Amended IN Assembly May 13, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2347Introduced by Assembly Member WoodFebruary 18, 2020 An act to amend Section 100805 of, and to add Section 100804 to, of the Government Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2347, as amended, Wood. Health care coverage: financial assistance.Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange (Exchange), also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Until January 1, 2023, existing law requires the Exchange to administer a program of financial assistance, and authorizes the program to provide assistance, including premium assistance subsidies, to program participants with household incomes at or below 600% of the federal poverty level.This bill bill, contingent upon an appropriation by the Legislature, would reduce premiums to zero for program participants with household incomes at or below 138% of the federal poverty level, and would specify scale the premium assistance subsidy amount for program participants with household incomes of 139% to 600%, inclusive, of the federal poverty level. The bill would require the financial assistance administered by the Exchange to include cost sharing reduction assistance to reduce the copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing of a program participant with a household income of 200% to 400%, inclusive, of the federal poverty level. level pursuant to the program design adopted by the board of the Exchange.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1.Section 100804 is added to the Government Code, to read:100804.(a)Financial assistance administered pursuant to Section 100800 shall include cost sharing reduction assistance to reduce a program participants copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing. Cost sharing reduction assistance shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design.(b)(1)Cost sharing reduction assistance shall be in addition to premium assistance provided pursuant to this title.(2)Cost sharing reduction assistance shall be in addition to cost sharing reduction assistance provided by the federal government, and shall not be subject to the income requirements of federal cost sharing reduction assistance.(3)Cost sharing reduction assistance shall be provided to program participants with a household income of 200 percent to 400 percent, inclusive, of the federal poverty level, and shall have a value consistent with the standard gold benefit design, with an actuarial value of 80 percent with respect to essential benefits.(c)Cost sharing reduction assistance shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that cost sharing reduction assistance shall not be subject to the income requirements of that section.(d)Consistent with federal law, cost sharing reduction assistance shall not be subject to reconciliation through the personal income tax. Eligibility for cost sharing reduction assistance shall be determined at the time of application.SEC. 2.SECTION 1. Section 100805 of the Government Code is amended to read:100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.
Amended IN Assembly May 13, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2347Introduced by Assembly Member WoodFebruary 18, 2020 An act to amend Section 100805 of, and to add Section 100804 to, of the Government Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2347, as amended, Wood. Health care coverage: financial assistance.Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange (Exchange), also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Until January 1, 2023, existing law requires the Exchange to administer a program of financial assistance, and authorizes the program to provide assistance, including premium assistance subsidies, to program participants with household incomes at or below 600% of the federal poverty level.This bill bill, contingent upon an appropriation by the Legislature, would reduce premiums to zero for program participants with household incomes at or below 138% of the federal poverty level, and would specify scale the premium assistance subsidy amount for program participants with household incomes of 139% to 600%, inclusive, of the federal poverty level. The bill would require the financial assistance administered by the Exchange to include cost sharing reduction assistance to reduce the copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing of a program participant with a household income of 200% to 400%, inclusive, of the federal poverty level. level pursuant to the program design adopted by the board of the Exchange.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
Amended IN Assembly May 13, 2020
Amended IN Assembly May 13, 2020
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill
No. 2347
Introduced by Assembly Member WoodFebruary 18, 2020
Introduced by Assembly Member Wood
February 18, 2020
An act to amend Section 100805 of, and to add Section 100804 to, of the Government Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2347, as amended, Wood. Health care coverage: financial assistance.
Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange (Exchange), also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Until January 1, 2023, existing law requires the Exchange to administer a program of financial assistance, and authorizes the program to provide assistance, including premium assistance subsidies, to program participants with household incomes at or below 600% of the federal poverty level.This bill bill, contingent upon an appropriation by the Legislature, would reduce premiums to zero for program participants with household incomes at or below 138% of the federal poverty level, and would specify scale the premium assistance subsidy amount for program participants with household incomes of 139% to 600%, inclusive, of the federal poverty level. The bill would require the financial assistance administered by the Exchange to include cost sharing reduction assistance to reduce the copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing of a program participant with a household income of 200% to 400%, inclusive, of the federal poverty level. level pursuant to the program design adopted by the board of the Exchange.
Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange (Exchange), also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Until January 1, 2023, existing law requires the Exchange to administer a program of financial assistance, and authorizes the program to provide assistance, including premium assistance subsidies, to program participants with household incomes at or below 600% of the federal poverty level.
This bill bill, contingent upon an appropriation by the Legislature, would reduce premiums to zero for program participants with household incomes at or below 138% of the federal poverty level, and would specify scale the premium assistance subsidy amount for program participants with household incomes of 139% to 600%, inclusive, of the federal poverty level. The bill would require the financial assistance administered by the Exchange to include cost sharing reduction assistance to reduce the copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing of a program participant with a household income of 200% to 400%, inclusive, of the federal poverty level. level pursuant to the program design adopted by the board of the Exchange.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1.Section 100804 is added to the Government Code, to read:100804.(a)Financial assistance administered pursuant to Section 100800 shall include cost sharing reduction assistance to reduce a program participants copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing. Cost sharing reduction assistance shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design.(b)(1)Cost sharing reduction assistance shall be in addition to premium assistance provided pursuant to this title.(2)Cost sharing reduction assistance shall be in addition to cost sharing reduction assistance provided by the federal government, and shall not be subject to the income requirements of federal cost sharing reduction assistance.(3)Cost sharing reduction assistance shall be provided to program participants with a household income of 200 percent to 400 percent, inclusive, of the federal poverty level, and shall have a value consistent with the standard gold benefit design, with an actuarial value of 80 percent with respect to essential benefits.(c)Cost sharing reduction assistance shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that cost sharing reduction assistance shall not be subject to the income requirements of that section.(d)Consistent with federal law, cost sharing reduction assistance shall not be subject to reconciliation through the personal income tax. Eligibility for cost sharing reduction assistance shall be determined at the time of application.SEC. 2.SECTION 1. Section 100805 of the Government Code is amended to read:100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
(a)Financial assistance administered pursuant to Section 100800 shall include cost sharing reduction assistance to reduce a program participants copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing. Cost sharing reduction assistance shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design.
(b)(1)Cost sharing reduction assistance shall be in addition to premium assistance provided pursuant to this title.
(2)Cost sharing reduction assistance shall be in addition to cost sharing reduction assistance provided by the federal government, and shall not be subject to the income requirements of federal cost sharing reduction assistance.
(3)Cost sharing reduction assistance shall be provided to program participants with a household income of 200 percent to 400 percent, inclusive, of the federal poverty level, and shall have a value consistent with the standard gold benefit design, with an actuarial value of 80 percent with respect to essential benefits.
(c)Cost sharing reduction assistance shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that cost sharing reduction assistance shall not be subject to the income requirements of that section.
(d)Consistent with federal law, cost sharing reduction assistance shall not be subject to reconciliation through the personal income tax. Eligibility for cost sharing reduction assistance shall be determined at the time of application.
SEC. 2.SECTION 1. Section 100805 of the Government Code is amended to read:100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.
SEC. 2.SECTION 1. Section 100805 of the Government Code is amended to read:
### SEC. 2.SECTION 1.
100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.
100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.
100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.
100805. (a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participants projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810.
(b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section.
(c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.
(d) The Contingent upon an appropriation by the Legislature, the premium assistance subsidy shall provide the following assistance:
(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.
(2) For a program participant with a household income of 139 percent to 400 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income. pursuant to the program design adopted by the board of the Exchange.
(3)For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.