BILL ANALYSIS Ó
AB 1 X1
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Date of Hearing: February 19, 2013
ASSEMBLY COMMITTEE ON HEALTH X1
Richard Pan, Chair
AB 1 X1 (John A. Pérez) - As Introduced: January 28, 2013
SUBJECT : Medi-Cal eligibility.
SUMMARY : Enacts statutory changes to implement the provisions
of the Patient Protection and Affordable Care Act (known as the
ACA) (Public Law 111-148), as amended by the Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152)
related to coverage expansion, eligibility, simplified
enrollment and retention in Medi-Cal, California's Medicaid
Program and California's Children's Health Insurance Program
(CHIP). Specifically, this bill :
Coverage Expansions
1)Effective January 1, 2014, expands eligibility for Medi-Cal
coverage to citizen and qualified immigrant adults who are
under age 65, not pregnant and not otherwise currently
eligible for Medi-Cal coverage.
2)Requires the transition of persons currently enrolled in a
Low-Income Health Program (LIHP) under California's Bridge to
Reform Section 1115(b) waiver to the new Medi-Cal expansion
program in accordance with the state transition plan that was
approved by the federal Centers for Medicare and Medicaid
Services (CMS).
a) Requires the person to be provided with notice of the
health plan that includes the current medical home
provider, the option to select that health plan, the
opportunity to choose a different plan, if available in
that county and informed that if no choice is made that
assignment will be automatically made to a plan that
contracts with the current medical home.
b) Requires notices to be sent to LIHP enrollees at the
time of their 2013 redetermination and again at least 90
days prior to transition to ensure that no person loses
coverage.
3)Requires the Department of Health Care Services (DHCS) to
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obtain approval from the United States Secretary of Health and
Human Services (HHS) to establish a benchmark benefit package
that includes the same benefits, services, and coverage that
are provided to all other full-scope Medi-Cal enrollees
supplemented by any benefits, services, and coverage included
in the essential health benefits (EHBs) package adopted by the
state and approved by the Secretary of HHS for the population
eligible for Covered California through the Health Benefits
Exchange (Exchange).
4)Effective January 1, 2014, extends Medi-Cal coverage to any
person under age 26, regardless of income or assets who was in
foster care in the state at age 18 and who is not otherwise
eligible.
5)Requires DHCS to identify and track all former independent
foster care adolescents who lost Medi-Cal coverage on or after
January 1, 2013 as a result of attaining 21 years of age in
order to enroll them in the Medi-Cal coverage for former
foster care youth.
6)Provides, to the extent federal financial participation (FFP)
is available, an adolescent who is in foster care on his or
her 18th birthday shall be deemed eligible without
interruption and without requiring a new application and
requires the following:
a) DHCS to develop and implement a simplified form and
process so that a person eligible as a former foster care
adolescent is not terminated unless the person provides
information that makes him/her ineligible.
b) The person to be enrolled in fee-for-service Medi-Cal
until contact is reestablished or ineligibility is
established.
c) Failure to return the form may not be the basis for
termination.
7)Revises the period of coverage for pregnant women in the
Access for Infants and Mothers (AIM) Program from 60 days
after the end of the pregnancy to the end of the month in
which the 60th day occurs, effective January 1, 2014.
8)Effective January 1, 2014, provides that pregnant women who
are currently eligible for pregnancy-related and postpartum
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services in the Medi-Cal program shall be eligible for
full-scope Medi-Cal services provided to other eligible
adults.
Transition to Modified Adjusted Gross Income (MAGI) - Effective
January 1, 2014
1)Requires DHCS to convert the existing income eligibility
standard to a MAGI-based income equivalency level for parents
of dependent children, caretaker relatives, children, and
pregnant women.
2)Provides that the maximum eligibility level shall be not less
than the dollar amount that is equivalent to the income level,
expressed as a percent of the federal poverty level (FPL) for
each eligibility group, plus all applicable income disregards,
exclusions, and deductions in effect on March 23, 2010, to
ensure that any population eligible for Medi-Cal, AIM or the
Healthy Families Program (HFP) does not lose coverage.
3)Provides that any individual whose income eligibility is
determined by means of the MAGI-based standard shall not be
subject to a limitation on assets or resources.
4)Repeals the provisions establishing eligibility for the
Section 1931(b) program that sets the maximum income at 100%
FPL, authorizes additional income disregards and deductions
and requires that Medi-Cal eligibility for these families is
based on establishing "deprivation" of a child as defined.
5)Applies a standardized 5% income disregard for determining
income eligibility for any individual, whose income
eligibility is determined by means of the MAGI-based standard,
in effect setting the 133% FPL standard at 138% and sets this
as the minimum income eligibility level.
6)Requires DHCS to adopt procedures that take into account
future changes in income and family size in order to grant or
maintain eligibility for those who may become ineligible or
would be ineligible if the determination was based solely on
the current income and family size at the point at which
eligibility is being determined, as follows:
a) Requires, for currently eligible individuals, financial
eligibility to be based on projected annual household
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income for the remainder of the current calendar year if an
income calculation based on the current monthly income
would result in an ineligible income level;
b) Requires, for new applicants, financial eligibility to
be based on projected annual household income and family
size for that year if a determination made solely on
current monthly income and family size would result in a
determination of income ineligibility; and,
c) Requires DHCS to implement a method to account for
reasonably predictable decreases in income and increase in
family size, based on a history of predictable income
fluctuations or other clear indicia of future decrease in
income and increase in family size. Prohibits the
assumption of potential future increases in income or
decreases in family size to make the individual ineligible
in the current month.
Application and Redetermination Simplification - Effective
January 1, 2014
1)Repeals the requirement that adults file mandatory semiannual
status reports regardless of whether there have been any
changes in income, family size, or other factors that affect
continued eligibility for the MAGI-based categories and
eliminates the requirement that a notice of action include the
requirement to file this status report.
2)Requires all state health subsidy programs, which includes
Medi-Cal, AIM, enrollment in a qualified health plan through
the Exchange and a Basic Health Plan, if there is one, to
accept self-attestation, instead of requiring production of
documentation for age, date of birth, family size, household
income, state residency, pregnancy, and any other applicable
criteria permitted under the ACA.
3)Repeals the requirement that DHCS adopt regulations for
determining whether an individual applying for Medi-Cal is a
resident of the state and county and repeals a specified list
of required documentation to prove residency.
