BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: SB 1002
S
AUTHOR: De León
B
VERSION: August 18, 2014
HEARING DATE: August 22, 2014
1
FISCAL: Yes
0
0
CONSULTANT: Mareva Brown
2
SUBJECT
Low-income individuals: eligibility determinations
SUMMARY
This bill would require the state departments of Health
Care Services (DHCS) and Social Services (CDSS) to seek
federal waivers to streamline the application and
re-application processes for the Medi-Cal and CalFresh
programs by using information from either application to
satisfy information requirements for both programs. The
bill requires CDSS to consult with stakeholders in
implementing this provision and authorizes CDSS to
implement this provision through an all-county letter, or
similar instructions.
ABSTRACT
Existing law:
1) Establishes under federal law the Supplemental
Nutrition Assistance Program (SNAP) to promote the
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STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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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)
2) Establishes in California statute the CalFresh
program to administer the provision of federal SNAP
benefits to eligible families and individuals. (WIC
18900 et seq.)
3) 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.)
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 DHCS to seek any federal waivers necessary
to use the eligibility information of individuals who
have been determined eligible for the CalFresh
program, as specified, to determine their Medi-Cal
eligibility. (WIC 14005.66)
This bill:
1) Makes various uncodified legislative findings
including:
a. That approximately 35 percent of Medi-Cal
recipients are potentially eligible to receive
CalFresh benefits, but are not currently
receiving those benefits.
STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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b. Only 77 percent of CalFresh recipients
are currently enrolled in Medi-Cal despite the
fact that the eligibility income threshold for
Medi-Cal is higher than it is for CalFresh.
c. Recent collaboration between the CDSS,
DHCS and county human services agencies has
resulted in the Express Lane Enrollment Project,
which is an effort to utilize information in a
CalFresh case file to determine eligibility for
Medi-Cal. The Express Lane Enrollment Project has
been very successful, resulting in more than
222,000 CalFresh recipients being enrolled into
Medi-Cal.
d. It is the intent of the Legislature in
enacting this act to streamline enrollment and
eligibility certification processes and
procedures for CalFresh and Medi-Cal, both at
initial enrollment and at renewal, to improve
access to CalFresh and Medi-Cal, and to reduce
administrative burdens on county agencies and
applicant households.
2) Adds to the existing statutory requirement that
DHCS seek any federal waivers necessary to use
eligibility information for CalFresh beneficiaries to
determine Medi-Cal eligibility, as specified, the
requirement that this information be used to
re-determine their Medi-Cal eligibility as well.
3) Requires CDSS to seek any federal waivers necessary
to use the eligibility information of individuals who
have been determined eligible for Medi-Cal under to
determine or re-determine their CalFresh eligibility.
4) Requires CDSS to consult with stakeholders in the
implementation of this section.
5) Requires CDSS to implement this section through an
all-county letter or similar instruction.
FISCAL IMPACT
According to an analysis by the Assembly Committee on
Appropriations, implementation of this bill will result in
STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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unknown but significant one-time administrative costs to
counties to incorporate these new rules into existing
redetermination procedures as well as Information
Technology costs, potentially in the range of $600,000
(GF/Federal) to program required changes into the three
Medi-Cal eligibility systems. Additionally, the Assembly
analysis estimated increased costs of potentially tens of
millions of dollars (GF/Federal) due to an increased the
time frame in which Medi-Cal beneficiaries are continuously
enrolled in the program. There also could be unknown,
significant costs to the CalFresh program for increased
participation. The analysis also estimated a one-time cost
of approximately $200,000 for DHCS and CDSS to develop the
waiver application.
BACKGROUND AND DISCUSSION
Purpose of the bill:
This bill seeks to improve CalFresh participation rates and
to reduce the churn rate in that program for beneficiaries
who are dropped from the program - typically due to late
paperwork -who then reapply and are reinstated within a
short time frame. It does this by requiring the state to
seek waivers allowing DHCS and CDSS to use information from
either the CalFresh or Medi-Cal application to satisfy
information requirements for establishing eligibility in
both programs.
