BILL ANALYSIS Ó
SB 4
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(Without Reference to File)
SENATE THIRD READING
SB
4 (Lara)
As Amended September 10, 2015
Majority vote
SENATE VOTE: Vote not relevant
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|Committee |Votes|Ayes |Noes |
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|----------------+-----+----------------------+--------------------|
|Health | | | |
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|(vote not | | | |
|relevant) | | | |
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|Appropriations | | | |
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|(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 | |
| | | | |
| | | | |
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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
services.
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
DHS.
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
uninsured.
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:
0002340
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