.
7)Requires DHCS, commencing six months after the effective date
of these provisions, to provide a status report to the
Legislature on a semiannual basis, until regulations have been
adopted.
8)Allows DHCS, in implementing these provisions, to contract as
necessary on a bid, or nonbid basis.
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EXISTING STATE LAW:
1)Establishes the Medi-Cal program, administered by DHCS, under
which low income individuals are eligible for health care
coverage.
2)Makes undocumented individuals, who are otherwise eligible for
Medi-Cal services, eligible only for care and services that
are necessary for the treatment of an emergency medical
condition and medical care directly related to the emergency,
as defined in federal law. Makes low-income undocumented
individuals Medi-Cal eligible for pregnancy-only coverage,
breast and cervical cancer-related treatment services, and
long-term care services. These services are referred to as
limited-scope Medi-Cal services.
3)Expands, through the 2015-16 Health Budget trailer bill,
full-scope Medi-Cal coverage to children, regardless of
immigration status, who currently would be eligible for
Medi-Cal if not for immigration status, beginning when DHCS
declares that systems are ready for implementation, but no
sooner than May 1, 2016. Requires children eligible in this
category to enroll in MCMC in those counties in which a
managed care plan is available. Requires DHCS to seek federal
financial participation (FFP), but requires coverage to be
provided regardless of FFP. Requires DHCS to provide a
semiannual status report to the Legislature until regulations
have been adopted.
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EXISTING FEDERAL LAW prohibits Medicaid matching funds for
medical assistance for an undocumented individual, except for
care and services necessary for the treatment of an emergency
medical condition (as defined) for an individual who otherwise
meets the eligibility requirements for medical assistance under
the state's Medicaid State Plan.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, 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 OF THIS BILL. According to the author, without access
to affordable, quality health insurance, people are forced to
rely on emergency care, which means they delay treatment until
they are sicker and treatment is more expensive. The author
also notes that the Legislature and the Governor, through the
enactment of 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 limited scope
Medi-Cal are quickly transitioned to full-scope Medi-Cal.
The author concludes, we've made enormous strides to reduce
California's uninsured population with the implementation of
the Patient Protection and Affordable Care Act (ACA), but only
when we include everyone can we have a truly healthy
California.
2)BACKGROUND.
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a) Current scope of Medi-Cal coverage for immigrants. In
order to be Medi-Cal eligible, an individual must be a
state resident and generally must be low-income. Recent
legal immigrants and undocumented immigrant adults who meet
income and residency requirements are Medi-Cal-eligible,
but the scope of that coverage depends on the immigration
status of the immigrant. Under existing state and federal
law, undocumented immigrants 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. Medi-Cal also provides coverage for undocumented
individuals needing breast and cervical cancer treatment,
family planning services through the Family Planning,
Access, Care, and Treatment program, and through temporary
presumptive eligibility programs.
b) Presidential action on immigration. In November 2014,
President Obama announced that the federal Department of
Homeland Security (DHS) would not deport certain
undocumented parents of U.S. citizens and parents of lawful
permanent residents. President Obama also announced an
expansion of the Deferred Action for Childhood Arrivals
program for undocumented youth who came to the United
States as children. Under a directive from the Secretary
of DHS, these parents and youth may be granted a type of
temporary permission to stay in the U.S. called "deferred
action." Deferred action is a form of administrative
relief from deportation whereby DHS authorizes a noncitizen
to remain in the U.S. temporarily. These individuals may
also apply for an employment authorization document (a work
permit) during the deferred action period. A grant of
deferred action is temporary and does not grant citizenship
or permanent lawful status. However, a person granted
deferred action is considered by the federal government to
be lawfully present for as long as the grant of deferred
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action status. These actions are expected to affect up to
4.4 million people, according to DHS.
c) The ACA and the remaining uninsured. A January 2015
report from the UC Berkeley Center for Labor Research and
Education and the UCLA Center for Health Policy Research
estimated the ACA is expected to reduce California's
uninsured rate by at least half by 2019, at which time the
ACA will be fully implemented, as they estimate 6.5 million
Californians would have remained uninsured by 2019 without
the ACA. The report indicates that between 2.7 and 3.4
million Californians will remain uninsured by 2019.
Overall, between 1.4 and 1.5 million undocumented
immigrants in California are projected to remain uninsured
in 2019, comprising up to half of all Californians
remaining uninsured.
3)SUPPORT. Health Access California supports this bill as it is
proposed to be amended because it would assure that kids do
not need to reapply to transition from restricted scope
Medi-Cal to full scope and kids who would not be in MCMC if
they were citizens or lawful residents will not be required to
enroll in Managed care. The National Immigration Law Center
(NILC) states, individuals and communities suffer when people
are uninsured. NILC notes, the uninsured are more likely to
be diagnosed with cancer at an advanced state, to die after a
heart attack or accident, and to suffer poor outcomes from a
stroke. NILC concludes we are all better off when everyone
has access to health insurance. The Western Center on Law and
Poverty supports this bill, noting as California leads the way
in implementing the ACA, providing comprehensive health
coverage for undocumented children is just the humane thing to
do.
4)OPPOSITION. We the People Rising opposes a previous version
of this bill, stating that U.S. Veterans and their children,
children in foster care, homeless families, and the unemployed
should be the focus of legislation in Sacramento - not
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individuals residing unlawfully in California.
5)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 is
currently pending a hearing in the Assembly Judiciary
Committee; however SB 10 will most likely be re-referred to
Assembly Health Committee.
