HomeMy WebLinkAboutMINUTES - 04052011 - C.32RECOMMENDATION(S):
SUPPORT AB 1296 (Bonilla): Health Care Eligibility, Enrollment, And Retention Act, a bill that enacts the Health
Care Eligibility, Enrollment, and Retention Act, to implement the requirement of creating a single statewide
application to be used by all entities accepting and processing applications, for enrolling consumers in health
coverage, as recommended by the Director of the Health Services Department.
FISCAL IMPACT:
No fiscal impact to the County.
BACKGROUND:
Existing law provides for various programs to provide health care coverage to persons with limited financial
resources, including the Medi-Cal program and the Healthy Families Program. Existing law provides for the licensure
and regulation of health care service plans by the Department of Managed Health Care.
Existing law, the federal Patient Protection and Affordable Care Act (PPACA), requires each state to, by January 1,
2014, establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by
qualified individuals and qualified
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD
COMMITTEE
Action of Board On: 04/05/2011 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYES 5 NOES ____
ABSENT ____ ABSTAIN ____
RECUSE ____
Contact: Lara DeLaney,
925-335-1097
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of
the Board of Supervisors on the date shown.
ATTESTED: April 5, 2011
David J. Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc:
C.32
To:Board of Supervisors
From:Legislation Committee
Date:April 5, 2011
Contra
Costa
County
Subject:SUPPORT AB 1296 (Bonilla): Health Care Eligibility, Enrollment, And Retention Act
BACKGROUND: (CONT'D)
small employers, as specified, and meets certain other requirements.
Existing law, the California Patient Protection and Affordable Care Act, creates the California Health Benefit
Exchange (Exchange), specifies the powers and duties of the board governing the Exchange relative to determining
eligibility for enrollment in the Exchange and arranging for coverage under qualified health plans, and requires the
board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and qualified
small employers by January 1, 2014.
AB 1296 (Bonilla) would enact the Health Care Eligibility, Enrollment, and Retention Act, which would require the
California Health and Human Services Agency, in consultation with specified entities, to establish a standardized
single application form and related renewal procedures for Medi-Cal, the Healthy Families Program, the Exchange,
and county programs, in accordance with specified requirements.
The bill would specify the duties of the agency and the State Department of Health Care Services under the act, and
would require the agency to report to the Legislature by January 1, 2012, regarding policy changes needed to
implement the bill, as specified.
According to the author, AB 1296 complements other PPACA-related legislation by streamlining and simplifying
eligibility and enrollment. This bill ensures the overall purpose of the PPACA is achieved; that people are enrolled
and benefit from the health programs that they can afford.
This bill implements a statewide approach to determine eligibility and allow enrollment of consumers in the most
appropriate of the four programs. This system ensures the much needed “no wrong door” application system is
applied and consumers are enrolled into the correct program.
Bill Summary
AB 1296 enacts the Health Care Eligibility, Enrollment, and Retention Act, to implement the ACA requirement of
creating a single statewide application to be used by all entities accepting and processing applications, for enrolling
consumers in health coverage. The system must be available to apply by phone, in person, by mail or online for
enrolling into Medi-Cal, Healthy Families, the Exchange, and county health programs.
This bill requires the California Health and Human Services Agency (CHHSA) to consult with the California
Department of Health Care Services (DHCS); Managed Risk Medical Insurance Board; the California Health Benefit
Exchange; counties; health care services plans; consumer advocates; and other stakeholders to develop plans and
procedures to determine eligibility, enrollment, and retention in programs. CHHSA shall report to the Legislature, by
January 1, 2012, on the policy changes needed to develop the system.
DHCS is required to also:
Develop a “no wrong door” policy: regardless of where a person applies, their application will be evaluated
using the same system and methodologies.
Ensure all applicants whose income is less than 400percent of the federal poverty level are eligible for one of
the programs.
Facilitate enrollment into other programs, such as CalFresh (formerly Food Stamps) and CalWORKs.
Preserve and streamline citizenship and identity verification for application and renewals to allow consumers
to move between programs seamlessly, without the need for additional verification.
Additionally, DHCS is required to develop procedures to ensure continuity of coverage at specific transitions,
including:
Turning 65 years of age.
Qualified immigrants reaching the five-year bar for receipt of public benefits, as provided in Section 1613 of
Title 8 of the U.S. Code.
