BILL ANALYSIS
SB 87
Page 1
Date of Hearing: June 13, 2000
ASSEMBLY COMMITTEE ON HEALTH
Martin Gallegos, Chair
SB 87 (Escutia) - As Amended: June 8, 2000
SENATE VOTE : 27-10
SUBJECT : Medi-Cal: eligibility.
SUMMARY : Provides a rebuttable presumption of Medi-Cal
eligibility for beneficiaries whose CalWORKs benefits have been
terminated; and provides Medi-Cal eligibility redetermination
procedures for cases in which CalWORKs benefits have been
terminated. Specifically, this bill :
1)Provides that when CalWORKs benefits are terminated, family
members are presumed eligible for Medi-Cal benefits, except as
specified. Provides this presumption of Medi-Cal eligibility
to be deemed a redetermination of the Medi-Cal eligibility,
unless the presumption is rebutted. Specifies that failure to
submit a CalWORKs reporting form shall not in itself rebut the
presumption of eligibility.
2)Provides that when an individual's basis of eligibility for
Medi-Cal benefits changes to any other basis there is no
period of ineligibility for the receipt of Medi-Cal benefits.
3)Requires the Department of Health Services (DHS), in
consultation with specified entities, to prepare a notice to
be used by counties, in order to inform eligible beneficiaries
that their Medi-Cal benefits will continue. Requires the
notice to be sent out at the same time as the notice of
discontinuation of cash aid. Requires the form to include a
statement that the beneficiary is required to submit an annual
reaffirmation form, as specified; a statement that the
beneficiary is required to report significant changes that may
affect eligibility, as specified; and a telephone number to
call for more information.
4)Requires a county to transfer a Medi-Cal beneficiary,
described in #1 above, who is no longer eligible for Medi-Cal
under that category, but is eligible for Medi-Cal under
another category, as specified, to the corresponding Medi-Cal
program. Requires eligibility to continue until the transfer
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is complete. Requires DHS to prepare a notice for such
circumstances, meeting the same criteria described in #3
above, to inform beneficiaries that their benefits have been
transferred. Requires additional specified information to be
included for beneficiaries transferred to transitional
Medi-Cal.
5)Requires DHS, no later than September 1, 2001, to submit a
federal waiver seeking authority to eliminate the reporting
requirements imposed by transitional Medicaid requirements.
6)Requires that Medi-Cal beneficiary cases described in #1 and
#4 above be assigned to a county eligibility worker within 10
days of the change in eligibility. Requires, within 10 days
of that assignment, the county to send case information, as
specified, to the beneficiary.
7)Specifies annual reaffirmation dates for specified
beneficiaries.
8)Requires DHS to adopt a mechanism, as specified, to
distinguish between cases of persons eligible for Medi-Cal
benefits. Requires the mechanism to be adequate to inform
managed care plans, in a timely manner, that a beneficiary's
basis for Medi-Cal eligibility has changed, and to include the
date the annual reaffirmation form is due, the due date for a
transitional Medi-Cal program report, and other specified
information.
9)Makes specified requirements of counties, DHS and contracting
managed care plans in order to maintain the most up-to-date
home addresses, telephone numbers, and other necessary contact
information and to encourage timely submission of specified
forms.
10)Requires a county, upon receipt of information about changes
in a beneficiary's circumstances, as specified, to redetermine
eligibility; and requires eligibility to continue during the
redetermination process, as specified. Requires the
redetermination process to include exploration of all possible
avenues for ongoing Medi-Cal eligibility, as specified; and 30
days of eligibility while an ex parte review is conducted.
Specifies procedures for redetermination and for ex parte
review.
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11)Requires the redetermination form to be designed so that it
may also be used as the annual reaffirmation form. Requires
DHS, to the extent feasible, to use the redetermination form
as the annual reaffirmation form.
12)Authorizes specified persons who have received 12 months of
transitional Medi-Cal and continue to meet the requirements
applicable to the additional six-month extension period, to
receive the six-month extension with federal matching funds,
free from federal reporting requirements.
13)Finds and declares that the provisions of this bill are
necessary to meet the federal requirements for continued
federal financial participation.
EXISTING LAW establishes:
1)The Medi-Cal program, administered by DHS, to provide health
services to qualified low-income, aged, blind and disabled
individuals; and requires reaffirmation of Medi-Cal
eligibility annually and at other times in accordance with
general standards established by DHS.
