BILL ANALYSIS
SENATE COMMITTEE ON INSURANCE
Senator Jackie Speier, Chair
SB92 (Hayden) Hearing Date: April 21, 1999
As Amended:
Fiscal: Yes
Urgency: No
SUMMARY
Senate Bill 92 would expand the list of "eligible
providers" under Healthy Families, eliminate "date of
entry" as a criterion for a child's eligibility, and
changes the definition of "resident" for purposes of
program eligibility.
DIGEST
Existing law
1. Establishes the Healthy Families Program (HFP),
administered by the Managed Risk Medical Insurance
Board (MRMIB), to provide health services, including
dental and vision benefits, to uninsured children in
families with household income at or below 200% of the
federal poverty level.
2. Establishes the Child Health and Disability Prevention
Program (CHDP) for purposes of the early identification
and treatment of "physical and mental disabilities"
before they become chronic or irreversible.
3. Requires the HFP program to pay for certain services
rendered to children up to 30 days in advance of when
they enrolled in the program. Payments are limited to
providers that participate in the CHDP.
4. Requires that an applicant to HFP must be applying on
behalf of a child who meets certain requirements,
including federal citizenship and immigration
requirements, and requires that an applicant be a
"resident" as defined under Section 244 Government
Code.
5. Bars program eligibility to children who entered the
U.S. after August 22, 1996, although federal law
permits states to include these children at the expense
of a state.
6. Continuously appropriates money from the HFP Fund for
purposes of implementing the program.
This bill
1. Would extend the 30 days prior payment provision of
existing law by including as eligible providers those
providers who render services through emergency rooms,
outpatient clinics or a department located in a
licensed acute care hospital, a community clinic, a
free clinic, a rural health clinic, and a federally
qualified health care center (as defined).
2. Would modify the definition of "resident" to include
an applicant who is physically present and living in
California, or a person who entered the state with a
job commitment or to seek employment, whether or not
currently employed. By modifying the definition of
"resident," the bill makes parents otherwise ineligible
to apply for HFP on behalf of their children eligible
to do so. This change makes the HFP definition of
residency consistent with Medi-Cal.
3. Would provide that a child otherwise eligible for
participation shall not be denied eligibility based on
the child's date of entry into the United States.
4. Would make #3 operative upon appropriation for purposes
of #3.
5. Would establish the Medi-Cal rate as the HFP rate for a
service if a rate were not otherwise established by
HFP.
6. Would not allow a child to be denied eligibility for
HFP based upon his or her date of entry into the United
States.
COMMENTS
1. Purpose of the bill . According to the author, it is
unfair to deny a child who would otherwise qualify for
HFP access based upon an arbitrary date of entry into
the U.S. It is far more cost-effective to provide
preventative care to children than to treat them in
emergency rooms, protects the health of all children by
screening for communicable diseases, and helps children
remain healthy during their crucial growth years. The
author states that the bill is particularly important
to the children of migrant farm workers. The author
also points out that California already allows new
immigrant children to be served by Medi-Cal if they
meet certain age and income requirements. The author
indicates that excluding children from HFP based upon
date of entry to the U.S. creates a perverse situation
in which some children in a family may have access to
medical care and some may not. Finally, the author
states that expanding the list of eligible providers
will encourage more providers to enroll children in the
HFP program.
2. Background . The CHDP was established in 1973 and
provides well-child assessments. When HFP was created,
it was anticipated that many of the children who would
eventually be covered by HFP would be initially
screened and steered towards HFP by CHDP-participating
service providers. Due to the wording of current law,
however, many of the other traditional providers of
care for children, such as rural health clinics or some
clinics owned and operated by a county, are not
eligible for reimbursement until a child is already
enrolled in HFP.
Under current law, children are denied eligibility
for HFP if they entered the United States after August
22, 1996. This bill would allow these children to be
eligible, upon appropriation, although under current
federal law the state is not eligible for a federal
match for these children.
Existing regulations specify that well-child
assessments and immunizations will be paid at Medi-Cal
rates while treatment services may be paid at Medi-Cal
or county-specific rates for certain counties that do
not contract with the state to pay their CHDP treatment
mandate costs. While some counties are mandated to pay
for treatment arising out of CHDP health screenings,
some of these treatment costs may now instead be
reimbursed by HFP. The regulations allow providers to
be reimbursed by the county at the rates the county has
established for these treatment services, and the state
will be reimbursed by the county. These rates may be
less than Medi-Cal rates. The bill requires that the
program use Medi-Cal rates to reimburse treatment
services.
