Amended in Senate April 22, 2014

Senate Bill No. 1005

Introduced by Senator Lara

(Coauthors: Senators Block, Calderon, De León, begin insert Evans, end insert Mitchell, Padilla, begin delete and Torres end delete begin insert Torres, and Wolk end insert )

(Coauthors: Assembly Members begin insert Alejo, Ammiano, end insert Bocanegra, Bonta, begin insert Campos, end insert Dickinson, Fong, begin insert Garcia, end insert Gonzalez, Roger Hernández, Jones-Sawyer, Pan, begin insert V. Manuel Pérez, end insert Rendon, begin insert Skinner, Ting, end insert and Yamada)

February 13, 2014

An act to add Title 22.5 (commencing with Section 100530) to the Government Code, begin insert to add Section 1366.7 to the Health and Safety Code, to add Section 10112.31 to the Insurance Code, end insert and to add Section 14102.1 to the Welfare and Institutions Code, relating to health care coverage, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

SB 1005, as amended, Lara. Health care coverage: immigration status.

Existing law, the federal Patient Protection and Affordable Care Act (PPACA), requires each state to begin delete , by January 1, 2014, end delete establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, and meets certain other requirements. PPACA specifies that an individual who is not a citizen or national of the United States or an alien lawfully present in the United States shall not be treated as a qualified individual and may not be covered under a qualified health plan offered through an begin delete Exchange. end delete begin insert exchange. end insert Existing law creates the California Health Benefit Exchange for the purpose of facilitating the enrollment of qualified individual and qualified small employers in qualified health plans as required under PPACA.

begin insert

Existing law governs health care service plans and insurers. A violation of the provisions governing health care service plans is a crime.

end insert

This bill would create the California Health Exchange Program begin delete For end delete begin insert for end insert All Californians within state government and would require that the program be governed by the executive board that governs the California Health Benefit Exchange. The bill would specify the duties of the board relative to the program and would require the board to, by January 1, 2016, facilitate the enrollment into qualified health plans of individuals who are not eligible for full-scope Medi-Cal coverage and would have been eligible to purchase coverage through the Exchange but for their immigration status. The bill would require the board to provide premium subsidies and cost-sharing reductions to eligible individuals that are the same as the premium assistance and cost-sharing reductions the individuals would have received through the Exchange. The bill would create the California Health Trust Fund For All Californians as a continuously appropriated fund, thereby making an appropriation, would require the board to assess a charge on qualified health plans, and would make the implementation of the program’s provisions contingent on a determination by the board that sufficient financial resources exist or will exist in the fund. The bill would enact other related provisions.

begin insert

The bill would require health care services plans and health insurers to fairly and affirmatively offer, market, and sell in the Exchange at least one product within each of 5 levels of coverage, as specified. Because a violation of the requirements imposed on health care service plans would be a crime, the bill would impose a state-mandated local program.

end insert

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. The federal Medicaid Program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.

This bill would extend eligibility for full-scope Medi-Cal benefits to individuals who are otherwise eligible for those benefits but for their immigration status. The bill would require that benefits for those services be provided with state-only funds only if federal financial participation is not available. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.

begin delete

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

end delete begin delete

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

end delete begin insert

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

end insert begin insert

This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.

end insert begin insert

With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

end insert

Vote: majority. Appropriation: yes. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

(a) It is the intent of the Legislature that all
Californians, regardless of immigration status, have access to
affordable health coverage and care.

(b) It is the intent of the Legislature that all Californians who
are eligible for Medi-Cal, a qualified health plan offered through
the California Health Benefits Exchange, or affordable
employer-based health coverage enroll in that coverage and obtain
the care that they need.

(c) It is further the intent of the Legislature, in enacting this
measure, to ensure that all Californians be included in eligibility
for coverage without regard to immigration status.

SEC. 2.  

Title 22.5 (commencing with Section 100530) is added
to the Government Code, to read:

 

Title 22.5.  CALIFORNIA HEALTH EXCHANGE
PROGRAM FOR ALL CALIFORNIANS

 

100530.  

(a) There is in state government the California Health
Exchange Program for All Californians, an independent public
entity not affiliated with an agency or department.

