HomeMy WebLinkAboutMINUTES - 06032014 - C.65RECOMMENDATION(S):
ADOPT a "Support" position on SB 1341, as amended, Mitchell. Medi-Cal: Statewide Automated Welfare System, a
bill that requires the Statewide Automated Welfare System to be the system of record for Medi-Cal and to contain all
Medi-Cal eligibility rules and case management functionality, as recommended by the Legislation Committee.
FISCAL IMPACT:
Unknown.
BACKGROUND:
At its May 1, 2014 meeting, the Legislation Committee voted unanimously to recommend a position of "Support" on
SB 1341 to the Board of Supervisors.
Current Status: 05/06/2014: In SENATE. Read second time and amended. Re-referred to Committee on
APPROPRIATIONS
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 06/03/2014 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: L. 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: June 3, 2014
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc:
C. 65
To:Board of Supervisors
From:LEGISLATION COMMITTEE
Date:June 3, 2014
Contra
Costa
County
Subject:Support Position on SB 1341, as amended, Mitchell. Medi-Cal: Statewide Automated Welfare System
BACKGROUND: (CONT'D)
SUMMARY : Requires the Statewide Automated Welfare System to be the system of record for Medi-Cal and to
contain all Medi-Cal eligibility rules and case management functionality. Authorizes the California Healthcare
Eligibility, Enrollment, and Retention System to house the business rules necessary for an eligibility
determination to be made for a Modified Adjusted Gross Income eligibility determination. Specifies the manner
in which the functionality to create and send notices of action for Medi-Cal and advanced premium tax credits
would be implemented.
Existing law:
1. Requires the Office of Systems Integration (OSI) to implement a statewide automated welfare system for the
following public assistance programs:
a. The CalWORKs program;
b. CalFresh;
c. The Medi-Cal program;
d. The foster care program;
e. The refugee program; and,
f. County medical services programs.
2. Requires statewide implementation of the Statewide Automated Welfare System (SAWS) for the programs
listed in 1) above to be achieved through no more than four county consortia, including the Interim SAWS
Consortium, and the Los Angeles Eligibility, Automated Determination, Evaluation, and Reporting System
(LEADER). Requires OSI to oversee the migration of the 39 counties composing the C-IV Consortium into a
system jointly designed by the 39 counties plus Los Angeles County under the LEADER Replacement System
contract. Requires this migration to result in a new consortium to replace the LEADER and C-IV Consortia.
This bill:
1. Requires SAWS to be the system of record for Medi-Cal, and requires SAWS to contain all Medi-Cal eligibility
rules and case management functionality.
2. Permits, as an exception to 1) above, the business rules necessary for an eligibility determination to be made
under the Modified Adjusted Gross Income (MAGI) rules pursuant to the federal Patient Protection and
Affordable Care Act (ACA) to be housed in the California Healthcare Eligibility, Enrollment, and Retention
System (CALHEERS). Requires, if DHCS implements this authority to house the MAGI business rules in
CalHEERS, these business rules to be made available to the SAWS consortia through an automated interface in
order for the consortia to determine eligibility for Medi-Cal under the MAGI rules.
3. Requires, effective January 1, 2016, the functionality to create and send notices of action for Medi-Cal and
advanced premium tax credits (APTC), to be implemented consistent with the following:
a. Requires SAWS to be used to generate noticing language and NOA documents, and to send NOA documents
for all Medi-Cal programs (MAGI and non-MAGI).
b. Requires CalHEERS to be used to:
i. Generate noticing language for APTC, including, but not limited to, Medi-Cal denial noticing language related
to APTC approvals; and,
ii. Generate and send NOA documents for the APTC only program. These two provisions apply if DHCS
exercises its authority to house the MAGI business rules in CalHEERS.
c. Requires SAWS to be used to combine the noticing language for Medi-Cal programs generated by SAWS and
the noticing language for APTCs generated by CalHEERS into one notice, and requires SAWS to be used to send
the document as one combined notice for all programs in any mixed eligibility cases that include an approval or
approvals for MAGI Medi-Cal eligibility determinations, non-MAGI Medi-Cal eligibility determinations, or both,
and APTC approvals. This provision applies if DHCS exercises its authority to house the MAGI business rules in
CalHEERS.
