BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 1002
S
AUTHOR: De León
B
VERSION: March 28, 2014
HEARING DATE: April 8, 2014
1
FISCAL: Yes
0
0
CONSULTANT: Mareva Brown
2
SUBJECT
Medi-Cal: redetermination
SUMMARY
When a Medi-Cal redetermination for eligibility is prompted
by a change in circumstances that was identified in a
CalFresh application or recertification, this bill requires
a county to begin a new 12-month Medi-Cal eligibility
period on a date that aligns with the beneficiary's
CalFresh certification period. Additionally, this bill
requires that when a county approves or recertifies
eligibility for CalFresh benefits from a Medi-Cal
recipient, as specified, the county shall begin a new
12-month Medi-Cal eligibility period that aligns the
beneficiary's eligibility period with his or her CalFresh
certification period. This bill implements these provisions
only to the extent permitted by federal law and to the
extent that they do not violate federal Medicaid
maintenance of effort rules.
ABSTRACT
Continued---
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Existing law:
1) Establishes the Medi-Cal program, administered by
the Department of Health Care Services, under which
qualified low-income individuals receive health care
services. (WIC 14000 et seq.)
2) Establishes under federal law the Supplemental
Nutrition Assistance Program (SNAP) to promote the
general welfare and to safeguard the health and well
being of the nation's population by raising the levels
of nutrition among low-income households. (7 CFR
271.1)
3) Establishes in California statute the CalFresh
program to administer the provision of federal SNAP
benefits to eligible families and individuals. (WIC
18900 et seq.)
4) Requires counties to seek to align the timing of
semi-annual reports for CalFresh recipients with
midyear status reports required by the Medi-Cal
program for CalFresh recipients who also are Medi-Cal
beneficiaries and who are subject to the Medi-Cal
midyear status reporting requirements. (WIC 18910 (b))
5) Requires a simplified eligibility process for
CalFresh enrollment to include expedited enrollment
in Medi-Cal, provisions for tracking data on
participants in both programs and requirements for
outreach to participants in CalFresh who are eligible,
but not enrolled in Medi-Cal. (WIC 18925)
6) Requires counties to perform redeterminations of
eligibility for Medi-Cal beneficiaries every 12 months
and to promptly redetermine eligibility whenever the
county receives information about changes in a
beneficiary's circumstances that may affect
eligibility for Medi-Cal benefits. These can include
the birth of a child, change in family size, or change
in income. (WIC 14005.37 (a))
7) Mandates that Medi-Cal eligibility shall continue
STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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during the redetermination process and that a
beneficiary's Medi-Cal eligibility shall not be
terminated until the county makes a specific
determination based on facts clearly demonstrating
that the beneficiary is no longer eligible for
Medi-Cal benefits under any basis and due process
rights guaranteed under this division have been met,
as specified. (WIC 14005.37 (d))
8) Requires a county to gather relevant and available
information to determine a beneficiary's Medi-Cal
eligibility prior to contacting the beneficiary for
the purposes of redetermining eligibility. Requires
the county to consider information contained in the
beneficiary's file or other information, including
more recent information available to the county,
including, but not limited to, Medi-Cal, CalWORKs, and
CalFresh case files of the beneficiary or of any of
his or her immediate family members, and other
sources, as specified. (WIC 14005.37 (e))
9) Requires, in the case of a redetermination due to a
change in circumstances, that the county begin a new
12-month eligibility period, if the county determines
that the beneficiary remains eligible for Medi-Cal
benefits. (WIC 14005.37 (n))
This bill:
1) Establishes this bill as "The Aligning
Opportunities for Health Act of 2014."
2) Requires that, if a county received or gathered the
information about a change in circumstances of a
Medi-Cal beneficiary during a CalFresh application or
recertification, and the beneficiary is determined
eligible to receive CalFresh benefits, then the county
shall begin the new 12-month Medi-Cal eligibility
period on a date that aligns the beneficiary's
eligibility period with his or her household CalFresh
certification period.