(b) The program shall be governed by the executive board
established pursuant to Section 100500. The board shall be subject
to Section 100500.

(c) It is the intent of the Legislature in enacting this program to
provide affordable coverage for Californians who would be eligible
for coverage and premium subsidies under the California Health
Benefit Exchange established under Title 22 (commencing with
Section 100500) but for their immigration status. It is further the
intent of the Legislature that Californians eligible under this title
be offered the same premiums and cost sharing that they would
be offered through the California Health Benefit Exchange but for
their immigration status.

100531.  

For purposes of this title, the following definitions
shall apply:

(a) “Board” means the board described in subdivision (b) of
Section 100530.

(b) “Carrier” means either a private health insurer holding a
valid outstanding certificate of authority from the Insurance
Commissioner or a health care service plan, as defined under
subdivision (f) of Section 1345 of the Health and Safety Code,
licensed by the Department of Managed Health Care.

(c) “Eligible individual” means an individual who would have
been eligible to purchase coverage through the Exchange but for
his or her immigration status and who is not eligible for full-scope
Medi-Cal coverage under state law.

(d) “Exchange” means the California Health Benefit Exchange
established by Section 100500.

(e) “Federal act” means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), and any amendments to, or regulations or
guidance issued under, those acts.

(f) “Fund” means the California Health Trust Fund for All
Californians established by Section 100540.

(g) “Health plan” and “qualified health plan” have the same
meanings as those terms are defined in Section 1301 of the federal
act.

(h) “Medi-Cal coverage” means coverage under the Medi-Cal
program pursuant to Chapter 7 (commencing with Section 14000)
of Part 3 of Division 9 of the Welfare and Institutions Code.

begin insert

(i) “Product” means one of the following:

end insert begin insert

(1) A health care service plan contract subject to Article 11.8
(commencing with Section 1399.845) of Chapter 2.2 of Division
2 of the Health and Safety Code.

end insert begin insert

(2) An individual policy of health insurance as defined in Section
106 of the Insurance Code, subject to Chapter 9.9 (commencing
with Section 10965) of Part 2 of Division 2 of the Insurance Code.

end insert begin delete

(i)

end delete

begin insert (j) end insert  “Program” means the California Health Exchange Program
for All Californians.

begin delete

(j)

end delete

begin insert (k) end insert  “Supplemental coverage” means coverage through a
specialized health care service plan contract, as defined in
subdivision (o) of Section 1345 of the Health and Safety Code, or
a specialized health insurance policy, as defined in Section 106 of
the Insurance Code.

100532.  

The board shall, at a minimum, do all of the following:

(a) Provide premium subsidies and cost-sharing reductions to
eligible individuals. The premium assistance and cost-sharing
reductions shall be the same as these individuals would have
received if they had been eligible to receive premium assistance
and cost-sharing reductions under the federal act by enrolling in
coverage through the Exchange.

(b) Enroll into coverage eligible individuals whose income
exceeds the thresholds for premium subsidies.

(c) Implement procedures for the certification, recertification,
and decertification, of health plans as qualified health plans. The
board shall require health plans seeking certification as qualified
health plans to do all of the following:

(1) Submit a justification for any premium increase prior to
implementation of the increase consistent with Article 6.2
(commencing with Section 1385.01) of Chapter 2.2 of Division 2
of the Health and Safety Code and Article 4.5 (commencing with
Section 10181) of Chapter 1 of Part 2 of Division 2 of the Insurance
Code.

(2) (A) Make available to the public and submit to the board
accurate and timely disclosure of the following information:

(i) Claims payment policies and practices.

(ii) Periodic financial disclosures.

(iii) Data on enrollment.

(iv) Data on disenrollment.

(v) Data on the number of claims that are denied.

(vi) Data on rating practices.

(vii) Information on cost sharing and payments with respect to
any out-of-network coverage.

(viii) Information on enrollee and participant rights under state
law.

(B) The information required under subparagraph (A) shall be
provided in plain language.

