BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 970
AUTHOR: De León
AMENDED: April 9, 2012
HEARING DATE: April 11, 2012
CONSULTANT: Bain
SUBJECT : Health Care Reform Eligibility, Enrollment, and
Retention Planning Act: coordination with other programs.
SUMMARY : Allows individuals to have application information
from the single state application for health subsidy programs to
be provided to county human service departments to initiate a
simultaneous application for the California Work Opportunity and
Responsibility to Kids (CalWORKs) and CalFresh programs.
Requires a county human services department to take information
used to renew a beneficiary's eligibility for a state health
subsidy program and use that information to continue or
recertify CalWORKs or CalFresh benefits for all eligible
individuals, if the beneficiary consents. Requires county human
services agencies to identify CalFresh recipients who are not
currently enrolled in a state health subsidy program and to
enroll such recipients into state health subsidy programs, if
the recipient consents.
Existing law:
1.Requires the California Health Benefit Exchange (Exchange) to
inform individuals of eligibility requirements for the
Medi-Cal program, the Healthy Families Program, or any
applicable state or local public program. Requires, through
screening of the application for coverage by the Exchange, if
the Exchange determines that an individual is eligible for any
such program, the Exchange to enroll that individual in the
program.
2.Requires, under the Health Care Reform Eligibility,
Enrollment, and Retention Planning Act, the California Health
and Human Services Agency (Agency), in consultation with the
Department of Health Care Services (DHCS), the Managed Risk
Medical Insurance Board (MRMIB), the Exchange, the California
Office of Systems Integration, counties, health plans,
consumer advocates, and other stakeholders to undertake a
planning and development process regarding the federal Patient
Protection and Affordable Care Act (ACA) related to
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eligibility for, and enrollment and retention in, state health
subsidy programs.
3.Requires DHCS, in consultation with MRMIB and the Exchange, to
develop a single, accessible, standardized paper, electronic,
and telephone application for state health subsidy programs as
part of the stakeholder process in 2) above. Requires the
application to be used by all entities authorized to make an
eligibility determination for any of the state health subsidy
programs, and by their agents.
This bill:
1.Requires, at the time of initial application for or renewal of
health care coverage using the single state application
required under existing law, that an individual be allowed to
consent to have his or her application information used by the
appropriate county human services department to initiate a
simultaneous application for CalWORKs and CalFresh, and by
other state or local departments for other human services or
work support programs identified by the workgroup established
by this bill.
2.Requires a county human services department, with a
beneficiary's consent, to take information used to renew a
beneficiary's eligibility for a state health subsidy program
and use that information to continue or recertify CalWORKs or
CalFresh benefits for all eligible individuals, if the
information is sufficient to meet the requirements for a
CalWORKs or CalFresh semiannual report or annual
recertification.
3.Requires Agency to convene a workgroup of human services and
health care advocates, legislative staff, representatives of
county human services departments and county eligibility
workers, and staff from appropriate state and local
departments, to consider and develop a plan for the
integration of additional human services and work support
programs into the process described in 1) above.
4.Requires the above requirements to be implemented by December
31, 2015.
5.Requires, by October 1, 2013, a county human services agency
to do all of the following, using data to which the agency has
access:
a. Identify nonassistance CalFresh recipients who are
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not currently enrolled in a state health subsidy program;
b. Inform the recipients not currently enrolled in a
state health subsidy program of the requirement to be
enrolled in health coverage under the ACA, and of their
right to, and likely eligibility for, free or low-cost
health coverage; and
c. Enroll such recipients into the state health subsidy
program for which he or she is eligible, beginning on the
earliest date that the recipient is eligible, with a
recipient's consent, if information in his or her
CalFresh case file is sufficient to establish eligibility
for health care coverage.
6.Requires a county, for a CalFresh recipient identified
pursuant to 5) above who cannot be enrolled into a state
health subsidy program based upon the information available
within the case file, to make every reasonable effort to
contact the CalFresh recipient to obtain the information
needed to enroll the recipient in a state health subsidy
program. Requires the information shared under this provision
to be used exclusively for the purposes specified in this
provision.
