BILL ANALYSIS
AB 525
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Date of Hearing: April 19, 2005
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 525 (Chu) - As Amended: April 4, 2005
SUBJECT : Health care.
SUMMARY : Requires Department of Health Services (DHS) to
develop and implement a system and a card, to be known as the
Health Access Programs Card, to enroll individuals in state
health care programs, as specified. Specifically, this bill :
1)Deletes the requirement that, to be eligible to participate in
the Access for Infants and Mothers (AIM) program, a person
must be a resident of the state for at least six continuous
months prior to application.
2)Prohibits the Managed Risk Medical Insurance Board (MRMIB)
from imposing, as a condition of eligibility for AIM, a
durational residency requirement, a written verification of
pregnancy requirement, a requirement that a pregnancy be fewer
than 30 weeks, or 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.
3)Requires DHS, to the extent that federal financial
participation is available and if the option exists, to exempt
pregnant women receiving Medi-Cal from any resource standard,
including, but not limited to, countable resources. Requires
DHS to seek approval for implementation of this option by
March 1, 2006 or, if the option does not exist, a waiver to
implement this exemption.
4)Requires pregnant women to be eligible for Medi-Cal beginning
in the first trimester of pregnancy to the extent that federal
financial participation is available. Requires DHS to submit
a request for a waiver or approval from the federal government
by March 1, 2006.
5)Requires any individual who is determined to be eligible for
the Family Planning, Access, Care, and Treatment (Family PACT)
program to have the option of being deemed to have applied and
been determined to be eligible for:
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a) Medi-Cal benefits for pregnancy-related care if the
individual becomes pregnant during the period for which the
individual has been certified as being eligible to receive
Family PACT services; and,
b) Medi-Cal breast and cervical cancer screening and
treatment for uninsured women, as defined, or presumptive
eligibility for Medi-Cal for underinsured, as defined and
as specified, if, during the period for which the
individual's Family PACT eligibility has been certified,
both of the following apply:
i) The Family PACT services provided for diagnostic and
treatment services for cancers that threaten reproductive
capability have been exhausted for the individual; and,
ii) The requirements of the Breast and Cervical Cancer
Treatment Program (BCCTP) are met.
c) Prostate cancer screening and treatment under the
Improving Access, Counseling, and Treatment for
Californians with Prostrate Cancer (IMPACT) program, if,
during the period for which the individual's Family PACT
eligibility has been certified, all of the following apply:
i) The individual is at least 18 years of age and under
66 years of age;
ii) The individual has been diagnosed with prostate
cancer; and,
iii) Services for the individual under Family PACT for
diagnoses and treatment services for cancers that
threaten reproductive capability have been exhausted.
6)Requires any individual who has undergone screening under b)
or c) above and would have the option of being eligible for
Family PACT but for the fact that she is pregnant at the time
of application to be deemed to have applied and been
determined to be eligible for Medi-Cal pregnancy-related and
other health care benefits, as specified.
7)Requires any pregnant individual, who has undergone screening
under this bill and would be eligible for Family PACT except
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that her income exceeds 200% of the federal poverty level
(FPL), and whose income does not exceed 300% FPL to have the
option of being deemed and determined to be eligible for AIM.
8)Requires DHS, no later than July 1, 2006, to develop and
implement an enrollment system and card known as the Health
Access Programs Card, as specified. Requires DHS to consult
with representatives of providers, consumers, counties, and
health plans in the development and implementation of the
Health Access Programs Card.
9)Makes findings and declarations related to appropriations for
prevention and treatment services for dental and periodontal
disease during pregnancy and states legislative intent to
reaffirm the Legislature's commitment to the provision of
nonemergency Medi-Cal benefits for those services by requiring
DHS to immediately inform Denti-Cal and other Medi-Cal
providers through a provider bulletin or bulletins that such
services for dental and periodontal disease are included for
all pregnant beneficiaries. Prohibits this from being delayed
pending adoption of administrative regulations.
EXISTING LAW :
1)Requires DHS, during fiscal years in which the Legislature has
appropriated funds for this purpose, to provide breast cancer
and cervical cancer screening services under a federal grant
made by the federal Centers for Disease Control and Prevention
(CDC) Breast and Cervical Cancer Early Detection Program
(BCEDP) to eligible low-income individuals. An individual is
eligible for these services if their family income does not
exceed 200% of FPL.
2)Provides for the Family PACT Waiver Program, under which,
comprehensive clinical family planning services are provided
to any person who has a family income at or below 200% of FPL
and who is eligible to receive those services pursuant to the
terms of the waiver.
