BILL ANALYSIS �
AB 50
Page 1
GOVERNOR'S VETO
AB 50 (Pan)
As Amended September 5, 2013
2/3 vote
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|ASSEMBLY: |54-24|(June 14, 2013) |SENATE: |33-5 |(September 9, |
| | | | | |2013) |
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|ASSEMBLY: |57-19|(September 10, | | | |
| | |2013) | | | |
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Original Committee Reference: HEALTH
SUMMARY : Expands full-scope Medi-Cal to cover pregnant women
with income between 59% and 100% of the federal poverty level
(FPL).
The Senate amendments delete the provisions of the bill as
passed by the Assembly and instead expand full-scope Medi-Cal
coverage to pregnant women with income between 59% and 100% FPL.
AS PASSED BY THE ASSEMBLY , this bill enacted provisions relating
to the federal Patient Protection and Affordable Care Act (ACA)
regarding presumptive eligibility by hospitals, enrollment in
Medi-Cal managed care plans, and the collection of demographic
data on the standardized application for state health subsidy
programs. This bill also contained an urgency clause to ensure
that the provisions of this bill go into immediate effect upon
enactment.
FISCAL EFFECT : According to the Senate Appropriations
Committee, based on the prior version of this bill:
1)Unknown costs to provide full-scope benefits to pregnant women
with household incomes between 60% and 100% of FPL [General
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Fund (GF) and federal funds]. Under current law and practice,
pregnant women with incomes from 59% to 100% of FPL are
eligible for Medi-Cal benefits limited to pregnancy-related
services. This bill would extend eligibility to include all
Medi-Cal benefits for this population. The Department of
Health Care Services (DHCS) has been unable to provide
information on the anticipated number of eligible women this
change would impact or the marginal increase in spending to
provide full-scope Medi-Cal benefits.
2)Likely one-time costs in the hundreds of thousands to low
millions to adopt regulations for various provisions of
current law implementing changes to the Medi-Cal program under
the ACA (GF and federal funds).
3)Likely one-time costs in the hundreds of thousands to develop
a new methodology for reimbursing county governments for their
costs to perform Medi-Cal eligibility determinations (GF and
federal funds).
4)One-time costs of $100,000 to $150,000 to modify Information
Technology (IT) systems to allow the health care coverage
application system for Medi-Cal and the California Health
Benefit Exchange (Exchange) to include required demographic
questions in the application (federal funds or special funds).
COMMENTS : According to the author, this bill is necessary for
enactment of provisions needed to implement the ACA, but had to
be deleted from the final versions of SB 1 X1(Ed Hernandez and
Steinberg), Chapter 4, Statutes of 2013-14 First Extraordinary
Session, and AB 1 X1 (John A. P�rez), Chapter 3, Statutes of
2013-14 First Extraordinary Session. The Exchange, now known as
Covered California, was established in 2010 by AB 1602 (John A.
P�rez), Chapter 655, Statutes of 2010, and SB 900 (Alquist),
Chapter 659, Statutes of 2010. Through the Exchange people with
incomes up to 400% FPL are eligible for advanced payment of
premium tax credits, subsidies, and cost sharing reductions,
depending on their income. The ACA also requires states to have
a single streamlined application for Exchange subsidies, their
Medicaid programs, and their Children's Health Insurance
Program. Covered California and DHCS are joint program sponsors
of the California Health and California Healthcare Eligibility,
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Enrollment, and Retention System (CalHEERS), which is the IT
system running both the online application for the Exchange,
Medi-Cal, and Access for Infants and Mothers program and also
the phone service center functions. The portal will offer
eligibility determinations for both Medi-Cal and federally
subsidized coverage through the Exchange. It will allow
enrollment through multiple access points including mail, phone,
and in-person applications. The CalHEERS business functions
include interfacing with the Medi-Cal eligibility data system.
It will also have the capacity to be a secure interface with
federal and state databases in order to obtain and verify
information necessary to determine eligibility.
On August 16, 2012, Governor Brown submitted a letter to the
President Pro Tempore of the Senate and the Speaker of the
Assembly informing them of his plan to call a Special Session in
the beginning of the next legislative session to continue the
work of implementing the ACA. On January 24, 2013, Governor
Brown issued a proclamation to convene the Legislature in
Extraordinary Session (also known as Special Session) to
consider and act upon legislation necessary to implement the ACA
in the areas of California's private health insurance market,
rules and regulations governing the individual and small group
market, California's Medi-Cal program, changes necessary to
implement federal law, and options that allow low-cost health
coverage through Covered California to be provided to
individuals who have income up to 200% of the FPL. AB 2 X1
(Pan), Chapter 1, Statutes of 2013-14 First Extraordinary
Session and SB 2 X1 (Ed Hernandez) Chapter 2, Statutes of
2013-14 First Extraordinary Session address the insurance market
reforms, and SB 3 X1 (Ed Hernandez) Chapter 5, Statutes of
2013-14 First Extraordinary Session addresses the option of
low-cost health coverage.
AB 1 X1 and SB 1 X1 implement provisions of the ACA regarding
Medi-Cal eligibility and program simplification including the
use of Modified Adjusted Gross Income and expansion of
eligibility in the Medi-Cal program to address the second of the
three areas identified in the Governor's Special Session
proclamation. At the time AB 1 X1 and SB1 X1 were heard in the
policy committees both bills provided full scope Medi-Cal
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coverage to pregnant women up to 200% FPL. In the meantime, the
Brown Administration proposed an alternative with regard to
women with income over 100% FPL who are eligible to purchase a
Qualified Health Plan (QHP) through the Exchange. As a result,
the provisions relating to pregnancy coverage were amended out
of AB1 X1 and SB1 X1 before they were sent to the Governor and
these provisions are now amended into this bill. This
alternative would have provided for all cost-sharing, including
premiums and co-payments to be paid by the Medi-Cal program and
for the benefits provided by the QHP to be supplemented with
Medi-Cal pregnancy-related benefits. However, agreement could
not be reached with stakeholders and the provisions relating to
the affordability wrap were deleted from this bill.
GOVERNOR'S VETO MESSAGE :
Assembly Bill 50 would provide "full-scope" health
care coverage for pregnant women between 60 and 100
percent of federal poverty level, during the first and
second trimesters of pregnancy, if they otherwise meet
Medi-Cal eligibility requirements. Currently, pregnant
women in this and higher income groups (up to 200
percent of the federal poverty level), receive all
medically necessary services related to their
pregnancy.
While I support this policy, I can't support this
bill.
Through the 2013 Budget Act and AB 1 and SB 1 in this
year's special session, we enacted a historic
expansion of our state's Medi-Cal program. Many
trade-offs were made in determining our ultimate
policy direction. Expanding coverage options for
pregnant women, however, remained unresolved.
Rather than enacting a piecemeal change, further
discussion should take place on the entire category of
pregnancy-only coverage, not just women between 60-100
percent of the federal poverty level.
The development of the 2014-15 budget is underway. I
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am directing the Department of Health Care Services to
work on a more complete proposal for January.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0002894