BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 311
S
AUTHOR: Alquist
B
AMENDED: April 16, 2009
HEARING DATE: April 22, 2009
3
CONSULTANT:
1
Dunstan/cjt
1
SUBJECT
Healthy Families program: dental-only coverage
SUMMARY
States legislative intent to enact provisions of federal
law related to the Healthy Families program. Requires the
Managed Risk Medical Insurance Board (MRMIB) to develop a
supplemental dental coverage program for children who are
insured, otherwise eligible for Healthy Families, and
without other dental coverage.
CHANGES TO EXISTING LAW
Existing federal law:
Existing federal law establishes the Children's Health
Insurance Program (CHIP) which provides matching funds for
state health insurance programs. Existing federal law
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. Existing federal law provides that federal
assistance programs, including Medicaid and CHIP, are
limited to U.S. citizens and specified legal immigrants.
Existing federal law has authorized states to provide a
supplemental dental coverage option for children enrolled
in a group health plan or health insurance offered by an
Continued---
STAFF ANALYSIS OF SENATE BILL SB 311 (Alquist)Page 2
employer, but who do not have dental coverage and otherwise
meet Healthy Family eligibility requirements. Existing
federal law allows states to exercise the supplemental
dental health option if a state meets specific federal
requirements.
Existing state law:
Existing state law establishes the Healthy Families program
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. Existing state law provides that the Managed Risk
Medical Insurance Board (MRMIB) administers Healthy
Families. Existing law establishes premiums that certain
eligible families must pay for their Healthy Families
coverage.
This bill:
This bill also states the Legislature's intent to enact
state law to implement the new federal Children's Health
Insurance Program Reauthorization Act of 2009 (CHIPRA).
This bill requires the Managed Risk Medical Insurance Board
(MRMIB) to develop a program that offers dental insurance
for those children who are enrolled in their parent's
health insurance, but do not have access to dental
insurance and otherwise meet Healthy Families eligibility
requirements. The bill provides that the program will not
take effect until a separate appropriation is made and the
state receives matching federal funds. This bill
authorizes MRMIB to adopt and readopt emergency regulations
to implement the program.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
The author states that SB 311 will implement needed changes
in the Healthy Families program in light of the enactment
of the federal CHIPRA law. The author argues that these
changes will allow conformity with the new federal
requirements, and take advantage of the new federal funds
and program flexibility.
STAFF ANALYSIS OF SENATE BILL SB 311 (Alquist)Page 3
According to the author, the state should prepare itself to
take advantage of changes in federal law that allow states
to provide dental insurance for low-income children who
already have other health insurance coverage. The author
points to a report by the Dental Health Foundation that
states dental disease, not obesity, not asthma, is by far
the number one health problem for children. The author
cites the 2007 California Health Interview Survey, which
estimates that nearly 500,000 children in California missed
school in 2003 due to dental problems. The author points
out that, left untreated, tooth decay can lead to pain,
nutritional problems, tooth loss, sleep deprivation,
attention deficit, failure to thrive, and slower physical
and social development.
Background
One of the first acts of President Obama was to sign
CHIPRA, which reauthorized the federal CHIP program that
provides funds for the state's Healthy Families program.
The reauthorization legislation increased California's
allotment almost two-fold. The state's allotment had been
expected to be $800 million for this federal fiscal year,
and with the new legislation, should reach $1.5 billion.
These allotments are allocated to states based on a formula
and states must provide matching funds in order to receive
the federal funds. California currently receives 65
percent of its Healthy Families program expenses from the
federal match; the state contributes the other 35 percent.
Among the new provisions in CHIPRA that could apply to
Healthy Families are the following:
a. Application of new citizenship documentation and
identification requirements.
b. Mental health and substance abuse parity
requirements.
c. Dental coverage requirement.
d. Supplemental dental coverage option.
e. Specified clinic payment and practice provisions.
f. New standards for managed care plans.
g. Compliance with federally determined quality
requirements.
h. Federal matching funds for specified legal
immigrants who previously were ineligible.
i. New express lane options allowing simplified
application processes
STAFF ANALYSIS OF SENATE BILL SB 311 (Alquist)Page 4
j. Optional use of state purchasing pool.
aa. Premium assistance requirements, including enhanced
coordination between the private employer and the
public coverage.
bb. Enhanced federal match for translation services,
including in state Medicaid programs.
The supplemental dental coverage option is available for
children enrolled in a group health plan or health
insurance offered by an employer, but who do not have
dental coverage. The children must meet Healthy Family
eligibility requirements. Additional federal requirements
are that the state have the highest income eligibility
standard allowed under federal law prior to CHIPRA, a state
cannot limit or waitlist eligible children, and provides
the supplemental benefits to all children who apply and are
eligible.
