BILL ANALYSIS
AB 158
Page 1
Date of Hearing: January 15, 2008
ASSEMBLY COMMITTEE ON HEALTH
Mervyn M. Dymally, Chair
AB 158 (Ma) - As Amended: January 7, 2008
SUBJECT : Medi-Cal: benefits for nondisabled persons infected
with hepatitis B.
SUMMARY : Establishes a new Medi-Cal eligibility category for
non-disabled persons with the hepatitis B virus (HBV) contingent
on federal approval and federal financial participation (FFP).
Specifically, this bill :
1)Requires the Department of Health Care Services (DHCS) to
expand Medi-Cal eligibility to any person with HBV who would
otherwise qualify for Medi-Cal if the person were disabled.
Requires this expansion to begin on July 1, 2009 or the date
that all necessary federal waivers have been obtained,
whichever is later.
2)Requires DHCS to develop an allocation mechanism to enroll
individuals eligible pursuant to #1) above on a first-come,
first-served basis.
3)Requires individuals eligible for Medi-Cal pursuant to #1)
above to elect a Medi-Cal managed care (MCMC) plan in those
counties in which a MCMC plan is available, unless DHCS
determines that the cost neutrality requirements and
enrollment goals of this bill can be achieved without
requiring the MCMC election.
4)Requires DHCS to ensure that specified existing MCMC standards
are met in implementing this bill.
5)Requires DHCS to establish capitation rates for services
provided pursuant to this bill. Specifies that capitation
rates may not exceed 95% of the Medi-Cal fee-for-service costs
for individuals with HBV.
6)Requires DHCS to meet federal revenue neutrality requirements
through savings generated by the voluntary enrollment of
Medi-Cal beneficiaries, who are disabled as a result of HBV,
into MCMC, and requires DHCS to engage in specified outreach
activities to encourage this enrollment. States that DHCS is
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not precluded from implementing other means of meeting federal
neutrality requirements. Prohibits DHCS from enrolling any
individuals in the program established pursuant to #1) above
until DHCS can ensure sufficient savings to meet the federal
neutrality requirement.
7)Requires DHCS to do all of the following:
a) Implement this bill by means of an all-county letter or
similar instruction;
b) Seek the appropriate federal waiver, as specified; and,
c) Implement this bill only if, and to the extent that, FFP
is available.
8)States legislative intent regarding the purpose of this bill.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by the DHCS,
which provides comprehensive health benefits to low-income
children, their parents or caretaker relatives, pregnant
women, elderly, blind or disabled persons, nursing home
residents, and refugees who meet specified eligibility
criteria.
2)Establishes, to the extent that FFP is available, the Medi-Cal
aged and disabled program. Sets the upper limit of financial
eligibility for this program at 100% of the federal poverty
level (FPL) plus a specified additional amount ($230 for an
individual; $310 for a couple).
3)Permits the financial eligibility requirements specified in
#2) above to be adjusted upwards to reflect the cost of living
in California, contingent upon appropriation in the annual
Budget Act.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee. Because this bill requires cost neutrality, there
should be no cost for expanding eligibility. However, there
would be some state cost for submitting necessary waiver
applications to the federal government.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, this bill is
necessary to help individuals with HBV receive necessary care
before they become disabled, because early disease management
and treatment are the keys to saving lives and saving limited
health care dollars. By expanding Medi-Cal eligibility to
nondisabled individuals with HBV, the state avoids the high
costs of treating advanced liver disease, including the
expense of liver transplantation.
2)BACKGROUND . This bill is modeled after, and includes very
similar language to, AB 2197 (Koretz), Chapter 687, Statutes
of 2002. AB 2197 requires DHCS to expand eligibility for
Medi-Cal benefits to persons with human immunodeficiency virus
(HIV) who are not disabled, but who, if disabled, would
qualify for Medi-Cal benefits. AB 2197 has not been
implemented and is the subject of a lawsuit, which is
discussed in more detail in #5) below.
3)HEPATITIS B VIRAL INFECTION . According to the Centers for
Disease Control and Prevention (CDC), HBV is a disease caused
by a highly infectious virus that attacks the liver and can
cause lifelong infection, cirrhosis of the liver, liver
cancer, liver failure, and death. HBV is the most common
life-threatening liver infection in the world and a major
global public health problem. According to the Hepatitis B
Foundation, two billion people have been infected world wide,
of whom 400 million have chronic infections. An additional
10-30 million become infected each year. An estimated one
million people die each year from HBV and its complications.
