BILL ANALYSIS Ó
SB 1002
Page 1
Date of Hearing: July 2, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 1002 (De Leon) - As Amended: March 28, 2014
Policy Committee: HealthVote:17-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill requires counties to begin a new 12-month eligibility
period for Medi-Cal when approving or recertifying an
individual's eligibility for CalFresh benefits in order to align
Medi-Cal and CalFresh eligibility periods, unless doing so would
reduce benefits or increase the share of costs for any member of
the beneficiary's family.
FISCAL EFFECT
1)Unknown, significant one-time administrative costs to counties
to incorporate these new rules into existing redetermination
procedures. Counties are funded by DHCS to process Medi-Cal
eligibility, but are currently reimbursed on a historical and
negotiated basis, not on a time-basis or per-case basis.
Therefore, increased county administrative costs will result
in additional one-time cost pressure, but the additional costs
will not be funded directly, so there is no direct state cost
impact. On a longer-term basis, the new rules are not likely
to have a significant ongoing fiscal impact on administrative
costs.
2)Estimated Information Technology costs of approximately
$600,000 (GF/federal) to program required changes in to the
three Medi-Cal eligibility systems used by county offices.
3)By increasing the time period for which an individual is
continuously enrolled in Medi-Cal, this bill is likely to
increase costs for Medi-Cal benefits. Precise estimates are
unavailable, but the increased costs could potentially be in
the tens of millions of dollars (GF/federal). For example,
assuming this bill allows 1 million people get an average of
SB 1002
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an extra week of Medi-Cal benefits at a cost of $43/week, $43
million total funds (GF/federal).
COMMENTS
1)Purpose . The author asserts California has taken great strides
to improve dual enrollment and strengthen alignment between
CalFresh and Medi-Cal, and that this bill builds on these
efforts by improving program efficiency for both
administrators and the low-income families they serve. The
author states the need to reapply for benefits in such a
situation is redundant and inefficient for both low-income
families and administering agencies.
2)Background . Counties perform Medi-Cal, CalWORKs and CalFresh
eligibility determinations for the state. Individuals can
apply for all three programs at one time using a joint
application, but individuals may also apply for each program
at different times using separate applications. When
individuals apply for CalFresh and Medi-Cal at different
times, they can have different deadlines to renew eligibility
for each program. According to state data from the last
quarter of 2012, 66% of Medi-Cal households received CalFresh
and 77% of CalFresh households received Medi-Cal. Currently,
in the case of a CalFresh redetermination due to a change in
circumstances, if a county determines that the beneficiary
remains eligible for Medi-Cal benefits, the county begins a
new 12-month eligibility period. This bill goes further in
that it requires a new 12-month eligibility period to begin
when renewing CalFresh regardless of whether relevant
circumstances have changed.
3)Previous Legislation.
a) AB 191 (Bocanegra), Chapter 669, Statutes of 2013,
focuses on strengthening the connection between Medi-Cal
and CalFresh by improving alignment between income limits.
b) SB 970 (De León) of 2012 allowed an individual, at
initial application or renewal of health care coverage
using the single state application, to have his or her
health care application information used to initiate a
simultaneous application for CalWORKs or CalFresh programs
to be transmitted to the applicable county human services
department to initiate the application, if the individual
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granted consent, among its other provisions. SB 970 was
vetoed by Governor Brown who objected to the bill's
creation of a work group and a required report.
4)Staff Comments . One provision of this bill will require a
county worker to assess eligibility for Medi-Cal at CalFresh
redetermination, but to only extend Medi-Cal eligibility for
an additional 12 months if doing so would not increase the
beneficiary's share of cost or reduce Medi-Cal benefits for
any member of the beneficiary's CalFresh family budget unit.
This could result in a situation where an eligibility worker
performs an assessment, realizes a beneficiary is ineligible,
but does not disenroll the beneficiary. It is unclear whether
this would be federally allowable, and it does not appear to
be fiscally prudent to keep beneficiaries on Medi-Cal rolls
who are known not to be eligible. Staff suggests this
provision be modified.
In addition, this bill appears to require immediate
implementation upon its effective date, in that it does not
specify a delayed implementation date. County eligibility
staff and information technology systems are currently
operating with a backlog of hundreds of thousands of pending
applications, as well as millions of delayed renewals. Given
counties are struggling to accomplish significant core
workload, it is unclear that aligning redetermination periods
is an appropriate priority for the state at this time.
Finally, the goal of aligning eligibility periods may be
elusive for many beneficiaries. Both Medi-Cal and CalFresh
are safety net programs and have natural exit and reentry.
Even for beneficiaries who stay on the program, the two
eligibility periods could be initially aligned and then later
become misaligned due to different rules about when
eligibility can be reset.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081