Senate Bill No. 464

Introduced by Senator Hernandez

February 25, 2015

An act to amend Section 14102.5 of the Welfare and Institutions Code relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

SB 464, as introduced, Hernandez. Health care coverage: enrollment reporting.

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, 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. 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. Existing law requires the department, in collaboration with the exchange, to prepare reports that include specified information about the enrollment process for insurance affordability programs, and to make those reports public on at least a quarterly basis, for the purpose of informing specified entities about the enrollment process for those programs.

This bill would make technical, nonsubstantive changes to the latter provision.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14102.5 of the Welfare and Institutions
Code is amended to read:

14102.5.  

(a) The department shall, in collaboration with the
Exchange, the counties, consumer advocates, and the Statewide
Automated Welfare System consortia, develop and prepare one or
more reports that shall be issued on at least a quarterly basis and
shall be made begin delete publicly available end delete begin insert public end insert within 30 days following
the end of each quarter, for the purpose of informing the California
Health and Human Services Agency, the Exchange, the Legislature,
and the public about the enrollment process for begin delete all end delete insurance
affordability programs. The reports shall comply with federal
reporting requirements and shall, at a minimum, include the
following information, to be derived from, as appropriate
depending on the data element, CalHEERS, MEDS, or the
Statewide Automated Welfare System:

(1) For applications received for insurance affordability
programs through any venue, all of the following:

(A) The number of applications received through each venue.

(B) The number of applicants included on those applications.

(C) Applicant demographics, including, but not limited to,
gender, age, race, ethnicity, and primary language.

(D) The disposition of applications, including all of the
following:

(i) The number of eligibility determinations that resulted in an
approval for coverage.

(ii) The program or programs for which the individuals in clause
(i) were determined eligible.

(iii) The number of applications that were denied for any
coverage and the reason or reasons for the denials.

(E) The number of days for eligibility determinations to be
completed.

(2) With regard to health plan selection, all of the following:

(A) The health plans that are selected by applicants enrolled in
an insurance affordability program, reported by the program.

(B) The number of Medi-Cal enrollees who do not select a health
plan but are defaulted into a plan.

(3) For annual redeterminations conducted for beneficiaries, all
of the following:

(A) The number of redeterminations processed.

(B) The number of redeterminations that resulted in continued
eligibility for the same insurance affordability program.

(C) The number of redeterminations that resulted in a change
in eligibility to a different insurance affordability program.

(D) The number of redeterminations that resulted in a finding
of ineligibility for any program and the reason or reasons for the
findings of ineligibility.

(E) The number of days for redeterminations to be completed.

(4) With regard to disenrollments not related to a
redetermination of eligibility, all of the following:

(A) The number of beneficiary disenrollments.

(B) The reasons for the disenrollments.

(C) The number of disenrollments that are caused by an
individual disenrolling from one insurance affordability program
and enrolling into another.

(5) The number of applications for insurance affordability
programs that were filed with the help of an assister or navigator.

(6) The total number of grievances and appeals filed by
applicants and enrollees regarding eligibility for insurance
affordability programs, the basis for the grievance, and the
outcomes of the appeals.

(b) The department shall collect the information necessary for
these reports and develop these reports using data obtained from
the Statewide Automated Welfare System, CalHEERS, MEDS,
and any other appropriate state information management systems.

(c) For purposes of this section, the following definitions shall
apply:

(1) “CalHEERS” means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.

(2) “Exchange” means the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500)
of the Government Code.

(3) “Statewide Automated Welfare System” means the system
developed pursuant to Section 10823.

(4) “MEDS” means the Medi-Cal Eligibility Data System that
is maintained by the department.

(d) 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 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. Beginning
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 until regulations have been adopted.

(e) This section shall become operative on January 1, 2014.