BILL ANALYSIS �
AB 1296
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1296 (Bonilla)
As Amended September 1, 2011
Majority vote
-----------------------------------------------------------------
|ASSEMBLY: |51-27|(June 2, 2011) |SENATE: |23-14|(September 7, |
| | | | | |2011) |
-----------------------------------------------------------------
Original Committee Reference: HEALTH
SUMMARY : Enacts the Health Care Eligibility Reform, Enrollment,
and Retention Planning Act and requires, the California Health
and Human Services Agency (CHHSA), in consultation with the
Department of Health Care Services (DHCS), Managed Risk Medical
Insurance Board, the California Health Benefit Exchange
(Exchange), the California Office of Systems Integration,
counties, health care services plans, consumer advocates, and
other stakeholders to undertake a planning and development
process regarding the federal Patient Protections and Affordable
Care Act (PPACA), including regulations or guidance related to
eligibility, enrollment, and retention in state health subsidy
programs.
The Senate amendments :
1) Delete the January 1, 2012, end date for the planning
process and instead require the planning and development
process to be completed in time for the following:
a) Certification and approval of the eligibility,
enrollment, and retention system;
b) Approval for enhanced federal funding; and,
c) Readiness of the eligibility, enrollment, and retention
processes to accept and process applications, as required
by federal law.
2) Revise the requirement that DHCS consult with counties
and stakeholders regarding the use of the application form
developed by the federal Secretary of Health and Human
Services (HHS) as an alternative to the state form
developed pursuant to this bill by including it in the
AB 1296
Page 2
planning process.
3) Revise requirements regarding renewal procedures and
coordination across all public health coverage programs by
deleting specific requirements and instead include in the
planning process consideration of whether eligibility may
be renewed based on information from a public benefits
program and whether to permit a recipient to renew
eligibility by providing updated information at any time.
4) Require the planning process to also include:
a) The process and application for Medi-Cal eligibility of
the population that is not eligible under the Modified
Adjusted Gross Income (MAGI) standard;
b) Whether to adopt a process for hospitals to enroll
eligible infants online;
c) Data collection standards for demographic, language and
disability information;
d) Protections for the confidentiality of personal
information; and,
e) Development of a process for choosing a health plan.
5) Delete the requirement that CHHSA submit a report
regarding policy changes needed to the health committees of
the Legislature by April 1, 2012, and instead requires the
information to be provided to the appropriate fiscal and
policy committees by July 1, 2012, and adds the requirement
that it include statutory changes needed for
implementation.
6) Delete the requirement that the state form be tested and
operational by July 1, 2013 and instead require it to be
tested and operational as required by the federal Secretary
of HHS.
7) Make clarifying revisions to the application criteria
and require voluntary questions regarding demographic data
categories as specified.
8) Delete the specific authority to modify the existing
AB 1296
Page 3
provider-based application and process used for the Child
Health and Disability Prevention Gateway and presumptive
eligibility for pregnant women in families with income up
to 200% of the federal poverty level program for use as an
application for ongoing coverage for Medi-Cal and the
Healthy Families Program (HFP), for a program of
accelerated enrollment from the medical point of service
and the requirement for DHCS to adopt a process for
prenatal care providers to submit the application form for
pregnant women online and for hospitals to enroll eligible
infants online immediately without an application.
9) Authorize all state health subsidy programs to accept
self-attestation as permitted under state and federal law,
instead of requiring the production of documentation,
require the information to be verified as provided by PPACA
and implementing federal regulations and guidance, and
require a process and opportunity to provide additional
information and corrections.
10) Delete the requirement that an entity receiving the
application to treat it as an application for all public
coverage programs and enroll the applicant in the most
beneficial program the applicant is eligible for.
11) Require the application of a person who may otherwise be
eligible for Medi-Cal to be forwarded for an eligibility
determination if the individual is screened but does not
meet the MAGI eligibility standard.
12) Require the applications be referred to the county
health coverage program, where appropriate.
13) Require forms and notices to developed using plain
language and provided in a manner that affords meaningful
access to limited English-proficient individuals, as
specified and at a minimum in the same number of threshold
languages as required for Medi-Cal managed care.
14) Revise the process for receiving and acting on
stakeholder suggestions regarding the functionality of the
eligibility process and delete the requirement of a
publicly available evaluation by an independent expert.
15) Revise the privacy and confidentiality provisions to
AB 1296
Page 4
require compliance with federal and state law and delete
specific requirements.
16) Revise and add definitions and make other clarifying and
technical amendments.
AS PASSED BY THE ASSEMBLY , this bill was essentially similar to
the version as passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
CHHSA 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% General Fund, 50% federal funds, unless additional federal
or private funds are made available.
_________________________________________________________________
____
COMMENTS : According to the author, AB 1602 (John A. P�rez),
Chapter 655, Statues of 2010, and SB 900 (Alquist) Chapter 659,
Statutes of 2010, initiated the process to offer health care
coverage options to Californians by, among other things,
creating the structure and basic duties of the Exchange.
However, the author points out that the prior bills did not
establish the system, required by PPACA, to determine
eligibility for enrolling consumers in health coverage.
According to the author, the PPACA requires a seamless "no wrong
door" application system so that wherever a consumer applies
he/she is enrolled into the program for which he/she is
eligible.
Under the new federal health reform law, most U.S. citizens and
legal residents will be required to have health insurance
beginning in 2014. It is estimated that 4.7 million California
AB 1296
Page 5
children and adults who were uninsured during some part of 2009
will be eligible for health coverage under PPACA. The new law
establishes a state-based system of health insurance Exchanges
and expands Medicaid to make coverage readily available to
millions of uninsured people. The PPACA requires states to
change their Medicaid and State Children's Health Insurance
Program (CHIP), (HFP in California) eligibility rules in three
fundamental ways: 1) states must change the way income is
counted for the purpose of determining eligibility; 2) states
must eliminate the asset test for most populations; and, 3)
states must make a series of changes intended to improve the
process for determining and maintaining eligibility for their
public programs.
On August 12, 2011, HHS along with the Department of the
Treasury released three proposed rules to build on existing
momentum toward Exchange development in states. The rules seek
to create a path to a simple, seamless and affordable system of
coverage as follows:
1)Exchange Eligibility and Employer Standards: An HHS proposed
rule details the standards and process for enrolling in
qualified health plans and insurance affordability programs.
It also outlines basic standards for employer participation in
Small Business Health Options Program.
2)Health Insurance Premium Tax Credit: Treasury Department
proposed regulations lay out how individuals and families will
receive premium tax credits to help defray insurance costs.
The premium tax credits assist millions of middle-class
Americans to make it easier for them to purchase affordable
health insurance.
3)Medicaid Eligibility: Another HHS proposed rule expands and
simplifies Medicaid eligibility and promotes a simple,
seamless system of affordable coverage by coordinating
Medicaid and CHIP with the new Exchanges.
According to HHS, these proposed rules will offer consumers an
easy system to access whether they are eligible for the
Exchange, premium tax credits or other insurance affordability
programs without the need to submit multiple applications or
burdensome paperwork. In the weeks ahead, HHS and Treasury
Department are planning an outreach campaign and solicitation of
public comment on the three proposed rules from employers,
AB 1296
Page 6
consumers, state leaders, health care providers and insurers,
and the American people. In addition to accepting written
public comments for the next 75 days, the HHS will hold forums,
including in Sacramento.
The amendments to this bill reflect technical assistance and
other revisions suggested by the Secretary of CHHSA.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0002677