In the United States (U.S.), an estimated 12 million people
have been infected, of whom more than one million are
chronically infected. HBV is transmitted through contact with
blood and bodily fluids. According to Stanford University,
one in ten Asian and Pacific Islanders is living with chronic
HBV.
In the U.S., about 5% of people will become infected with HBV
sometime during their lives if they are not vaccinated. In
2006, an estimated 46,000 people contracted HBV infection in
the U.S. About half of adults who become infected have no
symptoms or signs of the disease. Studies have demonstrated
that about 15% of people who acquire hepatitis B are unable to
identify a risk factor that explains why they have the
disease. About 95% of infected adults recover after several
months. They clear the infection from their bodies and become
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immune. This means they won't get infected with HBV again.
They are no longer contagious and cannot pass HBV to others.
Unfortunately, about 5% of adults and up to 90% of children
under age 5 are unable to clear the infection from their
bodies and they develop chronic HBV infection, usually for
life, and have the risk of transmitting HBV to others. The
only way to know if a person is currently infected with HBV,
has recovered, is chronically infected, or could become
infected, is through blood tests. A person is considered
chronically infected with HBV if he or she has HBV in his/her
blood for more than 6 months. Sometimes chronically infected
people will spontaneously clear the infection from their
bodies, but most will not. Although most chronically infected
people have no serious problems with hepatitis B and lead
normal, healthy lives, some develop liver problems later.
Chronically infected people are at significantly higher risk
than the general population for liver failure or liver cancer.
It is recommended that a person with HBV infection see a
physician knowledgeable about the management of liver disease
every 6-12 months. Several drugs are available for the
treatment of chronic HBV. These drugs usually don't get rid
of the virus completely, but may reduce one's risk of serious
liver disease such as cirrhosis of the liver and liver cancer.
Each year, approximately 3,000-5,000 people in the U.S. die
of HBV-related chronic liver disease.
4)SUPPORT . Supporters argue that nondisabled persons with HBV
should be covered under the Medi-Cal program because the
current system of allowing HBV cases to go untreated in this
currently ineligible population ensures that we pay more for
treatment once the disease has progressed, unnecessarily
increasing both the suffering associated with the disease and
the chance of succumbing to it.
5)PREVIOUS LEGISLATION . AB 2197 (Koretz) requires DHCS to
expand eligibility for Medi-Cal benefits, with the exception
of prescription drug benefits provided by the AIDS Drug
Assistance Program (ADAP), to persons with HIV who are, and
remain, enrolled in ADAP and who are not disabled, but who, if
disabled, would qualify for Medi-Cal benefits. AB 2197 also
requires DHCS to develop an allocation method so that eligible
individuals can be enrolled in this program on a first-come,
first-served basis. On April 4, 2007, the AIDS Healthcare
Foundation filed a lawsuit in Los Angeles County Superior
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Court, alleging that DHCS "...has failed to comply with any
requirements contained in AB 2197. As a result, no additional
Californians have received Medi-Cal coverage and the attending
medical care and treatment."
6)COMMENTS AND QUESTIONS .
a) Because 95% of adults who develop an HBV infection
recover within six months and it is the 5% who don't
recover who are at risk for liver disease, should this bill
be amended to apply only to nondisabled individuals
chronically infected with HBV?
b) This bill requires cost neutrality and proposes to
achieve that neutrality by encouraging the voluntary
enrollment of existing disabled Medi-Cal beneficiaries, who
are disabled as a result of HBV, into MCMC. Is it likely
that there are enough disabled individuals with HBV, who
are not currently enrolled in MCMC, and who would shift to
MCMC in numbers that would be adequate to fund this bill?
REGISTERED SUPPORT / OPPOSITION :
Support
American Cancer Society
American Federation of State, County and Municipal Employees,
AFL-CIO
Daughters of Charity Health System (prior version)
Education for Healthy Choices (prior version)
Hepatitis B Foundation (prior version)
Service Employees International Union (prior version)
Opposition
None on file.
Analysis Prepared by : John Gilman / HEALTH / (916) 319-2097