(3) Permit individuals to learn, in a timely manner upon the
request of the individual, the amount of cost sharing, including,
but not limited to, deductibles, copayments, and coinsurance, under
the individual’s plan or coverage that the individual would be
responsible for paying with respect to the furnishing of a specific
item or service by a participating provider. At a minimum, this
information shall be made available to the individual through an
Internet Web site and through other means for individuals without
access to the Internet.

(d) Provide for the operation of a toll-free telephone hotline to
respond to requests for assistance.

(e) Maintain an Internet Web site through which enrollees and
prospective enrollees of qualified health plans may obtain
standardized comparative information on those plans.

(f) Assign a rating to each qualified health plan offered through
the program in accordance with the criteria developed by begin insert the end insert board.

(g) Utilize a standardized format for presenting health benefits
plan options in the program.

(h) Inform individuals of eligibility requirements for the
Medi-Cal program, the Exchange, or any applicable state or local
public program and, if through screening of the application by the
program, the program determines that an individual is eligible for
the state or local program, enroll that individual in the program.

(i) Establish and make available by electronic means a calculator
to determine the actual cost of coverage after the application of
any premium subsidy and any cost-sharing reduction pursuant to
subdivision (a).

(j) Establish a navigator program. Any entity chosen by the
board as a navigator under this subdivision shall do all of the
following:

(1) Conduct public education activities to raise awareness of
the availability of qualified health plans through the program.

(2) Distribute fair and impartial information concerning
enrollment in qualified health plans, and the availability of
premium subsidies and cost-sharing reductions through the
program.

(3) Facilitate enrollment in qualified health plans.

(4) Provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman established
under Section 2793 of the federal Public Health Service Act begin insert (42
U.S.C. Sec. 300gg-93) end insert , or any other appropriate state agency or
agencies, for any enrollee with a grievance, complaint, or question
regarding his or her health plan, coverage, or a determination under
that plan or coverage.

(5) Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being
served by the program.

100533.  

In addition to meeting the requirements of Section
100532, the board shall do all of the following:

(a) Determine the criteria and process for eligibility, enrollment,
and disenrollment of enrollees and potential enrollees in the
program and coordinate that process with the state and local
government entities administering other health care coverage
programs, including the Exchange, the State Department of Health
Care Services, and California counties, in order to ensure consistent
eligibility and enrollment processes and seamless transitions
between coverage.

(b) Develop processes to coordinate with the county entities
that administer eligibility for the Medi-Cal program.

(c) Determine the minimum requirements a carrier must meet
to be considered for participation in the program, and the standards
and criteria for selecting qualified health plans to be offered
through the program that are in the best interests of qualified
individuals. The board shall consistently and uniformly apply these
requirements, standards, and criteria to all carriers. In the course
of selectively contracting for health care coverage offered to
qualified individuals through the program, the board shall seek to
contract with carriers so as to provide health care coverage choices
that offer the optimal combination of choice, value, quality, and
service.

(d) Provide, in each region of the state, a choice of qualified
health plans at each of the five levels of coverage contained in
subsections (d) and (e) of Section 1302 of the federal act.

(e) Require, as a condition of participation in the program,
carriers to fairly and affirmatively offer, market, and sell in the
program at least one product within each of the five levels of
coverage contained in subsections (d) and (e) of Section 1302 of
the federal act. The board may require carriers to offer additional
products within each of those five levels of coverage. This
subdivision shall not apply to a carrier that solely offers
supplemental coverage in the program under paragraph (10) of
subdivision (a) of Section 100534.

(f) (1) Except as otherwise provided in this section, require, as
a condition of participation in the program, carriers that sell any
products outside the program to fairly and affirmatively offer,
market, and sell all products made available to individuals in the
program to individuals purchasing coverage outside the program.

(2) For purposes of this subdivision, “product” does not include
contracts entered into pursuant to Chapter 7 (commencing with
Section 14000) of, or Chapter 8 (commencing with Section 14200)
of, Part 3 of Division 9 of the Welfare and Institutions Code
between the State Department of Health Care Services and carriers
for enrolled Medi-Cal beneficiaries. “Product” also does not
include a bridge plan product offered pursuant to Section 100504.5.

