BILL NUMBER: AB 525 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 26, 2005
AMENDED IN ASSEMBLY APRIL 4, 2005
INTRODUCED BY Assembly Member Chu
FEBRUARY 16, 2005
An act 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 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 for
the AIM Program .
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 any asset standard, including an asset standard under
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 Waiver Program
benefits shall have the option of being be
deemed to be eligible under certain circumstances for
pregnancy-related care 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 Waiver 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 be deemed to be eligible for the
AIM program.
This bill would require the department to develop and implement
, for purposes of implementing these provisions related to
Family Pact Waiver Program benefits, an enrollment system
, and a card for purposes of implementing
these provisions related to Family PACT program benefits,
to be known as the Health Access Programs 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
both of the following requirements:
(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.
(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 1. 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 Program
:
(a) A durational residency requirement.
(b)
(a) A written verification of pregnancy requirement.
(c)
(b) A requirement that a pregnancy be fewer than 30
weeks.
(d)
(c) 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.
SEC. 2. 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 asset standard, including, but not
limited to, an asset standard under 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
available, pregnant women shall be eligible for Medi-Cal under this
section beginning in the first trimester of pregnancy. If 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.
(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 (e) and in which new income limits for the
program established by this section are adopted by the department.
(g) Subdivision (b) shall be applied retroactively to January 1,
1998.
(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.
SEC. 4.
SEC. 3. Section 14148.033 is added to the Welfare and
Institutions Code, to read:
14148.033.
(a) 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 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 Waiver Program services under subdivision
(a) (aa) of Section 14132.
(2) Medi-Cal breast and cervical cancer screening and treatment
for uninsured 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 Waiver Program
eligibility has been certified, both of the following apply:
(A) The Family PACT Waiver Program 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 concerning screening by a
provider meeting the criteria set forth therein are met.
(3) Prostate cancer screening and treatment under the Improving
Access, Counseling, and Treatment for Californians with Prostrate
Cancer (IMPACT) program administered by the department, if, during
the period for which the individual's Family PACT Waiver Program
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 have the option of being be
eligible for Family PACT Waiver Program 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 be 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 Waiver Program 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.
(e) (1) By no later than July 1, 2006, the department shall
develop and implement an enrollment system and
, and a card for the implementation of this section
, to be known as the Health Access Programs Card,
that is are 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 Health Access Programs Card.
SEC. 5. SEC. 4.
(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. 6. SEC. 5.
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.