BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1339
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|AUTHOR: |Monning |
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|VERSION: |April 11, 2016 |
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|HEARING DATE: |April 20, 2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Public social services: intercounty transfers
SUMMARY : Makes a number of changes to the inter-county transfer (ICT)
process when public assistance beneficiaries move from one
county to another county. Changes include requiring either the
old or new county to initiate the ICT process; specifying the
methods by which someone can request an ICT; requiring that all
benefits be transferred within 30 days of either county learning
of the move; requiring a simple, user-friendly process and
ensuring that recipients do not have to submit information they
have already provided; stating that counties should share case
files electronically whenever possible. Entitles a Medi-Cal
beneficiary moving to a new county to the full scope of benefits
for which he or she is enrolled in the county that he or she is
residing in at the time, notwithstanding any other provision of
law.
Existing law:
1)Makes it the responsibility of a recipient changing residence
from one county to another within the state to promptly notify
the county paying aid to the recipient of the move and to
apply for a redetermination of eligibility within the new
county of residence. Requires, through regulation, as a
condition of Medi-Cal eligibility, applicants and
beneficiaries, and persons acting on behalf of such applicants
or beneficiaries, to report specified information to the
county department, including a change of address that may
affect the determination of eligibility and share of cost
within 10 calendar days, following the date of the change.
2)Requires, as part of the ICT, the first county to notify the
second county of the recipient's move as soon as the
recipient's location in the second county is known.
SB 1339 (Monning) Page 2 of ?
3)Requires the county to which the recipient has moved to be
responsible for determining the recipient's continued
eligibility for payment of aid, as of the first day of the
month following 30 days after the first county has notified
the second county of the recipient's relocation.
4)Requires the first county to provide the second county with
copies of those documents, as specified by DHCS, necessary to
establish current eligibility and the grant amount.
5)Permits, pursuant to regulation, expedited disenrollments from
Medi-Cal managed care, subject to specified criteria. One of
the criteria is that the beneficiary has not used services for
which the plan is contractually obligated to pay during the
month for which disenrollment is requested.
6)Requires, through regulation, the Health Care Options Program
(HCO Program) to disenroll any member from a Medi-Cal managed
care plan when one of specified conditions is met. One of
those condition is there is a change of a member's place of
residence outside the plan's service area.
7)Requires an eligible beneficiary seeking to disenroll from a
Medi-Cal managed care plan to submit an enrollment or
disenrollment request on an original, signed enrollment/
disenrollment form to the HCO Program by mail, fax, telephone,
or in person at DHCS-approved HCO Program sites.
8)Requires expedited disenrollments to be effective on the first
day of the month in which the request is processed, and
requires the HCO Program to process all completed
disenrollments.
9)Requires the HCO Program to notify beneficiaries in writing of
the approval or disapproval of enrollment and disenrollment
requests, including expedited disenrollment requests, within
seven working days of receipt of the request.
10)Establishes, through regulation, the effective date of
enrollment or disenrollment is determined as follows:
a) Requires enrollment requests and non-expedited
disenrollment requests processed before the monthly
update to the Medi-Cal Eligibility Data System (MEDS) to
be effective on the first day of the month following the
month in which the request is processed; and,
SB 1339 (Monning) Page 3 of ?
b) Requires enrollment requests and non-expedited
disenrollment requests processed after the monthly update
to the MEDS to be effective on the first day of the
second month following the month in which the request is
processed.
1)Requires expedited disenrollment requests to be effective on
the first day of the month in which the request is processed,
whether submitted before or after the monthly update to MEDS.
This bill:
1)Requires it be the responsibility of a recipient changing
residence from one county to another to promptly notify either
the county from which he or she moves or the county to which
he or she moves of the change of residence. (This requirement
currently exists for Medi-Cal.)
2)Requires that recipients of CalWORKs, CalFresh, or Medi-Cal
have the right to report a change of residence in person, in
writing, telephonically, or, if the technology is available,
electronically online, and to be advised of this right at the
time of application and redetermination or recertification.
3)Requires counties, if a recipient moves from one county to
another county, as soon as either county is aware of the move,
that county to initiate an ICT for all benefits that the
recipient is receiving.
4)Requires benefits for all programs for which the recipient is
eligible to be transferred within 30 days after any county
becomes aware of the recipient's move in order to effectuate
the earliest possible start date.
5)Requires, to the greatest extent possible, the ICT process to
be simple and client friendly and minimize workload for county
eligibility operations. Requires the ICT to ensure the
applicant or recipient does not need to provide copies of
documents that were previously provided to the prior county of
residence, and there is no interruption in benefits.
6)Requires case file documents to be electronically shared
between the prior county of residence and the new county of
residence, to the extent possible, as specified by the
relevant state departments.
7)Prohibits, to the extent permitted by federal law and
SB 1339 (Monning) Page 4 of ?
regulation, the new county of residence from interviewing
recipients moving to that county from another county to
determine continued eligibility for CalWORKs or CalFresh until
the next scheduled recertification or redetermination.
