BILL NUMBER: AB 525 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 4, 2005
INTRODUCED BY Assembly Member Chu
FEBRUARY 16, 2005
An act to add Section 14148.033 to amend
Section 12698 of, and to add Section 12698.02 to, the Insurance Code,
and to amend Section 14005.30 of, and to add Section 14148.033 to,
the Welfare and Institutions Code, relating to Medi
-Cal health care .
LEGISLATIVE COUNSEL'S DIGEST
AB 525, as amended, Chu. Health care.
Existing law establishes the Access for Infants and Mothers (AIM)
Program, administered by the Managed Risk Medical Insurance Board, to
provide health insurance coverage for certain eligible persons who
pay a subscriber contribution. The AIM Program provides coverage, at
a minimum, to subscribers during one pregnancy, and for 60 days
thereafter, and to children less than 2 years of age who were born of
a pregnancy covered under this program to a woman enrolled in the
program before July 1, 2004. One of the program eligibility
requirements is that a participant be a resident of the state for at
least 6 continuous months prior to application.
This bill would eliminate that eligibility requirement and would
prohibit the board from imposing durational residency requirements as
a condition of eligibility for the AIM Program. The bill would also
prohibit the board from imposing 3 other requirements as conditions
of eligibility.
Existing law provides for the Medi‑Cal program, which is
administered by the State Department of Health Services, pursuant to
which medical benefits are provided to public assistance recipients
and certain other low‑income persons.
Existing law requires the department, to the extent that federal
financial participation is available, to provide Medi‑Cal
benefits to eligible individuals who meet certain income and resource
standards, including to individuals eligible through the exercise of
options under federal law made available to and exercised by the
state.
This bill would require the department, to the extent that federal
financial participation is available, to provide for the eligibility
of pregnant women beginning in the first trimester of pregnancy. The
bill would require, if a federal waiver or federal approval is
necessary, the department to submit a request for the waiver or
approval by March 1, 2006.
Existing law requires the department, to the extent that federal
financial participation is available, to exercise its option under
federal law to expand eligibility for Medi‑Cal by establishing
the amount of countable resources individuals or families are allowed
to retain at the same amount medically needy individuals and
families are allowed to retain, with an exception for a family of
one.
This bill would, by March 1, 2006, require the department, to
the extent federal financial participation is available,
to exercise an option under federal law, if one exists, to exempt
pregnant women from this and any other resource standard, or to seek
a federal waiver if a federal option does not exist.
Existing law requires the State Department of Health Services to
implement, as a Medi‑Cal program benefit, a program to provide
comprehensive clinical family planning services to any person who has
a family income at or below 200% of the federal poverty level, as
revised annually, and who is otherwise eligible to receive these
services, to be known as the Family Planning, Access, Care, and
Treatment (Family PACT) Waiver Program.
This bill would provide that certain individuals who are, or who
would be, but for being pregnant at the time of application, eligible
for Family PACT program benefits shall also be
have the option of being deemed to be eligible under
certain circumstances for additional
pregnancy‑related care , for and breast
and cervical cancer screening and treatment, to the
extent federal financial participation is available, and for
diagnostic and other treatment for certain other cancers that
threaten reproductive capability.
This bill would also provide that any individual who has undergone
screening under these provisions who would be eligible for Family
PACT program benefits, but for an income in excess of 200% of the
federal poverty level, and who meets certain requirements shall have
the option of being deemed to be eligible for the AIM program.
This bill would require the department to develop and implement an
enrollment system and card for purposes of implementing
this bill these provisions related to Family PACT
program benefits , to be known as the UniHealth
Health Access Progra ms
Card by July 1, 2006.
Under existing law, counties are responsible for determining
eligibility for benefits under the Medi‑Cal program.
By revising eligibility standards for the receipt of benefits
under the Medi‑Cal program, this bill would impose a
state‑mandated local program.
Under existing law, certain dental services are covered
Medi‑Cal benefits.
This bill would declare that the Legislature has appropriated
money in the Budget Act of 2001 and each subsequent Budget Act, for
the provision under the Medi‑Cal program of nonemergency
benefits for the prevention and treatment of dental and periodontal
disease for all beneficiaries during pregnancy to prevent premature
deliveries and low birthweights. The bill would require the
department to immediately implement the provision of these services
by informing Denti‑Cal and other Medi‑Cal providers
through provider bulletins that these benefits are included for all
pregnant beneficiaries. The bill would provide that the
implementation of this provision shall not be delayed pending
adoption of administrative regulations.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12698 of the Insurance Code is amended to read:
12698. To be eligible to participate in the program, a person
shall meet all both of the following
requirements:
(a) Be a resident of the state for at least six continuous months
prior to application. A person who is a member of a federally
recognized California Indian tribe is a resident of the state for
these purposes.
(b)
(a) (1) Until the first day of the second month
following the effective date of the amendment made to this
subdivision in 1994, have a household income that does not exceed 250
percent of the official federal poverty level unless the board
determines that the program funds are adequate to serve households
above that level.
