BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                       SB 4

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          (Without Reference to File)


          4 (Lara)

          As Amended  September 10, 2015

          Majority vote

          SENATE VOTE:  Vote not relevant

          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |Health          |     |                      |                    |
          |                |     |                      |                    |
          |(vote not       |     |                      |                    |
          |relevant)       |     |                      |                    |
          |                |     |                      |                    |
          |Appropriations  |     |                      |                    |
          |                |     |                      |                    |
          |(vote not       |     |                      |                    |
          |relevant)       |     |                      |                    |
          |                |     |                      |                    |


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          |Health          |     |Bonta, Bonilla,       |Maienschein,        |
          |                |13-5 |Burke, Chávez, Chiu,  |Lackey, Patterson,  |
          |                |     |Gomez, Gonzalez,      |Steinorth, Waldron  |
          |                |     |Nazarian,             |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Santiago,  |                    |
          |                |     |Thurmond, Wood        |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |

          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, and specifies children  
            subject to these provisions are not required to file a new  
            application for Medi-Cal.

          2)Requires children currently enrolled in restricted scope  
            emergency Medi-Cal be transferred to full scope services  
            immediately, as soon the program is operational (May 1, 2016).

          3)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,  


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            consumer advocates, and the Legislature.  

          4)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.

          5)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.

          6)Requires DHCS to seek any necessary federal approvals to  
            obtain federal financial participation 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  

          7)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.

          8)Requires DHCS, prior to implementation, to provide monthly  
            updates to the appropriate policy and fiscal committees of the  
            Legislature on the progress of implementation, and, 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.

          9)Allows DHCS, in implementing these provisions, to contract as  
            necessary on a bid, or nonbid basis.


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          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:  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 (Budget and Fiscal  
          Review Committee), 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.

          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  


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          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.  

          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 United  
          States (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 action status.  These actions  
          are expected to affect up to 4.4 million people, according to  

          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  


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          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  

          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.

          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 individuals residing  
          unlawfully in California.

          Analysis Prepared by:                                             
                          Lara Flynn / HEALTH / (916) 319-2097  FN:  


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