BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
SB 1002 (de León) - Medi-Cal: redetermination.
Amended: March 28, 2014 Policy Vote: Health 8-0,
Human Services 5-0
Urgency: No Mandate: Yes
Hearing Date: May 23, 2014 Consultant: Brendan McCarthy
SUSPENSE FILE.
Bill Summary: SB 1002 would require counties to reset a Medi-Cal
beneficiary's 12-month eligibility period to align with the
beneficiary's CalFresh eligibility period, under certain
circumstances.
Fiscal Impact:
Minor administrative costs to counties (General Fund and
federal funds). Counties are not likely to experience
significant administrative costs, because resetting the
Medi-Cal eligibility period would occur during a
redetermination of eligibility for the CalFresh program.
Potentially significant costs to the Medi-Cal program due
to increased enrollment, potentially in the millions to low
tens of millions per year (General Fund and federal funds).
Under current law, Medi-Cal beneficiaries must have their
eligibility redetermined every 12 months. Every year a small
but significant number of Medi-Cal beneficiaries lose their
eligibility temporarily due to administrative issues, for
example, not returning required forms or delays in locating
needed documents. Short term lapses in eligibility are
referred to as "churn". By resetting a beneficiary's
Medi-Cal eligibility when performing CalFresh eligibility
determinations, the bill is likely to reduce churn among
this population of beneficiaries. The reduction in churn
will, in turn, increase Medi-Cal costs, particularly the per
member per month payments made to managed care plans.
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 incomes below 100 percent of the federal
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poverty level, as well as blind, disabled, and certain other
populations. Generally, the federal government provides a 50
percent federal match for state Medi-Cal expenditures.
The federal Affordable Care Act allows states to expand Medicaid
(Medi-Cal in California) eligibility to persons under 65 years
of age, who are not pregnant, not entitled to Medicare Part A or
enrolled in Medicare Part B, and whose income does not exceed
133 percent of the federal poverty level (effectively 138
percent of the federal poverty level as calculated under the
Affordable Care Act). California has opted to expand eligibility
for Medi-Cal up to 138 percent of the federal poverty level.
The Affordable Care Act provides a significantly enhanced
federal match for the Medicaid expansion. Under the law, the
federal government will pay for 100 percent of the cost of the
Medicaid expansion in 2013-14 declining to a 90 percent federal
match in the 2020 federal fiscal year and thereafter.
Existing federal law provides for the Supplemental Nutrition
Assistance Program, known as CalFresh in California, which
provides financial assistance to low-income households to
purchase food. Under existing law, the gross income threshold
for CalFresh is 130 percent of the federal poverty level.
While both Medi-Cal and CalFresh provide benefits to low income
individuals, they have separate eligibility and enrollment
procedures. Qualifying individuals can apply for and enroll in
either or both programs through county human services
departments. However, there are also ways to apply for and one
program without applying for both (even if the individual would
be eligible for both). In addition, the two programs have
different requirements when a beneficiary's circumstances change
within the eligibility period. In the Medi-Cal program, if
circumstances change and a beneficiary is determined to still be
eligible, the 12-month eligibility clock is reset. In CalFresh,
a mid-year eligibility redetermination due to a change in
circumstances does not reset the eligibility clock. In 2012, 66%
of Medi-Cal households were also enrolled in CalFresh.
Therefore, it is common for an individual or household to have
different enrollment dates and thus different deadlines for
redetermining eligibility (which generally must happen annually
for both programs).
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Proposed Law: SB 1002 would require counties to reset a Medi-Cal
beneficiary's 12-month eligibility period to align with the
beneficiary's CalFresh eligibility period, under certain
circumstances.
Specifically, the bill would require:
If a county received information about a change in
circumstances as part of a CalFresh application or
redetermination and the applicant is eligible for CalFresh,
the county is required to reset the beneficiary's Medi-Cal
eligibility period to align with the CalFresh eligibility
period;
If a county recertifies eligibility or approves a CalFresh
application for a Medi-Cal beneficiary (who is not receiving
CalWorks or subject to a redetermination), the county is
required to reset the beneficiary's Medi-Cal eligibility
period to align with the CalFresh eligibility period;
Prohibit a county from aligning Medi-Cal and CalFresh
eligibility periods if doing so would reduce the
beneficiary's Medi-Cal benefits.
Related Legislation:
SB 970 (de León, 2012) would have allowed people applying
for health coverage to use the information in their
application to begin applications for other public programs
such as CalFresh. That bill was vetoed by Governor Brown.
SB 191 (Bocanegra, Statutes of 2013) established a
categorical eligibility for CalFresh benefits for a
household member who is eligible for Medi-Cal.
Staff Comments: Counties are responsible for making Medi-Cal
eligibility determinations and redeterminations. The bill may
add to county workload by requiring the counties to take a few
additional administrative steps when realigning the eligibility
periods for Medi-Cal, as required in the bill. On the other
hand, realigning the eligibility periods could reduce
administrative workload for the counties by eliminating the need
for a Medi-Cal redetermination later in a given year. To the
extent that the bill imposes administrative duties on the
counties, those costs would be paid as part of the Medi-Cal
program, rather than through a mandate claim.
Under federal law, the state can extend the Medi-Cal eligibility
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period, if a beneficiary is determined to remain eligible for
the program after a change in circumstance. However, federal law
does not allow the state to adjust the CalFresh eligibility
period. For some beneficiaries impacted by this bill, the two
eligibility periods could be initially aligned and then later
become mis-aligned. For example, if a beneficiary experienced a
later change in circumstance (for example, a new member of the
household or a change in income), the county may need to
determine whether the beneficiary is still eligible for both
Medi-Cal and CalFresh. Assuming the beneficiary remains eligible
for both programs, the county would then reset the beneficiary's
eligibility period for Medi-Cal, but could not do so for
CalFresh. In those cases, the eligibility periods would once
again be misaligned.