BILL ANALYSIS
AB 43
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Date of Hearing: April 20, 1999
ASSEMBLY COMMITTEE ON HEALTH
Martin Gallegos, Chair
AB 43 (Villaraigosa) - As Amended: April 15, 1999
SUBJECT : Healthy Families Program: eligibility.
SUMMARY : Revises the Healthy Families eligibility requirements
to allow children, their parents, and pregnant women in families
with income no more than 300% of the federal poverty level (FPL)
to enroll, prevents eligibility from being denied based on date
of entry into the United States, and establishes 12 months
continuous eligibility for children and 6 months continuous
eligibility for adults in managed care plans. Specifically,
this bill :
1)Revises Healthy Families Program eligibility to be based on
the minimum requirements and maximum flexibility permitted
under the federal Medicaid and State Children's Health
Insurance Programs (SCHIP), and to include:
b) A person who is under 19 years of age who is in a family
with income no more than 300% FPL.
c) An infant who would have been otherwise eligible for the
Access to Infants and Mothers program (AIM) but for the
creation of this program.
d) A child who is one to six with income at or below 133%
FPL who would otherwise be eligible for Medi-Cal but for
the creation of this program.
e) A child who is six to 19 with income at or below 100%
FPL who would otherwise be eligible for Medi-Cal but for
the creation of this program.
f) Any other uninsured child or underinsured infant or
child with family income no more than 300% FPL.
g) The parent of any individual eligible pursuant to a)
through e) above.
h) Any person or family eligible for Medi-Cal pursuant to a
specified family coverage category.
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i) Any pregnant woman with income at or below 200% FPL who
would otherwise have been eligible for Medi-Cal but for the
creation of this program.
j) Any pregnant woman who would otherwise have been
eligible for AIM but for the creation of this program.
11) Prohibits, to the extent consistent with federal law,
eligibility from being denied, terminated, restricted or
limited based on any of the following:
a) Family assets and resources.
b) Hours of work.
c) Failure to apply in person.
d) Lack of documentation proving income or residency.
e) Date of entry into the United States.
f) More than an annual redetermination process.
12) Prohibits a child who is otherwise eligible for
participation from being denied eligibility based on his or
her date of entry into the United States.
13) Makes DHS also responsible for various requirements that
are currently only applicable to the Managed Risk Medical
Insurance Board (MRMIB) in the administration of the Healthy
Families Program.
14) Replaces "children" with "families" throughout the statute
that authorizes the Healthy Families Program.
15) States that children excluded from coverage under Medicaid
or SCHIP are not eligible for coverage under Healthy Families.
16) Eliminates a requirement that subscribers continue to be
eligible for the program for a period of 12 months from the
month eligibility is established, and instead makes any
individual 19 or under who is determined to be eligible for
this program to remain eligible for those benefits for a
period no less than 12 months.
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17) Makes 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, eligible for those benefits for a period
of not less than six months.
18) Requires DHS and MRMIB to create and implement a simplified
application package, and to seek input from MRMIB, consumers,
advocates, providers, and other interested parties in the
development of the application.
19) Authorizes the simplified application to be mailed in and
processed through an independent entity by agreement with DHS
or through the county. Requires eligibility to be presumed
for a specified time period after an initial screening by the
independent entity or county. Requires DHS or the county to
make the final determination of eligibility. Prohibits
eligibility determinations from taking longer than 45 days.
20) Makes any child enrolled in the following programs also
eligible for Healthy Families, to the extent permitted by
federal law:
a) The Food Stamp Program;
b) The California Special Supplemental Food Program for Women,
Infants, and Children;
c) The federal Head Start Program; and
d) The federal School Lunch Program.
21)Requires the programs in #11 above to forward relevant
information, with the consent of the applicant, to the Healthy
Families program for purposes of establishing program
eligibility.
EXISTING LAW :
1)Provides for the Medi-Cal program, administered by DHS, to
provide comprehensive health care benefits to qualified,
low-income, aged, blind and disabled individuals, and
authorizes contracts with public and private health plans for
the provision of services to Medi-Cal beneficiaries.
2)Provides for a variety of eligibility categories in Medi-Cal
for determining eligibility for children, pregnant women and
infants, and low-income families. Requires certain applicants
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to meet resource tests and deprivation requirements.
Authorizes income disregards and deductions of certain
expenses. Requires documentation as proof of income and
residency. Requires annual reaffirmation and authorizes DHS
to require additional reporting.
3)Establishes the Healthy Families Program, administered by
MRMIB, to provide low-cost, subsidized health, vision, and
dental insurance to uninsured children who are not eligible
for Medi-Cal. Provides for a joint Medi-Cal and Healthy
Families mail-in application. Requires the payment of family
contributions and copayments for specified services. Provides
for a joint Medi-Cal and Healthy Families outreach and
education campaign.
4)Establishes the Access for Infants and Mothers (AIM) program,
administered by MRMIB, to provide comprehensive subsidized,
low cost, health insurance to women throughout their pregnancy
and for 60 days after their pregnancy and coverage to infants
for their first two years.
