BILL ANALYSIS
AB 115
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 115 (Beall)
As Amended June 24, 2009
Majority vote
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|ASSEMBLY: |79-0 |(May 4, 2009) |SENATE: |26-13|(August 24, |
| | | | | |2009) |
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Original Committee Reference: HEALTH
SUMMARY : Revises the Adult Health Coverage Expansion Program
(AHCEP) in Santa Clara County, authorized pursuant to AB 12
(Beall), Chapter 677, Statutes of 2007, for the purpose of
allowing AHCEP to provide health care coverage products to the
spouses, domestic partners, and eligible children of program
enrollees, as specified. Specifically, this bill :
1)Authorizes the local initiative in Santa Clara County, for
purposes of the AHCEP, to offer a "complementary product"
which provides coverage for a spouse, domestic partner, or the
eligible dependent children of a program enrollee, authorizes
the complementary product to provide coverage of different
health care services than are covered for eligible employees
in AHCEP, and to have different eligibility criteria than the
employee coverage.
2)Changes from 35% to 25% the percent of employees in a small
business who must be earning less than 350% of the federal
poverty level (FPL) ($37,905 for one person in 2009) in order
for the small business to be able to participate in AHCEP, and
eliminates the requirement in the existing authorizing law for
AHCEP that at least 50% of employees meet all employee
eligibility criteria;
3)Exempts the complementary product from specified requirements
imposed on all health plans and health insurers offering
coverage to small employers in firms of 2-50 employees;
4)Makes binding, and applies to dependents, the requirement that
the local initiative not limit or exclude coverage for any
eligible employee or dependent by type of illness, treatment,
medical condition, or accident, except for preexisting
conditions permitted under the existing law related to
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coverage for small employers.
5)Limits the requirement that the AHCEP, or any complementary
product offered to dependents, be guaranteed renewable,
authorizing Santa Clara County to drop from coverage
participating employers if the local initiative ceases to
offer the AHCEP pilot program.
6)Authorizes AHCEP to include within what is considered to be
the premiums paid to the health plan the value of
hospital-based services provided to program enrollees and
apportioned to the employee.
7)Deletes the existing law applicable to the AHCEP which
requires premiums and copayments for the program to be
established in a manner substantially similar to the Healthy
Families Program.
8)Prohibits the use of state General Fund monies for funding of
AHCEP or any related complementary products.
The Senate amendments:
1)Clarify that additional local funds may be used to pay for
coverage in the complimentary product authorized in this bill.
2)Make employer contributions voluntary and specify that
individuals receiving benefits shall pay for the complementary
products.
3)Add Senator Alquist as principal co-author.
EXISTING LAW :
1)Establishes the AHCEP, a pilot project administered by the
Medi-Cal local initiative in Santa Clara County, to provide
health care coverage to 5,000 or more low-income adults who
reside in Santa Clara County and who are employed in specified
small Santa Clara County firms and businesses. For purposes
of AHCEP:
a) Defines "small business" to mean an entity located in
Santa Clara County that employs 50 or fewer persons, with
at least 35% of the employees earning less than 350% FPL
for a family size of one, and that has not offered health
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care coverage to its employees for the past 12 months,
provided that the provisions of any such prior coverage
required the employer to contribute at least 50% of the
total amount of the premium for that coverage. Includes
individual franchise outlets within the definition of a
small business. Eligible employees must work for the
employer at least 20 hours per week;
b) Requires that at least 50% of the employees of an
otherwise eligible small business meet the individual
employee eligibility requirements for the program, that at
least 50% of those eligible employees choose to receive
coverage through the program in order for the small
business to qualify to participate in the program, and
excludes from eligibility dependents of an eligible
employee;
c) Requires that all health care services under the program
be provided by a provider operated by the county, or with
whom the county or local initiative has contracted to
provide health care services, except for emergency or
out-of-area care, or instances in which a required
specialized service is not contracted for by the county or
the local initiative; and,
d) Authorizes AHCEP to utilize premium subsidies for
eligible employees, as specified, and requires the county
and local initiative to negotiate discounted rates for
services provided to AHCEP participants by providers
operated by the county or by providers contracted with the
county to provide health care services.
2)Establishes the Medi-Cal program, administered by Department
of Health Care Services (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. Currently, adults may be
eligible for full scope Medi-Cal under the following
categories: parents (with incomes up to 100% FPL); medically
needy/indigent (up to 75% FPL); and, aged and disabled (up to
127% FPL).
3)Defines "local initiative" to mean a prepaid health plan that
is organized by, or designated by, a county government or
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county governments, or organized by stakeholders of a region
designated by DHCS, to provide comprehensive health care to
eligible Medi-Cal beneficiaries.
1)Requires all health plans and health insurers offering health
coverage to employers of 2-50 employees to issue that coverage
without any exclusion based on medical underwriting, requires
renewal of all coverage for small employers, at the option of
the small employer, as specified, and restrains the ability of
plans and insurers to set initial and renewal premiums, within
specified "rate bands," based on the health status,
occupation, or claims experience of the employees of a small
employer.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the bill as passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
Analysis Prepared by : Deborah Kelch / HEALTH / (916) 319-2097
FN: 0001878