Foster youth emancipation.
Family income, assets, household composition, or other circumstances change.
Comments from Health Services Department: "AB 1296 is aimed at streamlining the eligibility, enrollment and
retention processes. There remains the issues of methodology, process, and a host of technological challenges, but in
principle, as a future direction, we can support this bill."
Support:
Western Center on Law & Poverty (Sponsor)
Opposition:
None Received.
Status:
02/18/2011 INTRODUCED.
03/21/2011 To ASSEMBLY Committees on HEALTH and HUMAN SERVICES.
Disposition: Pending
CONSEQUENCE OF NEGATIVE ACTION:
This bill implements a statewide approach to determine eligibility and allow enrollment of consumers in the most
appropriate of the four health programs. This system ensures the much needed “no wrong door” application system is
applied and consumers are enrolled into the correct program. If the Board does not support the bill, Contra Costa
County cannot be listed as a supporter.
CHILDREN'S IMPACT STATEMENT:
None.
california legislature—2011–12 regular session
ASSEMBLY BILL No. 1296
Introduced by Assembly Member Bonilla
February 18, 2011
An act to add Part 3.8 (commencing with Section 15925) to Division
9 of the Welfare and Institutions Code, relating to public health.
legislative counsel’s digest
AB 1296, as introduced, Bonilla.Health Care Eligibility, Enrollment,
and Retention Act.
Existing law provides for various programs to provide health care
coverage to persons with limited financial resources, including the
Medi-Cal program and the Healthy Families Program. Existing law
provides for the licensure and regulation of health care service plans
by the Department of Managed Health Care. Existing law, the federal
Patient Protection and Affordable Care Act (PPACA), requires each
state to, by January 1, 2014, establish an American Health Benefit
Exchange that facilitates the purchase of qualified health plans by
qualified individuals and qualified small employers, as specified, and
meets certain other requirements. Existing law, the California Patient
Protection and Affordable Care Act, creates the California Health
Benefit Exchange (Exchange), specifies the powers and duties of the
board governing the Exchange relative to determining eligibility for
enrollment in the Exchange and arranging for coverage under qualified
health plans, and requires the board to facilitate the purchase of qualified
health plans through the Exchange by qualified individuals and qualified
small employers by January 1, 2014.
This bill would enact the Health Care Eligibility, Enrollment, and
Retention Act, which would require the California Health and Human
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Services Agency, in consultation with specified entities, to establish a
standardized single application form and related renewal procedures
for Medi-Cal, the Healthy Families Program, the Exchange, and county
programs, in accordance with specified requirements. The bill would
specify the duties of the agency and the State Department of Health
Care Services under the act, and would require the agency to report to
the Legislature by January 1, 2012, regarding policy changes needed
to implement the bill, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
The people of the State of California do enact as follows:
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SECTION 1.Part 3.8 (commencing with Section 15925) is
added to Division 9 of the Welfare and Institutions Code, to read:
PART 3.8. HEALTH CARE ELIGIBILITY, ENROLLMENT,
AND RETENTION ACT
15925.(a) This part shall be known, and may be cited, as the
Health Care Eligibility, Enrollment, and Retention Act.
(b) (1) By January 1, 2014, the California Health and Human
Services Agency, in consultation with the State Department of
Health Care Services (department), Managed Risk Medical
Insurance Board, the California Health Benefit Exchange
(Exchange), counties, health care services plans, consumer
advocates, and other stakeholders shall undertake a planning
process to develop plans and procedures to implement this part
and the federal Patient Protection and Affordable Care Act (Public
Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152),
related to eligibility for, and enrollment and retention in, public
health coverage programs.
(2) The agency shall submit a report to the Legislature by
January 1, 2012, regarding policy changes needed in order to
develop the eligibility, enrollment, and retention system for health
coverage in compliance with this part.
(c) A single, standardized paper application shall be used by all
entities accepting applications for all public health care programs,
including Medi-Cal, the Healthy Families Program, the Exchange,
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— 2 —AB 1296
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and county programs. An electronic application and a telephone
application shall also be developed, using the same eligibility
methodologies. All of these applications shall include simple,
user-friendly instructions, and require applicants to answer only
those questions that are necessary to determine eligibility for their
particular circumstances.
