BILL ANALYSIS
AB 963
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 963 (Ammiano) - As Amended: April 2, 2009
SUBJECT : Medi-Cal eligibility.
SUMMARY : For purposes of Medi-Cal eligibility, deems an
individual or family that submits and signs a Food Stamp Program
application to have met the requirement to submit and sign a
Medi-Cal application; deems a Medi-Cal beneficiary who completes
a periodic report or annual renewal form in the California Work
Opportunity and Responsibility to Kids (CalWORKs) Program or
Food Stamp Program to have met the requirement to return and
sign a periodic report or annual renewal form for the next
scheduled period in the Medi-Cal program; and, requires the
Department of Health Care Services (DHCS) to use pre-populated
renewal forms as the annual reaffirmation form in Medi-Cal.
Specifically, this bill :
1)Requires DHCS, in consultation with the Department of Social
Services (DSS), counties, representatives from the Statewide
Automated Welfare System (SAWS) consortia, consumer advocates,
and other stakeholder groups, to make all necessary
technological and policy changes to update data sharing,
computer programming, and administrative procedures, to ensure
that Medi-Cal is continued when a Medi-Cal beneficiary reports
a change in circumstances to the Food Stamp Program or the
CalWORKs program that would continue Medi-Cal eligibility.
2)Prohibits 1) above from increasing the frequency of the
reporting requirements in the Medi-Cal program or amending the
counties' obligation to redetermine Medi-Cal eligibility and
follow all due process requirements prior to terminating
Medi-Cal benefits.
3)Prohibits a beneficiary's failure to complete a periodic
report or annual renewal requirement in the CalWORKs program
or Food Stamp Program from resulting in the termination or
redetermination of Medi-Cal eligibility.
4)Declares the provisions in 1) through 3) above to be
declaratory of existing law, and prohibits implementation of
1) through 3) above from being delayed in order to implement
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the provisions of 5) through 12) below.
5)Deems a Medi-Cal beneficiary who completes a periodic report
or annual renewal form in the CalWORKs program or Food Stamp
Program to have met the requirement to return and sign a
periodic report or annual renewal form for the next scheduled
period in the Medi-Cal program.
6)Requires the county to deem the beneficiary to have met the
Medi-Cal annual redetermination requirement if information a
beneficiary submits in the CalWORKs program or Food Stamp
Program periodic reporting or annual renewal process is
sufficient to continue Medi-Cal eligibility.
7)Requires Medi-Cal beneficiaries to have their eligibility
continued for the greatest period of time allowed under state
law, and all scheduled renewal dates or reporting dates, if
any, to be reset from the date of redetermination. Prohibits
the above provisions from affecting a beneficiary's
responsibility to report changes to the county that affect
Medi-Cal eligibility within 10 days of their occurrence.
8)Requires the procedures described above to be conducted by
electronic means to the greatest extent possible and to be
developed according to 9) below.
9)Requires DHCS, in conjunction with counties, the DSS, and
representatives of the SAWS consortia, consumers, and other
affected stakeholder groups, to conduct a planning process and
develop administrative enrollment and renewal policies and
procedures, to be implemented by all county letters or similar
instructions.
10) Requires, after implementation by all county letters or
similar instructions, DHCS to adopt regulations in accordance
with the Administrative Procedure Act, and requires DHCS to
issue comprehensive implementing instructions no later than
March 1, 2011.
11) Requires the policies and procedures in 9) above to do all
of the following:
a) Establish appropriate data sharing procedures and
safeguards that do not require any additional consent from
beneficiaries for the information sharing and that meet
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confidentiality and privacy requirements in the Medi-Cal
program;
b) Give priority to the programming changes necessary to
enable the SAWS consortia to automate this enrollment and
renewal procedure in order to minimize manual workload;
and,
c) Develop procedural protections to ensure that
beneficiaries experience no disruption in coverage and no
diminution of their rights under Medi-Cal.
12) Prohibits the information shared among CalWORKS, Food
Stamps and Medi-Cal pursuant to 5) through 11) above from
being used for any other purposes except as set forth in 5)
through 11).
13) Deems an individual or family that submits and signs a
Food Stamp Program application through any method accepted by
the Food Stamp Program to have met the requirement to submit
and sign a Medi-Cal application.
14) Requires the county to enroll the applicant into the
Medi-Cal program if information an applicant submits in the
Food Stamp Program application is sufficient to establish
Medi-Cal eligibility.
