BILL ANALYSIS Ó
SB 970
Page 1
SENATE THIRD READING
SB 970 (De León)
As Amended August 20, 2012
Majority vote
SENATE VOTE :31-5
HEALTH 13-6 APPROPRIATIONS 12-5
-----------------------------------------------------------------
|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Gatto, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, |
| |Hayashi, | |Charles Calderon, Campos, |
| |Roger Hernández, Bonnie | |Davis, Fuentes, Hall, |
| |Lowenthal, Mitchell, Pan, | |Hill, Cedillo, Mitchell, |
| |V. Manuel Pérez, Williams | |Solorio |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Nestande, Silva, Smyth | |Nielsen, Norby, Wagner |
| | | | |
-----------------------------------------------------------------
SUMMARY : Authorizes, upon consent of the applicant, information
provided for the single state application for health subsidy
programs to be used to initiate a simultaneous application for the
California Work Opportunity and Responsibility to Kids (CalWORKs)
or the CalFresh programs. Specifically, this bill :
1)Provides that at the time a person applies for or renews health
coverage using the single state application, the person may also
consent to have the application information used by the county
human services department to initiate an application for
CalWORKs and CalFresh programs and requires the information to
be transmitted to the applicable county human services
department.
2)Requires the California Health and Human Services Agency (CHHSA)
to convene a work group of stakeholders, as specified, including
advocates, legislative staff, and staff from state and county
departments and agencies to consider the feasibility, costs and
benefits of integrating application and renewal process for
additional human services and work support programs with the
single state application for health subsidy programs and
requires CHHSA to provide information regarding the workgroup to
the appropriate fiscal and policy committees of the Legislature
SB 970
Page 2
by July 1, 2013.
3)Requires the functionality needed to implement 1) above to be
achieved no later than the expiration of a specified federal
waiver requiring states to evenly allocate the development costs
for systems that are federally funded and will be used to
determine eligibility for multiple programs.
4)Authorizes the Secretary of CHHSA to phase in implementation or
to entirely cease implementation, upon reporting a
recommendation to the Legislature, holding a public hearing, and
filing a declaration, if it is determined that implementation of
this bill would prevent timely implementation of the single
standardized application for state health subsidy programs.
5)Provides for this bill to become inoperative upon the filing of
the declaration pursuant to 4) above.
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 (HFP), or any applicable
state or local health care coverage program.
2)Requires, through screening of the application for coverage by
the Exchange, if the Exchange determines that an individual is
eligible for any such program, to enroll that individual in the
program.
3)Requires, under federal law, by January 2014, state enrollment
systems for persons eligible for health subsidy programs to
utilize a single streamlined application for Medi-Cal, HFP,
subsidized coverage through the Exchange, California Access for
Infants and Mothers Program (AIM) and the Basic Health Plan
(BHP) (if enacted).
4)Requires the Department of Health Care Services (DHCS), in
consultation with Managed Risk Medical Insurance Board (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. Requires
the application to be used by all entities authorized to make an
eligibility determination for any of the state health subsidy
SB 970
Page 3
programs, and by their agents.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs to CHHSA in the range of $50,000 to $200,000,
depending on the level of technical detail addressed and staff
support provided, to convene a planning workgroup to address
further integration of human services programs.
2)Information Technology (IT) costs of $1.8 million (a combination
of Temporary Assistance for Needy Families/maintenance of effort
(TANF/MOE), for costs attributed to CalWORKs and 50% federal,
50% General Fund (GF), for costs attributed to CalFresh) to
develop functionality that would satisfy the bill's
requirements. This bill requires an augmentation to a system
that has been commissioned by the California Health Benefit
Exchange (Exchange) and is now being designed and built.
3)Increases in CalWORKs grant costs, if individuals who would not
otherwise enroll in CalWORKs enroll as a result of data-sharing
protocols established by this bill. For every 35 families who
receive CalWORKs as a result of this bill, it would increase
costs by approximately $1 million (TANF/MOE) per year.
4)If this bill causes a 1% increase in non-assistance CalFresh
participation, it would bring in an additional $66 million
annually in 100% federally funded CalFresh benefits. Those
cases would cost approximately $2.5 million (50% GF, 50%
federal) to administer. However, those administrative costs are
estimated to be offset by an additional $1.8 million in state
sales tax revenue.
COMMENTS : According to the author, the goal of this bill is to
allow consumers applying for health coverage through the new
streamlined California Healthcare Eligibility, Enrollment and
Retention System (CalHEERS) to also apply for human services
programs, so they can receive needed public benefits. The author
argues that integrating human services programs into CalHEERS
increases administrative efficiency and streamlines the
application and renewal processes for consumers. The author
further states that additional strategies to reach those eligible
for CalFresh benefits (a 100% federally financed benefit) are
needed given California's low participation level.
SB 970
Page 4
Under the federal Patient Protection and Affordable Care Act of
2010 (Public Law 111-48) as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152) (ACA),
states must have a seamless, "no wrong door" system for
determining eligibility for and enrolling people into state health
subsidy programs. These include Medi-Cal, HFP, the Exchange, AIM,
and BHP (if enacted). Pursuant to this mandate, California must
implement a series of procedures that simplify enrollment into
Medi-Cal and HFP and coordinate with the Exchange. Under the ACA
and proposed federal guidelines, applicants will initially be
screened for eligibility under a new simplified Modified Adjusted
Gross Income (MAGI) standard without regard to the amount of
assets the family or individual owns. Individuals who do not meet
the MAGI income eligibility criteria will be further screened for
eligibility under the Medi-Cal aged, blind, or disabled category
or for a premium subsidy to purchase insurance through the
Exchange. Additional enrollment simplification and coordination
procedures include utilizing a single, streamlined application
form; establishing a Web site that permits individuals to apply
to, enroll in, and renew enrollment in Medi-Cal; to consent to
enrollment or reenrollment in coverage through electronic
signatures; ensuring that individuals who seek coverage through
Medi-Cal, HFP, or the Exchange are concurrently screened for
eligibility for all three options (including Exchange coverage
subsidies and the Basic Health Program, if enacted) and are
referred to the appropriate program for enrollment without having
to submit additional or separate applications for each program.
On May 31, 2012, the Exchange, in collaboration with DHCS and
MRMIB announced its intent to award a contract to Accenture LLC to
develop the Information Technology functions for this new
web-based system, referred to as CalHEERS, which will include the
design and scope of the new single point of eligibility for
individuals seeking subsidized coverage that will be launched
October 2013. CalHEERS will also offer a way for individuals who
are not eligible for subsidies to comparison shop and find the
best health plan for them. Small business owners and their
employees will be able to choose a plan through the Small Employer
Health Options Program. Under new, streamlined eligibility rules,
CalHEERS will make it easier for most individuals to obtain
Medi-Cal coverage and will serve as the enrollment portal for the
HFP. Some applicants who are eligible for Medi-Cal may still have
their eligibility determined and be enrolled by the counties. As
part of the development process, vendors had been directed to
include the capability for the system to be able to take
SB 970
Page 5
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.
Federal funds are available through December 31, 2015, to build
the new required health coverage enrollment system (100% federal
funds for the Exchange and 90% federal funds for 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.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097
FN: 0005086