BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1517|
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THIRD READING
Bill No: SB 1517
Author: Wolk (D)
Amended: 5/29/12
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/18/12
AYES: Hernandez, Harman, Alquist, Anderson, Blakeslee, De
Le�n, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/24/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
SUBJECT : County medical service program: fees
SOURCE : County Medical Services Program Governing Board
DIGEST : This bill requires County Medical Services
Program (CMSP) participation fees paid by counties to be
paid each fiscal year to the CMSP Governing Board to be
made in 10 equal payments (instead of 12 equal payments)
during the fiscal year, or as otherwise specified by the
CMSP Governing Board.
ANALYSIS :
Existing law:
1. Authorizes counties with a population of less than
300,000 in the 1990 census or that contracted with the
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Department of Health Services (now the Department of
Health Care Services (DHCS)) during the 1990-91 fiscal
year under a specified provision of law to elect to
participate in the CMSP, for the purpose of providing
health services to eligible county residents. Counties
that elect to participate in the program may establish a
CMSP Governing Board, and the Governing Board is
required to administer the CMSP.
2. Allows the Department of Finance (DOF) to authorize a
loan of up to $30 million for deposit into the CMSP
account to ensure that there are sufficient funds
available to reimburse providers and counties under
CMSP.
3. Requires CMSP participation fees paid by counties to be
paid each fiscal year, as a condition of participating
in CMSP to the CMSP Governing Board in 12 equal monthly
payments, or as otherwise specified by the CMSP
Governing Board.
4. Requires DHCS, pursuant to federal approval of a
demonstration project, to authorize local Low Income
Health Programs (LIHPs) to provide health care services
to eligible low-income individuals under certain
circumstances. LIHPs are established at local option,
and are authorized to cover individuals up to 200% of
the federal poverty level (FPL) (200% of the FPL is at
or below $22,340 for an individual in 2012). LIHPs are
in effect until December 31, 2013, and no state General
Fund moneys can be used to fund LIHP services or any
related local administrative costs.
This bill requires CMSP participation fees paid by counties
to be paid each fiscal year to the CMSP Governing Board to
be made in 10 equal payments (instead of 12 equal payments)
during the fiscal year, or as otherwise specified by the
CMSP Governing Board.
Background
CMSP was established in 1983, after the Legislature
transferred responsibility for providing health services to
low-income adults, referred to as medically indigent adults
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(MIAs) from the state Medi-Cal program to the counties.
There are currently 34 primarily rural counties electing to
provide for care of the MIAs through CMSP that are
principally located in the northern and eastern portions of
California. CMSP provides medical care services to
indigent adults ages 18 to 64, with incomes at or below 200
percent of the FPL (at or below $22,340 for an individual
in 2012) who are not eligible for Medi-Cal and who are
county residents. Individuals with incomes above 67% of
the FPL up to 200% of the FPL (between $7,484 and $22,340
for an individual in 2012) have a share of cost before CMSP
coverage begins. Individuals with incomes below 67% of the
FPL do not have a share of cost. Emergency services are
provided when the person's immigration status is not known.
The average monthly enrollment in CMSP at the end of 2011
was approximately 62,000 individuals. The CMSP Governing
Board, established through existing law, has responsibility
for setting program eligibility standards, defining the
scope of covered health care benefits, and determining
payment rates for health care providers delivering
emergency and non-emergency services to CMSP members. For
2011-12, CMSP assumed expenditures of $363 million,
revenues of $247 million and a beginning year fund balance
of $138 million.
In January 2012, the Governing Board established
"Path2Health," an LIHP for the 34 counties in CMSP. On
July 1, 2012, Yolo County will join CMSP and participate in
both CMSP and Path2Health. As an LIHP, Path2Health
provides broader coverage than the prior CMSP benefit
package and eliminates CMSP eligibility restrictions,
specifically, the asset test and the share-of-cost
requirement for individuals with incomes between 67 and
100% of the FPL. Path2Health also provides expanded mental
health and substance abuse counseling benefits that were
not previously covered by CMSP. Projected enrollment in
Path2Health and CMSP as a result of the eligibility changes
and enhanced awareness and outreach is projected to
increase by 28,000, for total combined enrollment of
approximately 89,000 by the end of 2013.
LIHPs are established at county option, and services
provided through LIHPs are not an entitlement. LIHPs are
authorized to cover low-income individuals 19 to 64 years
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of age, who are not pregnant, with family incomes at or
below 200% of the FPL (at or below $22,340 for an
individual in 2012), who are not eligible for the Medicare
Program, the Medi-Cal program, the Healthy Families
Program, or other third-party coverage, have satisfactory
immigration status, and meet county of residence
requirements. Each LIHP can establish an upper income limit
for eligible individuals, and can limit enrollment, subject
to specified conditions, including state approval. The
state match used to draw down federal Medicaid funds for
LIHPs comes from local funds. Existing law prohibits state
General Fund moneys from being used to fund LIHP services
or any related administrative costs incurred by counties.
As of January 2012, total statewide LIHP enrollment was
321,825 individuals.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
According to the Senate Appropriations Committee, minor
costs to program participants (Local Fund).
SUPPORT : (Verified 5/29/12)
County Medical Services Program Governing Board (source)
ARGUMENTS IN SUPPORT : This bill is sponsored by the CMSP
Governing Board to make two changes. First, this bill
codifies the current Governing Board practice of requiring
fees to the CMSP Governing Board to be made in 10 equal
payments. Second, this bill helps the CMSP Governing Board
address cash flow needs associated with Path2Health and
CMSP so that timely payments can be made to health care
providers for services provided to indigent adults under
those two programs. The sponsor states federal Medicaid
matching funds for the LIHP and the cycle of payments under
realignment provide revenues to CMSP five to eight months
after expenditures are made. In the absence of this loan
authority, the sponsor states the Governing Board will be
required to seek loan financing solely through the
commercial financial markets, which will be time consuming
and potentially quite costly, depending on the financial
instruments that are utilized.
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CTW:mw 5/29/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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