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AB-174 Health care coverage: financial assistance.(2019-2020)

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Date Published: 08/12/2019 02:00 PM
AB174:v95#DOCUMENT

Amended  IN  Senate  August 12, 2019
Amended  IN  Senate  June 26, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  March 27, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 174


Introduced by Assembly Member Wood

January 08, 2019


An act to add and repeal Section 100509 of the Government Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 174, as amended, Wood. Health care coverage: financial assistance.
Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. PPACA defines a “qualified health plan” as a plan that, among other requirements, provides an essential health benefits package. Existing state law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA.
SB 78 of the 2019–20 Regular Session would, until January 1, 2023, create PPACA. Existing law, until January 1, 2023, requires the Exchange, among other duties, to administer an individual market assistance program to provide health care coverage financial assistance to California residents with household incomes at or below 600% of the federal poverty level.
This bill would, until January 1, 2023, require the board of the Exchange to develop and prepare one or more reports to be issued at least quarterly and to be made publicly available within 30 days following the end of each quarter biannual public reports for the purpose of informing the California Health and Human Services Agency, the Legislature, and the public about the enrollment process for the individual market assistance program. The bill would require the reports to contain specified information, including, among other things, the number of applications received for the program, pr="localprogram"> Local Program: NO  

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


SECTION 1.

 Section 100509 is added to the Government Code, to read:

100509.
 (a) The board shall develop and prepare one or more reports that shall be issued at least quarterly and be made publicly available within 30 days following the end of each quarter biannual public reports for the purpose of informing the California Health and Human Services Agency, the Legislature, and the public about the enrollment process for the individual market assistance program pursuant to Title 25 (commencing with Section 10800). The reports shall include, but not be limited to, the following deidentified, aggregated information:
(1) The number of applications received for the individual market assistance program. program during the reporting period.
(2) The number of applicants included on those applications. the applications referenced in paragraph (1).
(3) Aggregate applicant demographics, including, but not limited to, gender, age, race, ethnicity, and primary language.

(4)The disposition of applications, including all of the following:

(A)The number of eligibility determinations that resulted in approval for financial assistance.

(B)The program or programs for which the applicants were determined eligible.

(C)The number of applicants that were denied financial assistance and the reason or reasons for the denials.

(4) The disposition of applications submitted during the reporting period, including the number of eligibility determinations that resulted in approval for state premium assistance.
(5) The number of program participants and average monthly state premium assistance received by participants in the following categories:
(A) Between 401 Above 400 percent to and at or below 600 percent, inclusive, of the federal poverty level.
(B) Between 139 Above 200 percent to and at or below 400 percent, inclusive, of the federal poverty level.
(C) At or below 138 percent of the federal poverty level.

(6)The amount of the financial assistance provided to program participants in each of the federal poverty levels described in paragraph (5).

(7)The number of program participants subject to reconciliation in each of the federal poverty levels described in paragraph (5).

(8)The health plans selected by applicants as reported by the program.

(9)The total number of grievances and appeals filed by applicants and enrollees, the basis for the grievance, and the outcomes of the appeals.

(6) The qualified health plan issuers selected by program participants.

(10)

(7) Any other information the board determines to be relevant to the individual market assistance program design.
(b) The report reports required to be submitted to the Legislature pursuant to subdivision (a) shall be submitted in compliance with Section 9795.
(c) This section shall remain in effect only until January 1, 2023, and as of that date is repealed.

SEC. 2.

This act shall become operative only if Senate Bill 78 of the 2019–20 Regular Session is chaptered and becomes operative.