4)Revises provisions related to appealing a denial of a
determination of residency by repealing the requirement that a
determination of residency shall not be granted unless the
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evidence supports an intent to remain indefinitely and instead
requires that the evidence supports a finding consistent with
the following requirements which define state residency for
purposes of Medi-Cal eligibility:
a) For an individual 21 years of age or older an
attestation that he or she lives in the state and either
intends to reside in the state or has entered the state
with a job commitment or to seek employment. Specifies
that the individual is not required to have a fixed address
or to be currently employed;
b) An individual under 21 years of age who is capable of
indicating intent and is emancipated or married may be
determined a resident if he or she meets the requirements
of a) above;
c) For an individual under 21 years of age who does not
qualify under b) above and is not eligible for Medi-Cal as
a foster child, or by virtue of a linkage to other public
programs, state residency is established if the child lives
in the state and no fixed address is required or the child
resides with a parent, parents, or caretaker relative who
meet the requirements of a) above; or,
d) For an individual who is incapable of stating intent or
who is living in an institution requires that the state of
residency be determined by applicable federal regulations.
5)Revises provisions relating to an individual who maintains a
residence outside the state for at least two months and is
terminated due to failure to provide required documentation of
continued residence in California and who reapplies, to
require the person to be reinstated upon a showing of
residence in the state and that no permanent residence has
been established in another state, provided other eligibility
criteria are met.
6)Allows a person who is applying for a state health subsidy
program to file an application on his or her own behalf or on
behalf of his or her family. Allows the person to designate
an individual or organization to assist or represent him or
her. Provides for an authorized representative to apply or
renew on a person's behalf including guardians, conservators,
public agency representatives, legal counsel, relative,
friend, or other designated individual.
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7)Provides that a person who contests or appeals an eligibility
or benefits determination has the right of self-representation
or to be represented by legal counsel, a friend, or other
designated spokesperson.
8)Repeals the requirement of an annual reaffirmation and
provides that the Medi-Cal eligibility is to be renewed
annually and no more frequently than once every 12 months for
individuals whose financial eligibility is determined by use
of the MAGI-based standard.
9)Revises the process for Medi-Cal eligibility redetermination
by adding requirements, as specified in federal regulations,
that information useful to verifying financial eligibility,
such as wages or enrollment or eligibility in other similar
income based programs, should be obtained from other state and
federal agencies or electronically from federal and state
databases prior to contacting the individual.
10)Adds a requirement that if the county is able to renew
eligibility based on the information obtained through 9)
above, the county must notify the individual of the basis of
the eligibility determination, inform the individual of the
obligation to correct any inaccuracies by internet, telephone,
mail, in person, or other commonly available electronic means
and that the individual is not required to sign and return the
form if the information is accurate.
11)Requires the county to make reasonable efforts to reduce
multiple notices by requiring the notice of eligibility
renewal to include other relevant program eligibility
information.
12)Revises the process in a case where the county is not able to
obtain enough information to complete an eligibility
redetermination and is required to contact the individual by
telephone by a adding a requirement to attempt to contact the
person by electronic communication as well.
13)Revises the process in a case where not enough information is
available pursuant to 9) or 12) above by:
a) Requiring the county to send a form containing the
currently available relevant information instead of a form
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that highlights the missing information;
b) Prohibiting the county from requesting information from
non-applicants, and,
c) Adding a requirement that the form advise the individual
to provide information to the county via internet, by
telephone, by mail, in person, or electronically and that
the form must be signed.
14)Revises the procedures in a case where the individual submits
an incomplete form and is terminated after 20 days because of
the failure to submit a completed application as follows:
a) Adds a requirement to attempt to contact the individual
by electronic means as well as by telephone; and,
b) Extends from 30 to 90 days the period for rescission of
a termination if the individual submits a completed form.
15) In the case of an individual establishing eligibility on the
basis of disability, requires the county to consider blindness
and disability to be continuing until a determination
otherwise as specified, effective January 1, 2014.
EXISTING LAW :
1)Establishes, under state and federal law, the Medicaid program
(Medi-Cal in California) as a joint federal and state program
offering a variety of health and long-term services to
low-income women and children, low-income residents of
long-term care facilities, seniors and people with
disabilities.
2)Establishes, under federal law, CHIP to provide health
coverage to children in families that are low-income, but with
incomes too high for qualify for Medicaid.
3) Provides under state and pre ACA federal law that in
order to qualify for full-scope without a share of cost,
Medi-Cal services a pregnant woman must have family income
below 100% of the FPL, have assets below the allowable
level, meet qualifying immigration status requirements and
must either have another dependent child in the home or be
in the third trimester.
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4) Provides pregnancy-related services to women with family
income below 200% FPL, defined as services required to
assure the health of the pregnant woman and the fetus.
There is no share of cost and no assets limits for this
program.
5) Establishes the AIM program to provide prenatal care,
labor and delivery coverage for pregnant women with family
income between 200% and 300% of the FPL and for children
less than two years of age who were born of a pregnancy
covered under AIM.
6) Provides that citizen and legal immigrant children in
foster care are eligible for full scope Medi-Cal benefits
regardless of income or assets and upon attaining age 18,
remain eligible for full-scope, no share of cost Medi-Cal
with no income or assets requirements as former foster care
children until age 21.
7) Establishes a process for the redetermination of an
individual's eligibility for Medi-Cal annually.
8) Effective January 1, 2014, requires an individual to
have the option to apply for state subsidy programs, which
includes the state Medicaid program, the state CHIP,
enrollment in a qualified health plan through a state
exchange and a Basic Health Plan, if there is one, by
either in person, mail, online, telephone, or other
commonly available electronic means.
9) Effective January 1, 2014, requires development of a
single, accessible standardized application for the state
subsidy programs to be used by all eligibility entities and
establishes a process for developing and testing the
application.
10) Creates the Exchange, as an independent state entity
governed by a five-member board, to be a marketplace for
Californians to purchase affordable, quality health care
coverage, claim available tax credits and cost-sharing
subsidies and one way to meet the personal responsibility
requirements of the ACA.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
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committee.