15) Requires counties, for an applicant who is not enrolled
into the Medi-Cal program based upon information provided in
his or her Food Stamp Program application, to make every
reasonable effort to gather information available to the
county that is relevant to the applicant's Medi-Cal
eligibility prior to contacting the applicant.
16) Requires counties to follow the same process used for
redeterminations of eligibility contained in existing law
(known as SB 87, Chapter 1088, Statutes of 2000) in order to
attempt to establish Medi-Cal eligibility.
17) Requires all Medi-Cal applicants whose Medi-Cal
eligibility is established pursuant to 13) through 16) above
(through submitting and signing a Food Stamps application) to
have their eligibility established for the greatest period of
time allowed under state law, and requires all scheduled
renewal dates or reporting dates, if any, to be set
accordingly from the date the Medi-Cal applicant submits his
or her Food Stamp Program application.
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18) Prohibits 13) through 17) above (deeming an individual
that submits a Food Stamps application to have met the
requirement to submit a Medi-Cal application) from affecting a
beneficiary's responsibility to report changes to the county
that would affect their Medi-Cal eligibility within 10 days of
their occurrence.
19) Requires the procedures in 13) through 17) to be conducted
by electronic means to the greatest extent possible and to be
developed according to 21) below.
20) Prohibits the information shared between Food Stamps and
Medi-Cal from being used for any other purposes except as set
forth in 13) through 19).
21) Requires DHCS, (for deeming an individual that submits and
signs a Food Stamp application to have met the requirement to
submit and sign a Medi-Cal application in 13) through 20)
above), in conjunction with counties, DSS, and representatives
of the SAWS consortia, consumers, and other affected
stakeholder groups, to conduct a planning process and develop
administrative enrollment and renewal policies and procedures,
to be implemented by all county letters or similar
instructions. Requires DHCS to adopt regulations in
accordance with the Administrative Procedure Act, after
implementation by all county letters or similar instructions.
Requires comprehensive implementing instructions to be issued
no later than March 1, 2011.
22) Requires the policies and procedures in 21) above to do
all of the following:
a) Establish appropriate data sharing procedures and
safeguards that do not require any additional consent from
applicants for the information sharing pursuant and that
meet confidentiality and privacy requirements in the
Medi-Cal program;
b) Give priority to the programming changes necessary to
enable the SAWS consortia to automate this application and
enrollment procedure in order to minimize manual workload;
c) Develop procedural protections to ensure that applicants
experience no delay in coverage and no diminution of their
rights under Medi-Cal law; and,
d) Develop a procedure whereby applicants for benefits
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under the Food Stamp Program are informed about the
benefits of the Medi-Cal program and are given an
opportunity to opt out of Medi-Cal enrollment. Requires
the opt-out procedure to be minimally burdensome to the
applicant, and requires the county to presume the applicant
wants to be enrolled in the Medi-Cal program unless the
applicant expressly opts out verbally, in writing, or
electronically, and the county documents the opt out in the
case file.
23) Requires DHCS, in conjunction with counties and
representatives of the SAWS consortia, consumers, and other
affected stakeholder groups, to establish procedures and
guidelines for pre-populated renewal forms for all potential
and current Medi-Cal beneficiaries.
24) Requires the pre-populated renewal forms and procedures to
be used for all beneficiaries whose Medi-Cal eligibility is
not accomplished through the renewal procedures set forth in
this bill. Requires periodic reporting forms, if any, to also
be created in accordance with this requirement.
25) Requires DHCS to use the pre-populated renewal form as the
annual reaffirmation form required under existing law.
26) Requires the procedures and guidelines established
pursuant to this bill to include a timeline for phasing in
this procedure statewide, beginning in January 2011, and fully
phasing in the procedure by January 2012.
EXISTING LAW :
1)Establishes the Medi-Cal Program, which is administered by
DHCS, and under which qualified low-income individuals receive
health care benefits.
2)Establishes the Food Stamp Program, under which food stamps
are allocated by each county in accordance with federal
requirements, and the CalWORKS program, under which each
county provides cash assistance and other benefits to
qualified low-income families and individuals who meet
specified eligibility criteria. Both the Food Stamp Program
and the CalWORKs program are administered at the state level
by DSS.