7.Requires DHCS, in conjunction with counties, the Department of
Social Services, and representatives of the Statewide
Automated Welfare System (SAWS) consortia, county eligibility
workers, consumers, and other affected stakeholder groups, to
conduct a planning process and develop administrative
enrollment and renewal policies and procedures, which DHCS is
required to implement by means of all-county letters or
similar instructions from the director.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, SB 970 has two
goals: (1) to allow consumers applying for health coverage
through the new streamlined California Healthcare Eligibility,
Enrollment and Retention System (CalHEERS is an information
technology system) to also apply for human services programs,
so they can receive needed public benefits; and (2) to
maximize enrollment in health coverage by 2014 by identifying
CalFresh recipients who are uninsured and, with their consent,
using their CalFresh information to apply for health coverage.
Integrating human services programs into CalHEERS increases
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administrative efficiency and streamlines the application and
renewal processes for consumers. The benefits of maximizing
health coverage enrollment are several. Californians will be
required by law to have health coverage in 2014 and coverage
for the newly eligible will be paid for with 100 percent
federal funds from 2014-2016, going to a still-high 90 percent
federal match by 2020. Multiple strategies are needed to
maximize health coverage enrollment including "pre-enrollment"
of eligible populations such as CalFresh recipients.
Additional strategies to reach those eligible for CalFresh
benefits (a 100 percent federally financed benefit) are also
needed given California's low participation level.
2.The ACA, enrollment application process, and SB 970 proposed
changes. The ACA makes numerous changes to increase the number
of individuals with health coverage. These changes include
requiring a single streamlined form for state health subsidy
programs, and by allowing individuals to be able to apply in
person, by mail, through the internet, or by telephone.
California, through the Exchange, has issued a request for
proposal (RFP) to implement a new information technology
system known as CalHEERS. CalHEERS will provide a
"one-stop-shop" to determine eligibility for non-subsidized
health coverage for individuals in the Exchange, and
subsidized coverage for individuals eligible for state health
subsidy programs. The Exchange RFP for CalHEERS calls for
vendors to provide the ability to notify the applicant that he
or she may be eligible for other state programs (for example,
CalWORKs and CalFresh), that would direct the individual to
the appropriate links, and collect and send the basic
application data (along with any documents provided by the
applicant) to the system of record for that program to
complete the application process. The Exchange asked vendors
to have the ability to provide this expanded system by
December 31, 2015, but the Exchange has a not made a decision
on whether it wishes to purchase these additional services
(known as a "state option to buy"). Vendor submissions to the
Exchange were submitted earlier this year, and the bids are
not public information. Vendor selection is anticipated for
late April or early May 2012. Once the contract has been
awarded, the contract and the dollar amounts will be made
public.
The current application process for Medi-Cal is primarily
through county human services departments, where individuals
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can apply either in person, through the mail, or online. In
addition, individuals can also apply (through the county) for
enrollment in human services programs such as CalWORKs or
CalFresh (previously known as Food Stamps) using the same
application, but those programs have additional requirements
that Medi-Cal does not.
3.Prior legislation. AB 1296 (Bonilla), Chapter 641, Statutes of
2011, the Health Care Eligibility, Enrollment, and Retention
Act, requires the Agency, in consultation with other state
departments and stakeholders, to undertake a planning process
to develop plans and procedures regarding these provisions
relating to enrollment in state health programs and federal
law. AB 1296 also requires that an individual would have the
option to apply for state health programs through a variety of
means.
4.Support. This bill is sponsored by the Western Center on Law
and Poverty (WCLP) to allow people applying for health
coverage online to use their information to start an
application for public programs such as CalFresh and CalWORKs
and, with their consent, would enroll uninsured CalFresh
recipients into health coverage. This bill would also require
the new single state application and the CalHEERS system to
horizontally integrate public benefits by allowing people
applying for health coverage through CalHEERS to also start an
application for public benefit programs including CalFresh,
CalWORKs and other programs determined by a workgroup to
ensure that California continues the obligation to provide
Californians with the benefits for which they are eligible.
WCLP states that when someone walks into a county office today
or logs onto the internet to apply for one public program,
they have the option of applying for multiple programs.