COMMENTS :
1)PURPOSE OF THIS BILL . On January 24, 2013, Governor Brown
issued a proclamation to convene the Legislature in
Extraordinary Session to consider and act upon legislation
necessary to implement the ACA in: a) the areas of
California's private health insurance market, rules and
regulations governing the individual and small group market;
b) California's Medi-Cal program and changes necessary to
implement federal law; and, c) options that allow low-cost
health coverage through Covered California, California's
Exchange, to be provided to individuals who have income up to
200% of the FPL. This bill along with SB 1 X1 (Ed Hernandez)
addresses the second of the three areas identified in the
Governor's proclamation, that is to adopt the provisions of
the ACA related to eligibility changes in Medi-Cal. One of
the most significant is the addition of a new eligibility
category made up of childless adults between age 19 and 65 and
who are not disabled or pregnant and were not previously
eligible for Medi-Cal. In addition, the ACA provides coverage
for individuals up to age 26, who were in the foster care
system at age 18. Equally significant are the provisions that
advance the purpose of the ACA to expand access to health
coverage through improvements in Medicaid and CHIP, ensure
coordination between Medicaid, CHIP, and the Exchange and
simplify the enrollment and renewal process. In regulations
adopted on March 23, 2012, CMS states that although there are
short-term burdens associated with implementation, over time
the Medicaid program will be made substantially easier for
states to administer and for individuals to navigate by
streamlining Medicaid eligibility, simplifying Medicaid and
CHIP eligibility rules for most individuals, and creating a
coordinated process that result in a seamless enrollment
experience across Medicaid, CHIP, and the new exchanges.
2)BACKGROUND . Starting in calendar year 2014, the ACA replaces
many of the complex categorical groupings and limitations in
the Medicaid program and provides eligibility to all
nondisabled, non-pregnant individuals between the ages of 19
and 65 with family income at or below 133% FPL, provided that
the individual meets certain non-financial eligibility
criteria, such as citizenship. Also beginning in 2014, the
ACA requires MAGI to be used in determining eligibility for
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this new Medi-Cal population, as well as for families,
children, and caretaker relatives and for subsidized coverage
through the Covered California. The MAGI is based on the
federal Internal Revenue Code (IRC). The ACA generally adopts
MAGI as a way to count household income and eliminates the
existing variety of income disregards and deductions currently
used by states. In addition, there are no resource or assets
limits under MAGI. Using MAGI methods, household income will
be the sum of the income of every individual who is in the
household, minus a standard income disregard of five
percentage points of the FPL for the applicable household
size. The rule also aligns family size under Medicaid rules
with the IRC MAGI definition. As a result there are a small
number of situations in which the transition from current
rules to MAGI rules will result in different household
compositions than under the old rules.
According to a model of California insurance markets known as
the California Simulation of Insurance Markets, 5.6 million
Californians were without health insurance in 2012 or 16% of
the population under age 65. A recent study estimates that
when California implements the Medi-Cal provisions, more than
1.4 million of these individuals will be newly eligible, of
which between 750,000 and 910,000 are expected to be enrolled
at any point in time by 2019. This study, Medi-Cal Expansion
under the Affordable Care Act: Significant Increase in
Coverage with Minimal Cost to the State, published by UC
Berkeley Center for Labor Research and Education and UCLA
Center for Health Policy Research in January 2013, also finds
that about 2.5 million Californians are already eligible for
Medi-Cal but not enrolled and between 240,000 and 510,000 of
them are expected to be enrolled at any point in time by 2019
as a result of implementing the ACA.
3)LOW-INCOME CHILDLESS ADULTS . As passed, the ACA required
states to extend the new Medicaid coverage to all individuals
between ages 19 and 64 with incomes up to 133% of the FPL,
($14,856 for an individual based on the 2012 FPL) known as the
"newly eligible" category. In March of 2012, the Supreme
Court of the United States held three days of testimony on the
constitutionality of two major provision of the ACA arising
out of two cases heard in the 11th Circuit Court of Appeals,
National Federation of Independent Business v. Sebelius , and
Florida v. Department of Health and Human Services (2011) 11th
Circuit Nos. 11-11021 & 11-11067, the individual mandate and
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this Medicaid expansion. Subsequently, a majority of the
Supreme Court upheld the individual mandate in National
Federation of Independent Business v. Sebelius , 132 S. Ct.
2566 (2012). However, the Court found the Medicaid expansion
was unconstitutionally coercive on states. The Court noted
that those states that refuse to expand coverage requirements
would see ALL of their Medicaid funds cut off, not just the
funds for the expansion. States can decline to participate,
the Court indicated, but also noted that States that wish to
participate can be required as condition of accepting funds to
comply with ACA's conditions for the use of those funds. A
majority of the Court found that this issue was appropriately
remedied by circumscribing the HHS Secretary's enforcement
authority, thus leaving the Medicaid expansion intact, but at
state's option to adopt. This ruling also left the mandatory
provisions relating to eligibility simplification,
streamlining, and enrollment intact. The ACA provides that
for this population the Federal medical assistance percentage
(FMAP) will be 100% for 2014, 2015, and 2016; decreasing to
95% in 2017; 94% in 2018; 93% in 2019; and 90% thereafter.
Recent guidance from HHS clarified that states will only
receive the enhanced 100% matching rate in 2014 through 2016
if they expand eligibility all the way up to 138% of the FPL.
HHS will consider partial expansions to a lower income level,
but states exercising this option would only receive the
regular federal matching rate which is 50% in California.
a) Medically indigent adults. In California, traditionally
the counties have been the health care provider of last
resort for all indigent or the very low-income population
under what is commonly known as the Section 17000 (of the
Welfare and Institutions Code) responsibility. When the
federal Medicaid program was established in 1966 and
implemented in California, eligibility was initially
limited to low-income individuals linked to a federal
"categorical" program. These included aged, blind, and
disabled persons, as well as parents and children receiving
grants under the Aid to Families with Dependent Children
(AFDC) program. A number of federal initiatives have
resulted in expanded coverage for parents and children and
some childless adults with specific conditions. For
instance, in 1996 when AFDC was replaced with Temporary
Assistance for Needy Families (TANF), states were allowed
to set more liberal rules so that families who lose
eligibility for cash aid may retain eligibility for
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Medi-Cal under what is called the Section 1931(b) program.
This was implemented in California in 1998. These families
were still required to meet other assets and resources
limits and non-income eligibility rules such as the
"deprivation" rule. This means that at least one of the
child's parents is absent, deceased, or disabled, or that
the principal wage earner is unemployed or underemployed.
Other expansions have included certain refugees or limited
scope programs such as for pregnant women up to 200% FPL,
the Breast and Cervical Cancer Treatment Program, kidney
dialysis, and tuberculosis treatment. However most
nonpregnant, non-disabled, childless adults between the
ages of 19 and 65 continued to be ineligible for the
federal match provided through the Medi-Cal program, and
were known as Medically Indigent Adults (MIAs).
In the 1970's the state began providing financial assistance
to the counties for the costs of MIAs and extended Medi-Cal
eligibility to this population as a state-only program.
However, in the recession of 1982, the legislature
transferred responsibility back to the counties along with
70% of the funding. This funding has been reduced over the
years through a variety of budget related actions including
the 1991-92 Realignment which transferred new program and
funding responsibilities to the counties along with new
revenue sources.