2)The CalWORKs program, which provides cash assistance and
supportive services to qualified low-income families.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . This bill is jointly sponsored by the
National Center for Youth Law (NCYL) and the Western Center on
Law and Poverty (WCLP). This bill presumes, when a family
loses eligibility for the CalWORKs program, Medi-Cal
eligibility unless a county has information indicating the
family is eligible under a different program or ineligible;
and deems this presumptive eligibility to be redetermination.
Additionally, this bill establishes a uniform process for
counties to follow when an individual's Medi-Cal eligibility
changes. The author states that with the passage of the
federal welfare reform law and the corresponding drop in
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welfare caseloads, states have seen large numbers of Medi-Cal
beneficiaries losing their Medi-Cal benefits. This occurred
even though federal law specifically addressed this issue and
guaranteed Medicaid eligibility to families formerly on cash
aid. The author states several studies and HCFA letters that
highlight the fact that many former Temporary Assistance for
Needy Families (TANF) recipients have lost their Medicaid
eligibility. The most recent HCFA letter requires states to
determine whether any individuals and families have lost their
Medicaid coverage without a proper notice, redetermination,
and an ex parte review. States must then reinstate such
individuals and conduct a follow-up eligibility review. The
author states that in California, counties have followed
various procedures in addressing this issue and that this bill
codifies current federal law and regulation, providing a
mechanism for all counties to follow in meeting the federal
requirement and ensuring individuals do not lose their
eligibility.
WCLP writes that various studies have shown that huge numbers
of eligible families lose their Medi-Cal benefits because of
unnecessarily burdensome paperwork requirements. For example,
the huge majority of families remain eligible for free
Medi-Cal when they leave welfare. Under federal welfare
reform, the receipt of Medi-Cal is no longer connected to the
receipt of welfare. The CalWORKs welfare-to-work,
immunization, school attendance and monthly reporting
requirements do not apply to Medi-Cal, so termination of
welfare for those reasons should not affect Medi-Cal
eligibility. Also, if the family left welfare to work, the
family should be eligible for up to two years of transitional
Medi-Cal. Nevertheless, many families leaving welfare are
unnecessarily required to complete various lengthy and
duplicative Medi-Cal forms. County practice in these
procedures varies so much that a family's ongoing receipt of
Medi-Cal arbitrarily depends on which county they happen to
reside in. Many families erroneously believe that receipt of
welfare is a necessary precondition to receipt of Medi-Cal
benefits, further complicating matters. WCLP states this bill
remedies these problems; complies with the federal
requirements that Medi-Cal benefits be provided to families
until the county affirmatively knows that the family is no
longer eligible; and creates a uniform process for counties to
follow when a family's circumstances change. NCYL states this
bill will clarify the federally required Medi-Cal retention
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procedures both for families and individuals leaving CalWORKs,
and those who have Medi-Cal without CalWORKs. As the CalWORKs
caseload continues to decline, fewer and fewer families will
be entering the Medi-Cal program through the receipt of cash
aid. NCYL states this bill would make it easier for eligible
families and individuals to keep Medi-Cal not only
when they leave CalWORKs, but also if they have been receiving
Medi-Cal without welfare and their circumstances change.
2)SUPPORT . Asian and Pacific Islander American Health Forum
(APIAHF) writes in support of this bill stating that many
families, including immigrant families, who are eligible for
Medi-Cal, have lost their coverage or may not even realize
they are eligible for benefits. APIAHF states this bill will
help them retain benefits for which they are already eligible,
and maintain continuity of important health care services.
California Primary Care Association (CPCA) writes that
retention in the Medi-Cal program has proven to be a
continuous challenge. To deal with that challenge, CPCA
supports the approach adopted in this bill. CPCA states this
bill strikes a delicate balance between marshalling the
resources at a health plan's disposal and protecting the free
and informed choice of consumers when selecting a health plan.
3)RELATED LEGISLATION . AB 2415 (Migden) deletes a requirement
that Healthy Families Program (HFP) eligibility for children
who are qualified aliens is dependent upon federal financial
participation and revises application and income eligibility
requirements for Medi-Cal and HFP. AB 2415 is currently
pending in the Senate.
REGISTERED SUPPORT / OPPOSITION :
Support
National Center for Youth Law (co-sponsor)
Western Center on Law and Poverty (co-sponsor)
100% Campaign
Asian and Pacific Islander American Health Forum
California Association of Public Hospitals and Health Systems
California Primary Care Association
Children Now
Children's Defense Fund - CA
Consumers Union
The Children's Partnership
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Opposition
None on file
Analysis Prepared by : Ellen McCormick / HEALTH / (916) 319-2097