COMMENTS:
1. Author's statement. According to the author, this bill will clarify the respective roles of SAWS and CalHEERS
in order to minimize confusion and errors related to Medi-Cal eligibility under the ACA. This bill will also ensure
that NOAs are able to be tailored in the manner consistent with legal requirements, and will protect the counties'
ability to correct erroneous denials or benefits assignments.
2. Background. The federal ACA changed the income eligibility rules for Medicaid for the newly eligible and
some of the currently eligible to a tax-based system for counting individual or household income called Modified
Adjusted Gross Income (MAGI). These MAGI income counting eligibility rules are also used to calculate
eligibility for APTCs and cost-sharing subsidies in Covered California. CalHEERS contains the business rules for
MAGI eligibility determinations and is used by both Covered California and counties in determining eligibility
for APTC and MAGI Medi-Cal. CalHEERS is a web-based application portal where individuals and small
businesses can research, compare, check their eligibility for, apply, and purchase health coverage. CalHEERS was
designed to interface with various federal, state, and local information technology systems to perform the
administrative functions necessary for the purchase of health insurance. For example, CalHEERS is required to
interface with a federal data hub (a database that consolidates data from the Internal Revenue Service, Social
Security Administration, and other federal entities) to assess income, citizenship, and other data necessary to
determine eligibility for various ACA health coverage options. CalHEERS must interface with the three SAWS
consortia, which have their own eligibility determination functionality built into their own system (the three
consortia are LEADER, California Work Opportunity and Responsibility to Kids Information Network [CalWin],
and Consortium IV [C-IV]). The interface between SAWS and CalHEERS went live on January 21, 2014, but it
continues to be upgraded.
3. Notices of Action. Existing law requires county social service departments to notify beneficiaries in writing of
their Medi-Cal-only eligibility or ineligibility, and of any changes made in their eligibility status or share of cost.
These notifications are called a "Notice of Action." NOAs inform Medi-Cal beneficiaries of:
a. Any approval, denial or discontinuance of eligibility;
b. A change in the beneficiary's share of cost;
c. The reason an action is being taken and the law or regulation that requires the action (if the action is a denial,
discontinuance or increase in share of cost); and,
d. The right to request a state hearing.
NOAs must also include the name and telephone number of the eligibility worker who completed the eligibility
determination, and the date the form was completed. As currently designed, CalHEERS does not allow counties to
create, edit, and send NOAs for Medi-Cal.
4. Prior legislation. AB 1296 (Bonilla), Chapter 641, Statutes of 2013 enacts the Health Care Eligibility,
Enrollment and Retention Act, requiring state entities who administer health care coverage programs to undertake
a variety of activities related to eligibility, enrollment and renewal of health care coverage through Medi-Cal, the
Healthy Families Program, and Covered California. AB 1296 required that an individual screened as not eligible
for MAGI Medi-Cal but who may be potentially eligible for Medi-Cal on another basis to have his or her
application or case forwarded to the Medi-Cal program for an eligibility determination.
