SB 28

Bill Subjects

Abstract

(1) Existing law establishes the California Major Risk Medical Insurance Program (MRMIP) , which is administered by the Managed Risk Medical Insurance Board (MRMIB) , to provide major risk medical coverage to persons who, among other things, have been rejected for coverage by at least one private health plan. Under the federal Patient Protection and Affordable Care Act (PPACA) , each state is required, by January 1, 2014, to establish an American Health Benefit Exchange that makes available qualified health plans to qualified individuals and small employers. Existing state law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014. Existing law also requires the board to undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange and to undertake outreach and enrollment activities. This bill would require MRMIB to provide the Exchange, or its designee, with specified information of subscribers and applicants of MRMIP in order to assist the Exchange in conducting outreach to those subscribers and applicants. The bill would require the board governing the Exchange to provide a specified notice informing those subscribers and applicants that they may be eligible for reduced-cost coverage through the Exchange or no-cost coverage through Medi-Cal. (2) 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. Chapters 3 and 4 of the First Extraordinary Session of 2013–14, to be effective on the 91st day after adjournment of that session, implement various provisions of PPACA relating to determining eligibility for the Medi-Cal program. This bill would authorize the department to implement some of those provisions by, among other things, all-county letters, until the time any necessary regulations are adopted. The bill would require the department to adopt regulations implementing those provisions by July 1, 2017. (3) Existing law, to be effective on the 91st day after adjournment of the First Extraordinary Session of 2013–14, requires the department, commencing January 1, 2014, to develop a program to implement provisions that would authorize individuals or their authorized representatives to select Medi-Cal managed care plans via the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) , as specified. In this regard, the program is required to include training of specialized county employees to carry out the program. This bill would, instead, require the program to include training of individuals, including county human services staff, to carry out the program. (4) Existing law requires the department to establish and maintain a County Administrative Cost Control Plan under which costs for county administration for the determination of eligibility for benefits are controlled, as specified. Existing law requires the department to develop and implement a new budgeting methodology for Medi-Cal county administrative costs to be used to reimburse counties for eligibility determinations for applicants and beneficiaries, and requires that the budgeting methodology include identification of the costs of eligibility determinations for applicants, and the costs of eligibility redeterminations and case maintenance activities for recipients, for different groupings of cases. This bill would instead provide that the budgeting methodology may include identification of the costs of eligibility determinations for applicants, and the costs of eligibility redeterminations and case maintenance activities for recipients, for different groupings of cases. The bill would authorize the development of the new budgeting methodology to include, among other things, county survey of costs, time and motion studies, and in-person observations by department staff. The bill would require that the new budgeting methodology be implemented no sooner than the 2015–16 fiscal year and that it reflect the impact of PPACA implementation on county administrative work. The bill would make other technical changes.