(d) All locations, systems, portals, assistors, or entities of any
kind accepting applications for the programs identified in
subdivision (c) shall use and accept the applications described in
subdivision (c) as an application for all of the described programs.
An entity processing applications shall enroll an applicant in the
most beneficial program for which the applicant is eligible. If an
application is forwarded or transferred among entities for
processing, this process shall not impose any burden on the
applicant. The applicant shall be informed of how to get
information about the status of his or her application at any time.
(e) An applicant shall not be required to provide any verification
that is not necessary for the purpose of evaluating eligibility or
that may be verified using reliable databases approved by the
department for the purpose of evaluating eligibility. An applicant
shall be given an opportunity to provide his or her own verifications
if he or she prefers, but shall not be required to do so. An applicant
shall not be denied eligibility for a program specified in this section
without being given an opportunity to correct any information
provided by a verifying entity.
(f) Applications shall be evaluated so as to provide a real-time
determination of eligibility, including applicable cost sharing and
subsidies, whenever possible. When a real-time determination is
not possible, an applicant shall be granted presumptive enrollment
to the fullest extent allowed by federal law. Presumptive enrollment
shall continue until the applicant is enrolled in ongoing coverage
under Medi-Cal, the Exchange, Healthy Families, or a county
health program, or found to be ineligible for all of these programs
and informed of the denial of coverage in accordance with all
applicable due process requirements. For purposes of this part,
“real-time determination of eligibility” means an eligibility
determination made at the time the application is submitted.
(g) The eligibility, enrollment, and retention system shall use a
consumer-mediated approach, pursuant to which consumers shall
receive assistance to understand decisions they may make,
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AB 1296— 3 —
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including those concerning subsidies, plan choice, hardship
exemptions, and verifications. This approach shall provide
consumers with a meaningful opportunity to provide information
that ensures their enrollment in, and retention of, health care
coverage, in the most beneficial program for which they are
eligible.
(h) At application, renewal, or a transition due to a change in
circumstances, consumers shall move seamlessly between programs
without providing additional verification, application, or other
information.
(i) The department shall develop procedures to ensure continuity
of coverage at specific transitions, including, but not limited to,
all of the following:
(1) When a consumer reaches 65 years of age.
(2) When a qualified alien reaches the five-year bar for receipt
of public benefits, as provided in Section 1613 of Title 8 of the
United States Code.
(3) When a foster youth reaches the age upon which his or her
foster care benefits terminate.
(4) When family income, assets, household composition, or
other circumstances change.
(j) The department shall streamline and coordinate eligibility
rules and requirements among the programs identified in
subdivision (c) to ensure that all applicants whose income is less
than 400 percent of the federal poverty level shall be eligible for
one of those programs, and all entities processing applications use
the same methodologies to determine which program is most
beneficial for each applicant. This process shall include
coordination of rules for determining income levels, assets,
household size, documentation requirements, and citizenship and
identity information, so that all applications result in coverage in
the most beneficial program and seamless transition between
programs.
(k) The department shall maximize coordination and enrollment
in other public benefits programs, including, but not limited to,
the California Work Opportunity and Responsibility to Kids
(CalWORKs) program, the California Special Supplemental Food
Program for Woman, Infants, and Children (WIC), and CalFRESH,
both by accepting an application and reporting information from
those programs as an application for health benefits, and by using
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health benefit applications to initiate applications for those
programs, to the extent allowed by federal law.
(l) Renewal procedures shall be coordinated across all programs
and entities that accept and process renewal information, so as to
use all available information to renew benefits or transfer
beneficiaries seamlessly between programs without placing a
burden on the beneficiary. Renewal procedures shall be as simple
and user friendly as possible, shall require beneficiaries to provide
only that information which has changed, and shall use all available
methods for renewal, including, but not limited to, face-to-face,
telephone, and online renewal.
(m) All programs shall use standardized forms and notices and
notices to ensure that beneficiaries are fully informed and
understand what information is required from them for renewal,
if any, and are informed of any transfer, and how the transfer will
affect the beneficiary’s costs access to care, delivery system, and
responsibilities.
(n) (1) The requirement for submitting a report imposed under
subdivision (b) is inoperative on January 1, 2016, pursuant to
Section 10231.5 of the Government Code.
(2) A report submitted pursuant to subdivision (b) shall be
submitted in compliance with Section 9795 of the Government
Code.
O
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AB 1296— 5 —