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SB-1540 Children’s health care coverage.(2007-2008)

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SB1540:v98#DOCUMENT

Amended  IN  Senate  April 23, 2008

CALIFORNIA LEGISLATURE— 2007–2008 REGULAR SESSION

Senate Bill
No. 1540

Introduced  by  Senator Correa

February 22, 2008

An act to amend Section 123870 of the Health and Safety Code, to amend Sections 12693.43, 12693.70, 12693.73, 12693.76, 12693.98, and 12693.98a of, to add and repeal Sections 12693.55.1, 12693.56, 12693.57, 12693.701, 12693.981a, and 12693.983 of, and to add and repeal Chapter 16.2 (commencing with Section 12694.1) of Part 6.2 of Division 2 of, the Insurance Code, and to amend Sections 14005.23, 14011.65, and 14011.65a of, and to add and repeal Sections 14005.26 and 14011.61 of, the Welfare and Institutions Code, relating to health care coverage. An act relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 1540, as amended, Correa. Health care coverage: children. Children’s health care coverage.

(1)Existing

Existing law establishes various public programs to provide health care coverage to eligible children, including the Medi-Cal program administered by the State Department of Health Care Services and county welfare agencies, and the Healthy Families Program administered by the Managed Risk Medical Insurance Board. Children through 18 years of age are eligible for health care coverage under these programs if they meet certain household income and other criteria including specified citizenship and immigration status requirements. Under existing law, the applicant’s signed statement as to the value or amount of income is accepted for eligibility purposes under the Healthy Families Program if documentation cannot otherwise be provided.

This bill would establish a pilot program in Orange County that would, until January 1, 2014, expand the health care coverage available to children who are residents of Orange County, as specified. The bill would, until January 1, 2014, expand eligibility for the Medi-Cal program and the Healthy Families Program by allowing children who are residents of Orange County with family incomes at or below 300% of the federal poverty level to qualify for the program and would delete the specified citizenship and immigration status requirements with respect to those children. The bill would require the Managed Risk Medical Insurance Board, by January 2009, in consultation with stakeholders, to implement a process by which applicants who are residents of Orange County self-certify income and income deductions for purposes of establishing eligibility for the Healthy Families Program. The bill would, until January 1, 2014, create the Healthy Families Buy-In Program that would be administered by the Managed Risk Medical Insurance Board and would make the coverage provided under the Healthy Families Program available to children who are residents of Orange County, whose household income exceeds 300% of the federal poverty level, and who meet other specified criteria. The bill would specify that coverage under the buy-in program would include services provided under the California Children’s Services Program (CCSP) for children eligible for CCSP and would deem the child’s family financially eligible for benefits under CCSP. Because the bill would thereby expand eligibility for the CCSP, which is administered by a county’s public health or social welfare department, it would impose a state-mandated local program. The bill would specify the family contribution required for children enrolled in the buy-in program and would require an additional payment, as determined by the Managed Risk Medical Insurance Board, from the family of a child determined eligible for CCSP.

The bill would also make various related modifications to the Medi-Cal program and the Healthy Families Program and would require the State Department of Health Care Services and the Managed Risk Medical Insurance Board to maximize federal matching funds for the expansion of eligibility for the Medi-Cal program and the Healthy Families Program provided by this act. Because the expansion of, and modifications to, the Medi-Cal program would impose certain duties on Orange County relative to administration of that program, the bill would impose a state-mandated local program.

The bill would require the Managed Risk Medical Insurance Board and the State Department of Health Care Services to develop a process to transition the enrollment of children from the Children’s Health Initiative of Orange County into the Medi-Cal program and the Healthy Families Program.

(2)Existing law establishes the Healthy Families-to-Medi-Cal Bridge Benefits Program to provide any person enrolled for coverage under the Healthy Families Program who meets certain criteria, as specified, with 2 calendar months of health care benefits in order to provide the person with the opportunity to apply for the Medi-Cal program.

This bill would establish the Healthy Families to Medi-Cal Presumptive Eligibility Program to, until January 1, 2014, provide a child who is a resident of Orange County and meets certain other criteria, as specified, with presumptive eligibility benefits identical to the full scope of benefits provided under the Medi-Cal program until a Medi-Cal eligibility determination is made, at which point either the child would be enrolled in the Medi-Cal program with no interruption in coverage or the presumptive eligibility benefits would terminate in accordance with due process requirements. The bill would require the Managed Risk Medical Insurance Board to execute a declaration upon implementation of this program and to monitor the program to ensure that all eligible children are enrolled in a timely manner.

(3)Existing law establishes the Healthy Families Presumptive Eligibility Program, administered by the Managed Risk Medical Insurance Board, to provide a child who satisfies specified criteria with health care benefits while the board determines the child’s eligibility for the Healthy Families Program.

