BILL NUMBER: AB 43 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 15, 1999
INTRODUCED BY Assembly Member Villaraigosa
(Principal coauthors: Assembly Members Cedillo and Gallegos)
DECEMBER 7, 1998
An act to amend Section 12693.70 of, and to add Section
12693.705 to, the Insurance Code, and to amend Section 14012 of, and
to add Section 14005.235 to, the Welfare and Institutions Code
Sections 12693.70, 12693.71, 12693.72, 12693.73, and
12693.75 of, to add Sections 12693.705 and 12693.745 to, to repeal
and add Section 12693.74 of, the Insurance Code , relating to
children health care , and making an
appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
AB 43, as amended, Villaraigosa. Children: Healthy Families
Program: eligibility.
(1) Existing
Existing law establishes the Healthy Families Program to
arrange for the provision of health , dental, and vision
services to eligible children pursuant to Title XXI of the
Social Security Act, the State Children's Health Insurance Program
. Under existing law, in order to be eligible, an applicant
must be applying on behalf of a child, who meets certain
requirements, including being in a family having a gross annual
household income equal to or less than 200% of the federal poverty
level, and meeting the citizenship and immigration status
requirements established by federal law. Under existing law the
program is administered by the Managed Risk Medical Insurance Board.
Under existing law, the level of health benefits for program
subscribers is required to be equivalent to those provided to state
employees through the Public Employee's Retirement System as of
January 1, 1998, except as specified.
This bill would require that a child's family have a
gross annual household income equal to or less than 250% of the
federal poverty level for purposes of eligibility, and
eligibility to be determined based on the minimum requirement and
maximum flexibility permitted under Title XIX and Title XXI of the
Social Security Act.
The bill would require the department and the board, to the extent
feasible and permissible under federal law and with receipt of
necessary federal approval, to develop a simplified program
application and enrollment form for applicants that could be
submitted by mail. The bill would require, to the extent consistent
with federal law, that eligibility not be based on family assets and
resources, or hours worked, or failure to apply in person, or lack of
documentation, or date of entry into the United States, or more than
an annual redetermination process.
The bill would provide that a child who is otherwise
eligible for participation shall not be denied eligibility based on
the child's date of entry into the United States.
Existing law continuously appropriates money from the Healthy
Families Fund for purposes of implementation of the Healthy Families
Program.
This bill, by liberalizing an eligibility criterion for
participation within this program and thereby covering a new pool of
participants, would make the moneys in this continuously appropriated
fund available for a new or expanded purpose, and would thereby
result in an appropriation.
(2) Existing law provides for the Medi-Cal program, through which
health care benefits are provided to eligible individuals. Existing
law requires reaffirmation of eligibility for Medi-Cal benefits for
persons, whose eligibility is not determined on the basis of
eligibility for CalWORKs program benefit recipients and supplemental
security income benefit recipients, on an annual basis or at other
times as required by the State Department of Health Services.
This bill would revise Medi-Cal income eligibility standards for
otherwise eligible individuals to include any child under 19 years of
age whose family income does not exceed 133% of the federal poverty
level. This bill would revise the reaffirmation of eligibility
requirement to limit reaffirmations of eligibility for Medi-Cal
benefits on any basis other than annually to apply only to persons
who are 19 years of age or older.
Existing law requires local governments to determine Medi-Cal
eligibility. This bill by changing the eligibility standards may
increase the number of persons for whom there would have to be an
eligibility determination, thus creating a state-mandated local
program.
(3) The
The bill would require the department or each county to determine
eligibility under the Healthy Families Program, thus creating a
state-mandated local program.
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, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
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.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12693.70 of the Insurance Code is amended to
read:
12693.70. To be eligible to participate in the program, an
applicant shall meet all of the following requirements:
(a) Be an applicant applying on behalf of an eligible child, which
means a child who is all of the following:
(1) Greater than 12 months of age and less than 19 years of age.
An application may be made on behalf of a child less than 12 months
of age for coverage to begin as early as the child's first birthday.
(2) Not eligible for no-cost full-scope Medi-Cal or Medicare at
the time of application.
(3) In compliance with Sections 12693.71 and 12693.72.
(4) A child who meets citizenship and immigration status
requirements that are applicable to persons participating in the
program established by Title XXI of the Social Security Act.