(g) Determine when an enrollee’s coverage commences and the
extent and scope of coverage.

(h) Provide for the processing of applications and the enrollment
and disenrollment of enrollees.

(i) Determine and approve cost-sharing provisions for qualified
health plans.

(j) Establish uniform billing and payment policies for qualified
health plans offered in the program to ensure consistent enrollment
and disenrollment activities for individuals enrolled in the program.

(k) Undertake activities necessary to market and publicize the
availability of health care coverage and subsidies through the
program. The board shall also undertake outreach and enrollment
activities that seek to assist enrollees and potential enrollees with
enrolling and reenrolling in the program in the least burdensome
manner, including populations that may experience barriers to
enrollment, such as the disabled and those with limited English
language proficiency.

(l) Select and set performance standards and compensation for
navigators selected under subdivision begin delete (h) end delete begin insert (j) end insert of Section 100532.

(m) Employ necessary staff. The board shall employ staff
consistent with the applicable requirements imposed under
subdivision (m) of Section 100503.

(n) Assess a charge on the qualified health plans offered by
carriers that is reasonable and necessary to support the
development, operations, and prudent cash management of the
program.

(o) Authorize expenditures, as necessary, from the fund to pay
program expenses to administer the program.

(p) Keep an accurate accounting of all activities, receipts, and
expenditures. Commencing January 1, 2017, the board shall
conduct an annual audit.

(q) (1) Notwithstanding Section 10231.5, annually prepare a
written report on the implementation and performance of the
program functions during the preceding fiscal year, including, at
a minimum, the manner in which funds were expended and the
progress toward, and the achievement of, the requirements of this
title. The report shall also include data provided by health care
service plans and health insurers offering bridge plan products
regarding the extent of health care provider and health facility
overlap in their Medi-Cal networks as compared to the health care
provider and health facility networks contracting with the plan or
insurer in their bridge plan contracts. This report shall be
transmitted to the Legislature and the Governor and shall be made
available to the public on the Internet Web site of the program. A
report made to the Legislature pursuant to this subdivision shall
be submitted pursuant to Section 9795.

(2) In addition to the report described in paragraph (1), the board
shall be responsive to requests for additional information from the
Legislature, including providing testimony and commenting on
proposed state legislation or policy issues. The Legislature finds
and declares that activities including, but not limited to, responding
to legislative or executive inquiries, tracking and commenting on
legislation and regulatory activities, and preparing reports on the
implementation of this title and the performance of the program,
are necessary state requirements and are distinct from the
promotion of legislative or regulatory modifications referred to in
subdivision (c) of Section 100540.

(r) Maintain enrollment and expenditures to ensure that
expenditures do not exceed the amount of revenue in the fund, and
if sufficient revenue is not available to pay estimated expenditures,
institute appropriate measures to ensure fiscal solvency.

(s) Exercise all powers reasonably necessary to carry out and
comply with the duties, responsibilities, and requirements of this
title.

(t) Consult with stakeholders relevant to carrying out the
activities under this title, including, but not limited to, all of the
following:

(1) Health care consumers who are enrolled in health plans.

(2) Individuals and entities with experience in facilitating
enrollment in health plans.

(3) The executive director of the Exchange.

(4) The State Medi-Cal Director.

(5) Advocates for enrolling hard-to-reach populations.

(u) Facilitate the purchase of qualified health plans in the
program by qualified individuals no later than January 1, 2016.

(v) Require carriers participating in the program to immediately
notify the program, under the terms and conditions established by
the board when an individual is or will be enrolled in or disenrolled
from any qualified health plan offered by the carrier.

(w) Ensure that the program provides oral interpretation services
in any language for individuals seeking coverage through the
program and makes available a toll-free telephone number for the
hearing and speech impaired. The board shall ensure that written
information made available by the program is presented in a plainly
worded, easily understandable format and made available in
prevalent languages.

100534.  

(a) The board may do the following:

(1) Collect premiums and assist in the administration of
subsidies.

(2) Enter into contracts.

(3) Sue and be sued.

(4) Receive and accept gifts, grants, or donations of moneys
from any agency of the United States, any agency of the state, any
municipality, county, or other political subdivision of the state.

