BILL ANALYSIS
AB 1595
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1595 (Jones) - As Amended: April 5, 2010
SUBJECT : Medi-Cal: eligibility.
SUMMARY : Expands Medi-Cal coverage to persons with income that
does not exceed 133% of the Federal Poverty Level (FPL),
effective January 1, 2014.
EXISTING LAW :
1)Establishes the federal Medicaid Program, Medi-Cal in
California, administered by the Department of Health Care
Services, to provide comprehensive health care services and
long-term care to pregnant women, children, and people who are
aged, blind, and disabled.
2)Requires, under federal law, that states, by January 2014,
offer Medicaid coverage to all adults up to 133% of FPL and
authorizes a phase-in immediately
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the purpose of
this bill is to implement the new federal law to expand
Medi-Cal benefits to those with an income that does not exceed
133% of FPL. Low-income adults, including those without
children, will be eligible, as long as their incomes didn't
exceed 133% of FPL, or $14,404 for individuals and $29,326 for
a family of four, according to current poverty guidelines. The
federal government will provide significant new funding for
this expansion of Medi-Cal. The author states that adults
living in poverty lack the financial ability to purchase
health insurance. The expansion of the Medi-Cal system will
provide health insurance coverage to millions of Californians
who cannot current afford to see a doctor for preventative
care, basic health care needs or serious illness.
2)BACKGROUND : On March 23, 2010, President Obama signed the
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Patient Protection and Affordable Care Act; P. L. 111-148, as
amended by the Health Care and Education Reconciliation Act of
2010; P. L. 111-152. Among other provisions, the Affordable
Act requires, as of January 2014 that states include all
adults up to 133% of the FPL in its Medicaid Program and
provides enhanced federal matching assistance funds (FMAP).
The Patient Protection and Affordable Care Act establishes a
new eligibility category for all non-pregnant, non-Medicare
eligible childless adults under age 65 who are not otherwise
eligible for Medicaid and requires minimum Medicaid coverage
at 133% FPL based on modified gross income with a special
adjustment of 5% to bring effective income eligibility to 138%
FPL. Eligibility is to be determined without assets or
resource tests.
3)NEW MEDICAID FUNDING . The traditional FMAP for California has
been 50% federal funds, 50% state funds. The American
Recovery and Reinvestment Act (ARRA) provided an enhanced FMAP
until January 2011. The ARRA enhancement for California
changed the sharing ratio to 62% federal/ 38% state. For
newly eligible individuals, the federal health care reform
provides full 100% federal funding for 2014-2016; 95% for
2017; 94% for 2018; 93% for 2019 and 90% for 2020 and beyond.
If a state enacts early expansion, it is done at the current
FMAP until 2019 when it goes to 93% and in 2010 to 90%.
4)SUPPORT . The American Federation of State, County and
Municipal Employees, AFL-CIO (AFSCME) writes in support that
due to the lack of a universal health care program in
California, millions of men women and children are literally
left out in the cold because they cannot afford proper
insurance. The supporters argue that this bill will serve as
a means toward implementing health care reform for California.
5)RELATED LEGISLATION :
a) AB 1602 (John A. Perez) enacts the California Patient
Protection and Affordable Care Act to implement reforms
under the federal Patient Protection and Affordable Care
Act in California and creates the California Health Benefit
Exchange for the purchase of health care coverage.
Prohibits group or individual health care service plans or
health insurers (carriers) from establishing lifetime or
unreasonable annual limits on the dollar value of benefits.
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Requires carriers to provide minimum coverage for
specified preventive services. Prohibits carriers from
imposing preexisting condition exclusions for enrollees or
insureds under 19 years of age. Prohibits the limiting age
for dependent health care coverage to be less than 26 years
of age. AB 1602 is set for hearing on April 20, 2010 in
the Assembly Health Committee.
b) AB 1887 (Villines) establishes the state temporary high
risk pool program in order to be eligible for high risk
pool funds under the federal Patient Protection and
Affordable Care Act. AB 1887 is set for hearing on April
20, 2010 in the Assembly Health Committee.
c) AB 2345 (De La Torre) requires carriers, after January
1, 2011, to meet the requirements of specified provisions
of the federal Public Health Service Act, related to
federal health care reform. AB 2345 is set for hearing on
April 20, 2010 in the Assembly Health Committee.
d) AB 2244 (Feuer) among other things, prohibits carriers
from denying coverage on the basis of an actual or expected
health condition effective January 1, 2011 for children and
effective January 1, 2014 for adults. AB 2244 is pending
in the Assembly Appropriations Committee.
e) AB 2477 (Jones) deletes the provision that requires
Mid-Year Status Reports for children from January 1, 2011
to July 1, 2012, therefore establishes continuous
eligibility for children in the Medi-Cal Program. AB 2477
is pending in the Assembly Appropriations Committee.
f) SB 900 (Alquist) establishes the California Health
Benefits Exchange within the California Health and Human
Services Agency and would requires the Exchange to, among
other things, implement specified functions imposed by the
federal Patient Protection and Affordable Care Act. SB 900
is set for hearing in the Senate Health Committee on April
21, 2010.
g) SB 1088 (Price) prohibits, with a specified exceptions,
the limiting age for dependent children from being less
than 27 years of age. SB 1088 is set for hearing in the
Senate Health Committee on April 21, 2010.
6)POLICY QUESTION: States have the option to begin providing
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medical assistance to individuals eligible under this new
group as of April 1, 2010 at the current sharing ratio. Does
the author intend to foreclose this possibility? If not
language should be added as follows:
Nothing in this section is intended to prevent an earlier
phase-in as authorized under federal law.
7)TECHNICAL AMENDMENTS : To further the author's intent of
establishing the newly established eligibility group for
low-income adults this bill should be amended to clarify that
it applies to a person who is not age 65 or older; pregnant;
entitled to or enrolled in benefits under Medicare Part A;
enrolled under Medicare Part B; or described in any other
mandatory groups.
REGISTERED SUPPORT / OPPOSITION :
Support
The American Federation of State, County and Municipal
Employees, AFL-CIO
Health Access California
The 100% Campaign (The Children's Partnership, Children Now,
Children's Defense Fund-California, and PICO California)
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097