Pending federal approval of a state waiver, this bill would
allow a county eligibility worker to re-determine a
person's eligibility for Medi-Cal based on the fact that
they had a current CalFresh benefit. The author states that
while recent efforts to promote horizontal integration
between public benefits have encouraged dual enrollment at
the point of application, this does not always happen. When
benefits are not aligned, families have to submit
duplicative paperwork under different deadlines in order to
maintain eligibility for both programs. Individuals and
families can become confused, inadvertently miss a deadline
and be dropped from the program, according to the author.
The bill's sponsor, Western Center on Law and Poverty,
writes that it will build upon the successful Express Lane
Eligibility pilot that California implemented this year
STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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permitting CalFresh beneficiaries to opt into Medi-Cal.
County workers are already required to see if someone is
still eligible for Medi-Cal. Under SB 1002 if a county
worker sees an individual is a CalFresh participant, they
would simply renew their Medi-Cal eligibility, according to
WCLP. The County Welfare Directors Association (CWDA)
writes in support of this bill, "This (bill) better
streamlines both programs and utilizes essential data from
one program to grant eligibility for both." CWDA also notes
that several components of the Affordable Care Act have
been challenging to implement due to technology challenges,
but that this bill's expansion of the existing pilot "will
facilitate a truly simplified eligibility enrollment
process for individuals."
Assembly Amendments:
This bill passed out of the Senate with language that
required the state to align the Medi-Cal redetermination
deadlines with the CalFresh recertification period for
beneficiaries who are enrolled in both programs. This
alignment, while providing efficiency for many
beneficiaries, still posed a problem when circumstances,
such as a change in income or household size, required a
beneficiary to submit additional information resulting in a
new recertification date. The current version of the bill
strikes the previous language and instead seeks to align
the eligibility and redetermination process for both
programs by asking DHCS and CDSS to seek federal waivers
necessary to permit the departments to use either CalFresh
or Medi-Cal eligibility information to evaluate
beneficiaries' eligibility for both programs.
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
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<1> http://cfpa.net/food-insecurity-2013
STAFF ANALYSIS OF SENATE BILL 1002 (De León)
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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; 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 asset tests, work requirements and specific
documentation requirements and timelines. The average
monthly benefit for a CalFresh recipient, as SNAP is called
in California, is $153.13 per month, or $5.10 per day. For
years, California has ranked last among states in SNAP
participation rates, prompting concerns expressed by the
USDA, stories in the state's newspapers and many
legislative hearings, including two in 2014. In
California, 58 percent of CalFresh beneficiaries are
children.
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 is because a beneficiary did not
return required paperwork completely or on time. The
process of discontinuing then re-instating a family is
time-consuming for participants and costly for the
counties. California's churn rate was 38 percent in the
final quarter of 2012 and varies widely across counties.
This bill specifically seeks to reduce the state's churn
rate.
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. Among them is the requirement that CDSS seek
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any federal waivers necessary to use the eligibility
information of individuals who have been determined
eligible for the CalFresh program, and who are under 65
years of age and are not disabled, to determine their
Medi-Cal eligibility. (WIC 14005.66)
Overlap between Medi-Cal and CalFresh / Express Lane
Enrollment
According to CDSS data from the last quarter of 2012, 66
percent of Medi-Cal households received CalFresh benefits
and 77 percent of CalFresh households received Medi-Cal
benefits. In 2013, the federal Centers for Medicare and
Medicaid Services (CMS) issued a notice to state welfare
directors encouraging them to use a variety of strategies
to streamline enrollment, including coordinating SNAP and
Medicaid enrollment. The Legislature adopted trailer bill
language (SBX 1 1, Chapter 4, Statutes of 2013) authorizing
DHCS to seek waivers to enact the Express Lane Enrollment
Project, which targets specific CalFresh recipients for
enrollment into Medi-Cal based on their CalFresh
eligibility. This program was begun in counties in February
2014.
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.
VOTES
Assembly Floor 77 - 0
Assembly Appropriations 12 - 0
Assembly Health 17 - 0
Senate Floor 34 - 0
Senate Appropriations 7 - 0
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Senate Human Services 5 - 0
Senate Health 8 - 0
POSITIONS
Support: Western Center on Law and Poverty
(co-sponsor)
California Food Policy Advocates
(co-sponsor)
California Association of Food Banks
California Welfare Directors Association
Oppose: None received
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