BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 18
Author: Leno (D) and Hernandez (D)
Amended: 8/18/14
Vote: 21
PRIOR VOTES NOT RELEVANT
SENATE HEALTH COMMITTEE : 6-2, 8/27/14 (Pursuant to Senate Rule
29.10)
AYES: Hernandez, Beall, DeSaulnier, Evans, Monning, Wolk
NOES: Morrell, Nielsen
NO VOTE RECORDED: De Le�n
ASSEMBLY FLOOR : 55-21, 8/20/14 - See last page for vote
SUBJECT : Medi-Cal renewal
SOURCE : Health Access California
Western Center on Law and Poverty
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to accept contributions by private foundations
in the amount of at least $6 million for the purposes of
providing Medi-Cal renewal assistance payments, starting January
1, 2015. This bill also requires DHCS, in collaboration with
the County Welfare Directors Association and legal services
organizations to develop renewal assistance training for
community-based organizations.
Assembly Amendments delete the Senate version of this bill
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relating to California Health Benefits Review Program and
instead add the current language.
ANALYSIS : Existing law authorizes DHCS to accept
contributions by private foundations in the amount of at least
$26.5 million, and to obtain an equal amount of federal matching
funds, to support and fund Medi-Cal outreach and enrollment
activities, as well as payments for in-person Medi-Cal
enrollment assistance.
This bill:
1. Appropriates to DHCS the sum of $6,000,000 from the
Healthcare Outreach and Medi-Cal Enrollment Account, to be
available for encumbrance or expenditure until December 31,
2016, and the sum of $6,000,000 from the Federal Trust Fund,
to be available for encumbrance or expenditure until December
31, 2016.
2. Authorizes DHCS to make allocations from the contributions
to fund Medi-Cal renewal assistance activities, and requires
funding allocation to be used only for Medi-Cal renewal
assistance activities, and prohibits the funds from
supplanting existing local, state, and foundation funding of
any county renewal assistance activities.
3. Requires DHCS to seek federal matching funds for the
contributions to the extent permissible for training,
testing, certifying, supporting, and compensating persons and
entities providing renewal assistance, and for any other
permissible renewal assistance-related activities.
4. Requires DHCS to seek all necessary federal approvals for
purposes of obtaining the federal funding, and that, to the
extent federal funding is received, reimbursements for costs
incurred under the approved allocations be made in compliance
with federal law.
5. Requires payments for renewal assistance to be distributed
to community-based organizations providing renewal assistance
to Medi-Cal beneficiaries. Requires DHCS to make authorized
payments to counties for distribution of funds to
community-based organizations, and authorizes counties to
retain an amount for administrative costs that have been
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approved by the DHCS.
6. Authorizes DHCS to determine the number of allocations and
the process to apply for an allocation, and to consult or
obtain technical assistance from private foundations in
implementation of the application and allocation process.
7. Authorizes DHCS to consider distributing funds to
community-based organizations in an area or region of the
state if a county or counties acting jointly do not seek an
allocation, or funds are made available.
8. Requires DHCS, in collaboration with the County Welfare
Directors Association, to develop renewal assistance training
for employees of community-based organizations that are to be
consistent with the counties' human services agencies
Medi-Cal redetermination timeframes and process, and requires
the community-based organizations' employees providing
renewal assistance to complete this training in order to be
eligible for renewal assistance payments.
9. Requires DHCS to require progress reports from those
receiving funding allocations.
10.Authorizes DHCS to recoup or withhold all or part of an
allocation for failure to comply with any requirements or
standards set forth by DHCS.
11.Authorizes DHCS to expend a portion of $500,000 authorized
for expenditures relating to Medi-Cal outreach and enrollment
funded by previous private foundation contributions and
matching federal funds to administer the activities set forth
in this bill. Requires private foundation funding to be
expended only for filled positions and related administrative
expenses.
12.Authorizes DHCS to implement, interpret, or make specific
the provisions of this bill by means of all-county letters,
provider bulletins, or similar instructions.
13.Requires the provisions of this bill to cease to be
implemented when all of the private foundation contributions
and any federal matching funds have been exhausted.
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Comments
According to the author's office, this bill provides the
mechanism necessary to obtain federal matching dollars for $6
million. The California Endowment (The Endowment), a private
health foundation that provides grants to community-based
organizations throughout California, is willing to contribute to
help individuals renew their Medi-Cal coverage. The author's
office states, as part of its work in leading the nation on the
implementation of the Affordable Care Act (ACA), California has
developed an outreach and enrollment infrastructure of
community-based organizations and county employees who have
assisted millions of Californians to enroll in Covered
California and Medi-Cal. The author's office adds that these
Californians will need to renew their coverage in order to keep
it for the year 2015, and that renewal assistance will be
particularly important in 2014-15 as existing Medi-Cal enrollees
move from welfare-based income and household eligibility rules
to modified adjusted gross income (MAGI)-based eligibility
rules.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee:
Expenditures of $12 million beginning in January 2015
(assuming costs are shared 50% private foundation funding, 50%
federal funds) on grants to community-based organizations to
assist with Medi-Cal renewal. This bill appropriates $6
million from the specified special fund (Healthcare Outreach
and Medi-Cal Enrollment Account, which was created through an
uncodified trailer bill section, Section 5 of SB 101, Budget
and Fiscal Review Committee, Chapter 361, Statutes of 2013)
and $6 million in federal matching funds.
