BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 970 (De Leon) - Health care reform eligibility and enrollment
Amended: April 17, 2012 Policy Vote: Health 8-0
Urgency: No Mandate: Yes
Hearing Date: May 24, 2012 Consultant: Brendan McCarthy
SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Bill Summary: SB 970 would require the state's new single
application for health subsidy programs (being developed
pursuant to the Affordable Care Act) to interface with
eligibility and enrollment systems used by county social service
programs. The bill would require county social service programs
to identify CalFresh participants that are eligible for Medi-Cal
but not enrolled, and enroll them in Medi-Cal.
Fiscal Impact:
Unknown costs to convene a workgroup and develop a plan to
integrate social service program eligibility and enrollment
systems into the single application (mostly federal funds).
Increased costs, up to $300 million per year (50% General
Fund, 50% federal funds) due to enrollment in Medi-Cal by
eligible CalFresh participants.
Background: Current law requires the Department of Health Care
Services and the California Health Benefit Exchange to develop a
single state application for people who wish to apply for state
health subsidy programs (including subsidized health coverage
purchased through the Exchange). The system will be designed to
allow applicants to apply in person at county social service
offices, over the phone, or on the internet. Applicants who are
eligible for state health subsidy programs, such as Medi-Cal,
are required to be enrolled in those programs through the single
state application.
The Exchange is in the process of evaluating vendor proposals
for the development of the single state application, known as
the California Healthcare Eligibility, Enrollment and Retention
System (CalHEERS). As part of the development process, vendors
have been directed to include the capability for the system to
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be able to take application information and pass that along to
county social service agencies, so that they may use it to
determine eligibility for social service programs, such as
CalWorks or CalFresh. In addition, some applicants who are
eligible for Medi-Cal will still need to have their eligibility
determined and be enrolled by the counties.
Proposed Law: SB 970 would require information provided to
CalHEERS to be forwarded to county human service departments to
determine whether the applicant is eligible for CalWorks and
CalFresh. The bill would require counties to use the information
forwarded from the single state application to determine
eligibility for those programs.
The bill would require the Health and Human Services Agency to
convene a workgroup of interested stakeholders to integrate
social service programs into the single state application
process.
The bill would require counties to attempt to determine whether
CalFresh program participants are eligible, but not enrolled, in
Medi-Cal and to enroll them if appropriate.
Related Legislation: AB 1296 (Bonnilla) Chapter 641 of 2011
requires the Health and Human Services Agency to develop a
process for individuals to enroll in state health subsidy
programs, and requires that the process allow applicants to
apply through a variety of means.
Staff Comments: The Exchange is currently reviewing bids from
vendors for the development of the CalHEERS system. At this
time, the total cost to develop the system and the specific cost
to allow the system to share information with county social
service departments is unknown. The Exchange intends to select a
vendor sometime in late April or early May of 2012.
Under current law and practice, county social service
departments use one of three information technology systems to
perform eligibility determinations, enrollment in Medi-Cal,
CalFresh and CalWorks, and case management. To date, those the
counties have received federal financial participation through
each of those programs for the development and maintenance of
those systems. Recently, however, the federal Centers for
Medicare and Medicaid Services indicated that in the future,
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funding from Medi-Cal would no longer be available to support
those systems.
There are a significant number of people in the state who are
eligible for Medi-Cal, but not enrolled in the program. By one
estimate, there may be more than 300,000 such CalFresh
participants. Because the bill would require counties to attempt
to enroll all CalFresh participants who are eligible for
Medi-Cal into the program, the bill could increase Medi-Cal
costs substantially. The extent to which this population will be
enrolled in Medi-Cal is unknown. If 50% of the eligible
population were ultimately enrolled in Medi-Cal, the total
annual costs could be up to $300 million per year (50% General
Fund and 50% federal funds). In addition, because the bill
mandates that county social service offices attempt to identify
and enroll those CalFresh participants in Medi-Cal, the bill
imposes a reimbursable mandate on the counties, and the state
may be liable for reimbursing the counties' administrative
costs.
Proposed Author Amendments: Specify that the bill's provisions
shall only be implemented to the extent that they do not delay
the development of the single application for health programs.