(2) Upon the first day of the second month following the effective
date of the amendment made to this subdivision in 1994, have a
household income that is above 200 percent of the official federal
poverty level but does not exceed 250 percent of the official federal
poverty level unless the board determines that the program funds are
adequate to serve households above the 250 percent of the official
federal poverty level.
(c)
(b) Pay an initial subscriber contribution of not more
than fifty dollars ($50), and agree to the payment of the complete
subscriber contribution. A federally recognized California Indian
tribal government may make the initial and complete subscriber
contributions on behalf of a member of the tribe only if a
contribution on behalf of members of federally recognized California
Indian tribes does not limit or preclude federal financial
participation under Title XXI of the Social Security Act. If a
federally recognized California Indian tribal government makes a
contribution on behalf of a member of the tribe, the tribal
government shall ensure that the subscriber is made aware of all the
health plan options available in the county where the member resides.
SEC. 2. Section 12698.02 is added to the Insurance Code, to read:
12698.02. The board shall not impose any of the following as a
condition of eligibility for the AIM program:
(a) A durational residency requirement.
(b) A written verification of pregnancy requirement.
(c) A requirement that a pregnancy be fewer than 30 weeks.
(d) A requirement that an enrollee pay monthly premiums for 12
months or pay premiums for any month in which a woman has ceased to
be pregnant, including as a result of a miscarriage.
SEC. 3. Section 14005.30 of the Welfare and Institutions Code is
amended to read:
14005.30. (a) (1) To the extent that federal financial
participation is available, Medi‑Cal benefits under this
chapter shall be provided to individuals eligible for services under
Section 1396u‑1 of Title 42 of the United States Code,
including any options under Section 1396u‑1(b)(2)(C) made
available to and exercised by the state.
(2) The department shall exercise its option under Section
1396u‑1(b)(2)(C) of Title 42 of the United States Code to adopt
less restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi‑Cal under paragraph (1).
(3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u‑1
(b)(2)(C) of Title 42 of the United States Code authorizing the state
to disregard all changes in income or assets of a beneficiary until
the next annual redetermination under Section 14012. The department
shall implement this paragraph only if, and to the extent that the
State Child Health Insurance Program waiver described in Section
12693.755 of the Insurance Code extending Healthy Families Program
eligibility to parents and certain other adults is approved and
implemented.
(b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u‑1(b)(2)(C) of Title 42 of the United States Code as
necessary to expand eligibility for Medi‑Cal under subdivision
(a) by establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).
(c) To the extent that federal financial participation is
available, the department shall exercise its option, if this option
exists, under Section 1396a(a)(10)(A)(ii)(IX) and (l)(3)(A) of Title
42 of the United States Code to exempt pregnant women receiving
benefits pursuant to this section from any resource standard,
including, but not limited to, the resource standard established
pursuant to subdivision (b). The department shall, by March 1, 2006,
seek approval for implementation of this option, or, if this option
does not exist, a waiver to implement this subdivision.
(d) To the extent that federal financial
participation is availabl e, pregnant women shall be
eligible for Medi‑Cal under this section beginning in the first
trimester of pregnancy. I f a federal waiver or other
federal approval is necessary to implement this subdivision, the
department shall submit a request for the waiver or approval by March
1, 2006.
(e) To the extent federal financial
participation is available, the department shall, commencing March 1,
2000, adopt an income disregard for applicants equal to the
difference between the income standard under the program adopted
pursuant to Section 1931(b) of the federal Social Security Act (42
U.S.C. Sec. 1396u‑1) and the amount equal to 100 percent of the
federal poverty level applicable to the size of the family. A
recipient shall be entitled to the same disregard, but only to the
extent it is more beneficial than, and is substituted for, the earned
income disregard available to recipients.
(d)
(f) For purposes of calculating income under this
section during any calendar year, increases in social security
benefit payments under Title II of the federal Social Security Act
(42 U.S.C. Sec. 401 and following) arising from
cost‑of‑living adjustments shall be disregarded
commencing in the month that these social security benefit payments
are increased by the cost‑of‑living adjustment through
the month before the month in which a change in the federal poverty
level requires the department to modify the income disregard pursuant
to subdivision (c) (e) and in which
new income limits for the program established by this section are
adopted by the department.
(e)
(g) Subdivision (b) shall be applied retroactively to
January 1, 1998.
(f)
(h) Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department shall implement, without taking regulatory
action, subdivisions (a) and (b) of this section by means of an all
county letter or similar instruction. Thereafter, the department
shall adopt regulations in accordance with the requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. Beginning six months after the
effective date of this section, the department shall provide a status
report to the Legislature on a semiannual basis until regulations
have been adopted.
SECTION 1.
