BILL ANALYSIS
AB 2352
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2352 (John A. Perez) - As Introduced: February 19, 2010
SUBJECT : Medi-Cal: organ transplants: antirejection medication.
SUMMARY : Requires Medi-Cal beneficiaries to remain eligible to
receive Medi-Cal coverage for anti-rejection medication for up
to two years following an organ transplant unless during that
time the beneficiary becomes eligible for Medicare or private
health insurance that would cover the medication.
EXISTING LAW :
1)Establishes the Medicaid (Medi-Cal in California) Program,
administered by the Department of Health Care Services (DHCS),
under which basic health care services are provided to
qualified low-income persons.
2)Requires organ transplants and donor surgeries to be covered
under the Medi-Cal Program when an organ transplant is
provided to a Medi-Cal beneficiary who is eligible for
full-scope benefits under the Medi-Cal Program in a medical
facility that meets the requirements of and is approved by
DHCS.
3)Requires, under federal law, eligibility in Medi-Cal be
re-determined at least every twelve months, with the exception
that disability can be authorized to continue until a review
team authorized under federal regulations determines that a
recipient's disability no longer meets the definition of
disability contained in the plan.
4)Requires, under federal law, that states, by January 2014,
offer Medicaid coverage to all adults up to 133% of the
federal poverty level (FPL) and authorizes a phase-in
immediately.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
AB 2352
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1)PURPOSE OF THIS BILL . According to the author, there are
currently some patients that qualify for Medi-Cal under a
federal rule allowing coverage for patients with end-stage
renal disease (on dialysis). Those patients, if they are able
to receive a kidney and have an organ transplant, will only
receive coverage for their immunosuppressive medication for
one year post-transplant. However, a person's Medi-Cal
eligibility ends when he or she no longer meets the
eligibility requirement of end-stage renal disease.
Patients in this particular group may not be eligible for
Medi-Cal under any other eligibility criteria, and they may
also be ineligible for Medicare, either because they have not
paid into Social Security for a sufficient time or because of
their immigration status. The author states if these patients
were dual-eligible for Medicare and Medi-Cal, Medicare would
pay for immunosuppressive coverage for an additional two
years, so the patient would have immunosuppressive drugs for a
total of three years post-transplant. Because patients who
have had a kidney transplant must have immunosuppressive drugs
or their body will naturally reject the organ, they have a
medical need for the anti-rejection medication to prevent
kidney failure, being placed back on dialysis or, in a
worst-case scenario, death. The author argues the state has
already paid for the organ transplant surgery (the cost of
transplant surgery is $50,000 to $100,000 according to the
author) and it makes no sense to drop Medi-Cal coverage for
these patients after only a year when many organ transplant
patients are not yet stable or ready to enter the workforce.
2)BACKGROUND . This bill creates continuity of treatment for
patients who are initially on a specific dialysis-only
Medi-Cal program which serves beneficiaries with chronic
kidney disease and who require dialysis. Dialysis is a
substitute for the normal functioning of the kidneys. It
filters waste products from the blood. Following a kidney
transplant, these patients no longer require dialysis and are
no longer deemed disabled for the purposes of their very
narrow Medi-Cal coverage. If a patient has no Medi-Cal,
private insurance, or Medicare coverage, they are at risk for
organ failure, a return to dialysis, death, or a new
transplant. The author indicates a significant investment has
already been made via the transplant and patients should be
afforded continuity of care at a much lower costs than
alternatives.
AB 2352
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3)FEDERAL HEALTH CARE REFORM . On March 23, 2010, President
Obama signed the Patient Protection and Affordable Care Act
(the 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
states, as of January 2014 to include all adults up to 133% of
the FPL in its Medicaid Program and provides an enhanced
federal matching assistance funds (FMAP). States have the
option to begin providing medical assistance to individuals
eligible under this new group as of April 1, 2101. Transplant
patients who have income under 133% of FPL will have
full-scope Medi-Cal once this is implemented.
4)SUPPORT . The National Kidney Foundation of Northern
California and Nevada writes in support that access to
anti-rejection drugs is necessary and must be a priority in
the health care delivery system for transplant patients
because they help to suppress the immune system rejection of
the new organ. BIOCOM writes in support that advances in
anti-rejection medications have decreased the incidence of
adverse reactions to a donated organ significantly, but it
still remains one of the gravest dangers facing transplant
recipients. Extending the Medi-Cal coverage period gives
transplant recipients another year of guaranteed access to
these products, and they can continue to recover and grow
stronger.
5)PRIOR LEGISLATION . AB 998 (John A. Perez) would have provided
that Medi-Cal beneficiaries shall remain eligible to receive
Medi-Cal coverage for anti-rejection medication for up to 3
years following an organ transplant, unless the beneficiary
becomes eligible for Medicare or private health insurance that
would cover the medication. AB 998 died on the Assembly
Appropriations Committee suspense file.
6)POLICY QUESTIONS. DHCS indicates that fee-for-service
Medi-Cal provided coverage for 2,447 major organ transplants
in 2008; 2,619 in 2007; and 2,528 in 2006. These numbers
include individuals who may also have had Medicare coverage.
Of these transplant recipients, the number of beneficiaries
who had 36 months of continuous Medi-Cal eligibility was 271
in 2008; 298 in 2007 and 346 in 2006. Current federal law
requires the eligibility of Medicaid recipients be
AB 2352
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re-determined at least every twelve months, with the exception
that disability can be authorized to continue until a review
team determines that a recipient's disability no longer meets
the definition of disability. In addition, state law requires
a mid-year status report for adults and an annual
reaffirmation of Medi-Cal eligibility. For those Medi-Cal
beneficiaries whose disability (and therefore Medi-Cal
eligibility) ends but who have an on-going need for
anti-rejection medication, Medi-Cal coverage ends unless the
person is otherwise eligible under another Medi-Cal
eligibility provision. By requiring that Medi-Cal
beneficiaries remain eligible to receive Medi-Cal coverage for
anti-rejection medication for up to two years following an
organ transplant (unless the beneficiary becomes eligible for
Medicare or private health insurance that covers the
medication), this bill may establish a state-only Medi-Cal
Program [meaning FMAP would not be available] for
anti-rejection medication for these individuals. Is that the
author's intent?
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
AFL-CIO
Astellas Pharma
BIOCOM
California Healthcare Institute
Donate Life California
National Kidney Foundation of Northern California and Northern
Nevada
California Transplant Organ Network
Western Center on Law and Poverty
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097