BILL ANALYSIS �
AB 1223
Page 1
Date of Hearing: May 3, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1223 (Committee on Veterans Affairs) - As Introduced:
February 18, 2011
SUBJECT : Medi-Cal: Public Assistance Reporting Information
System.
SUMMARY : Requires the Department of Health Care Services (DHCS)
to utilize the federal Public Assistance and Reporting
Information System (PARIS) to identify veterans and their
dependents or survivors who are enrolled in the Medi-Cal Program
and assist them in obtaining federal veterans' health care
benefits statewide instead of as a two-year pilot program in
three counties. Specifically, this bill :
1)Requires DHCS to exchange information with PARIS and identify
veterans and their dependents or survivors who are receiving
Medi-Cal benefits.
2)Requires DHCS to refer identified Medi-Cal beneficiaries who
are receiving high-cost services, including long-term care
(LTC), to county veteran service officers (CVSOs) to obtain
information regarding, and assistance in obtaining, U.S.
Department of Veteran's Affairs (USDVA) benefits.
3)Requires DHCS to enter into an agreement with the California
Department of Veterans Affairs (CDVA) to perform CVSO outreach
services in connection with the pilot program and requires the
agreement to contain performance standards that would allow
DHCS to measure the effectiveness of the pilot program.
4)Requires DHCS to enter into any agreements that are required
by the federal government to utilize the PARIS system.
5)Requires DHCS to perform any information technology activities
that are necessary to utilize the PARIS system.
6)Authorizes DHCS to implement this bill by means of written
directives without taking further regulatory action and
provides for an expedited contracting process.
7)Repeals provisions relating to a two-year, three county pilot
project including the requirement to monitor and evaluate for
outcome and savings.
AB 1223
Page 2
EXISTING LAW :
1)Establishes the federal Medicaid Program, Medi-Cal in
California, administered by DHCS, to provide comprehensive
health care services and LTC to pregnant women, children, and
people who are aged, blind, and disabled.
2)Requires DHCS to implement by July 1, 2009 and administer a
two-year, three-county pilot program to utilize the federal
PARIS to identify veterans and their dependents or survivors
who are enrolled in the Medi-Cal program and assist them in
obtaining federal veterans' health care benefits and
authorizes DHCS to implement the pilot project statewide if it
determines that the pilot is cost effective and continue
operation of PARIS indefinitely.
3)Establishes CDVA to aid and assist California veterans and
their families and to administer the California Veterans
Homes.
4)Establishes, under federal law, the USDVA, and within it, the
Veterans Health Administration (VA), which is responsible for
VA medical centers and outpatient clinics.
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 remove the pilot project nature of the
provisions in existing law and require DHCS to implement the
program statewide. The author relies on an analysis by the
Legislative Analyst's Office (LAO) in 2007 that stated that
implementing PARIS could save the state millions of dollars
annually in General Fund costs by shifting eligible veterans
enrolled in Medi-Cal who might be eligible for the USDVA
health care system. According to the LAO Report, 144,000
veterans and dependents on Medi-Cal coverage could be eligible
for comprehensive medical care and health services through the
USDVA health care system. The author argues that connecting
only 10% of these veterans will save the state $25 million
annually.
2)BACKGROUND . According to the LAO analysis:
AB 1223
Page 3
a) Data Suggests Many Veterans Use Medi-Cal . Under federal
law, the Medicaid Program is intended to be the payer of
last resort, meaning that all other available sources for a
beneficiary's provision of care, such as private insurance
or other federal programs (such as the VA), must be
exhausted before Medi-Cal can provide services. Although
county welfare workers are supposed to screen for veterans
when processing Medi-Cal applications, a 2005 survey
performed by the US Census Bureau indicates that
approximately 144,000 veterans in California received
Medi-Cal benefits. The LAO estimated the cost of such
benefits totals approximately $500 million ($250 million
General Fund). The LAO further assumed that because
approximately 90,000 of the 144,000 veterans served in
World War II, the Korean War, and the Vietnam War, they
likely fall into the aged and disabled category of
beneficiaries. The costs to treat the aged and disabled
are generally higher than costs to treat other groups of
beneficiaries, such as children. The LAO concluded that if
some portion of these veterans received medical services
through the VA, the state could potentially save many tens
of millions of dollars.
b) Medical Benefits Often Greater Than Those Provided by
Medi-Cal . Participation in the VA health care system
provides veterans with access to a wide range of
coordinated health care services. Once enrolled in the VA
healthcare system, veterans may also have greater access to
some medical benefits, such as mental health counseling and
treatment for alcohol and substance abuse, than they would
have under Medi-Cal. For example, the VA does not place a
cap on the cost of dental services or limit the number of
days a patient can be hospitalized for inpatient stays on a
yearly basis. Unlike Medi-Cal, the VA system does not
require that a beneficiary pay down his or her assets until
they become "medically needy" before covering the costs of
LTC. The VA also has no requirement for repayment of LTC
services as in the Medi-Cal Program.
