BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 2325 (J. Pérez) - Medi-Cal: CommuniCal.
Amended: June 12, 2014 Policy Vote: Health 6-2
Urgency: No Mandate: No
Hearing Date: August 4, 2014
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 2325 would require the Department of Health
Care Services to establish a program to provide for and
reimburse for medical interpretation services provided to
Medi-Cal enrollees with limited English proficiency. The bill
would grant collective bargaining rights to interpreters
providing services through the program.
Fiscal Impact:
One-time costs of $1.4 million to develop program
guidelines, seek necessary federal approvals, and develop
billing systems (50% General Fund, 50% federal funds).
One-time costs of about $50,000 to develop regulations
relating to collective bargaining of translators by the
Public Employment Relations Board (General Fund).
One-time costs of about $90,000 and ongoing costs of about
$50,000 per year to oversee an election by translators to
choose a collective bargaining agent by the Public
Employment Relations Board (General Fund).
Periodic costs up to $1 million for negotiating a
memorandum of understanding with the established bargaining
unit and overseeing the implementation by the Department of
Human Resources (General Fund).
Ongoing costs of about $37 million per year to provide
translation services in fee-for-service Medi-Cal, based on
estimates of the existing Medi-Cal fee-for-service
population with limited English proficiency (General Fund
and federal funds).
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Unknown costs in Medi-Cal managed care (General Fund and
federal funds). Under current law, health plans are required
to provide interpretation services, including managed care
plans that contract with the Department of Health Care
Services. It is unclear whether the bill's requirement to
provide "certified medical interpretation services" at
reimbursement rates subject to collective bargaining would
increase costs for translation services, above the costs
already being incurred. Similarly, the bill requires
in-person translation to be the preferred method of
communication in many instances. Under current practice,
many providers in the managed care system make use of
telephone interpretation services. To the extent that
providers switch to in-person translation services, costs
are likely to increase.
The federal financial participation rate for the costs
above may vary. Generally, the federal government pays for
50% of Medi-Cal costs. However, the federal government pays
an increase reimbursement rate the former Health Families
population is 65%. Finally, for the Medi-Cal expansion
population, the federal government pays 100% of the cost,
declining to 90% by 2020. (Federal law allows for a 75%
match for certain costs of interpretation that are
considered administrative costs. However, the Department
indicates that the provision of interpretation services
under the bill would be considered Medi-Cal benefits and
would be subject to the normal federal match.)
Background: Under state and federal law, the Department of
Health Care Services operates the Medi-Cal program, which
provides health care coverage to pregnant women, children and
their parents with low incomes, as well as blind, disabled, and
certain other populations. Pursuant to the federal Affordable
Care Act, California has opted to expand eligibility for
Medi-Cal up to 138 percent of the federal poverty level and to
include childless adults.
With the exception of certain populations (for example,
individuals eligible for limited scope Medi-Cal benefits or
individuals dually eligible for Medi-Cal and Medicare in most
counties), managed care is the primary system for providing
Medi-Cal benefits. The Department estimates that in 2014-15, 7.5
million Medi-Cal beneficiaries (73 percent of total enrollment)
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will receive care through the managed care system.
The federal Civil Rights Act of 1964 and implementing
regulations prohibit the discrimination against any person based
on race, color, or national origin by entities that receive
federal assistance. The federal Office for Civil Rights enforces
these requirements and has indicated through guidance that
entities receiving federal funding may be required to provide
access to translation services for limited English-speaking
program beneficiaries.
Current state law requires all licensed managed care plans to
provide interpretation services to enrollees who are limited
English proficient. Current law also requires all licensed
managed care plans to provide translation services based on the
concentration of non-English speaking enrollees. These
requirement apply to Medi-Cal managed care plans, but allow the
regulatory agencies to deem Medi-Cal managed care plans in
compliance if they meet more stringent requirements through
contractual requirements.
Despite these requirements in law, there are indications that
not all Medi-Cal beneficiaries are receiving care in a
linguistically appropriate manner. According to the California
Health Interview Survey, about 8% of adults in Medi-Cal had
difficulty understanding their doctor or required another person
to help them understand their doctor. Similarly, about 7% of the
parents of children enrolled in Medi-Cal had difficulty
understanding their doctor or needed another person to help them
understand their doctor.
Proposed Law: AB 2325 would require the Department of Health
Care Services to establish a program to provide for and
reimburse for medical interpretation services provided to
Medi-Cal enrollees with limited English proficiency. The bill
would grant interpreters providing services through the program
with collective bargaining rights.
Major provisions of the bill would:
Require the Department of Health Care Services to establish
the "CommuniCal" program for interpretation services to
Medi-Cal beneficiaries;
Permit Medi-Cal health care providers, in both
fee-for-service and managed care, to use CommuniCal;
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Require CommuniCal to be administered by an independent
broker;
Require participating interpreters to be certified by the
Department;
Require certified interpreters to have specified
qualifications;
Grant CommuniCal interpreters the right to be represented
by a labor organization, which would be responsible for
state-wide collective bargaining for the interpreters;
Provide the procedures under which interpreters may select
a labor organization and the responsibilities of the
Department of Human Resources and the Public Employment
Relations Board in bargaining with such a labor
organization.
Related Legislation: AB 1263 (J. Perez , 2013) and AB 2392 (J.
Perez, 2012) were substantially similar to this bill. AB 1263
was vetoed by Governor Brown and AB 2392 was moved to the
Assembly Inactive File on concurrence in Senate amendments.
Staff Comments: The availability of enhanced federal financial
participation for translation services indicates that there may
be opportunities to improve access to care for non-English
proficient Medi-Cal beneficiaries at a reduced cost to the
state. On the other hand, it is not clear whether the program to
provide certified translation services, as required under the
bill, would be a more economical method of providing translation
services than the current methods used by health care providers.
If a centralized system managed by the Department is more costly
than the methods currently in use, cost savings may be minimal.
Improving translation services for people with limited English
proficiency would likely have mixed impacts on Medi-Cal costs.
By improving enrollees' ability to communicate with providers,
the bill is likely to enable enrollees to more easily access
care, increasing utilization and costs. On the other hand,
better communication between a patient and a provider may
improve the patient and the provider's ability to manage the
patient's health, potentially reducing long-term costs.
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