Children's dental health
According to a 2006 report by the Dental Health Foundation
entitled, "Mommy, It Hurts to Chew," dental disease is the
number one health problem among children in California. The
report was based on a survey, conducted during the
2004-2005 school year, which assessed 21,000 children in
kindergarten and third grade in nearly 200 randomly
selected schools across the state. The assessment found
that by the time children are in kindergarten, more than 50
percent already have dental decay, while 19 percent of the
third graders who were screened have a history of untreated
decay. The survey found that children with neglected teeth
suffer from pain, infection, poor nutrition as a result of
difficulty chewing and swallowing food, tooth loss, sleep
deprivation, attention deficit, and slower social
development. The survey also found that for the poor,
Hispanic, and the uninsured, the percentage of tooth decay
is higher than other populations.
Relevant legislation
SB X3 26 (Alquist) contains identical provisions as SB 311.
This bill is in the Senate Rules Committee.
AB X3 24 (Jones) would state legislative intent to enact
changes resulting from federal economic stimulus
legislation and the reauthorization of CHIP. The bill is
in the Assembly Rules Committee.
STAFF ANALYSIS OF SENATE BILL SB 311 (Alquist)Page 5
Arguments in support
Supporters argue that SB 311 will implement key provisions
of the federal Children's Health Insurance Program (CHIP)
Reauthorization Act, including dental-only coverage for
children enrolled in private medical coverage. They point
out that poor oral health is one of the leading causes of
school absenteeism. They note that over half a million
California children missed one or more school days due to
dental problems (not routine check-ups) according to the
2007 California Health Interview Survey. They state that
the survey also shows that approximately 1.4 million (13
percent) of California's children have private medical
coverage but lack dental coverage. Children NOW argues
that health coverage is incomplete unless it includes
dental coverage, as poor oral health can impact overall
health in both acute and chronic ways. The Dental Health
Foundation estimates that between 125,000 and 175,000
children would be eligible for the supplemental dental
coverage. The California Medical Association notes that
dental health issues cause more preventable emergency room
visits than diabetes and almost 40 percent of those visits
are children under the age of 18. The 100% Campaign argues
that there are key provisions in federal law that need to
be implemented to leverage federal funds and enroll as many
eligible but unenrolled children, and this bill opens the
opportunity for the state take advantage of opportunities
for performance bonuses, outreach funds and improved
express lane.
COMMENTS
1. This bill will be a vehicle for implementing the
changes that are either necessary or desirable given
federal law changes. The enactment of CHIPRA does grant
the states new options as well as imposing new requirements
on state programs. Additional information is needed from
both the Centers for Medicare and Medicaid Services, as
well as DHCS and MRMIB, before there is sufficient
information and direction regarding other statutory
changes. This bill is likely to be further amended to
reflect new information as it becomes available.
2. The federal government has yet to provide full guidance
on the supplemental dental coverage option. Under federal
law, states have to meet specific criteria to exercise the
supplemental dental health option. Given the absence of
STAFF ANALYSIS OF SENATE BILL SB 311 (Alquist)Page 6
specific federal guidance, there is a lack of certainty as
to what a state must do to meet the federal requirements.
According to CHIPRA, a state must have the highest income
eligibility standard allowed under federal law as of
January 1, 2009 or obtain a waiver. Also a state cannot
place eligible children on a waiting list. California
considered using a waiting list for the current year
because of inadequate funding relative to the number of
applicants. A grant from the California Children and
Families Commission eliminated the need for using the list.
3. Technical amendments
Page 3, beginning line 17
(a) Subject to subdivisions (b) and (c), the board shall
provide dental-only coverage as authorized by Section 501
of the Children's Health Insurance Program Reauthorization
Act of 2009 (Public Law 111-3). To be eligible to receive
this coverage, a child shall be an eligible child, as
described in subdivision (a) of Section 12693.70, except
that the child shall be enrolled in a group health plan or
employer-sponsored coverage that does not provide dental
benefits or cost sharing that meets the requirements of
Section 12693.63 and its implementing regulations.
Page 3, beginning line 26.
(b) The board may adopt, and may only one time readopt,
regulations, deemed to be emergency regulations, to
implement subdivision (a). The This adoption and one-time
readoption of a regulation authorized by this subdivision
is deemed to address an emergency, for purposes of Sections
11346.1 and 11349.6 of the Government Code, and the board
is hereby exempted for this purpose from the requirements
of subdivision (b) of Section 11346.1 of the Government
Code.
POSITIONS
Support: 100% Campaign,
a collaborative of Children Now,
Children's Defense Fund, The Children's
Partnership and PICO California
California Dental Association
California Medical Association
Children NOW
STAFF ANALYSIS OF SENATE BILL SB 311 (Alquist)Page 7
Dental Health Foundation
Oppose: None received
-- END --