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AB-2472 Health care coverage: Covered California.(2017-2018)

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Date Published: 04/16/2018 09:00 PM
AB2472:v97#DOCUMENT

Amended  IN  Assembly  April 16, 2018
Amended  IN  Assembly  March 23, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2472


Introduced by Assembly Member Wood
(Coauthors: Assembly Members Arambula, Chiu, and Friedman)

February 14, 2018


An act to add Chapter 2.34 (commencing with Section 1414.10) to Division 2 of the Health and Safety Section 100523 to the Government Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2472, as amended, Wood. Health care coverage: Medi-Cal: public purchase option. Covered California.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA required each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health plans by qualified individuals and qualified small employers.
Existing state law establishes the California Health Benefit Exchange, also known as Covered California, within state government. Existing law specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans by qualified individuals and qualified small employers.
This bill would require the board to prepare an analysis and evaluation, known as a feasibility analysis, to determine the feasibility of a public health insurance plan option to increase competition and choice for health care consumers. The bill would require the feasibility analysis to contain, among other things, an actuarial and economic analysis of a public health insurance plan and an analysis of the extent to which a new public health insurance plan option could address the underlying factors that limit health plan choices in some regions. The bill would require the board to submit the feasibility analysis to the Legislature on or before January 1, 2020.

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. Existing law establishes eligibility criteria for beneficiary enrollment in the Medi-Cal program, and requires counties to make eligibility determinations for those purposes.

This bill would require the State Department of Health Care Services to apply to the United States Department of Health and Human Services for federal waivers to permit individuals whose income is greater than the income eligibility threshold for Medi-Cal benefits to purchase coverage under the Medi-Cal program through a separate public purchase option. The bill would require the Director of Health Care Services to report to the health and budget committees of the Legislature on its progress in this regard by January 1, 2020. The bill would require the department to prepare an implementation plan for the public purchase option, including specified components, and to submit the plan to the health committees of both houses of the Legislature by March 1, 2020.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: 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) A review of health plans contracted through Covered California in 2018 by ZIP Code indicates that there are approximately 213 ZIP Codes or portions of ZIP Codes, constituting 8 percent of ZIP Codes or portions of ZIP Codes in California, in which consumers have only one choice for a health plan, and approximately 635 ZIP Codes or portions of ZIP Codes, constituting 24 percent of ZIP Codes or portions of Zip Codes in California, in which consumers are limited to two health plan choices.
(2) Consumers have only one health plan choice in the Counties of Monterey, San Benito, San Luis Obispo, Santa Barbara, Inyo, and Mono, and in most of Kings County.
(3) Twenty-two additional counties have two or fewer health plan choices in all the ZIP Codes or portions of ZIP Codes in those counties. For approximately one-third of the ZIP Codes in California, consumers are limited to two or fewer health plan choices in their regions.
(b) It is the intent of the Legislature to look at options to improve competition in areas with limited health plan choices.

SEC. 2.

 Section 100523 is added to the Government Code, to read:

100523.
 (a) The board shall prepare an analysis and evaluation, known as a feasibility analysis, to determine the feasibility of a public health insurance plan option to increase competition and choice for health care consumers.
(b) At a minimum, the feasibility analysis shall include all of the following:
(1) An actuarial and economic analysis of a public health insurance plan.
(2) A plan to expand the participation of public health plans, including county organized health systems and local health plans.
(3) A state developed public health insurance plan.
(4) A list of necessary federal waivers for a public health insurance plan.
(5) A discussion of potential funding and state costs for a public health insurance plan.
(6) An analysis of the extent to which a new public health insurance plan option could address the underlying factors that limit health plan choices in some regions.
(c) In developing the feasibility analysis, the board shall consult with key stakeholders, including, but not limited to, consumer advocates, health care providers, and health plans, including, but not limited to, county organized health systems and local health plans.
(d) The board shall submit the feasibility analysis to the Legislature on or before January 1, 2020. The feasibility analysis shall be submitted in compliance with Section 9795.

SECTION 1.Chapter 2.34 (commencing with Section 1414.10) is added to Division 2 of the Health and Safety Code, to read:
2.34.Public Purchase Option
1414.10.

(a)The State Department of Health Care Services shall apply to the United States Department of Health and Human Services for federal waivers to permit individuals whose income is greater than the income eligibility threshold for Medi-Cal benefits to purchase coverage under the Medi-Cal program through a separate public purchase option in accordance with this chapter.

(b)The Director of Health Care Services shall report to the health and budget committees of both houses of the Legislature on the progress in receiving the federal waivers described in subdivision (a) by January 1, 2020.

1414.11.

(a)The State Department of Health Care Services shall prepare an implementation plan for the public purchase option described in Section 1414.10. At a minimum, the plan shall include all of the following:

(1)Actuarial and economic analyses.

(2)Eligibility requirements.

(3)Program benefits.

(4)Enrollment process.

(5)Premiums and cost sharing.

(6)Participation of public and private health plans, including county organized health systems and local health plans.

(7)Relationship of the plan to Covered California and the subsidized individual market.

(8)Administration.

(b)The department shall submit the plan described in subdivision (a) to the health committees of both houses of the Legislature by March 1, 2020. The plan shall be submitted in compliance with Section 9795 of the Government Code.