According to a June 2005 report prepared for the California
HealthCare Foundation, Caring for Medically Indigent Adults
in California: A History, by Deborah Reidy Kelch, two types
of configurations emerged after this transfer. Larger
counties operated their own MIA programs and smaller
counties contracted back to the state in what became known
as the County Medical Services Program (CMSP). CMSP now
includes 35 counties and is run by an independent governing
board. This June 2005 report also points out that as
expected, some counties implemented narrow definitions of
medical necessity to manage program costs. Counties with
their own hospitals and clinics tended to provide more
generous benefits.
b) Medicaid waiver expansions. In 2005, the State of
California sought a five year federal waiver as a Medicaid
demonstration project under the authority of Section
1115(a) of the Social Security Act. Under the 2005 waiver,
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$180 million in federal funds were allotted to the
county-based Health Care Coverage Initiatives (HCCI) to
provide coverage to more than 130,000 medically-indigent
adults who are not eligible for other public programs.
Using a competitive process, California selected 10
counties in waiver years three, four, and five (September
1, 2007-August 31, 2010) to provide coverage to this
population through an organized system of care. The
participating counties-Alameda, Contra Costa, Kern, Los
Angeles, Orange, San Diego, San Francisco, San Mateo, Santa
Clara, and Ventura-used local expenditures, referred to as
Certified Public Expenditures, to draw down the available
federal funds. In November 2010, California received
federal approval for a new five year Waiver, entitled "A
Bridge to Reform." A key component of this waiver is the
establishment of the LIHPs as a transition to
implementation of the ACA. The Special Terms and
Conditions (STCs) that accompanied the Bridge to Reform
Demonstration Waiver approval by CMS treat this
county-based coverage as a Medicaid Coverage Expansion and
a bridge to the more significant coverage that is effective
in 2014. Under this federal waiver and implementing state
legislation, counties draw down federal Medicaid matching
funds to cover low-income adults. This Demonstration
builds on the 10 county HCCIs from the 2005 waiver by
offering participation to all counties in the state to
cover as many as 500,000 low-income uninsured individuals.
All but five counties have established or are in the
process of establishing a LIHP. The STCs also require the
development of a transition plan so that this population
can be seamlessly converted to a MAGI Medicaid expansion
population on January 1, 2014 under the ACA. This bill
codifies this process.
c) Medi-Cal benefit package for the Medi-Cal expansion
population . Since 2006, state Medicaid programs have had
the option to provide certain groups of Medicaid enrollees
with an alternative benefit package known as "benchmark" or
"benchmark-equivalent" coverage, based on one of three
commercial insurance products or a fourth,
"Secretary-approved" coverage option. The four benchmarks
are: i) The Standard Blue Cross/Blue Shield Preferred
Provider Option offered through the Federal Employees
Health Benefit program; ii) State employee coverage that is
offered and generally available to state employees; iii)
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The commercial health maintenance organization or HMO with
the largest insured commercial, non-Medicaid enrollment in
the state; and, iv) Secretary-approved coverage which can
include the Medicaid state plan-benefit package offered in
that state.
California has not implemented this federal option. The ACA
requires states to select a benefit package for the
Medi-Cal expansion population using "benchmark" or
"benchmark-equivalent" coverage. "Benchmark" means that
the benefits are at least equal to one of the statutorily
specified benchmark plans, and "benchmark-equivalent" means
that the benefits include certain specified services, and
the overall benefits are at least actuarially equivalent to
one of the statutorily specified benchmark coverage
packages.
The ACA requires any Medicaid benchmark benefit package to
additionally provide coverage for the EHBs that private
health plans covering individuals and small employers are
required to provide under the ACA. The 10 EHBs are
ambulatory patient services, emergency services,
hospitalization, maternity and newborn care, mental health
and substance use disorder services, including behavioral
health treatment, prescription drugs, rehabilitative and
habilitative services and devices, laboratory services,
preventive and wellness services and chronic disease
management, and pediatric services, including oral and
vision care.
In November 2012, CMS provided additional guidance to states
on Medicaid benchmark benefit coverage options for the
expansion population of adults who become newly eligible
for Medicaid as of January 1, 2014, now referred to as
"Alternative Benefit Plans". The guidance indicates that
the process for incorporating the 10 EHBs will generally
follow the regulations that apply to individual and small
group markets in state exchanges, but will include some
modifications unique to Medicaid and that further guidance
will be provided in the future.
The November 2012 guidance did clarify that in designing
the Alternative Benefit Plan, a state will choose from one
of the four reference plan options described above. If the
state selects a reference plan that is also one of the
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options available for defining EHBs in the individual or
small group market (referred to as "base benchmark options"
in the proposed EHB regulations), then the Alternative
Benefit Plan will be deemed to have met the requirement to
cover all EHBs as long as the selected plan includes the 10
EHB categories. If the selected reference plan is missing
one of the 10 EHB categories, then the state must follow
the supplementation process described in the EHB
regulations, as amplified by forthcoming Medicaid
regulations. If the state selects a reference plan that is
not one of the options available for defining EHBs in the
individual or small group market, then the state must
select one of the EHB base benchmark options; compare the
benefits in the Medicaid Alternative Benefit Plan to the
selected EHB base benchmark option; and to the extent
needed, supplement the Alternative Benefit Plan.
This would be in addition to any other requirements for
benchmark or benchmark equivalent plans, including
non-emergency medical transportation, Early and Periodic
Screening, Diagnostic, and Treatment services, family
planning services, and federal mental health parity (known
as the Mental Health Parity and Addition Equity Act
compliance).
This bill would require DHCS to seek federal approval to
establish a benchmark benefit package that includes the
same benefits, services, and coverage that are provided to
all other full-scope Medi-Cal enrollees. In addition,
these benefits would be supplemented by any benefits,
services, and coverage included in the EHB package adopted
by the state and approved by the federal Secretary of
Health and Human Services.
4) Transition to MAGI . Effective January 1, 2014, states
will use the MAGI-based methodology for determining the
income of an individual and the individual's household, as
applicable, for purposes of eligibility for Medicaid or
CHIP where a determination of income is required.
According to CMS, to promote coordination and avoid gaps or
overlaps in coverage, the new methodology is aligned with
the one that will be used to determine eligibility for the
premium tax credits and cost sharing reductions available
to certain individuals purchasing coverage on the
Affordable Insurance Exchanges starting in 2014. Under the
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statute, MAGI-based income methodologies will not apply to
determinations of Medicaid eligibility for elderly and
disabled populations. As interpreted by CMS regulations,
the new MAGI-based methodology includes certain unique
income counting and household composition rules.
