BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 997|
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THIRD READING
Bill No: SB 997
Author: Lara (D)
Amended: 5/31/16
Vote: 21
SENATE HEALTH COMMITTEE: 7-1, 4/13/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nielsen
NO VOTE RECORDED: Nguyen
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SUBJECT: Health care coverage: immigration status
SOURCE: Health Access California
DIGEST: This bill requires undocumented children eligible for
full-scope Medi-Cal benefits who were enrolled in a
comprehensive, low-cost coverage provided by Kaiser Permanente
(Kaiser) or a Medi-Cal managed care plan as of May 1, 2016 to be
enrolled in full-scope Medi-Cal with Kaiser or their Medi-Cal
managed care plan if the undocumented child is determined
eligible for full-scope Medi-Cal benefits.
ANALYSIS:
Existing law:
1)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
Medi-Cal provides coverage to children in families with
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incomes up to 266% of the federal poverty level (FPL (266% of
the FPL is at or below $53,626 for a family of 3 in 2016).
2)Extends eligibility for full-scope Medi-Cal benefits to
individuals under 19 years of age who do not have, or are
unable to establish, satisfactory immigration status,
commencing after the DHCS director determines that systems
have been programmed for implementation, but in no case sooner
than May 1, 2016. (Full scope Medi-Cal coverage for
undocumented children began in May 2016.)
3)Requires that individuals under 19 years of age enrolled in
limited scope Medi-Cal at the time the DHCS director makes the
determination to be enrolled in the full scope of Medi-Cal
benefits, if otherwise eligible, pursuant to an eligibility
and enrollment plan. Prohibits these individuals from being
required to file a new application for Medi-Cal.
4)Requires an undocumented child eligible for full scope
coverage to enroll in a Medi-Cal managed care health plan to
the extent permitted by state and federal law. Prohibits
enrollment in a Medi-Cal managed care health plan from
precluding a beneficiary from being enrolled in any other
children's Medi-Cal specialty program for which he or she
would otherwise be eligible.
5)Requires, at the time of determining or redetermining the
eligibility of a Medi-Cal program applicant or beneficiary who
resides in an area served by a managed health care plan or
pilot program in which beneficiaries may enroll, each
applicant or beneficiary to be informed of the managed care
and fee-for-service options available regarding methods of
receiving Medi-Cal benefits. This is referred to as the
"health care options" process.
This bill:
1)Requires, in order to maximize continuity of care and
coverage, undocumented children eligible for full-scope
Medi-Cal benefits who were enrolled in comprehensive, low-cost
coverage provided by Kaiser or a Medi-Cal managed care plan as
of May 1, 2016 to be enrolled in full-scope Medi-Cal with
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Kaiser or their Medi-Cal managed care if the undocumented
child is determined eligible for full-scope Medi-Cal benefits,
notwithstanding any other law.
2)Requires DHCS, using information provided to it by health
plans, to determine whether prior to May 1, 2016, an
undocumented child who is eligible for full-scope Medi-Cal
benefits was enrolled in Kaiser coverage.
3)Requires DHCS, before the child's transition to full-scope
Medi-Cal, to provide the child's representative with timely,
linguistically appropriate notice of the transition. Requires
the notice to contain all of the following information:
a) Which Medi-Cal managed care plan or plans contain the
child's existing primary care provider in those counties in
which the health plan does not directly contract as a
Medi-Cal managed care health plan with DHCS;
b) That the child, subject to his or her ability to change
his or her health plan (as described below), will be
assigned to his or her existing health plan if enrolled in
full-scope Medi-Cal benefits after May 1, 2016, and that if
the child wants to keep his or her primary care provider,
no additional action will be required;
c) That if the child's existing primary care provider in
Kaiser is not contracted with any Medi-Cal managed care
plan in the enrollee's county of residence or if the
enrollee's existing health plan is not an available
Medi-Cal managed care plan in the child's county of
residence, he or she will receive all provider and health
plan information required to be sent to new enrollees. If
the child does not affirmatively select one of the
available Medi-Cal managed care plans within 30 days of
receipt of the notice, he or she will automatically be
assigned a plan through the DHCS-prescribed auto-assignment
process;
d) That the child may choose any available Medi-Cal managed
care plan and primary care provider in his or her county of
residence, if more than one such plan is available in the
county where he or she resides, and he or she will receive
all provider and health plan information required to be
sent to new enrollees and instructions on how to choose or
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change his or her health plan and primary care provider;
and,
e) That the child does not need to take any action to
retain his or her health plan and primary care provider if
he or she is enrolled in full-scope Medi-Cal benefits.