3)Requires Family PACT services to include a complete
obstetrical history, gynecological history, contraceptive
history, personal medical history, health risk factors, family
health history, including genetic or hereditary conditions,
and a complete physical examination on initial and subsequent
periodic visits.
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4)Provides for the AIM program, administered by MRMIB, under
which comprehensive health care services are provided to
pregnant women and their infants who have family income
between 200% and 300% of FPL.
FISCAL EFFECT : Unknown.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, there are
myriad of state public health care programs in California, all
of which have different services, eligibility requirements,
target populations, and enrollment and recertification
procedures. Beneficiaries of public health care programs
often must navigate a disjointed system of care to obtain the
services they need. The existing patchwork of California's
public programs is convoluted and complex, and often leads to
the underutilization of preventive care services and the
over-utilization of emergency rooms. An integrated system of
care, which provides recipients with continuity in services
and providers, is needed. States have the option under
federal law to create more integrated systems. Under SB 24
(Figueroa) Chapter 895, Statutes of 2003, California will
begin exercising some of these options, laying the foundation
for real-time provider-based enrollment that could be used not
just for pregnant women, but across programs. This bill would
create a health access card for limited-scope Medi-Cal
benefits and a provider-based enrollment system that allows
automatic enrollment into Medi-Cal.
2)WOMEN'S HEALTH . There are approximately 10.2 million women
between the ages of 18 and 64 in California. Thirty-six
percent (3.7 million) have family incomes below 200% FPL and
are therefore considered low-income. Approximately half of
all nonelderly women are non-Latino white, 26% are Latinas,
11% are Asian Americans, 6% are African-American, and American
Indian/Alaska Native and Pacific Islanders each comprise less
than 1% of the population. A December 2003 study by the UCLA
Center for Health Policy Studies examined the health insurance
coverage, health status, and access to care of women ages 18
to 64 in California. The researchers found that women's
health status varies by age, poverty level, and
race/ethnicity, which provide a backdrop for discussions
focused on health insurance coverage, access to care issues,
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and health disparities among women. Low-income women are
three times more likely than those with higher incomes to
report fair or poor health. Thirty percent of low-income
women reported being in fair or poor health and very few of
these women report their health as excellent (12%). In
contrast, among women with family incomes at 200% or over the
poverty level, only 10% report fair or poor health. Women of
color were also more likely than white women to report their
health status as fair or poor.
Approximately 1.7 million (17%) of nonelderly women were
uninsured at the time of the survey. Approximately 69% of the
uninsured nonelderly women had family incomes below 200% FPL
and over one-third of uninsured women lacked a place where
they receive regular care. The data suggested that while
Medi-Cal remains a critical source of insurance for many
low-income women, those with Medi-Cal coverage were more
likely than privately insured women to experience gaps in
coverage, potentially limiting their relationship with the
health care system. Uninsured and low-income women were also
less likely to obtain screening tests for detecting emerging
health conditions. The researchers concluded that continued
public and private efforts are necessary to increase health
insurance coverage and continuity of that coverage among
nonelderly women and that the majority of California's
uninsured women have low incomes, requiring solutions that
account for their limited resources.
3)AIM . The AIM program is administered by MRMIB and provides
low-cost, comprehensive health insurance coverage to uninsured
pregnant women with family incomes between 200% and 300% of
the FPL. This coverage extends from pregnancy to 60 days post
partum and covers infants up to two years of age. Enrollees
pay 1.5% of their adjusted annual household income after
income deductions and there are no co-payments or premiums.
The program was changed in 2004-05 to allow for the direct
enrollment of infants born to AIM mothers into the Healthy
Families program.
4)FAMILY PACT . Family PACT was created in 1996 to provide
clinical family planning services under the DHS Office of
Family Planning. This federal waiver demonstration program is
accessed through local private physicians, hospitals, public
health and community clinics. Family PACT provides
comprehensive family planning services to low-income women and
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men to promote optimal reproductive health and to reduce
unplanned pregnancy. Primary services are birth control,
reproductive health assessment, sexually transmitted disease
prevention and treatment, and female and male sterilization.
According to DHS, as of FY 2001-02, over 1.44 million
beneficiaries have been served and there are over 2,000 Family
PACT enrolled clinical providers. Beneficiaries are
individuals at risk of pregnancy or causing pregnancy, do not
have Medi-Cal coverage or access to health insurance.
Medi-Cal clients with an unmet share of cost may also be
eligible. Eligibility determination and enrollment are
conducted at the provider's office with point of service
activation of a client membership card.