Currently, states' methodologies for determining Medicaid and
CHIP income eligibility vary widely, primarily due to
differences in the application of income disregards. To
determine eligibility, the state first determines an
individual's (or family's) gross income using a combination
of state and federal rules on household or family
composition, and then applies deductions, or disregards,
which are income amounts that are not considered countable,
such as childcare expenses. These income deductions or
disregards can vary by state, type of income, and by
eligibility group. The resulting net income is then
compared to an income eligibility threshold (referred to as
the net income standard), expressed as a percentage of the
FPL to determine whether the individual is income eligible
for Medicaid or CHIP. By converting to the MAGI rules and
collapsing most existing eligibility into three broad
categories, this methodology has an impact on how household
income is counted. For example, a stepparent with no
financial obligation for a child is not counted in the
household income under existing rules, but may be under
MAGI.
a) Conversion methodology . States are required to apply
conversion methodologies for two purposes. One is the
conversion of net income standards under existing programs
in order to implement the simplified MAGI-based equivalent
eligibility income level under which the minimum
eligibility level will be set at 138% FPL for children,
parents and caretaker relatives. CMS has two options for
states, either a standardized methodology developed by CMS
or a state may propose an alternative and demonstrate to
CMS how it meets the statutory objectives. However CMS is
also developing a second conversion methodology for the
purpose of determining the state's applicable FMAP for each
population, including for newly eligible individuals.
Under the ACA, individuals who are currently not eligible
for a state's Medicaid program, but become eligible under
the expansions will be matched at the higher ratio of 100%
until 2017, stepping down to 90% by 2019 and thereafter,
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whereas the state will continue to receive a 50-50 match
for individuals who would have been eligible under the
current rules. More guidance on how this will be
determined is expected to be forthcoming.
b) Application to children's programs . Until January 1,
2013, California's CHIP program, known as HFP, provided
health insurance for about 900,000 children up to age 19 in
families with incomes above the Medi-Cal threshold but
below 250% of FPL. Under the CHIP program, states have the
option to create a stand-alone program such as HFP or
expand its Medicaid program to include these children in
families with higher income. In both options, states
receive the two-dollar federal match for every state dollar
to provide coverage for the CHIP population. As
implemented in California, Medi-Cal covered infants under
age one in families with income under 200% of FPL, children
aged one to five in families with income up to 133% FPL,
and children age six to 18 in families with income up to
100% FPL. A child in a family with income over the
threshold but up to 250% FPL was covered by HFP. As part
of the eligibility simplification, the ACA requires, by
January 1, 2014, that all children in families with income
up to 133% FPL to be covered by the state's Medicaid
program, thereby eliminating discontinuity based on the age
of the child. The ACA also requires states to maintain
eligibility thresholds for children that are at least as
generous as those in place at the time of enactment. The
ACA also gives the states authority to integrate CHIP into
the exchanges.
However, the Brown Administration proposed to move up the
Medi-Cal transfer to 2013 and to shift the remainder of the
children (with incomes up to 250% FPL) to Medi-Cal, rather
than integrate CHIP into the Exchange or retain as a
stand-alone program. The Legislature adopted a modified
version as part of the 2012-13 Budget. AB 1494 (Committee
on Budget), Chapter 28, Statutes of 2012, provided for the
transition of all children from HFP to Medi-Cal starting no
earlier than January 1, 2013. The transition, as modified
by the Legislature in AB 1494, breaks up the transfer to
Medi-Cal into four phases. Phase 1 has been subsequently
subdivided into three parts. Federal approval for Part A
was received at the end of December and began on January 1,
2013 and affected approximately 200,000 children in eight
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counties: Alameda, Riverside, San Bernardino, San
Francisco, Santa Clara, Orange, San Mateo, and San Diego.
An implementation schedule has been developed for
transitioning the remainder of the children that sets
transition timelines that are related to whether the child
is in a plan that participates in the Medi-Cal program, or
will have to select a new plan or new primary care
provider. All newly eligible children are being enrolled
into Medi-Cal.
5) ENROLLMENT AND SIMPLIFICATION . Effective January 1,
2014, the ACA envisions a streamlined, simplified and
seamless enrollment system that employs minimal use of
paper documentation and relies on modern technology to the
greatest extent possible for all the state subsidy
programs. For example, CMS states in the Preamble to the
March 23, 2012 Rules and Regulations, as follows: whether
conducted by a public or private entity, it is anticipated
that eligibility determinations using MAGI-based standards
will be highly automated, utilizing business rules
developed by the State Medicaid agency. In the most
simplified cases, which can be determined without human
intervention or discretion, we are clarifying that
automated systems can generate Medicaid eligibility
determinations, without suspending the case and waiting for
an eligibility worker to finalize the determinations.
Except for certain specified information such as citizenship
and immigration status, the Regulations allow states to
accept attestation of needed information. CMS further
states that this applies to both financial and
non-financial verification and that if self-attestation is
not accepted, states must access available electronic data
bases prior to requiring additional information or
documentation in verifying all factors of eligibility.
With regard to forms, the Secretary is required to develop a
single streamlined application. A state may develop its
own single, streamlined form, but it must be approved by
the Secretary and meet the Secretary-established standards.
The ACA also requires that an individual determined to be
ineligible for the Medicaid program or the state's CHIP
program is to be screened for eligibility for enrollment in
the Exchange and if applicable, premium assistance without
being required to submit an additional or separate
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application. Supplemental forms may only be required for
individuals whose eligibility cannot be determined through
the application of the MAGI standard. States are required
to establish procedures that enable individuals to enroll
and renew through an Internet website and to consent to
enrollment or reenrollment through electronic signature.
States are also required to ensure that the Medicaid
program, the CHIP program and the Exchange utilize a secure
electronic interface sufficient to allow for a
determination of eligibility for coverage or enrollment as
appropriate. CMS has directed states to analyze current
verification procedures to determine the policy and systems
modifications that will be needed in order for the state to
achieve this streamlined verification process. There are a
number of key steps that California has already undertaken,
but in other cases new systems or revisions to existing
processes will be necessary to ensure that the spirit and
intent of the ACA is carried out.
a) AB 1296 (Bonilla), Chapter 641, Statutes of 2011 . AB
1296 codified many of the requirements of the ACA with
regard to a streamlined, simplified, and coordinated
eligibility system. For instance it selected the option
for a state developed single application over the option of
using one developed by the Secretary. It established a
stakeholder process as a forum to review and discuss many
of the options and implementation issues and challenges
that are created by the ACA with regard to these issues.