SEC. 4. Section 14148.033 is added to the Welfare and
Institutions Code , to read:
14148.033. (a) Any Notwithstanding any
other law and with the exception of the program described in
paragraph (3), only to the extent that federal financial
participation is available, any individual who is determined to
be eligible for benefits under subdivision (aa) of Section 14132 for
comprehensive clinical family planning shall be
have the option of being deemed to have applied and been
determined to be eligible for the following:
(1) Medi-Cal benefits for pregnancy-related care under this
chapter if the individual becomes pregnant during the period for
which the individual has been certified as being eligible to receive
Family PACT services under subdivision (a) of Section 14132.
(2) Breast Medi‑Cal breast and
cervical cancer screening and treatment for uninsured or
underinsured women individuals or presumptive
eligibility for Medi‑Cal for underinsured individuals as
described in Sections 104160 and 104161 of the Health and Safety Code
and Section 14007.71 , if, during the period for which the
individual's Family PACT eligibility has been certified, both of the
following apply:
(A) The Family PACT services provided under paragraph (8) of
subdivision (aa) of Section 14132 for diagnostic and treatment
services for cancers that threaten reproductive capability have been
exhausted for the individual.
(B) The provider cancer
screening requirements of subdivision (c) of Section 104162 are met
.
(3) Prostate cancer screening and treatment upon
exhaustion of eligibility for Family PACT Services
under the Improving Access, Counseling, and Treatment for
Californians with Prostrate Cancer (IMPACT) program administered by
the department, if, during the period for whic h the
individual's Family PACT eligibility has been certified, all of the
following apply:
(A) The individual is at least 18 years of age and under 66 years
of age.
(B) The individual has been diagnosed with prostate cancer.
(C) Services for the individual under paragraph (8) of
subdivision (aa) of Section 14132 for diagnoses and treatment
services for cancers that threaten reproductive capability have
been exhausted .
(b) For purposes of paragraph (2) of subdivision (a):
(1) "Uninsured" means not covered for breast or cervical cancer
treatment services by any of the following:
(A) No cost full scope Medi-Cal.
(B) Medicare.
(C) A health care service plan contract or policy of disability
insurance.
(D) Any other form of health care coverage.
(2) "Underinsured" means either of the following:
(A) Covered for breast or cervical cancer treatment services by
any health care insurance listed in subparagraph (B), (C), or (D) of
paragraph (1), but the sum of the individual's insurance deductible,
premiums, and expected copayments in the initial 12-month period that
breast or cervical cancer treatment services are needed exceeds
seven hundred fifty dollars ($750).
(B) Covered by share-of-cost or limited scope Medi-Cal, if the
individual is not otherwise eligible for treatment services pursuant
to Section 14007.71.
(c) Any individual who has undergone screening under this section
and would be have the option of being
eligible for Family Pact PACT benefits
under subdivision (aa) of Section 14132, but for the fact that she is
pregnant at the time of application for those services, shall be
deemed to have applied and been determined to be eligible for those
pregnancy-related and other health care benefits specified in
subdivision (a).
(d) Any individual to whom all of the following applies shall have
the option of being deemed to have applied and been determined to be
eligible for the Access for Infants and Mothers Program under Part
6.3 (commencing with Section 12695) of Division 2 of the Insurance
Code:
(1) The individual is pregnant.
(2) The individual has undergone screening under this section and
would be eligible for Family PACT benefits under subdivision (aa) of
Section 14132, but for the fact that her income exceeds 200 percent
of the federal poverty level.
(3) The individual's income does not exceed 300 percent of the
federal poverty level.
(d)
(e) (1) By no later than July 1, 2006, the
department shall develop and implement an enrollment system and card
for the implementation of this section, to be known as the
UniHealth Access Health Access Programs Card,
that is consistent with this section and Section 14148.03.
(2) The department shall consult with representatives of
providers, consumers, counties, and health plans in the development
and implementation of the UniHealth Access
Health Access Programs Card.
SEC. 5. (a) The Legislature hereby finds and declares that in the
Budget Act of 2001 and each subsequent Budget Act thereafter, the
Legislature has appropriated money for the provision under the
Medi‑Cal program of nonemergency benefits for the prevention
and treatment of dental and periodontal disease for all beneficiaries
during pregnancy to prevent premature deliveries and low
birthweights.
(b) These preventive and treatment dental services for pregnant
women result in net savings to the Medi‑Cal program by avoiding
the far more costly medical and other interventions needed to treat
and care for premature and low birthweight disabled newborns
immediately at birth and throughout life.
(c) It is the intent of the Legislature to reaffirm its commitment
to the provision of the benefits described in subdivision (a) for
which money has consistently been appropriated.
(d) Therefore, the State Department of Health Services shall
immediately implement the provision of services described in
subdivision (a) by clearly informing Denti‑Cal and other
Medi‑Cal providers through a provider bulletin or bulletins
that the benefits described in subdivision (a) are included for all
pregnant beneficiaries. The implementation required under this
subdivision shall not be delayed pending adoption of administrative
regulations.
SEC. 2.
SEC. 6.
If the Commission on State Mandates determines that this act
contains costs mandated by the state, reimbursement to local agencies
and school districts for those costs shall be made pursuant to Part
7 (commencing with Section 17500) of Division 4 of Title 2 of the
Government Code.