BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1339 (Monning) - Public social services: intercounty
transfers
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|Version: April 21, 2016 |Policy Vote: HUMAN S. 4 - 0, |
| | HEALTH 7 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 16, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 1339 would make a number of changes to the
intercounty transfer process used when a beneficiary of public
assistance programs moves between counties.
Fiscal
Impact:
Potential one-time costs up to $150,000 to revise existing
regulations governing the intercounty transfer process by the
Department of Health Care Services (General Fund and federal
funds).
Potential one-time costs up to $150,000 to revise existing
regulations governing the intercounty transfer process by the
Department of Social Services (General Fund).
Unknown cost for the Medi-Cal Managed Care Office of the
Ombudsman to allow beneficiaries to electronically request
expedited disenrollment from a managed care plan (General Fund
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and federal funds). Currently the Office has systems in place
to process electronic requests for expedited plan
disenrollments. However, current practice limits this
capability to county eligibility workers who must complete the
application on a beneficiary's behalf. It is not clear whether
opening this capability to beneficiaries themselves would
require significant system changes.
Unknown state reimbursable mandate costs, to the extent that
the bill results in significantly higher administrative costs
to the counties (General Fund). In general, the bill does not
impose a higher level of service on the counties, as a whole.
Rather, the bill changes existing processes at the county
level. There are some elements of the bill, however, that may
increase county costs. For example the bill requires counties
to transfer responsibility for benefits within 30 days of
either county becoming aware of a recipient's move, whereas
current law requires the transfer of responsibility to occur
on the first day of the month following 30 days of
notification to the receiving county. Whether shortening the
timeline for transferring responsibility will have a
significant administrative cost to the counties is unknown.
Unknown additional expenditures for CalFresh and CalWorks
benefits due to additional beneficiaries retaining eligibility
after a move between counties (General Fund and local funds).
Under current law, the receiving county is required to
determine a beneficiary's continuing eligibility for aid. This
bill would prohibit the receiving county from interviewing
recipients to determine continuing eligibility. By removing
this requirement, it is likely that the bill will result in
some beneficiaries retaining benefits until the next
redetermination period who would have lost benefits after a
move (e.g. because the beneficiary no longer meets program
eligibility requirements). The extent of this impact is
unknown.
Unknown additional costs for Medi-Cal benefits (General Fund
and federal funds). Most Medi-Cal beneficiaries are enrolled
in managed care. Medi-Cal does not allow an enrollee to be
covered by more than one managed care plan in any given month.
Under current practice, when a Medi-Cal enrollee moves between
counties, the enrollee would normally only be eligible for
emergency services in the new county until his or her
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disenrollment from the original managed care plan was
processed. If the beneficiary has received any health care
services from the original managed care plan during a month,
even an expedited disenrollment request is not effective until
the beginning of the next month. Under the bill, a beneficiary
would be able to request an expedited disenrollment that would
be effective the next business day. The beneficiary would then
be entitled to full-scope fee-for-service benefits for the
remainder of the month. Making this change will allow some
number of beneficiaries to access additional, non-emergency
health care services for the remainder of the month of the
move. The extent of those costs is unknown.
Background: Under current law, eligibility determinations and case
management for CalFresh, CalWorks, and Medi-Cal are generally
performed by counties. The cost of providing benefits under
CalFresh and Medi-Cal are generally a state responsibility
(funded with state and federal funds), whereas the
responsibility for providing CalWorks benefits are shared
between the state and local governments (with federal funding).
When a recipient of one of those programs moves between
counties, there is a process in law directing how the transfer
of responsibility for the recipient should be transferred
between counties (referred to as the inter-county transfer or
ICT process). Current law requires a recipient who moves between
counties to notify the original county, which then initiates the
inter-county transfer system.
Proposed Law:
SB 1339 would make a number of changes to the intercounty
transfer process used when a recipient of public assistance
programs moves between counties.
Specific provisions of the bill would:
Require a recipient to notify either the original county
or the new county of the change of residence;
Require either county to initiate the inter-county
transfer upon notification of the recipient's move;
Require benefits for all programs the beneficiary is
eligible for to be transferred within 30 days of either
county becoming aware of the move;
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Prohibit the beneficiary from having to provide
documents to the new county that were already provided to
the original county and require electronic sharing of case
files;
Prohibit the new county from interviewing recipients to
determine continuing eligibility for CalFresh or CalWORKs
until the next scheduled redetermination is required;
Require Medi-Cal beneficiaries moving between counties
to be granted an expedited disenrollment from their
Medi-Cal managed care plan effective the next business day,
upon request;
Require the Medi-Cal Managed Care Office of the
Ombudsman to allow electronic requests from beneficiaries;
Require a beneficiary who has disenrolled from the
Medi-Cal managed care plan in the original county to be
eligible for full-scope fee-for-service Medi-Cal benefits
in the new county, until enrollment in a managed care plan
in the new county;
In counties where there is a Medi-Cal county organized
health system, require the beneficiary to be enrolled on
the first day of the month the new county of residence
assumes responsibility for the beneficiary;
In counties where there is no county organized health
system, the usual health plan choice would apply.
Staff
Comments: Current policy prohibits a Medi-Cal beneficiary from
being enrolled in two Medi-Cal managed care plans in the same
month. Under current practice, the Department of Health Care
Services pays Medi-Cal managed care plans a per member per month
payment to cover the costs of providing health care services.
The Department does not "claw back" payments for beneficiaries
who disenroll from a managed care plan during a month through
the expedited disenrollment process. By allowing beneficiaries
to access full-scope Medi-Cal benefits immediately in the new
county, the bill will result in some amount of double coverage
for medical services.
The bill requires counties to share case files electronically.
There is an existing electronic system in place that should be
able to allow this document sharing to occur.
Counties are required to pay for a portion of CalWorks benefits.
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By expediting the transfer of responsibility for providing
CalWorks benefits between counties, the bill will result in
receiving counties incurring costs sooner than would occur under
current law, whereas sending counties would be relieved of those
costs sooner. The net effect should not be an overall increase
in expenditures for CalWorks benefits. (Aside from the potential
increase in eligibility due to the prohibition on redetermining
eligibility upon a transfer.) Therefore, it is unlikely that
counties would be successful in seeking state reimbursement for
the increased benefit costs due to the expedited deadlines for
processing transfers.
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