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 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 the federal Patient Protection and Affordable Care Act. Existing law requires an entity making eligibility determinations for an insurance affordability program to ensure that an eligible applicant and recipient meets all program eligibility requirements and complies with all necessary requests for information. Under existing law, if an individual is ineligible for an insurance affordability program for a reason other than income eligibility, that individual is to be referred to the county health coverage program in the individual’s county of residence.

This bill would require the Exchange, beginning no later than July 1, 2021, to enroll an individual in the lowest cost silver plan or another plan, as specified, upon receiving the individual’s electronic account from an insurance affordability program. The bill would require enrollment to occur before coverage through the insurance affordability program is terminated, and would prohibit the premium due date from being sooner than the last day of the first month of enrollment. The bill would require the Exchange to provide an individual who is automatically enrolled in the lowest cost silver plan with a notice that includes specified information, including the individual’s right to select another available plan or to not enroll in the plan.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan providing individual or group health care coverage or a health insurer to notify an enrollee, subscriber, policyholder, or certificate holder who ceases to be enrolled in coverage that the individual may be eligible for coverage through the Exchange or Medi-Cal.

This bill would require a health care service plan providing individual or group health care coverage or a health insurer to notify an enrollee, subscriber, policyholder, or certificate holder that the health care service plan or health insurer will provide the individual’s contact information to the Exchange if the individual ceases to be enrolled in coverage, and to include a notice that includes specified information, including advising individuals to consider their options carefully if they are eligible for enrollment in the Medicare Program. The bill would allow an individual to opt out of that transfer of information, and would require a health care service plan or health insurer to transfer the information of an individual who ceased to be enrolled in coverage and who did not opt out to the Exchange beginning January 1, 2021, in a manner prescribed by the Exchange. Because the bill would expand the scope of a crime with respect to health care service plans, the bill would impose a state-mandated local program.

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 no reimbursement is required by this act for a specified reason.