Today's Law As Amended


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SB-65 Health care coverage: financial assistance.(2019-2020)



As Amends the Law Today


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 participant’s 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 participant’s 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 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 participant’s 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 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 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.
(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.