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AB-2347 Health care coverage: financial assistance.(2019-2020)

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Date Published: 02/18/2020 09:00 PM
AB2347:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2347


Introduced by Assembly Member Wood

February 18, 2020


An act to amend Section 100805 of, and to add Section 100804 to, the Government Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2347, as introduced, 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. Existing state law creates the California Health Benefit Exchange (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. Until January 1, 2023, existing law requires the Exchange to administer a program of financial assistance, and authorizes the program to provide assistance, including premium assistance subsidies, to program participants with household incomes at or below 600% of the federal poverty level.
This bill would reduce premiums to zero for program participants with household incomes at or below 138% of the federal poverty level, and would specify the premium assistance subsidy amount for program participants with household incomes of 139% to 600%, inclusive, of the federal poverty level. The bill would require the financial assistance administered by the Exchange to include cost sharing reduction assistance to reduce the copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing of a program participant with a household income of 200% to 400%, inclusive, of the federal poverty level.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


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.