6)PREVIOUS LEGISLATION.
a) SB 1005 (Lara) of 2014 would have established the
California Health Exchange Program for All Californians
(CHEPFAC) within state government and would have required
that CHEPFAC be governed by the executive board that
governs Covered California. SB 1005 would have required
Covered California, by January 1, 2016, to facilitate the
enrollment of individuals who would have been eligible to
purchase coverage through Covered California but for their
immigration status and extend 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.
b) SB 900 (Alquist), Chapter 659, Statutes of 2010,
establishes Covered California as an independent public
entity within state government, and requires Covered
California to be governed by a board composed of the
Secretary of California Health and Human Services Agency,
or his or her designee, and four other members appointed by
the Governor and the Legislature who meet specified
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criteria.
c) AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010,
specifies the powers and duties of Covered California
relative to determining eligibility for enrollment in the
Covered California and arranging for coverage under
qualified health plans.
d) AB X1 1 (John A. Pérez), Chapter 3, Statutes of 2013-14
First Extraordinary Session, implemented specified Medicaid
provisions of the ACA, including the expansion of federal
Medicaid coverage to low-income adults with incomes between
0% and 138% of the federal poverty level. AB X1 1 also
implemented a number of the Medicaid ACA provisions to
simplify the eligibility, enrollment and renewal processes
for Medi-Cal.
e) SB X1 1 (Ed Hernandez and Steinberg), Chapter 4,
Statutes of 2013-14 First Extraordinary Session,
established the existing Medi-Cal benefit package as the
benefit package for the expansion population eligible under
the ACA and expanded the Medi-Cal benefit package for the
existing population and newly eligible under the ACA to
include mental health services and substance use disorder
services required under the essential health benefit
legislation adopted in 2012 that were not currently covered
by Medi-Cal.
SB X1 1 also implemented a number of the Medicaid
ACA-related provisions to simplify the eligibility,
enrollment and renewal processes for Medi-Cal and also made
recent immigrant childless adults, who would be eligible
for Medicaid funding under the ACA except for the five-year
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bar who are enrolled in Covered California with an Advanced
Premium. Tax Credit, eligible for Medi-Cal benefits not
covered by their Covered California plan. For these
individuals, DHCS would be required to pay the individual's
premium and cost-sharing (referred to as a "Medi-Cal
wrap"). The Medi-Cal wrap has not yet been implemented.
Until it is, these recent legal immigrant adults are
Medi-Cal eligible.
7)TECHNICAL AMENDMENTS. The author is proposing technical and
clarifying amendments which will:
a) Clarify that kids currently enrolled in restricted scope
emergency Medi-Cal will not be required to submit a new
application when they transition to full-scope coverage.
b) Ensure that kids currently enrolled in restricted scope
emergency Medi-Cal will be transferred to full scope
services immediately, as soon the program is operational
(May 1, 2016).
c) Require DHCS to provide monthly updates to the
appropriate policy and fiscal committees of the Legislature
on the status of the implementation of these provisions.
REGISTERED SUPPORT / OPPOSITION:
Support (previous version)
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Advancement Project
AIDS Project Los Angeles
Alliance for Boys and Men of Color
Alliance of Catholic Healthcare
American Civil Liberties Union of California
American Federation of State, County and
Municipal Employees
Anti-Defamation League
Asian Americans Advancing Justice
Sacramento
Asian Law Alliance
ASPIRE Los Angeles
California Alliance of Retired Americans
California Asian Pacific Islander Budget
Partnership
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California Association of Public Hospitals and
Health Systems
California Black Health Network
California Chapter of the American College of
Emergency Physicians
California Communities United Institute
California Coverage and Health Initiatives
California Faculty Association
California Family Health Council
California Family Resource Association
California Healthy Nail Collaborative
California Immigrant Policy Center
California Labor Federation
California Latinas for Reproductive Justice
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California Nurses Association
California Pan-Ethnic Health Network
California Partnership
California Primary Care Association
California Program of All-Inclusive Care for
the Elderly
California Rural Legal Assistance Foundation
California School Employees Association
California School-Based Health Alliance
California State Council of the Service
Employees International Union
California Teachers Association
Campaign for a Healthy California
Central California Alliance for Health
Center for Empowering Refugees and
Immigrants
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Children Now
Children's Defense Fund California
Children's Partnership
Coalition for Humane Immigrant Rights of
Los Angeles
Community Action Fund of Planned
Parenthood of Orange and
San Bernardino Counties
Community Clinic Association of
Los Angeles County
Community Health Partnership
Consumers Union
Equality California
Friends Committee on Legislation of California
Health Access
Health Care for All - Contra Costa County
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HOPE (Hispanas Organized for Political
Equality)
Instituto Familiar de la Raza, Inc.
Korean Resource Center
Lutheran Office of Public Policy, California
March of Dimes California
Mexican American Legal Defense and
Educational Fund
National Association of Social Workers,
California Chapter
National Health Law Program
National Immigrant Law Center
Pacific Asian Counseling Service
PICO California
Planned Parenthood Action Fund of Santa
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Barbara, Ventura and San Luis Obispo
Counties
Planned Parenthood Action Fund of the Pacific
Southwest
Planned Parenthood Advocacy Project
Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Pasadena and
San Gabriel Valley
Planned Parenthood Northern California
Action Fund
Planned Parenthood Mar Monte
San Francisco Community Clinic Consortium
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Santa Cruz Women's Health Center
St. Anthony Foundation
St. John's Well Child & Family Center
San Francisco Bay Area Physicians for Social
Responsibility
United Domestic Workers/AFSCME
Local 3930
United Ways of California
Western Center on Law and Poverty
Young Invincibles
Opposition (previous version)
We The People Rising
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Analysis Prepared by:Lara Flynn / HEALTH / (916)
319-2097