5. Support. This bill is jointly sponsored by the County Welfare Directors Association (CWDA) and the Service
Employees International Union. CWDA argues, in light of the decision to build CalHEERS, an agreement was
reached between the Administration, Covered California, and the counties that reflected existing statute naming
SAWS as the system of record for Medi-Cal and requiring Medi-Cal eligibility functions to be in SAWS. Per the
agreement, CalHEERS would serve as the system that applies the new MAGI rules, and SAWS was to proceed
with all other eligibility and enrollment case functions. CWDA states the intent of SAWS serving as the system of
record is to ensure program efficiency, efficacy, continuity, and cohesiveness via multi-program case
management, and to allow for ease of access to Medi-Cal while providing a more simplified process. This bill
would codify the agreed upon automation approach designed to comprehensively and seamlessly serve families'
needs for both their health care and human service needs. This approach allows families and individuals to obtain
coordinated services, both when they initially apply and as their circumstances change. The second component of
this bill is which entities issue NOAs. CWDA states a key issue with the design of CalHEERS is that is it does not
enable counties to create, edit, and send NOAs for Medi-Cal. NOAs are the documents that inform applicants and
beneficiaries of their eligibility results and provide them with information on how to appeal decisions made about
their case. Without the ability to customize notices in the manner consistent legal requirements, CWDA states
clients will receive significantly less informative or incomplete notices, leading to increased questions and
confusion about what is happening with their case and potentially making it more difficult for them to exercise
their due process rights.
Western Center on Law & Poverty (WCLP) writes it supports state law making clear that SAWS is the system of
record for Medi-Cal and should have all the Medi-Cal eligibility rules - with the caveat that the SAWS can access
the new Medi-Cal rules through an interface with CalHEERS. WCLP states, as advocates for low-income
consumers, it knows that many of its clients qualify for multiple public programs such as CalWORKs, CalFresh
and Medi-Cal, and having one system and entity maintaining their benefits is both consumer-friendly for
Californians and efficient administratively. Regarding NOAs, WCLP states it has advocated for understandable,
thorough, timely notices telling consumers about their eligibility and their rights. Sadly, this goal has been elusive
and the notices neither understandable nor timely. Given the many competing demands on CalHEERS, WCLP
says it has determined that consumers' interests would be better served by having the Medi-Cal notices generated
in SAWS with the important caveat that consumers should receive consolidated notices advising them about their
eligibility for both Medi-Cal and Covered California.
6. Drafting issue. Under existing law, until July 1, 2015, CalHEERS is jointly managed by DHCS and Covered
California. This bill designates DHCS as the entity that would be authorized to decide if the business rules
necessary for a MAGI eligibility determination are housed in CalHEERS. In discussions with the one of the bill's
sponsors, they indicated it was not intending that this bill change which entity makes the decision on this issue.
An amendment is needed to clarify that the decision-making entity is not changed by this bill.
SUPPORT AND OPPOSITION:
Support: County Welfare Directors Association (co-sponsor) Services Employees International Union California
(co-sponsor)
Tehama County Department of Social Services (co-sponsor)
Alameda County Social Services Agency
American Federation of State, County and Municipal Employees, AFL-CIO
California State Association of Counties
County of San Bernardino
County of San Diego
Del Norte County Board of Supervisors
San Mateo County Board of Supervisors
Santa Cruz County Board of Supervisors
Sonoma County Board of Supervisors
Ventura County Board of Supervisors
Western Center on Law & Poverty
Oppose: None received
CHILDREN'S IMPACT STATEMENT:
N/A
ATTACHMENTS
SB 1341 Bill Text
AMENDED IN SENATE APRIL 7, 2014
SENATE BILL No. 1341
Introduced by Senator Mitchell
February 21, 2014
An act to amend Section 10823 of the Welfare and Institutions Code,
relating to Medi-Cal.
legislative counsel’s digest
SB 1341, as amended, Mitchell. Medi-Cal: Statewide Automated
Welfare System.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law requires the Office of
Systems Integration in the State Department of Social Services to
implement a statewide automated welfare system for 6 specified public
assistance programs, including Medi-Cal.