3. Support . According to Health Access California and
others, this bill encourages providers not otherwise
participating in CHDP to enroll children in HFP by
reimbursing them under the conditions specified in the
bill. By expanding the list of providers who may be
reimbursed under HFP, Health Access California notes
that many more children will be identified as being
eligible for the program.
The California Immigrant Welfare Collaborative and
others indicate that covering these children through
HFP is more cost-effective than dealing with health
problems in the emergency room, and is consistent with
state policy for Medi-Cal eligibility (which does not
discriminate against legal immigrants based upon date
of entry). The Collaborative also indicates that,
according to CPS data, among all children arriving in
the U.S. since 1990, 30% fell within the HFP income
guidelines and 50% were medically uninsured.
4. Opposition . None received by the committee.
5. Policy differences between SB 92 and SB 112: SB 92 and
SB 112 (Figueroa) both amend Section 12693.41 of the
Insurance Code. The intent of the bills appears to be
broadly similar, i.e. to expand the coverage, and the
ease of administration, of the Healthy Families
Program. Policy differences between the bills are as
follows:
A) Eligible providers: SB 92 proposes an expansion of
eligible providers. Under SB 112, eligible providers
remain those who provide services through CHDP.
B) Timing of services: SB 92 leaves the current
Healthy Families standard in place -- services are paid
for if rendered within 30 days of enrollment . SB 112
proposes that payment be made up to 30 days after
services are rendered . MRMIB indicated in
conversations with staff that the current rule is meant
to encourage providers to enroll children. MRMIB also
indicated that the federal government has agreed to
provide its match for services rendered within 30 days
of enrollment. Changing the law as proposed in SB 112
would result in a loss of federal matching funds if a
child fails to enroll within 30 days of services being
rendered or if a child simply never enrolls. MRMIB
staff was unable to offer an opinion about whether the
federal government would agree to expand the 30 day
window in recognition that some providers may be
experiencing trouble being paid because of enrollments
that occur after 30 days.
C) Rates: Both bills propose changes in the rates
given providers, but the proposals differ. SB 92 makes
the rate paid by Medi-Cal the rate that is paid to
providers if Healthy Families has not already
established a rate. SB 112 effectively increases the
rates paid to providers for well-child health
assessments, immunizations and initial treatment
services in counties receiving tobacco tax (Prop. 99)
money. Currently, these counties pay slightly less
than Medi-Cal rates for these services.
D) Limitation on payment: SB 112 contains language
that prevents Healthy Families from making an
overlapping payment for initial treatment services
under Section 12693.41. SB 92 does not contain this
language.
E) Mandate to seek payment: SB 112 requires that
MRMIB seek payment from Medi-Cal for Medi-Cal eligible
children. SB 92 does not contain this requirement.
F) Fiscal intermediary: SB 92 allows MRMIB to use the
state fiscal intermediary to process payments. SB 112
requires MRMIB to use the state fiscal intermediary,
and exempts MRMIB from competitively bidding this
service, presumably because it is already provided to
the State under competitive bid.
6. Related Legislation: SB 111 (Figueroa) increases the
income threshold for Medi-Cal and SB 112 (Figueroa) as
noted. SB 168 (Speier) increases availability of
employer-sponsored health insurance to HFP
participants. SB 107 (Polanco) changes income
thresholds for Medi-Cal and HFP. SB 180 (Sher) requires
the Department of Health Services to contract with
community-based agencies to inform about, and enroll
families in, HFP. SB 87 (Escutia) allows qualified
entities to deem children presumptively eligible for
HFP. AB 43 (Villaraigosa) increases the income
threshold for HFP, and AB 497 (Gallegos) changes the
Medi-Cal income threshold.
7. Prior Legislation: SB 1398 (Hayden) and AB 1430
(Figueroa), both from the 1997-98 session.
POSITIONS
Support
Health Access California
California Immigrant Welfare Collaborative
California Nurses Association
California Association of Public Hospitals and Health
Systems
Mexican American Legal Defense and Educational Fund
National Health Law Program, Inc.
Center for Public Interest Law, University of San Diego
Children's Advocacy Institute
California Association of Catholic Hospitals
County of Santa Barbara Kids Network
Coalition for Humane Immigrant Rights of Los Angeles
Friends Committee on Legislation of California
Interfaith Coalition for Immigrant Rights
Oppose
None reported to the Committee
Consultant: Brian Perkins