BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 1296 (Bonilla)
Hearing Date: 8/25/2011 Amended: 7/13/2011
Consultant: Katie Johnson Policy Vote: Health 6-3
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BILL SUMMARY: AB 1296 would establish the Health Care
Eligibility, Enrollment, and Retention Act. The bill would
require the California Health and Human Services Agency (CHHS),
by January 1, 2012, in consultation with other state departments
and stakeholders, to have undertaken a planning process to
develop plans and procedures to implement these provisions
relating to enrollment in public programs and federal law. The
bill would require that an individual would have the option to
apply for public programs through a variety of avenues, would
specify the application form, establish presumptive eligibility
for all populations, and establish other requirements related to
renewal and transfer of coverage between programs.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
CHHS planning process likely in the hundreds of thousands of
Federal
dollars through January 1, 2014, and
possibly beyond
Ongoing administration unknown, potentially significant,General/
commencing January 1, 2014 Federal/
Special
*50 percent General Fund, 50 percent federal funds, unless
additional federal or private funds are made available.
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
This bill would require CHHS, by January 1, 2012, in
consultation with the Department of Health Care Services (DHCS),
the Managed Risk Medical Insurance Board (MRMIB), the California
Health Benefit Exchange (Exchange), counties, health care
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service plans, consumer advocates, and other stakeholders, to
have commenced a planning process to develop plans and
procedures to implement the enrollment and renewal requirements
established by these provisions and by the federal Patient
Protection and Affordable Care Act (PPACA). CHHS would be
required to provide information on the process regarding policy
changes needed to develop the eligibility, enrollment, and
retention system for health care coverage to the Legislature by
April 1, 2012. This bill would require DHCS to develop a
standardized application for all public health coverage
programs. These provisions, except where otherwise specified,
would become operative January 1, 2014.
This bill would permit an individual to have the option to apply
for public health coverage programs in person, by mail, online,
or by telephone. This bill would specify that there should be a
program of accelerated enrollment through which children and
pregnant women may enter public coverage at the point of medical
service, that infants would be deemed eligible without an
application at a hospital, real-time verification, information
pre-population, and presumptive eligibility for children,
pregnant women, and other adults, among other specified
requirements.
There would likely be significant General Fund and federal funds
costs to immediately enroll individuals in public coverage
programs that would be shared about 50 percent General Fund and
50 federal funds, unless the enrollees are newly eligible, where
the costs would be paid 100 percent federal funds until 2016.
Additionally, there would be information technology (IT) costs
likely in the millions of dollars to design a system to comply
with these provisions. IT costs could be shared at a federal
medical assistance percentage of up to 90 percent, or 10 percent
General Fund and 90 percent federal funds. Actual costs of
start-up and ongoing administration and sharing ratios are
unknown and are in a large part dependent on how CHHS, DHCS,
MRMIB, and the Exchange would choose to operationalize these
provisions.
Federal Exchange Funding
On August 12, 2011, California was awarded a Level One Exchange
establishment grant by the federal Department of Health and
Human Services in the amount of $39,421,383 for the purposes of
developing policy goals, securing consultants and experts, and
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engaging stakeholders in the Exchange planning process. It is
unclear whether or not these funds could be utilized to
implement this bill. The state previously received a $1 million
Exchange Planning Grant to start up the Exchange on September
29, 2010.
AS PROPOSED TO BE AMENDED. The author's proposed amendments
would, commencing January 1, 2012:
1) Require the planning process to be led by CHHS to allow
for stakeholders to provide meaningful input into the
planning and development of the aspects of eligibility,
enrollment, and retention identified in these provisions;
2) Require the planning and development process to consider
at least the following issues:
a. Whether or not to develop a state specific
enrollment form;
b. What process to use to establish Medi-Cal
eligibility for non-modified adjusted gross income
(MAGI) individuals;
c. A hospital process to immediately enroll
infants eligible for Medi-Cal and the Healthy Families
Program;
d. What data collection standards should be
utilized to collect specified information;
e. A process to allow individuals to update
eligibility information at times other than renewal
and to have the option to renew eligibility at the
time of the update;
f. Confidentiality protections;
g. How to enable applicants to select health
plans.
Commencing January 1, 2014, the author's proposed amendments
would:
1) Permit an individual to apply for coverage via
facsimile;
2) Require DHCS to develop a single, accessible application
as part of the planning process above and require the form
to be used by all entities permitted to determine
eligibility for state subsidy programs.
3) Require the application to be tested and operational by
the date as required by the HHS Secretary.
4) Modify the prepopulation requirements to be dependent
upon the capabilities of the yet to be developed
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eligibility and enrollment system;
5) Permit state health subsidy programs to accept
self-attestation;
6) Require electronic verification in a manner as provided
by PPACA;
7) Provide for automatic renewal if the recipient is
otherwise eligible for a public health coverage program.
Finally, the author's proposed amendments would delete costly
provisions of the bill including the requirement to provide
presumptive eligibility and other requirements that would have
decreased CHHS' flexibility in implementing the PPACA. Thus
costs would be reduced significantly. The planning process would
likely require resources in the hundreds of thousands of dollars
and would be federally funded. Actual expenditures would depend
on the scope, extent, and duration of the planning process. It
is unknown what the provisions commencing January 1, 2014, would
require in terms of resources, but it is likely to be
significant and would probably be integrated into the respective
Exchange, Medi-Cal, and Healthy Families eligibility divisions
as well as the development and implementation of the enrollment
information technology system, which would be 100 percent
federally funded.