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FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . This bill is jointly sponsored by
Western Center on Law & Poverty (WCLP), the Children's
Partnership and United Way of the Bay Area to streamline the
Medi-Cal eligibility process and eliminate duplicate,
burdensome paperwork. Additionally, this bill would require
DHCS to use pre-populated renewal forms as the annual
reaffirmation form in Medi-Cal, thereby helping beneficiaries
enroll by providing them with information they had submitted
previously and asking them to confirm or correct the
information.
WCLP states that California's 58 counties each administer
multiple programs to provide basic necessities to low-income
individuals and families, including Medi-Cal, Food Stamps, and
CaIWORKS, and many of the same people are eligible for two or
more programs. In the past, these programs existed in
separate silos and were usually administered by different
departments or divisions at the state and county levels.
Eligibility was calculated by different workers using
different forms. Today, although some of those divisions
remain, the counties now use computer systems that allow for
improved data sharing and communication, but duplicate sets of
forms and verifications are still often required. The
sponsors argue the time has come to streamline this process,
both for the benefit of the eligible Medi-Cal beneficiary and
the county worker.
While there is some data and file sharing reconciliation between
CalWORKs and Food Stamps, and between CalWORKs and Medi-Cal,
there is not reconciliation between Food Stamps and Medi-Cal.
Food Stamps and Medi-Cal have different reporting time lines
and requirements but the information required is essentially
the same. When families are asked more than once in a short
time period to provide the same or similar information to two
different workers who may be in the same or different
agencies, their success rate is lower and they lose benefits
due to confusion and difficulty complying, even though they
are still eligible. Technology has sufficiently improved so
that computer systems can already share information to
eliminate the need for duplicate requests of the same
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information. Proponents argue during this fiscal crisis both
for the state and its residents, this bill would make
processes and procedures more efficient for eligible Medi-Cal
beneficiaries and for counties.
2)BACKGROUND . SB 87 (Escutia) Chapter 1088, Statutes of 2000
requires counties to follow specified steps and procedures to
prevent the loss of Medi-Cal eligibility. For example, if a
county receives information about changes in a beneficiary's
circumstances that may affect Medi-Cal eligibility, the county
must promptly redetermine eligibility, Medi-Cal eligibility
must continue during the redetermination process, and Medi-Cal
eligibility cannot be terminated until the county makes a
determination that the beneficiary is no longer eligible for
Medi-Cal under any basis. In determining eligibility, a
county must make every reasonable effort to gather information
available to the county that is relevant to the beneficiary's
Medi-Cal eligibility prior to contacting the beneficiary, and
information sources for these efforts must include Medi-Cal,
CalWORKs, and Food Stamp Program case files of the beneficiary
or of any of his or her immediate family members, which are
open or were closed within the last 45 days, and wherever
feasible, other sources of relevant information reasonably
available to the counties.
3)ELIGIBLE BUT NOT ENROLLED . According to a December 2008 UCLA
Health Policy Research Brief using data from the 2007
California Health Interview Survey, among the 683,000 children
who were uninsured at the time of the survey, over half were
eligible for Medi-Cal or the Healthy Families Program (56.4%).
Of the 4.1 million adults who were uninsured at the time they
were interviewed, only 6.6% were eligible for Medi-Cal.
4)SUPPORT . Supporters of this bill include groups advocating on
behalf of children, health care providers and community
organizations that argue this bill would make common sense
steps to simplify Medi-Cal enrollment, and to make renewing
coverage easier. Supporters argue this bill would update
technology and processes so that when individuals provide
information to apply for or renew Food Stamps eligibility, the
data would automatically be used to also apply for or renew
Medi-Cal coverage.
5)PREVIOUS LEGISLATION . AB 2875 (Lieber) is similar to this
bill. AB 2875 was held on the Senate Appropriations suspense
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file.
REGISTERED SUPPORT / OPPOSITION :
Support
The Children's Partnership (cosponsor)
United Way of the Bay Area (cosponsor)
Western Center on Law & Poverty (cosponsor)
100% Campaign
Asian Community Mental Health Services
California Children's Hospital Association
California Immigrant Policy Center
California Medical Association
California Primary Care Association
California School Health Centers Association
Eden Counseling Services, Inc.
Health Access California
Lincoln Child Center
NICOS Chinese Health Coalition
PICO California
Sierra Institute for Community and Environment
St. Mary's Center
Opposition
None on file.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097