(5) Receive and accept gifts, grants, or donations from
individuals, associations, private foundations, or corporations, in
compliance with the conflict-of-interest provisions to be adopted
by the board at a public meeting.

(6) Adopt rules and regulations, as necessary. Until January 1,
2018, any necessary rules and regulations may be adopted as
emergency regulations in accordance with the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2). The adoption of these regulations
shall be deemed to be an emergency and necessary for the
immediate preservation of the public peace, health and safety, or
general welfare.

(7) Collaborate with the Exchange and the State Department of
Health Care Services, to the extent possible, to allow an individual
the option to remain enrolled with his or her carrier and provider
network in the event the individual experiences a loss of eligibility
for enrollment in a qualified health plan under this title and
becomes eligible for the Exchange or the Medi-Cal program, or
loses eligibility for the Medi-Cal program and becomes eligible
for a qualified health plan through the program.

(8) Share information with relevant state departments, consistent
with the applicable laws governing confidentiality, necessary for
the administration of the program.

(9) Require carriers participating in the program to make
available to the program and regularly update an electronic
directory of contracting health care providers so that individuals
seeking coverage through the program can search by health care
provider name to determine which health plans in the program
include that health care provider in their network. The board may
also require a carrier to provide regularly updated information to
the program as to whether a health care provider is accepting new
patients for a particular health plan. The program may provide an
integrated and uniform consumer directory of health care providers
indicating which carriers the providers contract with and whether
the providers are currently accepting new patients. The program
may also establish methods by which health care providers may
transmit relevant information directly to the program, rather than
through a carrier.

(10) Make available supplemental coverage for enrollees of the
program to the extent permitted by available funding. Any
supplemental coverage offered in the program shall be subject to
the charge imposed under subdivision (n) of Section 100533.

begin delete

(b) The program shall only collect information from individuals
or designees of individuals necessary to administer the program.

end delete begin insert

(b) (1) An applicant for health care coverage or for a premium
subsidy or cost-sharing reduction shall be required to provide only
the information strictly necessary to authenticate identity,
determine eligibility, and determine the amount of the credit or
reduction.

end insert begin insert

(2) Any person who receives information provided by an
applicant pursuant to paragraph (1), whether directly or by another
person at the request of the applicant, or otherwise obtains
information about the applicant through the program process shall
do both of the following:

end insert begin insert

(A) Use the information only for the purposes of, and to the
extent necessary in, ensuring the efficient operation of the program,
including verifying the eligibility of an individual to enroll through
the program or to claim a premium subsidy or cost-sharing
reduction or the amount of the credit or reduction.

end insert begin insert

(B) Not disclose the information to any other person except as
provided in this section.

end insert

(c) The board shall have the authority to standardize products
to be offered through the program.

100535.  

The board shall establish and use a competitive
process to select participating carriers and any other contractors
under this title. Any contract entered into pursuant to this title shall
be exempt from Chapter 2 (commencing with Section 10100) of
Division 2 of the Public Contract Code, and shall be exempt from
the review or approval of any division of the Department of General
Services.

100536.  

(a) The board shall establish an appeals process for
prospective and current enrollees of the program.

(b) The board shall not be required to provide an appeal if the
subject of the appeal is within the jurisdiction of the Department
of Managed Health Care pursuant to the Knox-Keene Health Care
Service Plan Act of 1975 (Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code) and its
implementing regulations, or within the jurisdiction of the
Department of Insurance pursuant to the Insurance Code and its
implementing regulations.

100537.  

(a) Notwithstanding any other provision of law, the
program shall not be subject to licensure or regulation by the
Department of Insurance or the Department of Managed Health
Care.

(b) Carriers that contract with the program shall have a license
or certificate of authority from, and shall be in good standing with,
their respective regulatory agencies.

100538.  

(a) Records of the program that reveal the deliberative
processes, discussions, communications, or any other portion of
the negotiations with entities contracting or seeking to contract
with the program, entities with which the program is considering
a contract, or entities with which the program is considering or
enters into any other arrangement under which the program
provides, receives, or arranges services or reimbursement shall be
exempt from disclosure under the California Public Records Act
(Chapter 3.5 (commencing with Section 6250) of Division 7 of
Title 1).

