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AB-2565 Affordability assistance: cost sharing.(2017-2018)

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Date Published: 05/26/2018 04:00 AM
AB2565:v96#DOCUMENT

Amended  IN  Assembly  May 25, 2018
Amended  IN  Assembly  April 12, 2018
Amended  IN  Assembly  March 23, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2565


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

February 15, 2018


An act to add Section 100504.2 to the Government Code, relating to health care coverage, and making an appropriation therefor.


LEGISLATIVE COUNSEL'S DIGEST


AB 2565, as amended, Chiu. Affordability assistance: cost sharing.
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 Covered California, the Exchange, and requires the board to facilitate the purchase of qualified health plans by qualified individuals and qualified small employers. Existing law establishes the California Health Trust Fund and continuously appropriates moneys in the fund for these purposes.
This bill would require the board to offer enhanced premium assistance to subsidize the premium payments of individuals who enroll in health care coverage through Covered California the Exchange and who, under federal law, would be eligible for premium tax subsidies, as specified. By requiring the board to offer this additional assistance, this bill would make an appropriation. The bill would make this requirement operative only to the extent that funding to cover the cost of the state subsidy is provided, by express reference, in the annual Budget Act or in another act making an appropriation for this purpose. The bill would require that administrative costs incurred by the board in making the state subsidy available would be paid from the California Health Trust Fund, thereby making an appropriation.
Vote: MAJORITY   Appropriation: YES   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 100504.2 is added to the Government Code, to read:

100504.2.
 (a) The board shall provide enhanced premium assistance to individuals who enroll in health care coverage through Covered California the Exchange and who, under federal law, would be eligible for premium tax subsidies.
(b) The enhanced premium assistance shall be in addition to applicable federal premium tax subsidies and shall not replace those subsidies.
(c) For the purposes of this section, income shall be determined at the time of application, based on modified adjusted gross income, as defined in the federal act for premium tax credits.
(d) The enhanced premium assistance shall be based on the adjusted monthly premium for the applicable second lowest cost silver level health care coverage with respect to the individual. Consistent with federal law, the assistance may be applied to the purchase of other health care coverage.
(e) The board shall require that the applicable percentage of income to be spent on premiums for any individual whose income is within an income tier specified in the following schedule shall increase on a sliding scale and in a linear manner from the initial premium percentage to the final premium percentage set forth in the schedule for that income tier:
(1) If the household income is less than 139 percent of the federal poverty level, the premium shall be zero.
(2) If the household income is between 139 percent and 149 percent of the federal poverty level, the premium scale shall begin at 0.08 percent and end at 0.95 percent.
(3) If the household income is between 149 percent and 199 percent of the federal poverty level, the premium scale shall begin at 0.95 percent and end at 5.00 percent.
(4) If the household income is between 199 percent and 249 percent of the federal poverty level, the premium scale shall begin at 5.00 percent and end at 6.56 percent.
(5) If the household income is between 249 percent and 299 percent of the federal poverty level, the premium scale shall begin at 6.56 percent and end at 8.16 percent.
(6) If the household income is between 299 percent and 400 percent of the federal poverty level, the premium shall not exceed 8.16 percent.
(f) For the purposes of this section, the term “silver level” has the same meaning as set forth in Section 1367.009 of the Health and Safety Code, and Section 10112.295 of the Insurance Code.
(g) This section is operative only to the extent that funding is provided, by express reference, to cover the cost of the state subsidy in the annual Budget Act or in another statute making an appropriation for this purpose. Administrative costs incurred by the board in providing the state subsidy pursuant to this section shall be paid from the California Health Trust Fund.