FISCAL EFFECT : Unknown
COMMENTS :
1)NEED FOR THIS BILL . This bill is one of a package of three
bills that is intended to create a comprehensive health care
program with an easy application and eligibility process to
cover children and their parents in families who earn no more
than 300% of the federal poverty level. The proposed program
would effectively reduce the number of low-income uninsured
Californians by integrating and expanding eligibility for
Medi-Cal for children and families, AIM, and the Healthy
Families Program. There are 7 million uninsured non-elderly
adults in California and over 1.8 million uninsured children.
Recent efforts to expand health care coverage for children
through the newly established Healthy Families Program and
expanded Medi-Cal for children have revealed that California's
patchwork health care system for low-income families is
complex, confusing, uncoordinated, and in many cases degrading
and demeaning. In fact, according to a recent UCLA report,
over 1.1 million uninsured children are currently eligible for
Medi-Cal or Healthy Families. A healthy economy and recent
changes in eligibility for public assistance programs as a
result of federal "welfare reform" have also contributed to
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California's growing uninsured population. Newly authorized
federal eligibility programs intended to continue health care
coverage to families moving off welfare have been confusing
and
difficult to implement, and families participating in the
workforce in low-paying jobs have limited access to health
insurance.
This package of bills is necessary to establish a coordinated
system of health care for California's low-income families who
have no access to or cannot afford employer based coverage.
Federal "welfare reform" provided states with the opportunity
to create health care programs separate from welfare. The
program proposed by these three bills uses this federal
authority and builds on the successes of Healthy Families,
Medi-Cal and AIM, and attempts to eliminate program
requirements that have been identified through focus groups,
reports, and interim hearings as obstacles and barriers to
enrollment and care. The program that would be created under
these bills would adhere to five guiding principles:
simplified eligibility, streamlined administration,
community-based outreach, expanded access to care, and maximum
federal financial participation.
2)SUPPORT. Many organizations representing health care
providers and health care consumers have submitted letters in
support of a prior version of this bill that expanded
eligibility for both Medi-Cal and Healthy Families and ensured
that no child would be denied program eligibility based on
their date of entry into the United States. Consumers Union
endorses continuous eligibility in Medi-Cal for children. The
California Association of Health Plans (CAHP) in a letter of
support of the prior version of this bill states that
differing regulations result in confusing programs and annual
redeterminations would improve the health care process for
children. The California Immigrant Welfare Collaborative in a
letter on this bill's prior version supports allowing
qualified immigrant children to enroll in Healthy Families
regardless of their date of entry into the United States
because it makes good health policy, its cost-effective, and
can prevent disease.
3)SUPPORT IF AMENDED . The California Psychiatric Association
(CPA) would support this bill if it is amended to clarify that
income eligibility will be determined based upon the prior
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year's or prior 6 month's average monthly income rather than
just the prior month. CPA is concerned about families who
lose eligibility because they are paid weekly or bi-weekly.
4)FEDERAL AUTHORIZATION . In a federal Health Care Financing
Administration (HCFA) document, entitled Supporting Families
in Transition, A Guide to Expanding Health Care Coverage in
the Post-Welfare Reform World , HCFA outlines the many
opportunities states have through Medicaid and SCHIP to reach
out to low-income families in need of health care. HCFA
indicates that in their Medicaid programs, states can: use
less restrictive financial methodologies to determine
eligibility, ease deprivation requirements by repealing the
"100-hour" rule, use less restrictive financial standards,
eliminate asset tests, provide 12 months continuous
eligibility for children, simplify redeterminations, expand
coverage to two-parent families covering children under SCHIP,
pay private health insurance premiums and cost-sharing, and
provide presumptive eligibility for children and pregnant
women. In this document, states are encouraged to simplify
application and enrollment processes in Medicaid and SCHIP,
create application sites outside of welfare offices, and place
Medicaid and SCHIP workers in communities. States can obtain
federal financial participation to implement all of these
options. This bill package proposes to implement many of
these recommendations.
5)RELATED LEGISLATION . AB 93 (Cedillo) and AB 1015 (Gallegos)
are the other two bills that comprise this package. While
this bill establishes the eligibility requirements, AB 93
provides for the application process, premium and copayment
structure, and program benefits, and AB 1015 focuses on
outreach and maximizing federal funding. In total, over 35
bills have been introduced in the
Assembly and Senate either expanding or simplifying
eligibility, streamlining administration, or consolidating
existing health care programs.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Health Plans (prior version)
California Catholic Conference (prior version)
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California Healthcare Association (prior version)
California Immigrant Welfare Collaborative (prior version)
The Asian Pacific American Legal Center of Southern California
(prior version)
California Mental Health Directors Association (prior version)
California Nurses Association (prior version)
California Psychiatric Association (if amended)
Consumers Union (prior version)
Friends Committee on Legislation (prior version)
Health Access California (prior version)
Kaiser Permanente (prior version)
Los Angeles Unified School District (prior version)
One individual (prior version)
Private Essential Access Community Hospitals, Inc. (prior
version)
Santa Clara County (prior version)
Service Employees International Union (prior version)
St. Joseph Health System (prior version)
The Coalition for Humane Immigrant Rights of Los Angeles (prior
version)
The National Immigration Law Center (prior version)
The Northern California Coalition for Immigrants Rights (prior
version)
Western Center on Law and Poverty (prior version)
Opposition
None on file
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097