(5) A resident of the State of California pursuant to Section 244
of the Government Code.
(6) In a family with a gross annual household income equal to or
less than 250 percent of the federal poverty level.
(b) If the applicant is applying for the purchasing pool, the
applicant shall pay the first month's family contribution and agree
to remain in the program for six months, unless other coverage is
obtained and proof of the coverage is provided to the program.
(c) An applicant shall enroll all of the applicant's eligible
children in the program.
(a) Program eligibility shall be determined based on the minimum
requirements and maximum flexibility permitted under Title XIX and
Title XXI of the Social Security Act.
(b) To be eligible to participate in the program, an applicant
shall be one of the following:
(1) A person who is under 19 years of age who is in a family with
income no more than 300 percent of the federal poverty level.
(2) An infant who would have been otherwise eligible for the
program pursuant to Part 6.3 (commencing with Section 12695) but for
the creation of this program.
(3) A child who is one to six, inclusive, years of age with income
at or below 133 percent of the federal poverty level who would have
been otherwise eligible for the program pursuant to Chapter 7
(commencing with Section 14000) of Part 3 of Division 9 of the
Welfare and Institutions Code but for the creation of this program.
(4) A child who is six to 19, inclusive, years of age with income
at or below 100 percent of the federal poverty level, who would have
otherwise been eligible for the program pursuant to Chapter 7
(commencing with Section 14000) of Part 3 of Division 9 of the
Welfare and Institutions Code but for the creation of this program.
(5) Any other uninsured or underinsured infant or child with
family income no more than 300 percent of the federal poverty level.
(6) The parent of any individual eligible pursuant to paragraphs
(1) to (5), inclusive.
(7) Any person or family eligible for the program pursuant to
Section 14005.30 of the Welfare and Institutions Code.
(8) Any pregnant woman with income at or below 200 percent of the
federal poverty level who would have otherwise been eligible for the
program pursuant to Chapter 7 (commencing with Section 14000) of Part
3 of Division 9 of the Welfare and Institutions Code but for the
creation of this program.
(9) Any pregnant woman who would otherwise have been eligible for
the program pursuant to Part 6.3 (commencing with Section 12695) but
for the creation of this program.
(10) Any pregnant woman, child, or child and his or her parent
with family income no more than 300 percent of the federal poverty
level shall be eligible for this program if they also meet the
minimum requirements for eligibility under federal law.
(c) To the extent consistent with federal law, under no
circumstances shall eligibility be denied, terminated, restricted, or
limited based on any of the following:
(1) Family assets and resources.
(2) Hours of work.
(3) Failure to apply in person.
(4) Lack of documentation proving income or residency.
(5) Date of entry into the United States.
(6) More than an annual redetermination process.
SEC. 2. Section 12693.705 is added to the Insurance Code, to read:
12693.705. A child who is otherwise eligible for participation
shall not be denied eligibility based on his or her date of entry
into the United States.
This section does not constitute a change in, but is declaratory
of, existing law.
SEC. 3. Section 14012 of the Welfare and Institutions Code is
amended to read:
14012. Reaffirmation shall be filed annually. With respect to
the determination of eligibility for any person 19 years of age or
older, reaffirmation may be required at other times in accordance
with general standards established by the department.
SEC. 4. Section 14005.235 is added to the Welfare and Institutions
Code, to read:
14005.235. To the extent federal participation is available, any
child under 19 years of age who meets all the other applicable
eligibility requirements shall be eligible for benefits under this
chapter if his or her family income does not exceed 133 percent of
the federal poverty level.
SEC. 5.
SEC. 3. Section 12693.71 of the Insurance Code is amended to read:
12693.71. (a) The department and the board shall
monitor applications to determine whether employers and employees
have dropped employer-sponsored dependent coverage in order to
participate in the program.
(b) The department and the board may disapprove an
application if it is determined that the children
family to be covered under the application were
was covered by an employer-sponsored insurance
within the last three months.
(c) If the department and the board imposes the
limitation identified in subdivision (b) or (d), it shall also
establish exceptions to this limitation in cases where prior coverage
ended due to reasons unrelated to the availability of the program.
This shall include, but not be limited to:
(1) Loss of employment due to factors other than voluntary
termination.
(2) Change to a new employer that does not provide an option for
dependent coverage.