This bill would require the Statewide Automated Welfare System to
be the system of record for Medi-Cal and to contain all Medi-Cal
eligibility rules and case management functionality. The bill would,
notwithstanding this provision, authorize the California Healthcare
Eligibility, Enrollment, and Retention System (CalHEERS) to house
the business rules necessary for an eligibility determination to be made,
as specified, pursuant to the federal Patient Protection and Affordable
Care Act. The bill would would, if the department exercises that
authority, require CalHEERS to make the business rules available to
the Statewide Automated Welfare System consortia to determine
Medi-Cal eligibility. The bill would require the Statewide Automated
98
Welfare System to house the functionality to create and send Notices
of Action for the Medi-Cal program, as specified, no later than January
1, 2016. specify, effective January 1, 2016, the manner in which the
functionality to create and send notices of action for the Medi-Cal and
premium tax credit programs would be implemented, including a
requirement that the Statewide Automated Welfare System be used to
generate noticing language and notice of action documents.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
The people of the State of California do enact as follows:
line 1 SECTION 1. Section 10823 of the Welfare and Institutions
line 2 Code, as amended by Section 9 of Chapter 13 of the First
line 3 Extraordinary Session of the Statutes of 2011, is amended to read:
line 4 10823. (a) (1) The Office of Systems Integration shall
line 5 implement a statewide automated welfare system for the following
line 6 public assistance programs:
line 7 (A) The CalWORKs program.
line 8 (B) CalFresh.
line 9 (C) The Medi-Cal program.
line 10 (D) The foster care program.
line 11 (E) The refugee program.
line 12 (F) County medical services programs.
line 13 (2) Statewide implementation of the statewide automated welfare
line 14 system for the programs listed in paragraph (1) shall be achieved
line 15 through no more than four county consortia, including the Interim
line 16 Statewide Automated Welfare System Consortium, and the Los
line 17 Angeles Eligibility, Automated Determination, Evaluation, and
line 18 Reporting System.
line 19 (3) Notwithstanding paragraph (2), the Office of Systems
line 20 Integration shall migrate the 35 counties that currently use the
line 21 Interim Statewide Automated Welfare System (SAWS) into the
line 22 C-IV system within the following timeline:
line 23 (A) Complete Migration System Test and begin User Acceptance
line 24 Testing on or before June 30, 2009.
line 25 (B) Complete implementation in at least five counties by
line 26 February 28, 2010.
line 27 (C) Complete implementation in at least 14 additional counties
line 28 on or before May 31, 2010.
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— 2 —SB 1341
line 1 (D) Complete implementation in all 35 counties on or before
line 2 August 31, 2010.
line 3 (E) Decommission the Interim Statewide Automated Welfare
line 4 System on or before January 31, 2011.
line 5 (4) Notwithstanding paragraph (2), the Office of Systems
line 6 Integration shall oversee the migration of the 39 counties
line 7 composing the C-IV Consortium into a system jointly designed
line 8 by the 39 counties plus Los Angeles County under the LEADER
line 9 Replacement System contract. This migration shall result in a new
line 10 consortium to replace the LEADER and C-IV Consortia.
line 11 (5) The consortia and the state shall take any action necessary
line 12 to ensure that the current SAWS maintenance and operations
line 13 agreements are extended for the LEADER and C-IV Consortia,
line 14 pending the completion of the LEADER Replacement System and
line 15 migration of the C-IV Consortium as set forth in paragraph (4),
line 16 and for the continuation of the Welfare Client Data System
line 17 Consortium.
line 18 (6) Each SAWS consortium shall provide a seat on its governing
line 19 body for a representative of the state and shall allow for the
line 20 stationing of state staff at the project site.
line 21 (b) Nothing in subdivision (a) transfers program policy
line 22 responsibilities related to the public assistance programs specified
line 23 in subdivision (a) from the State Department of Social Services
line 24 or the State Department of Health Care Services to the Office of
line 25 Systems Integration.
line 26 (c) (1) On February 1 of each year, the Office of Systems
line 27 Integration shall provide an annual report to the appropriate
line 28 committees of the Legislature on the statewide automated welfare
line 29 system implemented under this section. The report shall address
line 30 the progress of state and consortia activities and any significant
line 31 schedule, budget, or functionality changes in the project.
line 32 (2) The report provided pursuant to this subdivision in 2012
line 33 shall also include the projected timeline and key milestones for
line 34 the development of the LEADER Replacement System and of the
line 35 new consortium described in paragraph (4) of subdivision (a).