5)BREAST AND CERVICAL CANCER TREATMENT PROGRAM . BCCTP was
implemented in 2002 and provides low-income California
residents who have breast and/or cervical cancer no-cost
cancer treatment services. The program grants same-day,
full-scope Medi-Cal benefits from a doctor's office through an
internet-based application and eligibility determination
process. Only physicians enrolled in Every Woman Counts,
Family PACT, the Breast Cancer Early Detection Program, and
the Breast and Cervical Cancer Control Program may enroll a
patient in BCCTP after they have screened a patient under one
of those programs and diagnosed or confirmed a diagnosis of
breast and/or cervical cancer.
6)CALIFORNIA PERFORMANCE REVIEW . The California Performance
Review (CPR) was created by Governor Schwarzenegger in 2004 to
examine state government and make recommendations to establish
efficiencies and find General Fund savings. The review
released over 1200 recommendations. Included in the report
was a recommendation (HHS 02-12) to streamline state
administrative processes for funding local public health
programs, reducing processing times for execution of
agreements, and consolidating multiple public health funding
sources where appropriate. The report stated that the
burdensome contracting procedures of the state interfere with
the delivery of public health services and that city and
county health departments report that the administrative
burden of managing contracts with the state significantly
reduces the time staff can devote to program activities.
Although this bill differs from the exact proposal contained
in the CPR report, they are comparable in that it proposes to
consolidate enrollment and administrative functions of
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programs that serve similar, if not the same, populations.
7)INTEGRATED SYSTEM OF ENROLLMENT . According to the sponsors of
this bill, American Association of University Women,
California Family Health Council, Maternal Child Health
Access, and Planned Parenthood Affiliates of California, an
integrated system of care would ensure recipients and
providers continuity of services. All of the programs
identified in this bill have different enrollment procedures
and beneficiaries must navigate a disjointed system of care to
obtain the services. These barriers also discourage
participation by providers which further discourages access.
Streamlining the enrollment procedures for programs with
similar functions and similar eligibility requirements,
especially when the beneficiary is the same person presenting
for care, would reduce administrative costs, increase access
to care, and improve oversight capabilities.
8)RELATED LEGISLATION . AB 392 (Chan) permits any county, with
the assistance and participation of the appropriate state
departments, to implement a program for the funding and
delivery of services and benefits through an integrated and
comprehensive county health and human services system, as
specified. AB 624 (Montanez) requires DHS to include a
process, to be used at the option of the person applying on
the child's behalf for the CHDP program through the CHDP
Gateway, to simultaneously pre-enroll and apply for enrollment
into the Healthy Families or Medi-Cal programs. Both bills
are pending in the Assembly
9)PREVIOUS LEGISLATION . SB 24 (Figueroa) Chapter 895, Statutes
of 2003 creates the Prenatal Gateway and the Newborn Hospital
Gateway to simplify enrollment of prenatal women and certain
newborn infants into the Medi-Cal program. Last year, SB 1525
(Speier) would have required the Family PACT program to
administer the breast and cervical cancer early detection
program. SB 1525 was vetoed by the Governor, who stated that
"this Administration is undertaking a comprehensive review of
all state government functions through the (CPR). One of the
recommendations from CPR is to place all direct health care
services under the Health Purchasing Division while all
prevention services would be placed under the Public Health
Division. This bill would be inconsistent with that
recommendation. I have directed the Secretary of the Health
and Human Services Agency to review CPRs organizational
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recommendations closely. Pending completion of that review
and input from my CPR Commission, I am not prepared to
consolidate the two different program functions proposed by SB
1525 at this time."
10) TECHNICAL AMENDMENTS . To clarify the author's intent,
this bill should be amended as follows:
a) On page 8, line 5: delete "provider cancer screening
requirements" and on line 6, after "104162" insert
"concerning screening by a provider meeting the criteria
set forth therein"
b) On page 8, line 40: after "would" delete "have the
option of being" and insert "be" and on page 9, line 3
delete "be" and insert "have the option of being"
11) SUPPORT . The California Family Health Council, Maternal
Child Health Access, Planned Parenthood Affiliates of
California, American College of Obstetricians and
Gynecologists, the California Medical Association, and the
California Women Lawyers write that currently eligible
individuals must apply for each program contained in this bill
separately, which results in delays in care. The California
Commission on the Status of Women states that by creating the
Health Access Card, this bill simplifies the enrollment
process for both men and women, promoting continuous
integrated care and reducing administrative costs while not
changing any of the current program benefits, services or
eligibility requirements.
REGISTERED SUPPORT / OPPOSITION :
Support
American Association of University Women (cosponsor)
California Family Health Council (cosponsor)
Maternal Child Health Access (cosponsor)
Planned Parenthood Affiliates of California (cosponsor)
American College of Obstetricians and Gynecologists
California Commission on the Status of Women
California Medical Association
California Women Lawyers
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Opposition
None on file.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097