BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 997 (Lara) - Health care coverage: immigration status
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: April 20, 2016 |Policy Vote: HEALTH 7 - 1 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: May 9, 2016 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 997 requires undocumented children who are eligible
for full-scope Medi-Cal coverage and who are enrolled in
low-cost coverage provided by Kaiser Permanente or another
Medi-Cal managed care plan to be enrolled in full-scope Medi-Cal
with the same health plan.
Fiscal
Impact:
Likely one-time administrative costs of about $1 million for
the Department of Health Care Services to coordinate with
health plans and determine Medi-Cal eligibility for current
low-cost coverage enrollees (General Fund). The Department
will need to collect information from health plans about their
current low-cost coverage enrollees who are likely to gain
full-scope Medi-Cal eligibility, determine eligibility for
those individuals, and set up a special process for those
individuals to be directly enrolled with the same health plan
under full scope Medi-Cal. Because this is not the normal
process for determining Medi-Cal eligibility and assigning
enrollees to a Medi-Cal managed health plan, there will be
SB 997 (Lara) Page 1 of
?
additional workload for the Department. (Because undocumented
immigrants are generally not eligible for federal financial
participation, all costs will be General Fund costs.)
Likely increased Medi-Cal costs in the millions per year due
to increased enrollment in Medi-Cal under the bill (General
Fund). Under current law, undocumented immigrants under 19
years of age will be eligible for full-scope Medi-Cal on or
after May 1, 2016. The undocumented children who are the
subject of this bill will soon become eligible for full scope
Medi-Cal. However, without the bill, those children's' parents
will need to enroll them in Medi-Cal through the normal
application process. Given that these children are already
enrolled in health care coverage (often with a modest monthly
fee per child), it is likely that a high percentage of these
children's' parents will enroll them in Medi-Cal. However,
there is likely to be a small share of the current population
that will not enroll in Medi-Cal through the normal enrollment
process. Under the bill, the streamlined enrollment into
Medi-Cal is likely to reduce the number of individuals who
would lose coverage during the transition. For example, if 10%
of current program participants would not have transitioned to
Medi-Cal coverage without the bill and the bill reduces that
share to 5% losing coverage, the state cost for that
additional Medi-Cal coverage would be about $7 million per
year.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household income up to 138% of the federal poverty level and to
children with household income up to 266% of the federal poverty
level. The federal government provides matching funds that vary
from 50% to 90% of expenditures depending on the category of
beneficiary.
Under current law (SB 75, Committee on Budget and Fiscal Review,
Statutes of 2015) the state will expand eligibility for
full-scope Medi-Cal to undocumented immigrants under 19 years of
age on or after May 1, 2016. The Department of Health Care
Services indicates that coverage should begin about May 16,
2016. The cost of providing full-scope Medi-Cal benefits to
undocumented immigrants is not eligible for federal financial
SB 997 (Lara) Page 2 of
?
participation (although federal financial participation is
available for emergency and pregnancy-related services for
undocumented immigrants).
Currently, Kaiser Permanente and eight other Medi-Cal managed
care plans (including both local initiatives and county
organized health plans) offer low- or no-cost coverage to
low-income undocumented children. Kaiser covers about 64,000
children and the other plans cover a combined 13,000 children.
Most of those children are income-eligible for Medi-Cal.
Under current practice in Medi-Cal, when an applicant is
determined to be eligible, he or she is enrolled into
fee-for-service Medi-Cal and given information to select a
Medi-Cal managed care plan (in counties where there is more than
one plan). This system is referred to as the Health Care Options
process. If an enrollee does not select a plan, there is a
process for assigning enrollees to a Medi-Cal managed care plan.
Medi-Cal managed care enrollees are allowed to change health
plans monthly (when there is a coverage option). Current
regulation limits the ability of Medi-Cal managed care plans to
contact their enrollees with information that could be
interpreted as marketing material.
Proposed Law:
SB 997 requires undocumented children who are eligible for
full-scope Medi-Cal coverage and who are enrolled in low-cost
coverage provided by Kaiser Permanente or other Medi-Cal managed
care plans to be enrolled in full-scope Medi-Cal with the same
health plan.
Specific provisions of the bill would:
Require that children who are eligible for full-scope
Medi-Cal and were enrolled in low-cost coverage with Kaiser
Permanente or a Medi-Cal managed care plan shall be
enrolled in full-scope Medi-Cal with the same managed care
plan;
Require disclosure of specified information on Medi-Cal
eligibility and managed care plan options to the child's
representative;
SB 997 (Lara) Page 3 of
?
Require the Department of Health Care Services, using
information that is provided by health plans through an
existing process, to determine the Medi-Cal eligibility of
children enrolled in low-cost coverage;
Require the Department to provide specified information
to the child's representative;
Include a sunset date of January 1, 2019.
Related
Legislation: SB 10 (Lara) would extend full-scope Medi-Cal
eligibility to adults who would be eligible, except for their
immigration status. That bill is pending in the Assembly Health
Committee.
Staff comments: Once undocumented children are able to enroll in
Medi-Cal, it is likely that some of the children currently
provided coverage through Kaiser Permanente and other Medi-Cal
managed care plans will apply for and enroll in Medi-Cal. Since
enrolling these children to Medi-Cal will shift the cost of
providing their care from the managed care plans to the state,
it is likely that the managed care plans will take steps to
facilitate enrollment. However, current prohibitions on
marketing to members by Medi-Cal managed care plans will limit
the ability of plans that are currently providing coverage to
assist currently enrolled undocumented children with selecting
the same plan (when there is a choice). Therefore, there are
likely to be children who will not ultimately enroll with the
same health plan when they are enrolled in Medi-Cal managed
care. This is particularly true for the children currently
covered by Kaiser Permanente. That health plan not a primary
Medi-Cal managed care plan in most counties, although it is a
subcontracting Medi-Cal managed care plan in many more counties.
Applicants who would like to remain with Kaiser Permanente may
have difficulty navigating the Health Care Options process to
enroll back with Kaiser.
It is important to note that this bill is not an urgency measure
and so would not go into effect until January 1, 2016. It is not
known to what extent the health plans that are currently
providing free or low cost coverage to undocumented children
will still be offering such coverage by that date.
SB 997 (Lara) Page 4 of
?
-- END --