(3) Change of address so that no employer sponsored coverage is
available.
(4) Discontinuation of health benefits to all employees of the
applicant's employer.
(5) Expiration of COBRA coverage period.
(6) Coverage provided pursuant to an exemption authorized under
subdivision (i) of Section 1367 of the Health and Safety Code.
(d) If the department and the board determines, based
on evidence gathered during a reasonable period of program operation,
that a substantial share of funds expended for the program are
providing health coverage for children
families that have discontinued employer-based coverage in
order to enter the program or if required by the federal government
for state plan approval, the department and the board may
take actions to increase the three-month time limit specified in
subdivision (b), to such a time limit that cannot exceed six months.
SEC. 4. Section 12693.72 of the Insurance Code is amended to read:
12693.72. (a) The department and the board may
disapprove an application if it is determined that the
children family to be covered under the
application were was covered by an
individual health care service plan contract or individual disability
insurance policy during a specified period of time prior to the date
of application only if required by the federal government for state
plan approval. This time limitation period shall not exceed the time
period required by the federal government.
(b) If the department and the board imposes the time
limitation identified in subdivision (a), it shall also establish
exceptions to this limitation in cases where the prior coverage ended
due to reasons unrelated to the availability of the program. This
shall include, but not be limited to, the prior coverage being
pursuant to a health plan operating pursuant to an exemption
authorized by subdivision (i) of Section 1367 of the Health and
Safety Code.
SEC. 5. Section 12693.73 of the Insurance Code is amended to read:
12693.73. Notwithstanding any other provision of law, children
excluded from coverage under Title XIX or Title XXI of the
Social Security Act are not eligible for coverage under the program.
SEC. 6. Section 12693.74 of the Insurance Code is repealed.
12693.74. Subscribers shall continue to be eligible for the
program for a period of 12 months from the month eligibility is
established.
SEC. 7. Section 12693.74 is added to the Insurance Code, to read:
12693.74. Pursuant to Section 4731 of the federal Balanced Budget
Act of 1997 (P.L. 105-33), any individual who is 19 years of age or
younger and who is determined to be eligible for this program shall
remain eligible for those benefits for a period of no less than 12
months.
SEC. 8. Section 12693.745 is added to the Insurance Code, to read:
12693.745. Pursuant to Section 4709 of the federal Balanced
Budget Act of 1997 (P.L. 105-33), any individual older than 19 years
of age who is determined to be eligible for this program, and is
enrolled in a managed care plan, shall remain eligible for those
benefits for a period of not less than six months.
SEC. 9. Section 12693.75 of the Insurance Code is amended to read:
12693.75. The program shall make use of a simple and
easy to understand mail-in application process. (a)
The department and the board shall create and implement a simplified
application package, and shall seek input from the board, consumers,
advocates, providers, and other interested parties in the development
of the application.
(b) The simple application may be mailed in and processed through
an independent entity by agreement with the department, or through
the county. Eligibility shall be presumed for a specified time
period after an initial screening by the independent entity or
county. The department or county shall make the final determination
of eligibility. Under no circumstances shall eligibility
determinations take longer than 45 days.
(c) To the extent permitted by federal law, a child or family who
is enrolled in any of the following programs shall be eligible for
this program:
(1) The Food Stamp Program, provided for pursuant to Chapter 10
(commencing with Section 18900) of Part 6 of Division 9 of the
Welfare and Institutions Code.
(2) The California Special Supplemental Food Program for Women,
Infants, and Children, provided for pursuant to Article 2 (commencing
with Section 123275) of Chapter 1 of Part 2 of Division 106 of the
Health and Safety Code.
(3) The federal Head Start program, provided for pursuant to
Subchapter 2 (commencing with Section 9831) of Chapter 105 of Title
42 of the United States Code.
(4) The federal School Lunch programs, provided for pursuant to
Chapter 13 (commencing with Section 1751) of Title 42 of the United
States Code.
(d) The programs specified in subdivision (c) shall forward
relevant information, with the consent of the applicant, to this
program for purposes of establishing program eligibility.
SEC. 10. Notwithstanding Section 17610 of the Government
Code, 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. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.
Notwithstanding Section 17580 of the Government Code, unless
otherwise specified, the provisions of this act shall become
operative on the same date that the act takes effect pursuant to the
California Constitution.