3)CURRENT MEDI-CAL SCREENING OF VETERANS . As part of the
regular Medi-Cal eligibility screening process, workers in
county welfare offices are required to ask applicants whether
they have served in the armed forces and have veteran's
status. If a county eligibility worker determines that an
applicant is a veteran, the eligibility worker has the
applicant fill out a form, which is then forwarded to a CVSO
where a case worker will contact the VA to determine the
AB 1223
Page 4
benefits to which the applicant is entitled. The referral
process is intended to ensure that all possible outside
sources of income are obtained and available to help reduce
costs to the Medi-Cal Program. Medi-Cal currently reimburses
the CVSOs approximately $800,000 annually for these
activities.
4)PARIS . PARIS is an information sharing system, operated by
the U.S. Department of Health and Human Services,
Administration for Children and Families, which allows states
and federal agencies to verify public assistance client
circumstances. The PARIS system includes three different data
matches. The PARIS-Veterans match allows states to compare
their beneficiary information with the USDVA. The
PARIS-Federal match allows states to compare their beneficiary
information with the U.S. Department of Defense and the U.S.
Office of Personnel Management. The PARIS-Interstate match
allows states to compare their beneficiary information with
other states.
5)PILOT PROJECT . In May 2008, in response to the LAO
recommendation, DHCS proposed a two-year pilot program to use
PARIS match results to identify veteran Medi-Cal beneficiaries
receiving high-cost services in three pilot counties and refer
them to the CVSOs. DHCS proposed to use criteria to identify
Medi-Cal beneficiaries who are receiving high-cost disability
or LTC services in excess of $2,000 per month or other
appropriate dollar threshold. According to DHCS, veterans
with a service-connected disability may be eligible for full
USDVA coverage and could elect to receive USDVA care in lieu
of Medi-Cal. DHCS determined that it would not be effective
to designate a high priority on referral of individuals that
are only eligible for increased USDVA income benefits. DHCS
proposed instead, to focus the pilot program on enrolling
high-cost LTC or disabled Medi-Cal beneficiaries in the fully
federally funded USDVA system of healthcare. DHCS proposed to
seek the highest yield from its investment in CVSO outreach
efforts through targeting of these high cost beneficiaries.
According to DHCS maintaining the current county Medi-Cal
office referral process to adjust the Medi-Cal eligibility
income determination for newly identified USDVA income alone
would not be as cost-effective. Instead the pilot program
would focus on referring high-cost beneficiaries to the CVSOs
that could potentially offset Medi-Cal expenditures for their
health care.
According to DHCS, the PARIS-Veterans pilot project was
AB 1223
Page 5
implemented on July 1, 2009. DHCS entered into a memorandum
of understanding with the CDVA to operate the PARIS-Veterans
pilot program. Under the pilot, the CDVA is focusing outreach
efforts on veterans and their dependents or survivors who are
receiving Medi-Cal benefits and who are receiving high-cost
services in pilot counties. CDVA is tracking the contact of
these individuals and reporting outcomes to DHCS.
DHCS is also performing the PARIS matching process on a pilot
basis to test the cost effectiveness prior to implementing
statewide. For the first two matches, DHCS selected
beneficiary records from three California counties. In the
third match, DHCS selected from six California counties. In
the most recent PARIS-Veterans match, DHCS selected from 10
California counties.
Since implementation, DHCS has participated in eight instances
of the quarterly PARIS match process during the two year
implementation of the pilot program. Based on these matches,
DHCS has successfully identified veterans and their dependents
or survivors who are enrolled in the Medi-Cal Program. DHCS
and the CDVA have identified hundreds of Medi-Cal
beneficiaries that are simultaneously enrolled in the USDVA
system of health care. The pilot program outreach efforts
have resulted in some of the individuals choosing to no longer
be enrolled in Medi-Cal and have allowed DHCS to better
coordinate care with the USDVA system of health care. DHCS
does not identify the total number of veterans receiving
Medi-Cal benefits. The pilot ends on July 1, 2011. Actual
data resulting from the PARIS-Veterans pilot program will be
presented in a Legislative Report that is due on November 1,
2011.
6)OTHER STATES' EXPERIENCE . According to a Report from the
Legislative Budget Board of Texas in January 2011, other
states have successfully used the PARIS-Veterans to assist
veterans and save state funds. Washington State initially
provided a yearly sum to the USDVA via interagency contract
and also tried a 10% performance based contract. The program
has been so successful that the legislature appropriated $1
million and four staff. The estimated savings is $3.5 million
per year.
7)PRIOR LEGISLATION .
a) AB 1568 (Committee on Veterans Affairs) in 2009, would
have made PARIS pilot project a permanent, statewide
AB 1223
Page 6
program. AB 1658 was amended into a different subject
matter.
b) AB 3082 (Committee on Veterans Affairs) of 2008, would
have required any state or public assistance agency using
PARIS to identify veterans enrolled in the Medi-Cal Program
for the purpose of assisting them in obtaining federal
health care benefits. Required CDVA to develop a plan for
handling data-match information given to a CVSO. AB 3082
died on the Senate Appropriations Suspense File.
c) AB 1183 (Committee on Budget), Chapter 758, Statutes of
2008, requires DHCS to establish a two-year pilot program
for the use of PARIS by July 1, 2009, and to report to the
Legislature the effectiveness of the program and included
authority for DHCS to make PARIS a permanent program if the
program was deemed effective.
8)DOUBLE REFERRAL . This bill has been double-referred. It was
heard in the Veterans Affairs Committee on April 25, 2011 and
passed out on a vote of 9-0.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097