This bill would rename the program the Medi-Cal to Healthy Families Presumptive Eligibility Program.

(4)Existing law requires the state to administer, to the extent allowed under federal law, and only if federal financial participation is available, the Medi-Cal to Healthy Families Presumptive Eligibility Program to provide a child who meets specified eligibility requirements, including the income requirements of the Healthy Families Program, with benefits identical to full-scope benefits under the Medi-Cal program with no share of cost for the period during which the child has an application pending for coverage under the Healthy Families Program.

This bill would rename the program the Healthy Families Presumptive Eligibility Program. The bill would also establish, until January 1, 2014, to the extent allowed by federal law and to the extent federal financial participation is available, the Medi-Cal Presumptive Eligibility Program that would provide a child who is a resident of Orange County and meets other specified eligibility requirements with presumptive eligibility benefits identical to full scope benefits under the Medi-Cal program with no share of cost until the child is found eligible for the Medi-Cal program. The bill would require the county to forward the child’s application to the Healthy Families Program if it finds the child eligible for the Medi-Cal program with a share of cost.

(5)This bill would require the Orange County Public Health Department to, in consultation with the Children and Families Commission of Orange County, conduct a study on the expansion of eligibility for health care coverage created by this act and submit a report to the Legislature, as specified, with the findings from that study within a specified period of time.

(6)Existing law creates the Healthy Families Fund, and provides that money in the fund is continuously appropriated for purposes of the Healthy Families Program.

This bill would provide that the Managed Risk Medical Insurance Board may implement the provisions of the bill expanding the Healthy Families Program only to the extent that funds are appropriated for those purposes in the annual Budget Act or in another statute. The bill would also provide that its provisions may be implemented only if the State Department of Health Care Services obtains any necessary federal waivers, including a waiver of the Statewide application of the bill’s provisions.

(7)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.

This bill would make various Legislature findings and declarations related to the need to provide comprehensive health care coverage and programs for children in this state.
This bill would express the intent of the Legislature to launch a pilot program in Orange County to improve key health care services to children, as prescribed.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YESNO   Local Program: YESNO  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Dental health is often overlooked as a necessary component to the overall health of a child.
(b) The Children and Families Commission of Orange County has initiated a program to provide basic preventative dental diagnosis, including comprehensive education to families and providers including pediatricians, nurses, and preschool teachers.
(c) Orange County was selected as the only National Children’s Study Vanguard Center in California and the commission is the local sponsor of a countywide network of programs serving the early childhood health and learning of the community. The National Children’s Study is the largest long-term study of environmental and genetic effects on children’s health and has the potential for researchers to better understand how children’s genes and their environments interact to affect their health and development.
(d) The Kellogg Foundation selected the commission as one of eight national projects that will be highlighted in the final report entitled “Health Matters: The Role of Health in Place-Based Initiatives for Young Children” to identify and explore innovative and successful multisector initiatives that focus on young children, actively engage health and other sectors, and have the potential to serve as models and as a source of lessons learned.
(e) The commission has an existing, highly recognized infrastructure that could be used to facilitate and manage a pilot program that will focus on ensuring children from the prenatal stage to six years of age, inclusive, receive preventative health services to enhance early childhood development in the areas of dental health, developmental screenings, and immunizations.
(f) Providing a full range of testing and screenings for vision, speech, hearing, and other medical conditions to identify related developmental delays before a child is three years of age can result in earlier treatment and thus avoid potential learning delays and costly interventions if the health condition is diagnosed later.
(g) Increasing the number of children that are adequately immunized with four doses of DTP (diphtheria, tetanus, and pertussis/whooping cough); three doses of polio; and one dose of MMR (measles, mumps, and rubella) before their second birthday is a preventative health strategy for young children resulting in less susceptibility to childhood illnesses.
(h) The commission currently funds multiyear programs that provide children’s dental, developmental screening, and immunization services with Proposition 10 tobacco tax revenues in conjunction with other public agencies, private foundations, or individuals who enter into a children’s health care partnership.

SEC. 2.

 It is the intent of the Legislature to provide children in California with the opportunity to be healthy and to succeed in school. Recognizing that locally operated, innovative, and effective children’s health care programs currently exist that could potentially be replicated statewide, it is further the intent of the Legislature that a pilot program be launched in Orange County to improve key health care services to children, beginning at the prenatal stage, to measure outcomes in three areas, including children’s dental health, early developmental screenings and intervention, and increased immunization rates. The Legislature intends that the pilot project build on the work of the commission and encourage collaboration with health care providers in the state. The Legislature intends that this a pilot project be reviewed in order to assess any increased positive health status and school readiness of children under six years of age, as well as evaluating strategies and programs being utilized, for potential statewide replication.