(b) The following records of the program shall be exempt from
disclosure under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1) as
follows:

(1) (A) Except for the portion of a contract that contains the
rates of payments, contracts with participating carriers entered into
pursuant to this title on or after the date the act that added this
subparagraph becomes effective, shall be open to inspection one
year after the effective dates of the contracts.

(B) If contracts with participating carriers entered into pursuant
to this title are amended, the amendments shall be open to
inspection one year after the effective date of the amendments.

(c) Three years after a contract or amendment is open to
inspection pursuant to subdivision (b), the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.

(d) Notwithstanding any other law, entire contracts with
participating carriers or amendments to contracts with participating
carriers shall be open to inspection by the Joint Legislative Audit
Committee. The committee shall maintain the confidentiality of
the contracts and amendments until the contracts or amendments
to a contract are open to inspection pursuant to subdivisions (b)
and (c).

100539.  

(a) No individual or entity shall hold himself, herself,
or itself out as representing, constituting, or otherwise providing
services on behalf of the program unless that individual or entity
has a valid agreement with the program to engage in those
activities.

(b) Any individual or entity who aids or abets another individual
or entity in violation of this section shall also be in violation of
this section.

100540.  

(a) The California Health Trust Fund For All
Californians is hereby created in the State Treasury for the purpose
of this title. Notwithstanding Section 13340, all moneys in the
fund shall be continuously appropriated without regard to fiscal
year for the purposes of this title. Any moneys in the fund that are
unexpended or unencumbered at the end of a fiscal year may be
carried forward to the next succeeding fiscal year.

(b) The board of the program shall establish and maintain a
prudent reserve in the fund.

(c) The board or staff of the program shall not utilize any funds
intended for the administrative and operational expenses of the
program for staff retreats, promotional giveaways, excessive
executive compensation, or promotion of federal or state legislative
or regulatory modifications.

(d) Notwithstanding Section 16305.7, all interest earned on the
moneys that have been deposited into the fund shall be retained
in the fund and used for purposes consistent with the fund.

(e) Effective January 1, 2018, if at the end of any fiscal year,
the fund has unencumbered funds in an amount that equals or is
more than the board approved operating budget of the program
for the next fiscal year, the board shall reduce the charges imposed
under subdivision (n) of Section 100533 during the following fiscal
year in an amount that will reduce any surplus funds of the program
to an amount that is equal to the agency’s operating budget for the
next fiscal year.

100541.  

(a) The board shall ensure that the establishment,
operation, and administrative functions of the program do not
exceed the combination of state funds, private donations, and other
non-General Fund moneys available for this purpose.

(b) The implementation of the provisions of this title, other than
this section, Section 100530, and paragraphs (4) and (5) of
subdivision (a) of Section 100534, shall be contingent on a
determination by the board that sufficient financial resources exist
or will exist in the fund. The determination shall be based on at
least the following:

(1) Financial projections identifying that sufficient resources
exist or will exist in the fund to implement the program.

(2) A comparison of the projected resources available to support
the program and the projected costs of activities required by this
title.

(3) The financial projections demonstrate the sufficiency of
resources for at least the first two years of operation under this
title.

(c) The board shall provide notice to the Joint Legislative Budget
Committee and the Director of Finance that sufficient financial
resources exist in the fund to implement this title.

(d) If the board determines that the level of resources in the fund
cannot support the actions and responsibilities described in
subdivision (a), it shall provide the Department of Finance and the
Joint Legislative Budget Committee a detailed report on the
changes to the functions, contracts, or staffing necessary to address
the fiscal deficiency along with any contingency plan should it be
impossible to operate the program without the use of General Fund
moneys.

(e) The board shall assess the impact of the program’s operations
and policies on other publicly funded health programs administered
by the state and the impact of publicly funded health programs
administered by the state on the program’s operations and policies.
This assessment shall include, at a minimum, an analysis of
potential cost shifts or cost increases in other programs that may
be due to program policies or operations. The assessment shall be
completed on at least an annual basis and submitted to the Secretary
of California Health and Human Services and the Director of
Finance.