4)Requires Kaiser, Medi-Cal managed care plans, and their
designees to work with DHCS and its designees to facilitate
continuity of care and data sharing to the extent permissible
by state and federal law for purposes of implementing this
bill.
5)Limits the application of this bill only to an enrollee in a
service area of Kaiser or the Medi-Cal managed care as of the
effective date of this bill.
6)Sunsets the provisions of this bill on January 1, 2019.
Comments
1)Author's statement. According to the author, last year's
historic enactment of Health4All Kids, allows all low-income
California children, regardless of immigration status, to
enroll in Medi-Cal. Starting in May, all income-eligible
children will have access to comprehensive, zero-cost or
low-cost Medi-Cal benefits, including dental and mental health
coverage as well as the full array of health benefits
(doctors, hospitals, prescription drugs, and more). Currently,
over 120,000 undocumented children are enrolled in restricted
scope, emergency-only Medi-Cal and an additional 64,000
undocumented children have comprehensive health coverage
through Kaiser Permanente. That coverage was provided well
before the passage of Health4All Kids, when families with
undocumented children had very limited options for health
care. The children on restricted scope Medi-Cal will be
automatically shifted to full-scope Medi-Cal when Health4All
Kids is implemented in May 2016. Families will have an option
to select a health plan, or transition directly into a default
coverage option. This bill will ensure a seamless transition
to full-scope Medi-Cal coverage for eligible children who were
already enrolled in a comprehensive, low-cost health plan
prior to the enactment of Health4All Kids.
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2)Local coverage program for uninsured children. Kaiser
Permanente's Child Health Program (CHP) offers health coverage
to children under 19 who do not have access to health
insurance. CHP members are enrolled in the Kaiser Permanente
Platinum 90 HMO plan. Eligibility for CHP is for uninsured
children regardless of immigration status if they meet the
following criteria:
a) Live in a Kaiser Permanente service area;
b) Are under the age of 19;
c) Live in a household with incomes up to 300% of the FPL
(for example: $60,270 for a family of 3, $72,900 for a
family of 4 per 2016 guidelines);
d) Do not have access to any other public or private health
coverage including, but not limited to, Medi-Cal, Medicare,
a job-based health plan or coverage through Covered
California; and,
e) Kaiser's CHP has an enrollment of approximately 64,000
children statewide, and Kaiser believes approximately 95%
of them will meet the income requirements for full scope
Medi-Cal under SB 75 (Committee on Budget and Fiscal
Review, Chapter 18, Statutes of 2015).
In addition to the 64,000 children enrolled in Kaiser's CHP, a
2015 publication of the California HealthCare Foundation
identified an additional 13,111 children enrolled in local
Healthy Kids programs in 10 counties (Los Angeles, Riverside,
San Francisco, San Mateo, Santa Barbara, Santa Clara, Santa
Cruz, Solano, Ventura, and Yolo).
3)Medi-Cal Managed Care Models and Health Care Options Process.
When an individual applies for and initially qualifies for
Medi-Cal, they are initially covered under Medi-Cal FFS.
However, most individuals (including most children) must
mandatorily enroll in a Medi-Cal managed care plan.
Beneficiaries receive information on their plan choices
through what is known as the Health Care Option process, which
is administered by a vendor (Maximus) that contracts with
DHCS. Medi-Cal beneficiaries must choose a health plan within
30 days, and if they do not choose a plan within 30 days, a
plan is selected for them.
