BILL NUMBER: SB 10 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY SEPTEMBER 9, 2015
AMENDED IN ASSEMBLY JULY 7, 2015
AMENDED IN SENATE JUNE 2, 2015
INTRODUCED BY Senator Lara
DECEMBER 1, 2014
An act to add Section 100522 to the Government Code, and to
add Section 14102.1 to the Welfare and Institutions Code,
relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 10, 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.
This bill would require the Secretary of California Health and
Human Services 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 Exchange. The bill would require,
after that waiver has been granted, the 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.
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.
This bill would extend eligibility for 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, or for
limited scope Medi-Cal benefits if funding for full-scope benefits is
not 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.
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, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares all of the
following:
(1) The Legislature and the Governor, through the enactment of the
Budget Act of 2015 (Chapter 11 of the Statutes of 2015), expanded
Medi-Cal eligibility for children to ensure that no child in
California who is income eligible will be denied access to health
care coverage on the basis of immigration status.
(2) Expanding access and increasing enrollment in comprehensive
health care coverage is of benefit to the health and welfare of all
Californians.
(3) Longstanding California law provides full-scope Medi-Cal
benefits 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
increase opportunities for enrollment in comprehensive health care
coverage for adults, regardless of immigration status.
(c) 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 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) 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 persons 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. 2. 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 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 (2).
(2) 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) An individual who is eligible for coverage 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) An individual who is eligible for coverage 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 Medi-Cal 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.
SEC. 3. SEC. 4. If the Commission on
State Mandates determines that this act contains 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.