8)Entitles a Medi-Cal beneficiary moving to a new county to the
full scope of benefits for which he or she is enrolled in the
county that he or she is residing in at the time,
notwithstanding any other provision of law.
9)Requires, if the beneficiary is required to receive services
through a Medi-Cal managed care plan and he or she moves to
another county and is still enrolled in a managed care health
plan in the county from which he or she moved and needs
services in the new county and requests disenrollment to the
Medi-Cal Managed Care Ombudsman, the beneficiary to be
disenrolled as an expedited disenrollment from his or her
Medi-Cal managed care health plan effective the next business
day after the request is made.
10)Permits a beneficiary to request an expedited disenrollment
by telephone, in person, or electronically online. Requires
the expedited disenrollment request to be available for
submission by the beneficiary electronically online to reduce
administrative costs and increase access to medical services
for Medi-Cal beneficiaries.
11)Requires a beneficiary who is disenrolled from the Medi-Cal
managed care health plan in the county from which he or she
moved to receive services in the new county through the
fee-for-services delivery system until he or she is enrolled
in a Medi-Cal managed care health plan in the new county.
12)Requires, if the Medi-Cal beneficiary moves to a county that
provides Medi-Cal services through a county organized health
system (COHS), the beneficiary to be enrolled in that COHS
plan on the first day of the month the new county of residence
assumes responsibility for that beneficiary.
13)Requires, if a Medi-Cal beneficiary moves to a county without
a COHS, the usual health plan choice process to apply.
14)Prohibits failure to report a move to a different county
within the state in itself from constituting a basis for an
overpayment.
SB 1339 (Monning) Page 5 of ?
15)Requires responsibility for payment of aid to a person
qualifying for and receiving aid from a county who moves to
another county in this state to make his or her home, to be
transferred to the second county as soon as administratively
possible and within 30 days after either party becomes aware
of the aid recipient's move. Counties currently have transfer
responsibility as soon as administratively possible but not
later than the first day of the month following 30 days after
notification to the second county.
16)Prohibits an appropriation required under a specified
provision of existing law for the maintenance and support of
needy children and pregnant mothers from being required for
purposes of implementing this bill.
17)Repeals the existing ICT CalFresh provisions and replaces it
with the above-described provisions.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, this bill
modernizes and simplifies the ICT process in state statute to
make sure that benefits are not interrupted when a beneficiary
of the CalWORKs, CalFresh, or Medi-Cal program relocates.
There is some confusion among counties with regard to the
implementation of ICTs and there are instances in which the
sending or receiving county does not fully understand the
process due to current law being vague. For Medi-Cal
beneficiaries, delays in transfers is of particular concern
because it could disrupt continuity and access to care or cost
the state more money if the only other access to care in the
new county is the emergency room. This bill makes it clear in
the statute that Medi-Cal beneficiaries are entitled to care
in their new county even if they are in a health plan and
outlines procedures to ensure the consumer can enroll in the
new county.
2)ICT. The process of transferring cases for eligibility and
case management purposes is known as an ICT. The three major
programs (CalFresh, CalWORKs and Medi-Cal) all have ICT
procedures. DHCS guidance to counties instructs counties to
ensure all Medi-Cal cases remain active throughout the ICT
period with no interruption in benefits. Counties are
instructed not to terminate benefits when a Medi-Cal
SB 1339 (Monning) Page 6 of ?
beneficiary moves to another county until an effective date of
benefits for the beneficiary in the new county is confirmed.
In addition, counties are prohibited from requiring a
beneficiary to reapply for Medi-Cal benefits or apply for a
redetermination of eligibility in the new county solely due to
the change in county residence.
3)Double referral. This bill was heard in the Senate Human
Services Committee on March 30, 2016 and passed as amended on
a 4-0 vote.
4)Support. This bill is jointly sponsored by the Coalition of
California Welfare Rights, United Ways of California and
Western Center on Law and Poverty (WCLP). WCLP writes this
bill would modernize the process for transferring records for
people who are receiving CalWORKs, CalFresh or Medi-Cal when
they move from one county to another within California to
ensure no break in benefits. WCLP states that low-income
families move more frequently than higher income families, and
this is especially true during this time of low renter vacancy
rates, high eviction rates and the displacement of low-income
families of color from urban centers. Retaining safety net
benefits when moving to a new county is not only critical to
the health and stability of the family in their new community,
but also a right to which recipients are entitled. WCLP states
it has heard from community partners assisting consumers who
have had trouble transferring their benefits to a new county.
In these cases, people haven't been able to access medical
care or CalWORKs supportive services including cash aid,
transportation and child care services. WCLP states delays in
processing ICTs results in individuals and families who are
already struggling to get by on very limited means being
unable to participate in job training or see the doctor,
because their benefits have not been moved to their new
county. Current ICT rules require people to report the move to
the county human services agency in the county from which they
moved, which has proven not to work well sometimes, and the
process itself is outdated in a number of other respects. This
bill would streamline and modernize the ICT process.
