BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1541|
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THIRD READING
Bill No: AB 1541
Author: Assembly Health Committee
Amended: 7/23/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 10-0, 07/15/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Negrete McLeod, Pavley, Wolk
NO VOTE RECORDED: Maldonado
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 79-0, 5/28/09 - See last page for vote
SUBJECT : Health care coverage
SOURCE : Author
DIGEST : This bill extends from 30 days to 60 days the
time period an individual or dependent, who has lost or
will lose Healthy Families Program (HFP) coverage, as
specified, the Access for Infants and Mothers (AIM)
Program, or Medi-Cal program coverage, has to request
enrollment in group coverage without being considered a
late enrollee.
ANALYSIS : Existing federal law:
1.Establishes the Medicaid program which provides
comprehensive health coverage to low-income eligible
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individuals and families, including children; the aged,
blind, and disabled; and pregnant women, through a
program that reimburses states for the Medicaid programs
in the individual states.
2.Establishes the Children's Health Insurance Program
(CHIP) which provides matching funds for state children's
health insurance programs.
3.Provides specific guidance for determining eligibility
for Medicaid and CHIP while preserving flexibility for
states to administer these programs according to the
needs of the state.
4.Requires a group health plan to permit an eligible person
to enroll for coverage under the plan if the person's
coverage under Medicaid (Medi-Cal in California) or under
a state child health plan (such as California's Healthy
Families program) was terminated as a result of loss of
eligibility, and the person applies for coverage under
the group health plan not later than 60 days after that
termination.
Existing state law:
1.Establishes the state's Medicaid program known as
Medi-Cal, administered by the Department of Health Care
Services, 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 the AIM Program, administered by the Managed
Risk Medical Insurance Board (MRMIB), to provide low-cost
health care coverage for pregnant women and their
newborns.
3.Establishes the HFP, administered by MRMIB, to provide
low-cost insurance, including health, dental and vision
coverage to children who do not have health insurance, do
not qualify for free Medi-Cal and are in families at or
below 250 percent of the federal poverty level.
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4.Provides for the regulation of health plans by the
Department of Managed Health Care under the Knox-Keene
Health Care Service Plan Act of 1975 (Knox-Keene) and for
the regulation of health insurers by the California
Department of Insurance under the Insurance Code.
5.Authorizes health plans and insurers to exclude "late
enrollees," as defined, from group health care coverage
for no more than 12 months from the date of the
enrollee's application for coverage.
6.Defines a "late enrollee" as an eligible employee or
dependent who has declined health coverage under a health
benefit plan offered through employment or sponsored by
an employer at the time of the initial enrollment period
provided under the terms of the health benefit plan and
who subsequently requests enrollment in that plan.
7.Excludes from the definition of a "late enrollee"
individuals in specified circumstances, including an
individual, or his or her dependent, who has lost or will
lose HFP coverage, as specified, or no share-of-cost
Medi-Cal coverage and requests enrollment within 30 days
after termination of coverage.
8.Prohibits, under the California Constitution, a state
administrative agency from declaring a statute
unenforceable, or from refusing to enforce a statute on
the basis that federal law or federal regulations
prohibit the enforcement of such statute, unless an
appellate court has made a determination that the
enforcement of such statute is prohibited by federal law
or federal regulations.
This bill:
1.Extends from 30 days to 60 days the time period an
individual or dependent, who has lost or will lose
Healthy Families Program (HFP) coverage, as specified,
AIM, or Medi-Cal coverage, has to request enrollment in
group coverage without being considered a late enrollee.
2.States legislative intent to enact legislation that would
implement a provision of the Children's Health Insurance
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Program Reauthorization Act of 2009 (CHIPRA).
Background
On February 4, 2009, President Obama signed into law
CHIPRA, which reauthorizes CHIPRA for four and a half
years. The $32.8 billion cost ($40 billion over 5 years)
of CHIPRA is funded through an increase in federal tobacco
taxes, including a $.62 rise in the cigarette tax
(increasing the federal tax to $1.01 per pack).
CHIPRA includes a number of requirements for state CHIP
programs to meet, including a requirement that state plans
cover mental health and substance abuse parity benefits,
that Medicaid citizenship documentation and verification
requirements apply to CHIP, that federally qualified health
centers and rural health clinics be paid in CHIP as they
are in Medicaid, and that Medicaid managed care standards
be applied to CHIP.
CHIPRA also establishes new options for states, including
authorizing an expansion of coverage up to 300 percent of
the federal poverty level (FPL) (at or below $54,930 for a
family of three in 2009; current coverage generally goes to
250 percent FPL), and authorization to cover children above
300 percent FPL with the Medicaid matching rate (instead of
the higher CHIP matching rate). CHIPRA also allows states
to draw down federal matching funds for recent legal
immigrants in Medicaid and CHIP, offer "dental only"
coverage for children uninsured for dental coverage, and
receive enhanced federal financial participation for
translation and interpretation services.
According to a "Statement Related to Premium Assistance
Provision in CHIPRA," pertaining to Section 311, published
by the Centers for Medicare and Medicaid Services, prior to
the enactment of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), employees and their
dependents who became eligible for employment-based group
health plan coverage, but did not enroll when first given
the opportunity, had no guaranteed right under federal law
to join the group health plan if their circumstances
changed at a later time. The statement highlighted that,
even if the plan offered an annual open enrollment period,
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the individual would not only have to wait until that open
enrollment period began, but enrollment during that period
could be considered a "late enrollment" subject to a higher
premium or restricted benefits.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/19/09)
100 Percent Campaign
American Federation of State, County and Municipal
Employees, AFL-CIO
United Ways of California
ARGUMENTS IN SUPPORT : 100 Percent Campaign and United
Ways of California write in support that this bill would
align California law with federal law and would assist
California families in securing health insurance for their
children after the loss of public health insurance by
extending the time frame available to enroll in group
coverage.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,
Fong, Fuentes, Fuller, Furutani, Gaines, Galgiani,
Garrick, Gilmore, Hagman, Hall, Harkey, Hayashi,
Hernandez, Hill, Huber, Huffman, Jeffries, Jones, Knight,
Krekorian, Lieu, Logue, Bonnie Lowenthal, Ma, Mendoza,
Miller, Monning, Nava, Niello, Nielsen, John A. Perez, V.
Manuel Perez, Portantino, Price, Ruskin, Salas, Saldana,
Silva, Skinner, Smyth, Solorio, Audra Strickland,
Swanson, Torlakson, Torres, Torrico, Tran, Villines,
Yamada, Bass
NO VOTE RECORDED: Nestande
CTW:nl 8/28/09 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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