BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 997| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 SB 997 Page 2 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 SB 997 Page 3 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 SB 997 Page 4 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. SB 997 Page 5 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. SB 997 Page 6 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 SB 997 Page 7 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 SB 997 Page 8 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 SB 997 Page 9 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