AB 1296 further advanced the intent of the ACA by requiring
that only the information necessary for the eligibility
determination could be required and only from the person
who was applying for coverage. It also required that forms
be in simple user-friendly language, and accessible to
limited English proficient applicants as well as others
requiring accommodations for accessibility.
AB 1296 laid out a process for streamlining the application
and enrollment process by requiring the entity that made
the eligibility determination to grant eligibility
immediately, to allow prepopulation of forms using
information from available data sources and a simplified
process for verification, an opportunity for the applicant
to correct information, resolve discrepancies, or to supply
additional information as necessary.
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b) California Healthcare Eligibility, Enrollment and
Retention System (CalHEERS) Project . CalHEERS is a
procurement conducted jointly by the Exchange, DHCS, and
Managed Risk Medical Insurance Board to build the
Information Technology system to support the consumer
application and enrollment process at the Exchange.
Following extensive review and stakeholder comment and
input, Accenture was hired through a solicitation process
for the design, development, and deployment of CalHEERs.
The portal will offer eligibility determinations for both
Medi-Cal and federally subsidized Covered California
coverage through the Exchange. It will allow enrollment
through multiple access points including mail, phone, and
in-person applications. It is guided by a "no wrong door"
policy that is intended to ensure the maximum number of
Californians obtain coverage appropriate to their needs.
Eligibility and enrollment functions will be released in
September of 2013. The CalHEERS business functions include
interfacing with the Medi-Cal eligibility data system. It
will also have the capacity to be a secure interface with
federal and state databases in order to obtain and verify
information necessary to determine eligibility.
c) Income Fluctuations . Under the ACA Medicaid eligibility
remains based on monthly income at the time of application,
while eligibility for premium tax credits for Exchange
coverage is based on annual income. However, the CMS
guidance has been interpreted to provide states new options
to assess continuing Medicaid eligibility based on
projected annual income or by taking into account
anticipated changes in income, which would minimize
coverage gaps and transitions between Medicaid and Exchange
coverage due to small income fluctuations. Actual changes
in income must be reported by applicants and enrollees and
acted upon by the state or designated entity.
6) Renewal and redetermination . The ACA goal of reducing
the number of uninsured by creating a continuum of coverage
options for individuals with family incomes up to 400% FPL
and the increased reliance on electronically available data
has implications for how states process renewals and
redeterminations. For instance, unless the individual
provides information regarding a change in circumstances,
renewal for individuals whose eligibility is based on MAGI
can be no more frequently than once every 12 months. Since
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the individual is obligated to report changes in
circumstances, this requires the elimination of semiannual
reporting for adults in California. The state agency must
have procedures in place to ensure that beneficiaries make
timely and accurate reports of any change in circumstances
and that enable beneficiaries to report these changes
online, by phone, in person, or through other electronic
means. For non-MAGI groups, such as those who are blind or
disabled, the rule retains the existing provision that
eligibility be re-determined at least every 12 months, but
allows states to assume that blindness and disability
continue until there is a determination otherwise.
For MAGI-groups, state agencies will first seek to renew
eligibility by evaluating information from the individual's
electronic account or from other more current reliable data
sources. If the available information is sufficient to
determine continued Medicaid eligibility, the state is
required to renew coverage based on that information and
send an appropriate notice without requiring the individual
to sign and return the notice. Enrollees must correct any
inaccurate information in the notice online, in person, by
telephone or by mail. If it cannot be determined that the
individual remains eligible based on available information,
the individual must be provided with a pre-populated form
containing the information relevant to renewal that is
available to the agency and a reasonable period of time of
at least 30 days to provide the necessary information and
correct any inaccuracies online, in person, by telephone or
by mail. The state has the option to allow
self-attestation and then use information available through
electronic data sources for verification. The state cannot
require an in-person interview as part of the
redetermination process. AB 1296 adopted many of these
requirements and this bill makes additional conforming
changes.
This bill also implements the provisions that are designed to
reduce multiple unnecessary applications by allowing a
reconsideration period for individuals who are terminated
due to failure to submit a renewal form or information. In
such a case, if the individual subsequently submits within
90 days after the date of termination, the state is
required to redetermine the individual's eligibility
without requiring a new application.
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7)SUPPORT . Supporters such as the California Primary Care
Association, Community Clinic Consortium, California Academy
of Family Physicians, Consumers Union, American Federation of
State, County and Municipal Employees, and Maternal and Child
Health Access indicate that this bill will keep California
moving toward full implementation of the ACA and provide
low-income Californians with the coverage they need. The
American Cancer Society Cancer Action Network supports this
bill because expanding the Medi-Cal program will extend
lifesaving health coverage to millions more low-income
California residents. Other supporters, such as California
Health Advocates support this bill because it would give the
new expansion population the same scope of benefits provided
to the existing Medi-Cal population in addition to the EHBs
and would also provide full-scope benefits to pregnant women.
The California Hospital Association supports this bill because
it ensure that people are receiving the right care at the
right time and place and would decrease administrative
barriers. The California Labor Federation and other
supporters such as the California School Employees Association
points out that this bill will draw down an estimated $2.1 to
$3.5 billion in federal funds in 2014 alone and that an
investment in Medi-Cal will be a benefit to the California
economy. The Los Angeles County Board of Supervisors, in
support, explains that this bill would allow for a seamless
transition of persons enrolled in its LIHP without the loss of
health coverage.
Health Access California and the Western Center on Law and
Poverty indicate that this bill also simplifies and modernizes
the eligibility rules for the Medi-Cal program, which will
streamline the application and enrollment system.
Children's Advocates such as the 100% Campaign, PICO
California, and United Ways of California point out that the
Medi-Cal simplifications in this bill will be particularly
important for enrolling more children who are eligible but
currently uninsured and additionally as important is extending
Medi-Cal coverage to former foster youth up to the age of 26.
This provides a critical safety net to these vulnerable young
adults trying to make it on their own without parental
support.
8)REQUEST FOR AMENDMENTS . Organizations including the
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California Communities United Institute, Advancement Project,
California School Health Centers Association, California
Health Advocates, California Pan-Ethnic Health Network, Union
of Pan Asian Communities, APAIT Health Center and the Latino
Health Alliance all support this bill, but explain they feel
it must be expanded to include all legal permanent resident
adults with incomes less than 138% FPL because this is
critical to improve access to health care and eliminate health
disparities in our state.