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 1366.7 is added to the end insert begin insert Health and Safety Code end insert begin insert ,
to read: end insert

begin insert

begin insert 1366.7. end insert   

(a) For purposes of this section, the following
definitions shall apply:

(1) “Exchange” means the California Health Exchange
Program for All Californians established in Title 22.5 (commencing
with Section 100530) of the Government Code.

(2) “Federal act” means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the
Federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), and any amendments to, or regulations or
guidance issued under, those acts.

(3) “Health plan” has the same meaning as that term is defined
in subdivision (g) of Section 100530 of the Government Code.

(b) Health care service plans participating in the Exchange
shall fairly and affirmatively offer, market, and sell in the Exchange
at least one product within each of the five levels of coverage
contained in subsections (d) and (e) of Section 1302 of the federal
act. The board established under Section 100530 of the
Government Code may require plans to sell additional products
within each of those levels of coverage. This subdivision shall not
apply to a plan that solely offers supplemental coverage in the
Exchange under paragraph (10) of subdivision (a) of Section
100534 of the Government Code.

(c) (1) Health care service plans participating in the Exchange
that sell any products outside the Exchange shall fairly and
affirmatively offer, market, and sell all products made available
to individuals in the Exchange to individuals purchasing coverage
outside the Exchange.

(2) For purposes of this subdivision, “product” does not include
contracts entered into pursuant to Chapter 8 (commencing with
Section 14200) of, Part 3 of Division 9 of the Welfare and
Institutions Code between the State Department of Health Care
Services and health care service plans for enrolled Medi-Cal
beneficiaries.

(d) Commencing January 1, 2015, a health care service plan
shall, with respect to plan contracts that cover hospital, medical,
or surgical benefits, only sell the five levels of coverage contained
in subsections (d) and (e) of Section 1302 of the federal act, except
that a health care service plan that does not participate in the
Exchange shall, with respect to plan contracts that cover hospital,
medical, or surgical benefits, only sell the four levels of coverage
contained in subsection (d) of Section 1302 of the federal act.

(e) Commencing January 1, 2015, a health care service plan
that does not participate in the Exchange shall, with respect to
plan contracts that cover hospital, medical, or surgical benefits,
offer at least one standardized product that has been designated
by the Exchange in each of the four levels of coverage contained
in subsection (d) of Section 1302 of the federal act. This subdivision
shall only apply if the board of the Exchange exercises its authority
under subdivision (c) of Section 100534 of the Government Code.
Nothing in this subdivision shall require a plan that does not
participate in the Exchange to offer standardized products in the
small employer market if the plan only sells products in the
individual market. Nothing in this subdivision shall require a plan
that does not participate in the Exchange to offer standardized
products in the individual market if the plan only sells products
in the small employer market. This subdivision shall not be
construed to prohibit the plan from offering other products
provided that it complies with subdivision (d).

(f) A health care service plan participating in the Exchange
shall charge the same rate for the same product whether that
product is offered through the Exchange or in the outside market
notwithstanding any charge imposed by the program pursuant to
subdivision (n) of Section 100533 of the Government Code.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 10112.31 is added to the end insert begin insert Insurance Code end insert begin insert , to
read: end insert

begin insert

begin insert 10112.31. end insert   

(a) For purposes of this section, the following
definitions shall apply:

(1) “Exchange” means the California Health Exchange
Program for All Californians established in Title 22.5 (commencing
with Section 100530) of the Government Code.

(2) “Federal act” means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the
Federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), and any amendments to, or regulations or
guidance issued under, those acts.

(3) “Health plan” has the same meaning as that term is defined
in subdivision (g) of Section 100530 of the Government Code.

(b) Health insurers participating in the Exchange shall fairly
and affirmatively offer, market, and sell in the Exchange at least
one product within each of the five levels of coverage contained
in subsections (d) and (e) of Section 1302 of the federal act. The
board established under Section 100530 of the Government Code
may require insurers to sell additional products within each of
those levels of coverage. This subdivision shall not apply to an
insurer that solely offers supplemental coverage in the Exchange
under paragraph (10) of subdivision (a) of Section 100534 of the
Government Code.