line 36 (d) Notwithstanding any other law, the Statewide Automated
line 37 Welfare System consortia shall have the authority to expend within
line 38 approved annual state budgets for each system as follows:
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SB 1341— 3 —
line 1 (1) Make changes within any line item, provided that the change
line 2 does not create additional project costs in the current or in a future
line 3 budget year.
line 4 (2) Make a change of up to one hundred thousand dollars
line 5 ($100,000) or 10 percent of the total for the line item from which
line 6 the funds are derived, whichever is greater, between line items
line 7 with notice to the Office of Systems Integration, provided that the
line 8 change does not create additional project costs in the current or in
line 9 a future budget year.
line 10 (3) Make requests to the Office of Systems Integration for
line 11 changes between line items of greater than one hundred thousand
line 12 dollars ($100,000) or 10 percent of the total for the line item from
line 13 which the funds are derived, which do not increase the total cost
line 14 in the current or a future budget year. The Office of Systems
line 15 Integration shall take action to approve or deny the request within
line 16 10 days.
line 17 (e) (1) The Statewide Automated Welfare System shall be the
line 18 system of record for Medi-Cal and shall contain all Medi-Cal
line 19 eligibility rules and case management functionality.
line 20 (2) Notwithstanding paragraph (1), the business rules necessary
line 21 for an eligibility determination to be made under the Modified
line 22 Adjusted Gross Income (MAGI) rules pursuant to the federal
line 23 Patient Protection and Affordable Care Act (Public Law 111-148)
line 24 may be housed in the California Healthcare Eligibility, Enrollment,
line 25 and Retention System developed pursuant to Section 15926,
line 26 hereafter referred to as CalHEERS. The If the department exercises
line 27 that authority, the business rules contained in CalHEERS shall be
line 28 made available as a service to the Statewide Automated Welfare
line 29 System consortia consortia, through an automated interface, in
line 30 order for the consortia to determine eligibility for Medi-Cal under
line 31 the MAGI rules.
line 32 (3) The functionality to create and send Notices of Action for
line 33 the Medi-Cal program, including notices related to MAGI-based
line 34 eligibility, shall be housed within the Statewide Automated Welfare
line 35 System. This paragraph shall be implemented no later than January
line 36 1, 2016.
line 37 (3) Effective January 1, 2016, the functionality to create and
line 38 send notices of action for Medi-Cal and premium tax credit
line 39 programs, as described in Section 36B of Title 26 of the United
line 40 States Code, shall be implemented consistent with the following:
98
— 4 —SB 1341
line 1 (A) Except as specified in subparagraphs (B) and (C), the
line 2 Statewide Automated Welfare System shall be used to generate
line 3 noticing language and notice of action documents and to send
line 4 notice of action documents for all Medi-Cal programs, including,
line 5 but not limited to, MAGI and Non-MAGI based programs.
line 6 (B) If the department exercises its authority pursuant to
line 7 paragraph (2), CalHEERS shall be used to generate noticing
line 8 language for the premium tax credit program, including, but not
line 9 limited to, Medi-Cal denial noticing language related to tax subsidy
line 10 approvals, and shall be used to generate and send notice of action
line 11 documents for the premium tax credit only program.
line 12 (C) If the department exercises its authority pursuant to
line 13 paragraph (2), in any mixed eligibility cases that include an
line 14 approval or approvals for MAGI Medi-Cal eligibility
line 15 determinations, non-MAGI Medi-Cal eligibility determinations,
line 16 or both, and premium tax credit approvals, the Statewide
line 17 Automated Welfare System shall be used to combine the noticing
line 18 language for Medi-Cal programs generated by the Statewide
line 19 Automated Welfare System and the noticing language for the
line 20 premium tax credit program generated by CalHEERS into one
line 21 notice, and the Statewide Automated Welfare System shall be used
line 22 to send the document, as one combined notice, for all programs.
O
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SB 1341— 5 —