BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2352|
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THIRD READING
Bill No: AB 2352
Author: John A. Perez (D)
Amended: 7/15/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-0, 6/23/10
AYES: Alquist, Cedillo, Leno, Negrete McLeod, Pavley,
Romero
NO VOTE RECORDED: Strickland, Aanestad, Cox
SENATE APPROPRIATIONS COMMITTEE : 7-4, 8/12/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Ashburn, Emmerson, Walters, Wyland
ASSEMBLY FLOOR : 62-12, 6/1/10 - See last page for vote
SUBJECT : Medi-Cal: organ transplants: antirejection
medication
SOURCE : Author
DIGEST : This bill 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.
ANALYSIS :
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Existing federal law:
1. Establishes the Medicaid program to provide
comprehensive health benefits to low-income persons.
2. Mandates states that elect to provide Medicaid benefits
to cover certain eligibility groups, such as low-income
children, those receiving supplemental security income
(SSI) and others.
3. Allows states the option of providing Medicaid benefits
to other groups, including disabled persons who are not
eligible for SSI or children in families with incomes
above the mandatory coverage level.
Existing state law:
1. Establishes the Medi-Cal program as California's
Medicaid program, administered by the Department of
Health Care Services (DHCS), which provides
comprehensive health care coverage for low-income
individuals and their families; pregnant women; elderly,
blind, or disabled persons; nursing home residents; and
refugees who meet specified eligibility criteria.
2. Establishes that the Medi-Cal program comprises a
uniform schedule of health care benefits, including
transplants for eligible beneficiaries, subject to
utilization controls.
3. Provides limited Medi-Cal benefits for specified
life-sustaining treatments, including dialysis.
4. Establishes eligibility criteria for dialysis-only
benefits related to diagnosis, net worth and absence of
other coverage.
5. Provides that eligible beneficiaries for dialysis
benefits shall pay a share of cost based on their net
worth.
This bill:
1. Requires Medi-Cal beneficiaries to remain eligible to
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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.
2. States that DHCS may implement, interpret, or make
specific this section by means of all-county letters,
provider bulletins, or similar instructions, without
taking any further regulatory action.
Comments
This bill addresses the situation of a Medi-Cal beneficiary
who has received an organ transplant. The beneficiary may
have gained Medi-Cal eligibility through the special
treatment eligibility option for persons with end stage
renal disease, or by meeting other Medi-Cal eligibility
criteria. The renal disease eligibility is not full scope
and covers only dialysis and related services. As the
renal disease advances, the beneficiary is likely to become
disabled and then become eligible for full scope Medi-Cal.
Medi-Cal covers the cost of the major organ transplant
procedure and the anti-rejection medication. However, as
the beneficiary improves, they may lose their Medi-Cal
eligibility if they no longer meet the criteria for
disability, as determined by a review team. If the
beneficiary no longer is considered disabled, they will
lose their Medi-Cal eligibility, unless they retain
eligibility by meeting other criteria. Once they have lost
their eligibility, they will not have their antirejection
medicines covered by Medi-Cal.
While the beneficiary is enrolled in Medi-Cal, the federal
government is paying its share, generally 50 percent, of
the medical costs. This bill's eligibility expansion is
not a mandatory or optional coverage under federal law.
Because there is no federal match, the bill creates a
program for which the state pays the entire costs, also
known as a "state only" program. Federal matching funds
would only be available if the state were to pursue what is
known as a waiver. Under federal law, certain federal
requirements can be waived and federal matching funds
obtained. The state already has a number of waivers in its
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Medi-Cal program, but these do not include the population
addressed by this bill.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
Medication costs $190 $400
$400General
SUPPORT : (Verified 6/23/10) (prior version of bill)
American Federation of State, County and Municipal
Employees, AFL-CIO
Astellas Pharma, U.S., Inc.
California Healthcare Institute
California Medical Association
California Transplant Donor Network
Donate Life California
National Kidney Foundation
Western Center on Law & Poverty
ARGUMENTS IN SUPPORT : Supporters argue that that access
to antirejection 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. They also note that advances in
antirejection 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. They argue that 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.
ASSEMBLY FLOOR :
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AYES: Adams, Ammiano, Arambula, Bass, Beall, Bill
Berryhill, Blakeslee, Block, Blumenfield, Bradford,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Furutani, Galgiani, Gilmore, Hall, Hayashi, Hernandez,
Hill, Huber, Huffman, Jones, Lieu, Logue, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, Nestande, V.
Manuel Perez, Portantino, Ruskin, Salas, Saldana,
Skinner, Solorio, Swanson, Torlakson, Torres, Torrico,
Tran, Villines, Yamada, John A. Perez
NOES: Anderson, DeVore, Gaines, Garrick, Hagman, Jeffries,
Knight, Miller, Niello, Nielsen, Norby, Smyth
NO VOTE RECORDED: Tom Berryhill, Fuller, Harkey, Silva,
Audra Strickland, Vacancy
CTW:mw 8/16/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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