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3) Requires that, if a county recertifies eligibility
or approves an application for CalFresh benefits from
a Medi-Cal beneficiary who is not receiving CalWORKs
benefits, and who is not subject to a redetermination,
as specified above, the county shall begin a new
12-month Medi-Cal eligibility period that aligns the
beneficiary's eligibility period with the CalFresh
household certification period.
4) Specifies that a county shall not align the
Medi-Cal and CalFresh eligibility periods of a
beneficiary who is not subject to a redetermination
due to a change in circumstances identified in a
CalFresh application or recertification if doing so
would increase the beneficiary's share of cost or
reduce Medi-Cal benefits for any member of the
beneficiary's CalFresh family budget unit, in which
case the beneficiary's Medi-Cal eligibility period and
CalFresh certification period shall remain unaligned.
5) Specifies that the requirement to align programs
shall not be construed to permit a CalFresh recipient
who is otherwise ineligible for Medi-Cal benefits to
receive Medi-Cal benefits.
6) Requires that the alignment of eligibility periods
shall be implemented to the extent permitted by
federal law and to the extent that this action does
not violate federal maintenance of effort rules.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
This bill seeks to reduce the churn rate for CalFresh
beneficiaries who are dropped from the program - typically
due to late paperwork - and who then reapply and are
reinstated within a short time frame. It does this by
aligning the Medi-Cal redetermination deadlines with the
CalFresh recertification period for beneficiaries who are
enrolled in both programs. The author states that if
STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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deadlines are not aligned, families are required submit
separate and duplicate reports to continue enrollment in
each program, which can be confusing and result in people
being dropped from the program and quickly re-instated.
According to the author, this situation harms families who
lose essential nutrition benefits for which they are
eligible and counties, which are forced to expend critical
resources processing new applications on behalf of
households that never lost eligibility. Under this bill,
if a county can determine that a Medi-Cal beneficiary
remains eligible for Medi-Cal using information reported to
the county through a CalFresh application or CalFresh
certification form, the county must align the 12-month
CalFresh recertification period with the Medi-Cal 12-month
redetermination date.
Hunger
According to data from the UCLA Center for Health Policy
Research's California Health Interview Survey (CHIS), at
least 4 million low-income Californians struggled with food
insecurity during 2011-12. Researchers find that
food-insecure adults face higher risks of chronic diseases,
such as diabetes, hypertension and depression and poor
mental health. Food-insecure children had poorer academic
outcomes.<1> In 2011-12, UCLA reported that 14.5 percent of
Californians earning less than 200 percent of the federal
poverty level reported very low food security, and had to
cut back on food, or skip meals.
CalFresh
The U.S. Department of Agriculture's (USDA) Supplemental
Nutritional Assistance Program (SNAP) funds 100 percent of
food benefits to eligible individuals living in this
country. The program is administered in California as
CalFresh, and administrative funding is allocated through a
combination of federal, state and county funds. Specific
eligibility requirements for SNAP programs across the
country are set by the USDA, including gross- and
net-income asset tests for most recipients, work
requirements and specific documentation requirements and
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<1> http://cfpa.net/food-insecurity-2013
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timelines. The average monthly benefit for a CalFresh
recipient is $153.13 per month, or $5.10 per day. (The
maximum monthly CalFresh benefit for a household of four is
$632 or $5.27 per person, per day). In California, 58
percent of CalFresh recipients are children.
Participation rate
For years, California has been ranked last in the country
in SNAP participation rates, prompting concerns expressed
by the USDA, stories in the state's newspapers and many
legislative hearings, including two this year. In 2011,
the most recent data available, just 57 percent of eligible
individuals enrolled in the program, compared to a national
average of 79 percent. Additionally, California is tied
with Hawaii for the lowest SNAP participation rate in the
nation for working poor families who are eligible to
receive benefits: Just 44 percent of California's eligible
working poor families received CalFresh benefits. The
national average was 67 percent. CDSS notes that the low
CalFresh participation rate significantly impacts
California's economy, and particularly in impoverished
areas of the state, as every $5 of federal SNAP benefits
are calculated to generate $9 of local economic activity.
