California Senate Bill SB4 Amended / Bill

 BILL NUMBER: SB 4AMENDED BILL TEXT AMENDED IN ASSEMBLY JULY 7, 2015 AMENDED IN SENATE JUNE 1, 2015 AMENDED IN SENATE APRIL 28, 2015 AMENDED IN SENATE APRIL 6, 2015 INTRODUCED BY Senator Lara (Principal coauthor: Assembly Member Bonta) (Coauthors: Senators Hall, Hancock, Hernandez, Hill, Hueso, Mitchell, Monning, Pan, and Wolk) (Coauthors: Assembly Members Alejo,  Chiu,  Levine, Lopez, and Thurmond) DECEMBER 1, 2014 An act to add Section 100522 to the Government Code, and to  add Sections 14102.1 and 14102.2 to   amend Section 14007.8 of  the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 4, as amended, Lara. Health care coverage: immigration status. Existing law, the federal Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, and meets certain other requirements. PPACA specifies that an individual who is not a citizen or national of the United States or an alien lawfully present in the United States shall not be treated as a qualified individual and may not be covered under a qualified health plan offered through an exchange. Existing law creates the California Health Benefit Exchange for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA.  Existing law governs health care service plans and insurers. A willful violation of the provisions governing health care service plans is a crime.  This bill would require the Secretary of  the  California Health and Human Services  Agency  to apply to the United States Department of Health and Human Services for a waiver to allow individuals who are not eligible to obtain health coverage because of their immigration status to obtain coverage from the California Health Benefit Exchange. The bill would require  , after that waiver has been granted,  the California Health Benefit Exchange to offer  California  qualified health benefit plans, as specified, to these individuals. The bill would require that individuals eligible to purchase California qualified health plans pay the cost of coverage without federal assistance.  These requirements would become operative when federal approval of the waiver is granted.  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.  The federal Medicaid Program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.  Existing law extends eligibility for full-scope Medi-Cal benefits to individuals under 19 years of age who do not have, or are unable to establish, satisfactory immigration status, commencing after the Director of Health Care Services determines that systems have been programmed for implementation of this extension, but in no case sooner than May 1, 2016. Existing law requires these individuals to enroll in a Medi-Cal managed care health plan in those counties in which a Medi-Cal managed care health plan is available.   This bill would extend eligibility for full-scope Medi-Cal benefits to individuals under 19 years of age who are otherwise eligible for those benefits but for their immigration status. The bill would also extend eligibility for either limited scope Medi-Cal benefits or full-scope Medi-Cal benefits to individuals 19 years of age and older who are otherwise eligible for those benefits but for their immigration status if the department determines that sufficient funding is available. The bill would require these individuals to enroll into Medi-Cal managed care health plans, and to pay copayments and premium contributions, to the extent required of otherwise eligible Medi-Cal recipients who are similarly situated. The bill would require that benefits for those services be provided with state-only funds only if federal financial participation is not available. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.   This bill would require the State Department of Health Care Services to develop a transition plan for individuals under 19 years of age who are enrolled in restricted-scope Medi-Cal as of the effective date of the bill, and who are otherwise eligible for full-scope Medi-Cal coverage but for their immigration status, to transition directly to full-scope Medi-Cal coverage. The bill would require the department to notify these individuals, as specified.   The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.   This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.   With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.   This bill would require individuals enrolled in restricted-scope Medi-Cal at the time the director makes the above-described determination to be transitioned to full-scope Medi-Cal within 30 days of that determination. The bill would also require that an individual who is eligible pursuant to these provisions enroll in a Medi-Cal managed care health plan if the individual would otherwise have been required to enroll in that plan.  Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  yes   no  . THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) The Legislature finds and declares all of the following: (1) No child in California should endure suffering and pain due to a lack of access to health care services. (2) No individual in California should be excluded from obtaining coverage through the California Health Benefit Exchange by reason of immigration status. (3) Expanding access and increasing enrollment in comprehensive health care coverage benefits the health and welfare of all Californians.  (4) Longstanding California law provides full-scope Medi-Cal to United States citizens, lawful permanent residents, and individuals permanently residing in the United States under color of law, including those granted deferred action.   (b) It is the intent of the Legislature in enacting this act to extend full-scope Medi-Cal eligibility to every child in California who is currently ineligible for Medi-Cal due to his or her immigration status, as long as he or she meets the other requirements of the Medi-Cal program.   (c)   (b)  It is  further  the intent of the Legislature to ensure that all Californians are eligible to obtain health care coverage through the  exchange.   Exchange.   (d)   (c)  It is further the intent of the Legislature to increase opportunities for enrollment in comprehensive coverage for adults, regardless of immigration status, through the enactment of this bill.  (e)   (d)  It is further the intent of the Legislature that all Californians who are otherwise eligible for Medi-Cal, a qualified health plan offered through the California Health Benefit Exchange, or affordable employer-based health coverage, enroll in that coverage, and obtain the care that they need. SEC. 2. Section 100522 is added to the Government Code, to read: 100522. (a) The Secretary of California Health and Human Services shall apply to the United States Department of Health and Human Services for a waiver authorized under Section 1332 of the federal act as defined in subdivision (e) of Section 100501 in order to allow persons otherwise not able to obtain coverage by reason of immigration status through the Exchange to obtain coverage from the Exchange by waiving the requirement that the Exchange offer only qualified health plans  solely for the purpose of offering coverage to persons otherwise not able to obtain coverage by reason of immigration status  . (b) The Exchange shall offer  California  qualified health  benefit  plans that shall be subject to the requirements of this title, including all of those requirements applicable to qualified health plans. In addition, California qualified health plans shall be subject to the requirements of Section 1366.6 of the Health and Safety Code and Section 10112.3 of the Insurance Code in the same manner as qualified health plans. (c) Persons eligible to purchase California qualified health plans shall pay the cost of coverage without federal advanced premium tax credit, federal cost-sharing reduction, or any other federal assistance. (d) Subdivisions (b) and (c) of this section shall become operative upon federal approval of the waiver pursuant to subdivision (a). (e) For purposes of this section, a "California qualified health plan" means a product offered to those not otherwise eligible to purchase coverage from the Exchange by reason of immigration status and that comply with each of the requirements of state law and the Exchange for a qualified health plan.  SEC. 3.   Section 14102.1 is added to the Welfare and Institutions Code, to read: 14102.1. (a) (1) Notwithstanding any other law, an individual under 19 years of age who meets all of the eligibility requirements for full-scope Medi-Cal benefits under this chapter, but for his or her immigration status, shall be eligible for full-scope Medi-Cal benefits. (2) Notwithstanding any other law, an individual 19 years of age or older who meets all of the eligibility requirements for full-scope Medi-Cal benefits under this chapter, but for his or her immigration status, may be enrolled for full-scope Medi-Cal benefits, pursuant to paragraph (3). (3) When a county completes the Medi-Cal eligibility determination process for an individual 19 years of age or older who meets all of the eligibility requirements for full-scope Medi-Cal benefits under this chapter, but for his or her immigration status, the county shall transmit this information to the department to determine if sufficient funding is available for this individual to receive full-scope Medi-Cal benefits. If sufficient funding is available, the individual shall be eligible for full-scope benefits. If sufficient funding is not available, the individual shall be eligible for limited scope Medi-Cal benefits. (b) This section shall not apply to individuals eligible for coverage pursuant to Section 14102. (c) Individuals who are eligible under subdivision (a) shall be required to enroll into Medi-Cal managed care health plans to the extent required of otherwise eligible Medi-Cal recipients who are similarly situated. (d) Individuals who are eligible under subdivision (a) shall pay copayments and premium contributions to the extent required of otherwise eligible Medi-Cal recipients who are similarly situated. (e) Benefits for services under this section shall be provided with state-only funds only if federal financial participation is not available for those services. The department shall maximize federal financial participation in implementing this section to the extent allowable. (f) Eligibility for full-scope benefits for an individual 19 years of age or older pursuant to subdivision (a) shall not be an entitlement. The department shall have the authority to determine eligibility, determine the number of individuals who may be enrolled, establish limits on the number enrolled, and establish processes for waiting lists needed to maintain program expenditures within available funds. (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. The department shall adopt regulations by July 1, 2018, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Commencing July 1, 2016, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted pursuant to Section 14102.2.   SEC. 4.   Section 14102.2 is added to the Welfare and Institutions Code, to read: 14102.2. (a) (1) Except as provided in subdivision (c), individuals under 19 years of age who are enrolled in restricted scope Medi-Cal as of December 31, 2015, and who are eligible under Section 14102.1, shall be transitioned directly to full-scope coverage under the Medi-Cal program in accordance with the requirements of this section. The department shall develop a transition plan for those individuals under 19 years of age who are enrolled in restricted scope Medi-Cal as of the effective date of the act adding this section. (2) For purposes of this section, an "emergency care provider" is defined as a hospital in the county of the individual's residence where he or she received emergency care, if any. (b) Except as provided in subdivision (c), with respect to managed care health plan enrollment, a restricted-scope enrollee who is under 19 years of age and who applies and is determined eligible before October 1, 2015, shall be notified by the department at least 60 days before January 1, 2016, in accordance with the department's transition plan of all of the following: (1) Which Medi-Cal managed care health plan or plans contain his or her existing emergency care provider, if the department has this information and the emergency care provider is contracted with a Medi-Cal managed care health plan. (2) That the restricted scope enrollee who is under 19 years of age, subject to his or her ability to change as described in paragraph (3), will be assigned to a health plan that includes his or her emergency care provider and enrolled effective January 1, 2014. If the enrollee who is under 19 years of age wants