Children Now is requesting that amendments to specify that DHCS
work with community-based organizations and other stakeholders
to design an effective outreach plan and that the former
foster youth expansion be implemented immediately in order to
achieve parity with young adults who have not been in foster
care.
9)SUPORT IN CONCEPT . California State Council of the Service
Employees International Union (SEIU) sees this bill as a
critical part of the full implementation of the ACA.
Specifically, SEIU supports providing the same scope of EHBs
to the existing and expanded Medi-Cal population, as is
required in the private individual and small group market, as
it would result in one consistent benefit package across the
state. In addition SEIU states that this bill takes us in the
right direction but leaves a lot of work to be done.
10)RELATED LEGISLATION .
a) SB 1 X1 (Ed Hernandez and Steinberg) implement various
provisions of the ACA regarding Medi-Cal eligibility and
program simplification including the use of the MAGI and
expansion of eligibility in the Medi-Cal program. SB 1 X1
is set for hearing in the Senate Health Committee on
February 27, 2013
b) AB 2 X1 (Pan) reforms California's health insurance
market for individual purchasers and implements provisions
of the ACA prohibiting preexisting condition exclusions,
requiring guaranteed issuance of products, establishing
statewide open and special enrollment periods, and limiting
premium rating factors to age, geography, and family size,
and updates AB 1083 (Monning), Chapter 852, Statutes of
2012, relating to small group insurance market rules to
reflect new regulatory guidance. AB 2 X1 is set for
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hearing in the Assembly Health Committee on February 20,
2013.
c) SB 2 X1 (Ed Hernandez) reforms California's health
insurance market for individual purchasers and implements
provisions of the ACA prohibiting preexisting condition
exclusions, requiring guaranteed issuance of products,
establishing statewide open and special enrollment periods,
and limiting premium rating factors to age, geography, and
family size, and updates AB 1083 relating to small group
insurance market rules to reflect new regulatory guidance.
SB 2 X1 is set for hearing in the Senate Health Committee
on February 20, 2013 and in Senate Appropriations on
February 21, 2013.
d) SB 3 X1 (Ed Hernandez) establishes legislative intent to
create a bridge option that allows low-cost health coverage
to be provided to individuals within the Exchange and is
pending referral in the Senate Rules Committee.
e) SB 20 (Ed Hernandez) establishes legislative intent to
establish the Basic Health Program described in the ACA and
is also pending referral in the Senate Rules Committee.
f) SB 28 (Ed Hernandez and Steinberg) implement various
provisions of the ACA regarding Medi-Cal eligibility and
program simplification including the use of the MAGI and
expansion of eligibility in the Medi-Cal program. SB 28 is
currently in the Senate Health Committee.
g) AB 50 (Pan) implements various provisions of the ACA
related to allowing hospitals to make a preliminary
determination of Medi-Cal eligibility, allows forms for
renewal to be prepopulated with existing available
information and requires the process for Medi-Cal enrollees
to choose a plan to be coordinated with the Exchange. AB
50 is currently in the Assembly Health Committee.
11)PREVIOUS LEGISLATION .
a) AB 43 (Monning) of last Session would have expanded
Medi-Cal coverage to persons with income that does not
exceed 133% FPL, effective January 1, 2014 and would have
required a transition plan for persons enrolled in a LIHP.
AB 43 died on the Senate Inactive File.
AB 1 X1
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b) SB 677 (Ed Hernandez) of last Session would have
required DHCS to implement the provisions of the ACA
relating to eligibility and benefits in the Medi-Cal
program. SB 677 died on the Assembly Inactive File.
c) SB 1487 (Ed Hernandez) also from last Session would have
required DHCS to extend Medi-Cal eligibility to youth who
were formerly in foster care and who are under 26 years of
age, subject to FFP being available and to the extent
required by federal law. SB 1487 would have also made
legislative findings and declarations regarding the ACA,
stated legislative intent to ensure full implementation of
the ACA, and to enact into state law any provision of the
ACA that may be struck down by the United States Supreme
Court. SB 1487 was held on the Senate Appropriations
Committee suspense file.
d) AB 1066 (John A. Pérez), Chapter 86, Statutes of 2011,
enacts technical and conforming statutory changes necessary
to conform to the STCs required by CMS in the approval of
the Bridge to Reform Demonstration, including changing the
name of the LIHP from Coverage Expansion and Enrollment
Projects to the Medi-Cal Coverage Expansion and HCCI.
e) AB 342 (John A. Pérez), Chapter 723, Statutes of 2010,
enacted the LIHP and Coverage Expansion and Enrollment
Projects to provide health care benefits to uninsured
adults up to 200% of the FPL, at county option through a
Medi-Cal waiver demonstration project.
f) AB 1296, the Health Care Eligibility, Enrollment, and
Retention Act, requires the California Health and Human
Services Agency, in consultation with other state
departments and stakeholders, to undertake a planning
process to develop plans and procedures regarding these
provisions relating to enrollment in state health programs
and federal law. AB 1296 also requires that an individual
would have the option to apply for state health programs
through a variety of means.
g) SB 208 (Steinberg), Chapter 714, Statutes of 2010,
implemented provisions of the 2010 Section 1115 replacement
waiver including the Delivery System Reinvestment and
Improvement Pool, authorized DHCS to require the mandatory
enrollment of seniors and people with disabilities in a
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Medi-Cal managed care plan and required DHCS to implement
pilot projects to provide coordinated care to children in
the California Children's Services and to persons who are
eligible for Medi-Cal and Medicare.
h) AB 1595 (Jones) of 2010, would have required DHCS to
expand Medi-Cal eligibility to individuals with family
income up to 133% of FPL without regard to family status by
January 1, 2014. AB 1595 died on suspense in the Assembly
Appropriations Committee.
i) AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010,
establishes the Exchange as an independent public entity to
purchase health insurance on behalf of Californians with
incomes of between 100% and 400% FPL and employees of small
businesses. Clarifies the powers and duties of the board
governing the Exchange relative to the administration of
the Exchange, determining eligibility and enrollment in the
Exchange, and arranging for coverage under qualified
carriers.
j) SB 900 (Alquist), Chapter 659, Statutes of 2010,
establishes the Exchange. Requires the Exchange to be
governed by a five-member board, as specified.
12)POLICY COMMENTS .
a) Future federal guidance . On March 23, 2012, CMS issued
a final rule to implement the ACA provisions relating to
Medicaid and CHIP eligibility, enrollment simplification,
and coordination, effective January 1, 2014. HHS has also
issued a final rule (some of which are interim final)
regarding eligibility for premium tax credits, cost-sharing
reductions and enrollment in the exchanges and the
Department of the Treasury has issued a final rule
regarding health insurance premium assistance tax credits.