In addition to the ICT, this bill also addresses an issue in
Medi-Cal when people move from one county to another. WCLP
states that now that most people are in a Medi-Cal managed
care plan, there is the additional step of getting into a plan
in the new county once someone's address has been changed in
the eligibility system. People who move mid-month are still
SB 1339 (Monning) Page 7 of ?
enrolled in their Medi-Cal health plan from their old county.
They can access emergency services but often are unable to
access non-emergent services if their plan's network of
providers does not have providers in the new county. This can
be tragic for someone undergoing a course of treatment,
including people with acute conditions as well as pregnant
women in need of prenatal care. This bill will address access
to care by making it clear that Medi-Cal members are entitled
to care in their new county even if they are in a health plan
by outlining procedures for a consumer to disenroll from the
health plan in their old county through an expedited
disenrollment process so they can access services pending
enrollment into the new county. The bill largely formalizes
the current process whereby the Medi-Cal Managed Care
Ombudsman does expedited disenrollments for Medi-Cal members
who need non-emergent care. The new component in the bill is
the ability for a member to initiate this disenrollment online
- a process that already exists for county workers and should
be extended to consumers.
5)Change to expedited disenrollment. Under existing regulation,
expedited disenrollment from Medi-Cal managed care is subject
to specified criteria. One of the criteria is that the
beneficiary has not used services for which the Medi-Cal
managed plan is contractually obligation to pay during the
month for which disenrollment is requested. Under current
regulation, expedited disenrollment requests are be effective
on the first day of the month in which the request is
processed.
This bill would no longer limit the expedited disenrollment of
Medi-Cal managed care beneficiaries to individuals who have
not received services in a month in their original county
Medi-Cal managed care plan. Instead, this bill would require
that beneficiaries be disenrolled as an expedited
disenrollment effective the next business day after the
request is made. In addition, the beneficiary would be
entitled to the full scope of services for which he or she is
entitled in the new county for FFS Medi-Cal. The argument for
granting the same scope of coverage to a Medi-Cal beneficiary
in a new county is Medi-Cal is a statewide program, and its
beneficiaries have limited income and assets and are less
likely than individuals with private coverage to be able to
pay-out-of pocket for non-emergency services. In discussions
with DHCS on this issue, DHCS views allowing an expedited
disenrollment mid-month as "paying twice" as the state has
SB 1339 (Monning) Page 8 of ?
reimbursed the Medi-Cal managed care plan for that month of
care, and the beneficiary would then be eligible for the full
extent of their Medi-Cal covered services under this bill on a
fee-for-service basis in their new county.
6)Author's amendment. To clarify that this bill is not intended
to require Medi-Cal managed care plans to cover services
out-of-network when a beneficiary moves to another county, the
author proposes to amend this bill as follows:
(e) Notwithstanding subdivision (a) or any other law, a Medi-Cal
beneficiary moving to a new county shall be entitled to the full
scope of benefits for which he or she is enrolled in the county
that he or she is residing in at the time. For beneficiaries
required to receive services through a Medi-Cal managed care
health plan, the following shall apply:
(1) If the beneficiary moves to another county and is still
enrolled in a managed care health plan in the county from which
he or she moved and needs services in the new county, the
beneficiary shall, upon request to the Medi-Cal Managed Care
Ombudsman, be disenrolled as an expedited disenrollment from his
or her managed care health plan effective the next business day
after the request is made. A beneficiary may request an
expedited disenrollment by telephone, in person, or
electronically online. The request shall be available for
submission by the beneficiary electronically online to reduce
administrative costs and increase access to medical services for
Medi-Cal beneficiaries.
(2) A beneficiary who is disenrolled from the managed care
health plan in the county from which he or she moved pursuant to
paragraph (1) shall receive services be entitled to the full
scope of benefits for which he or she is entitled in the new
county through the fee-for-services delivery system until he or
she is enrolled in a managed care health plan in the new county.
SUPPORT AND OPPOSITION :
Support: Coalition of California Welfare Rights (co-sponsor)
United Ways of California (co-sponsor)
Western Center on Law and Poverty (co-sponsor)
Asian Law Alliance
Bay Area Legal Aid
California Food Policy Advocates
Central California Legal Services
Community Health Councils
SB 1339 (Monning) Page 9 of ?
County Welfare Directors Association
Courage Campaign
Disability Rights Legal Center
Hunger Action Los Angeles
Inland Empire United Way
Law Foundation of Silicon Valley
Legal Aid Society of Orange County
LIUNA Locals 777 & 792
Maternal and Child Health Access
National Association of Social Workers, California
Chapter
National Health Law Program
North Coast Opportunities, Inc.
Nurse-Family Partnership
Orange County United Way
Project Inform
San Francisco AIDS Foundation
The Children's Partnership
United Way of the Bay Area
United Way Fresno and Madera Counties
United Way Monterey County
United Way of Santa Cruz County
United Way of Stanislaus County
Oppose: None received
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