to keep his or her emergency care provider, no additional action shall be required if the emergency care provider is contracted with a Medi-Cal managed care health plan. (3) That the restricted scope enrollee who is under 19 years of age may choose any available Medi-Cal managed care health plan and primary care provider in his or her county of residence before January 1, 2016, if more than one such plan is available in the county where he or she resides, and he or she will receive all provider and health plan information required to be sent to new enrollees and instructions on how to choose or change his or her health plan and primary care provider. (4) That in counties with more than one Medi-Cal managed care health plan, if the restricted scope enrollee who is under 19 years of age does not affirmatively choose a plan within 30 days of receipt of the notice, he or she shall be enrolled into the Medi-Cal managed care health plan that contains his or her emergency care provider as part of the Medi-Cal managed care contracted network, if the department has this information about the emergency care provider, and the emergency care provider is contracted with a Medi-Cal managed care health plan. If the emergency care provider is contracted with more than one Medi-Cal managed care health plan, then the restricted scope enrollee who is under 19 years of age shall be assigned to one of the health plans containing his or her emergency care provider in accordance with an assignment process established to ensure the linkage. (5) That the enrollee who is under 19 years of age shall receive all provider and health plan information required to be sent to new enrollees. If the restricted scope enrollee who is under 19 years of age is not assigned to two Medi-Cal managed care health plans pursuant to paragraph (2), and does not affirmatively select one of the available Medi-Cal managed care health plans within 30 days of receipt of the notice, he or she shall automatically be assigned a plan through the department-prescribed auto-assignment process. (6) That the restricted scope enrollee who is under 19 years of age does not need to take any action to be transitioned to full-scope Medi-Cal or to retain his or her emergency care provider, if the emergency care provider is available pursuant to paragraph (2). (7) That the restricted scope enrollee who is under 19 years of age may choose not to transition to the full-scope Medi-Cal program, and what this choice will mean for his or her health care coverage and access to health care services. (c) Individuals who are under 19 years of age, who qualify under subdivision (a), and who apply and are determined eligible for restricted scope after the date identified by the department, which is not later than October 1, 2015, shall be considered late enrollees. Late enrollees shall be notified in accordance with subdivision (b), except according to a different timeframe, but will transition to full-scope Medi-Cal coverage on January 1, 2016. Late enrollees after the date identified in this subdivision shall be transitioned pursuant to the department's restricted scope transition plan process. (d) Emergency care providers that receive reimbursement for restricted scope coverage shall work with the department and its designees during the 2015 and 2016 calendar years to facilitate enrollment and data sharing for the purposes of delivering Medi-Cal services in the 2016 calendar year.   SEC. 5.   No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution for certain costs that may be incurred by a local agency or school district because, in that regard, this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution. However, if the Commission on State Mandates determines that this act contains other costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.   SEC. 3.   Section 14007.8 of the   Welfare and Institutions Code   is amended to read:  14007.8. (a)  (1)    After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of this section, but no sooner than May 1, 2016, an individual who is under 19 years of age and who does not have satisfactory immigration status or is unable to establish satisfactory immigration status as required by Section 14011.2 shall be eligible for the full scope of Medi-Cal benefits, if he or she is otherwise eligible for benefits under this chapter.  (2) Individuals enrolled in restricted-scope Medi-Cal at the time the director makes the determination described in paragraph (1) shall be transitioned to full-scope Medi-Cal within 30 days of the director's determination.  (b) To the extent permitted by state and federal law, an individual eligible under this section shall be required to enroll in a Medi-Cal managed care health plan  in those counties in which a Medi-Cal managed care health plan is available.   if the individual would otherwise have been required to enroll in the plan.  (c) The department shall seek any necessary federal approvals to obtain federal financial participation in implementing this section. Benefits for services under this section shall be provided with state-only funds only if federal financial participation is not available for those services. (d) The department shall maximize federal financial participation in implementing this section to the extent allowable. (e) This section shall be implemented only to the extent it is in compliance with Section 1621(d) of Title 8 of the United States Code. (f) (1) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time any necessary regulations are adopted. Thereafter, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (2) Commencing six months after the effective date of this section, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted. (g) In implementing this section, the department may contract, as necessary, on a bid or nonbid basis. This subdivision establishes an accelerated process for issuing contracts pursuant to this section. Those contracts, and any other contracts entered into pursuant to this subdivision, may be on a noncompetitive bid basis and shall be exempt from the following: (1) Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code and any policies, procedures or regulations authorized by that part. (2) Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code. (3) Review or approval of contracts by the Department of General Services.