Churn
When an individual or family who is receiving CalFresh
benefits is dropped from the program for reasons other than
a loss of fiscal eligibility, and then re-applies to the
program and is reinstated within 90 days, it is called
churn. Typically, this involves a beneficiary who does not
return required paperwork completely or on time in order to
remain on the program. The process of discontinuing a
family from benefits and then re-instating them is
time-consuming for both the low-income participant and the
counties as well as costly for the counties. California's
churn rate was 38 percent in the final quarter of 2012 and
varies within counties.
This bill specifically seeks to reduce churn by aligning
paperwork requirements with Medi-Cal redetermination
periods.
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Medi-Cal
Medi-Cal is California's version of the federal Medicaid
health insurance program for low-income families and
individuals. Within the Affordable Care Act, California has
taken a number of required steps to simplify the
application and redetermination processes for
beneficiaries.
A number of factors can prompt a change in circumstance
that must be reported to Medi-Cal. These include changes in
income, address, and family composition, a family member
leaves or enters a nursing or long term care facility, a
child drops out of or enters school, change in citizenship
status, and other factors. These must be reported to the
county within 10 days, and may prompt a redetermination of
benefits. Some changes - for example a change in address -
may not require a redetermination.
Overlap with between Medi-Cal and CalFresh
Each of California's 58 counties is tasked with determining
state eligibility for and granting benefits to low-income
individuals who apply for the Medi-Cal, CalWORKs and
CalFresh programs, each of which has slightly different
eligibility requirements. A joint application allows people
to apply for all three programs at once, although often the
programs are accessed through separate applications and
processed separately.
According to Department of Social Services data from the
last quarter of 2012, 66 percent of Medi-Cal households
received CalFresh and 77 percent of CalFresh households
received Medi- Cal. The Center on Budget and Policy
Priorities argued in a 2013 paper that using SNAP
information to determine and renew eligibility for Medicaid
would make it more likely that SNAP participants would
enroll in Medicaid and also would reduce Medicaid
administrative costs for the states and the federal
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government.<2>
Research by the Urban Institute published in February 2014
concluded that while little is known about the extent to
which low-income households receive multiple benefits and
in what combinations, some researchers have found that SNAP
beneficiaries are less likely to receive more than two
benefits than participants in other public programs and
that they are more likely to be enrolled in Medi-Cal than
in any other public benefit.<3>
Related legislation:
SB 970 (De León) 2012, would have allowed people applying
for health coverage to use the information in their health
application or renewal to start an application for public
programs such as CalFresh and CalWORKs. It was vetoed with
a message that the administration would pursue the goal
without the legislative mandate.
AB 191 (Bocanegra) Chapter 669, Statutes of 2013, established a
categorical eligibility for CalFresh benefits for a household
with a member who is, or is eligible to be, a Medi-Cal
beneficiary.
AB 6 (Fuentes) Chapter 501, Statutes of 2011, streamlined
reporting requirements for the CalFresh and CalWORKs programs.
POSITIONS
Support: California Food Policy Advocates
(co-sponsor)
Western Center on Law and Poverty
(co-sponsor)
Alameda County Community Food Bank
American Federation of State, County and
Municipal Employees (AFSCME)
Asian Law Alliance
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<2> Rosenbaum, Dorothy, et al, "A Technical Assessment of
SNAP and Medicaid Financial Eligibility Under the
Affordable Care Act," Center on Budget and Policy
Priorities, June 6, 2013, revised.
<3> Edelstein, Sara, et al, "Characteristics of Families
Receiving Multiple Public Benefits," The Urban Institute,
February 2014.
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California Association of Food Banks
California Coverage and Health Initiatives
California Center for Public Health Advocacy
California Hunger Advocacy Coalition
California Partnership
California WIC Association
Coalition of California Welfare Rights
Organization
Community Food and Justice Coalition
Congress of California Seniors
Greenlining Institute
Hunger Advocacy Network
Los Angeles Regional Food Bank
National Health Law Program
Redwood Empire Food Bank
San Diego Hunger Coalition
San Francisco Living Wage Coalition
St. Anthony Foundation
The Children's Partnership/Children
Now/Children's Defense Fund-California
United Ways of California
United Way of Fresno and Stanislaus Counties
Oppose: None received.
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