According to a December 2012, Issue Brief from the Kaiser
Commission on Medicaid and the Uninsured, Medicaid
Eligibility, Enrollment Simplification, and Coordination
under the Affordable Care Act: A Summary of CMS's March 23,
2012 Final Rule, there are a number of provisions in the
proposed rule that require further information and
clarification. For example, the regulations direct states
to convert their existing maximum income standards for
Medicaid and CHIP eligibility groups to MAGI-equivalents,
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but more guidance is needed regarding how states will make
this conversion. Moreover, the rule references performance
standards for state systems that have not yet been
developed. In addition, the rule includes a "reasonable
compatibility" standard that governs when states may
request additional information, including documentation,
from individuals to verify eligibility criteria. While the
rule provides some clarity on when income will be
considered reasonably compatible, more information is
needed about how states will define reasonable
compatibility for other eligibility criteria. Based on the
currently known requirements, this bill reflects
legislative intent to ensure full implementation in a
manner that maximizes federal funding opportunities,
simplifies applications, enrollment and retention and
provides benefits to the greatest extent allowed under
federal law. However as further guidance becomes
available, there may be a need for amendments and
revisions.
b) Verification of eligibility. CMS states that the
increased availability of electronic data matching,
including the 90% federal match that is available to states
for systems improvements, and the intent of the ACA to
create a coordinated and efficient eligibility and
enrollment system across insurance affordability programs
all support increased reliance on electronic verification.
CMS cautions that states that fail to take advantage of
this are undermining the policy of electronic primacy. In
furtherance of this goal, states have the flexibility to
approve eligibility based on self-attested information
subject to a later request for further information if
financial information cannot otherwise be verified. In
order to further advance these principles, CMS had provided
guidance to states that allows for minor discrepancies
between income information provided by an individual and
the electronic data match as long as it is "reasonably
compatible" in that both are below, at, or above the
eligibility level. Guidance is also provided with regard
to how states are to verify information if it is not within
these parameters. Finally, the individual may not be
denied eligibility or terminated without providing the
individual an opportunity to validate or dispute the
information.
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c) New Medicaid adult group . This bill enacts the ACA
Medicaid expansion to cover childless adults, under age 65
that was made optional by the Supreme Court decision in
National Federation of Independent Business v. Sebelius .
The Governor's Budget as introduced for 2013-14 outlines
two alternatives to the optional expansion - a state-based
approach or a county-based approach. No details of either
proposal have been released. The Governor's Budget Summary
states that implementation will requires a broader
discussion about the future of the state-county
relationship with the goal to strengthen local flexibility,
fairly allocate risk, and clearly delineate the respective
responsibilities of the state and the counties.
d) Benefits of Medi-Cal expansion . Numerous studies have
shown that Medicaid coverage improves access to health care
and intermediate health outcomes. Research on previous
expansions of Medicaid to adults in Arizona, Maine, and New
York found that Medicaid coverage was associated with
reduced mortality. Research on the Oregon Medicaid program
for previously uninsured low-income adults found that,
compared to similar adults who were not selected by lottery
to apply for Medicaid, people with Medicaid coverage were
70% more likely to report having a regular place of care
and 55% more likely to report having a usual doctor;
Medicaid coverage also increased the use of preventive care
such as mammograms (by 60%) and cholesterol monitoring (by
20%). Reducing the number and proportion of the uninsured
would benefit those with insurance coverage as well. The
Institute of Medicine found that insured adults in those
communities with high rates of uninsurance are more likely
to have difficulties obtaining needed health care and to be
less satisfied with the care they receive. The January
2013 report published by UC Berkeley Center for Labor
Research and Education and UCLA Center for Health Policy
Research also found that providing health insurance
coverage has substantial economic benefit. For instance,
health insurance coverage can improve educational outcomes
and worker productivity; will create jobs and more stable
funding for safety net providers that already serve
low-income communities.
e) Consequences of failure to expand Medi-Cal . If the
Medi-Cal expansion is not enacted for childless adults,
those with family incomes between 100% FPL and 400% and
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legal immigrants who are ineligible for Medi-Cal but have
income up to 400% FPL may purchase coverage through Covered
California. However, the lowest-income adults will not be
eligible for either Medi-Cal or subsidized coverage and
will continue to be the counties' responsibility thus
further straining the safety net providers and hospital
emergency departments.
f) Benefit plan for new eligible adult group . The November
2012 State Medicaid Director Letter provided additional
guidance on the Alternative Benefit Plan. However there
are a number of questions outstanding. For example, if a
state selects the Secretary approved option to define its
Alternative Benefit Plan (or selects any other option that
is not also a base benchmark option), it must also select
one of the 10 base benchmark options as its EHB reference
plan. States that have done this analysis often find that
some of the benefits covered in the base benchmark plan,
are not covered in their standard Medicaid package (e.g.
chiropractic services). Thus the question remains whether
the state must include these additional services in its
Medicaid Alternative Benefit Plan for the new adult group.
Likewise, the base benchmark plan may include services or
providers that federal Medicaid does not cover, such as
institutes of mental disease or fertility treatment,
raising the question of whether these services or providers
may or must be included in the state's Alternative Benefit
Plan. Forthcoming regulations may provide additional
guidance on the relationship between the states's
Alternative Benefit Plan and its selected base
benchmark/EHB reference plan.
REGISTERED SUPPORT / OPPOSITION :
Support
Advancement Project
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
APAIT Health Center
Asian Americans for Civil Rights and Equality
California Academy of Family Physicians
California Communities United Institute
California Coverage & Health Initiatives
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California Health Advocates
California Hospital Association
California Immigrant Policy Center
California Labor Federation
California Latinas for Reproductive Justice
California Nurses Association
California Pan-Ethnic Health Network
California Primary Care Association
California School Employees Association
California School Health Centers Association
California State Association of Counties
Children's Defense Fund California
Community Clinic Consortium
Consumers Union
Council of Mexican Federations
County of Los Angeles
EARN
Greenlining Institute
Health Access California
Inland Agency
Latino Coalition for a Healthy California
Latino Health Alliance
Los Angeles County Board of Supervisors
Maternal and Child Health Access
Mexican American Legal Defense and Educational Fund
National Council of La Raza
National Health Law Program
PICO California
Planned Parenthood Affiliates of California
Street Level Health Project
The 100% Campaign
The Children's Partnership
Transgender Law Center
Union of Pan Asian Communities
United Ways of California
Western Center on Law and Poverty
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH X1 / (916)
319-2097
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