Allowing consumers who apply for health coverage through
CalHEERS to initiate applications for human service and work
support programs is needed to ensure the state does not move
backward in providing integrated services to low-income
Californians. Beyond integrating the application, WCLP states
this bill also better integrates renewal processes between
health and public programs by requiring that, if the health
program renewal form has the necessary information to renew
eligibility for CalWORKs or CalFresh, that it be used to
satisfy the renewal requirement for that program, thereby
reducing administrative workload and streamlining the process
for consumers. In addition to linking health coverage
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applicants to public program benefits, this bill would go the
other way as well, by requiring county human services
departments, with a beneficiary's consent, to use the
information in their CalFresh case file to file an application
for health coverage. This will help Californians get the
health coverage they need through the Medi-Cal expansion and
subsidies in the Exchange and comply with the requirement on
January 1, 2014 to have health insurance.
Finally, WCLP states federal funds are available through
December 31, 2015 to build the new required health coverage
enrollment system (100 percent federal funds for the Exchange
and 90 percent federal funds for the Medi-Cal), and can be
used for a system that integrates public programs as well.
This bill requires that the public program integration be
completed within that timeframe.
5.Proposed amendment. This bill requires a county human services
department, with a beneficiary's consent, to take information
used to renew a beneficiary's eligibility for a state health
subsidy program and use that information to continue or
recertify CalWORKs or CalFresh benefits for all eligible
individuals, if the information is sufficient to meet the
requirements for a CalWORKs or CalFresh semiannual report or
annual recertification. In discussions between Department of
Social Services staff, legislative staff, the County Welfare
Directors Association of California, and the sponsor, one of
the issues raised was whether this provision of the bill
required or allowed eligibility redeterminations for CalFresh
to be done early (for example, in conjunction with a Medi-Cal
eligibility redetermination) when the required CalFresh
recertification and Medi-Cal renewal dates do not fall on the
same month, which would entail shortening the duration of
eligibility for CalFresh and was not the intent of the
proposed language. The author has proposed amendment language
to clarify that this bill is not to be construed to allow or
require the shortening of a CalFresh annual certification
period.
6.Recommended amendments.
a. Administrative and enrollment policies. This bill
requires DHCS, in conjunction with counties, the
Department of Social Services, and representatives of the
SAWS consortia, county eligibility workers, consumers,
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and other affected stakeholder groups, to conduct a
planning process and develop administrative enrollment
and renewal policies and procedures, which DHCS is
required to implement by means of all-county letters or
similar instructions from the director. Committee staff
recommends an amendment to this provision to have DHCS
develop administrative and enrollment policies in
consultation with affected stakeholders, as the existing
language could be read as requiring DHCS to reach an
agreement with the listed stakeholders on the
administrative and enrollment policies, which may not be
possible.
b. Use of provider bulletins instead of regulations.
This bill allows DHCS to implement administrative
enrollment and renewal policies and procedures without
taking regulatory action by means of all-county letters
or similar instructions. While the Legislature has
authorized this exemption from the rule-making provisions
of the Administrative Procedure Act (APA) when urgent
action is needed to immediately implement budget savings
proposals or for ease of program implementation, the
requirements set forth in the APA are designed to provide
the public with a meaningful opportunity to participate
in the adoption of state regulations and to ensure that
regulations are clear, necessary and legally valid and
broadly available to the public. Committee staff
recommends an amendment to this provision to initially
allow its provisions to be adopted by all-county letters
or similar instructions but to require the adoption of a
regulation by a date certain following the effective date
of this bill.
SUPPORT AND OPPOSITION :
Support: Western Center on Law and Poverty (sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
California Association of Food Banks
California Catholic Conference
California Center for Rural Policy, Humboldt State
University
California Commission on Aging
California Communities United Institute
California Coverage and Health Initiatives
California Family Resource Association
California Hunger Action Coalition
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California Immigrant Policy Center
California Pan-Ethnic Health Network
California Partnership to End Domestic Violence
California State Association of Counties
California WIC Association
Catholic Charities of California United
Children Now
Children's Defense Fund-California
The Children's Partnership
Coalition of California Welfare Rights Organizations,
Inc.
Community Clinic Association of Los Angeles County
Consumer Federation of California
County Welfare Directors Association
The Greenlining Institute
Having Our Say
Health Access California
Latino Coalition for a Health California
National Association of Social Workers, California
Chapter
National Health Law Program
River City Food Bank
San Francisco Food Security Task Force
Santa Clara County Board of Supervisors
United Ways of California
Oppose: None received.
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