Costs for Medi-Cal benefits in 2015 likely in the tens of
millions of dollars (General Fund (GF)/federal). This
estimate assumes the renewal assistance effort results in
significant numbers of enrollees who otherwise would not have
renewed their Medi-Cal eligibility. The GF share of costs
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could be in excess of $10 million to the low tens of millions
in the first year for additional Medi-Cal benefits. Actual GF
costs depends on how many new renewals are generated for
individual who otherwise may not have renewed, and the
corresponding federal share of cost. The one-time renewal
assistance will likely result in higher ongoing costs as well,
since a greater number of beneficiaries will likely maintain
enrollment in the program in future years.
To the extent greater continuous Medi-Cal enrollment results
in more beneficiaries receiving regular care for chronic
conditions, increased up-front benefits costs could
potentially be offset somewhat by fewer expensive
complications from uncontrolled chronic conditions. Such
costs offsets would be nebulous, but could be reflected in
lower managed care payments in future years.
SUPPORT : (Verified 8/27/14)
Health Access California (co-source)
Western Center on Law and Poverty (co-source)
AARP
Alliance for Boys and Men of Color
American Cancer Society - Cancer Action Network
Asian Americans Advancing Justice - Los Angeles
Asian Law Alliance
California Black Health Network
California Children's Health Coverage Coalition
California Coverage and Health Initiatives
California Immigrant Policy Center
California Optometric Association
California Pan Ethnic Health Network
California Primary Care Association
Children's Defense Fund California
Children Now
Congress of California Seniors
Korean Community Center of the East Bay
National Health Law Program
PICO California
Project Inform
San Francisco Community Clinic Consortium
SEIU United Healthcare Workers - West
SIREN - Services, Immigrant Rights, and Education Network
The Children's Partnership
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United Ways of California
Vision y Compromiso
OPPOSITION : (Verified 8/27/14)
Department of Finance
ARGUMENTS IN SUPPORT : The Western Center on Law and Poverty
(WCLP), a cosponsor of this bill, states that the role of
community-based organizations in assisting consumers with
enrollment into Medi-Cal has been critical to the progress
California has made in expanding the program and streamlining
eligibility rules. WCLP states it is similarly important to
have community-based organizations assist beneficiaries in
renewing their Medi-Cal coverage, particularly given the shift
under the ACA to MAGI eligibility rules. WCLP asserts that the
new Medi-Cal renewal application is confusing, and that while
there should be many improvements to the renewal process in
2015, due to the implementation of ex parte review and the use
of prepopulated forms, this will be a different type of renewal
process for which beneficiaries must adapt.
Health Access California, also a cosponsor of this bill, states
that the Endowment has generously offered $6 million to assist
consumers who are enrolled in Medi-Cal to renew that their
coverage, and that this bill allows a federal match for those
dollars. Health Access states that keeping eligible
beneficiaries enrolled in coverage assures ongoing access to
medically necessary care and reduces administrative overhead due
to avoidable churning of enrollment.
ARGUMENTS IN OPPOSITION : The Department of Finance is opposed
to this bill for the following reasons:
This bill results in additional General Fund costs of
approximately $8.7 million and imposes additional workload on
DHCS.
The bill is unnecessary because counties currently provide
assistance to Medi-Cal beneficiaries who are renewing their
eligibility.
In addition, federal health care reform has made
simplifications to Medi-Cal renewals, further making this bill
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unnecessary.
ASSEMBLY FLOOR : 55-21, 8/20/14
AYES: Alejo, Ammiano, Bloom, Bocanegra, Bonilla, Bonta,
Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,
Chesbro, Cooley, Dababneh, Daly, Dickinson, Eggman, Fong, Fox,
Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray, Hall,
Roger Hern�ndez, Holden, Jones-Sawyer, Levine, Lowenthal,
Medina, Mullin, Muratsuchi, Nazarian, Pan, Perea, John A.
P�rez, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Weber,
Wieckowski, Williams, Yamada, Atkins
NOES: Achadjian, Allen, Ch�vez, Conway, Dahle, Donnelly, Beth
Gaines, Gorell, Hagman, Harkey, Jones, Logue, Maienschein,
Mansoor, Melendez, Nestande, Olsen, Patterson, Wagner,
Waldron, Wilk
NO VOTE RECORDED: Bigelow, Grove, Linder, Vacancy
JL:d 8/27/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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