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Under Medi-Cal managed care, Medi-Cal beneficiaries generally
have a choice of at least two Medi-Cal managed care plans in
each county (except in COHS counties, which have one plan for
all beneficiaries). However, within the two-plan model and
COHS counties, Medi-Cal managed care plans subcontract with
other plans (including Kaiser). Outside of the geographic
managed care model, 79% of Kaiser's Medi-Cal enrollment
(515,911 individuals) are in Kaiser through sub-contracting
arrangements, where beneficiaries enrolled in the
subcontracting plan are considered to be enrollees of the main
contracting plan.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)Likely one-time administrative costs of about $1 million for
DHCS to coordinate with health plans and determine Medi-Cal
eligibility for current low-cost coverage enrollees (General
Fund [GF]). DHCS 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 additional workload for DHCS. (Because
undocumented immigrants are generally not eligible for federal
financial participation, all costs will be GF costs.)
2)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
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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.
SUPPORT: (Verified5/31/16)
Health Access California (source)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Chapter of the American College of Emergency
Physicians
California Black Health Network
California Immigrant Policy Collaborative
California Latinas for Reproductive Justice
California Pan Ethnic Health Network
Coalition of California Welfare Rights Organizations, Inc.
Pre-Health Dreamers
National Immigration Law Center
Service Employees International Union of California
Vision y Compromiso
OPPOSITION: (Verified5/31/16)
California Association of Health Plans
California Coverage & Health Initiatives
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Community Health Initiative Napa County
Give for a Smile
Community Health Initiative of Orange County
ARGUMENTS IN SUPPORT: This bill is sponsored by Health Access
California (HAC) so that undocumented children who currently
have coverage through the Kaiser's CHP or a Medi-Cal managed
care plan can more easily stay with their current plan if they
chose to. This bill will help make it easier for children to
remain with Kaiser or their Medi-Cal managed care plan when they
transition to full-scope Medi-Cal. HAC argues these families
should not face unnecessary barriers to keep their children with
their current plan, if they choose to do so. While moving the
kids currently in Kaiser to Medi-Cal seems like it should be an
easy thing to do, HAC states there are a number of statutory,
administrative and logistical barriers. One of the major
barriers is that Kaiser is a subcontractor of another Medi-Cal
managed care plan in most counties, making it confusing for
families to figure out how to stay with Kaiser. Ensuring the
undocumented children covered by Kaiser can maintain their
Kaiser coverage is made easier for the families if there is an
exception to the current rules that govern Medi-Cal managed care
will help minimize unnecessary barriers so that the undocumented
children covered by Kaiser can more easily stay with Kaiser, if
they choose to.
ARGUMENTS IN OPPOSITION: The California Association of Health
Plans (CAHP) writes in opposition to the previous version of
this bill that that this bill will move undocumented children
from a privately funded health insurance program into full-scope
Medi-Cal, using an approach that does not give these families
the opportunity to choose a different Medi-Cal Managed Care
Plan. CAHP believes that these kids should follow the normal
eligibility, enrollment and default process for Medi-Cal managed
care which allows for a health plan choice to be made. CAHP
concludes that one of the unintended consequences of designating
one plan for enrollment is that it appears to be giving an
exclusive direct contract for this population, which circumvents
the current procurement process.
The California Coverages & Health Initiatives (CCHI) writes in
opposition to the previous version of this bill that many
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families may opt to receive their health care services from a
provider that is closer to their home, which in many cases will
not be a Kaiser facility. CCHI states that Kaiser is not a
Medi-Cal plan in 13 of the counties where Kaiser CHP enrollees
reside, meaning these children will have to travel outside their
county to reach a Kaiser Medi-Cal provider. CCHI states that
many children enrolled in CHP will already be enrolled in
restricted scope Medi-Cal by the time this bill takes effect, or
will have chosen a plan other than Kaiser Medi-Cal, which will
create confusion as children will have to switch back. CCHI
concludes that the majority of children enrolled in CHP have a
sibling or parent in a Medi-Cal managed care plan, and it would
be best for families to add the child to their family's Medi-Cal
case and allow them to choose which health plan best meets their
needs.
Prepared by:Scott Bain / HEALTH /
5/31/16 20:45:32