(c) (1) Health insurers participating in the Exchange that sell
any products outside the Exchange shall fairly and affirmatively
offer, market, and sell all products made available to individuals
in the Exchange to individuals purchasing coverage outside the
Exchange.

(2) For purposes of this subdivision, “product” does not include
contracts entered into pursuant to Chapter 8 (commencing with
Section 14200) of Part 3 of Division 9 of the Welfare and
Institutions Code between the State Department of Health Care
Services and health insurers for enrolled Medi-Cal beneficiaries.

(d) Commencing January 1, 2015, an insurer shall, with respect
to policies that cover hospital, medical, or surgical benefits, only
sell the five levels of coverage contained in subsections (d) and
(e) of Section 1302 of the federal act, except that an insurer that
does not participate in the Exchange shall, with respect to policies
that cover hospital, medical, or surgical benefits, only sell the four
levels of coverage contained in subsection (d) of Section 1302 of
the federal act.

(e) Commencing January 1, 2015, an insurer that does not
participate in the Exchange shall, with respect to policies that
cover hospital, medical, or surgical benefits, offer at least one
standardized product that has been designated by the Exchange
in each of the four levels of coverage contained in subsection (d)
of Section 1302 of the federal act. This subdivision shall only apply
if the board of the Exchange exercises its authority under
subdivision (c) of Section 100534 of the Government Code. Nothing
in this subdivision shall require an insurer that does not participate
in the Exchange to offer standardized products in the small
employer market if the insurer only sells products in the individual
market. Nothing in this subdivision shall require an insurer that
does not participate in the Exchange to offer standardized products
in the individual market if the insurer only sells products in the
small employer market. This subdivision shall not be construed to
prohibit the insurer from offering other products provided that it
complies with subdivision (d).

(f) An insurer participating in the Exchange shall charge the
same rate for the same product whether that product is offered
through the Exchange or in the outside market notwithstanding
any charge imposed by the program pursuant to subdivision (n)
of Section 100533 of the Government Code.

end insert

begin delete SEC. 3. end delete
begin insert SEC. 5. end insert   

Section 14102.1 is added to the Welfare and Institutions
Code, to read:

14102.1.  

(a) Notwithstanding any other law, individuals who
meet all of the eligibility requirements for full-scope Medi-Cal
benefits under this chapter, but for their immigration status, shall
be eligible for full-scope Medi-Cal benefits.

(b) This section shall not apply to individuals eligible for
coverage pursuant to Section 14102.

(c) Benefits for services under this section shall be provided
with state-only funds only if federal financial participation is not
available for those services. The department shall maximize federal
financial participation in implementing this section to the extent
allowable.

(d) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. The department
shall adopt regulations by July 1, 2018, in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
Commencing July 1, 2015, and notwithstanding Section 10321.5
of the Government Code, the department shall provide a status
report to the Legislature on a semiannual basis, in compliance with
Section 9795 of the Government Code, until regulations have been
adopted.

begin delete SEC. 4. end delete
begin insert SEC. 6. end insert   

The Legislature finds and declares that Section 2 of
this act, which adds Section 100538 to the Government Code,
imposes a limitation on the public’s right of access to the meetings
of public bodies or the writings of public officials and agencies
within the meaning of Section 3 of Article I of the California
Constitution. Pursuant to that constitutional provision, the
Legislature makes the following findings to demonstrate the interest
protected by this limitation and the need for protecting that interest:

In order to ensure that the California Health Exchange Program
for All Californians is not constrained in exercising its fiduciary
powers and obligations to negotiate on behalf of the public, the
limitations on the public’s right of access imposed by Section 2
of this act are necessary.

begin delete

SEC. 5.  

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.

end delete

begin insert

begin insert SEC. 7. end insert   

end insert begin insert

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for certain
costs that may be incurred by a local agency or school district
because, in that regard, this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.

end insert begin insert

However, if the Commission on State Mandates determines that
this act contains other costs mandated by the state, reimbursement
to local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.

end insert