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SB-65 Health care coverage: financial assistance.(2019-2020)

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Date Published: 04/03/2019 09:00 PM
SB65:v98#DOCUMENT

Amended  IN  Senate  April 03, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 65


Introduced by Senator Pan

January 08, 2019


An act to add Section 100503.5 Title 25 (commencing with Section 100800) to the Government Code, relating to healthcare health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 65, as amended, Pan. California Health Benefit Exchange: Health care coverage: financial assistance.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various healthcare coverage market reforms. Among other things, the PPACA requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers and requires that state entity to meet certain other requirements. Existing law creates the California Health Benefit Exchange (the Exchange), also known as Covered California, for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the PPACA. Existing law requires the Exchange, among other duties, to develop options for providing financial assistance to help low-income and middle-income Californians access healthcare coverage. Existing law also establishes the California Health Trust Fund, a continuously appropriated fund, in the State Treasury for purposes of providing funding for the duties carried out by the Exchange.
This bill would require the Exchange, notwithstanding the provision establishing the California Health Trust Fund and only to the extent that the Legislature appropriates funding for these purposes, to administer a program of financial assistance assistance, to be known as the Affordable Care Access Plus Program, to help low-income and middle-income Californians access affordable healthcare coverage by requiring the Exchange to implement specified maximum premium contributions and to reduce copays and deductibles for individuals who meet specified income requirements. The bill would also require the Exchange to administer financial assistance in a manner that maximizes federally funded subsidies. health care coverage with respect to individual coverage that is made available through the Exchange. The bill would require the program to provide financial assistance to California residents with household incomes below 600% of the federal poverty level, and would authorize the program to provide other appropriate subsidies designed to make health care more accessible and affordable for individuals and households. The bill would require the Exchange to adopt a program design to implement these provisions by resolution of the board of the Exchange, as specified. The bill would require the Exchange to promulgate rules and regulations to implement these provisions, and would authorize any rules and regulations necessary to implement these provisions to be adopted as emergency regulations, as specified.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Title 25 (commencing with Section 100800) is added to the Government Code, to read:

TITLE 25. Affordable Care Access Plus Program

100800.
 (a) The Exchange shall implement this title only to the extent that the Legislature appropriates funding for this purpose.
(b) The Exchange shall administer a program of financial assistance, which shall be known as the Affordable Care Access Plus Program, to help low-income and middle-income Californians access affordable health care coverage with respect to individual coverage that is made available through the Exchange.
(c) The program shall provide financial assistance to California residents with household incomes below 600 percent of the federal poverty level, and may provide other appropriate subsidies designed to make health care more accessible and affordable for individuals and households.
(d) (1) The Exchange shall adopt, and may amend, a program design to implement this section by resolution of the board of the Exchange after a discussion by the board during at least one properly noticed board meeting before the board meeting at which the board votes on the final program design. The resolution shall be adopted at a duly noticed meeting.
(2) A resolution adopted pursuant to this section shall not take effect until after 10 days notification in writing to the Director of Finance and the Joint Legislative Budget Committee.
(3) The requirements of paragraph (2) may be waived by the joint written consent of the Director of Finance and the Chair of the Joint Legislative Budget Committee to adopt a resolution that is deemed urgent. A resolution adopted pursuant to this paragraph shall take immediate effect.
(4) The Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) shall not apply to the program design or a resolution adopted pursuant to this section.
(e) The Exchange shall provide appropriate opportunities for stakeholders and the public to consult in the design of the program.

100801.
 (a) A premium assistance subsidy provided by the program shall be remitted by the Exchange to a qualified health plan issuer, based on the program participant’s projected household income, household size, and other factors determined pursuant to the program design.
(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 a premium assistance subsidy shall not be subject to the income requirements of that section.

100802.
 For purposes of this title:
(a) “Applicable dependent program participant” means a dependent, as defined in Section 17056 of the Revenue and Taxation Code, who is also a program participant.
(b) “Exchange” means the California Health Benefit Exchange, also known as Covered California, established pursuant to Title 22 (commencing with Section 100500).
(c) “Federal poverty level” means the most recently published poverty guidelines, updated periodically in the Federal Register by the Secretary of Health and Human Services under the authority of Section 9902(2) of Title 42 of the United States Code, as of the first day of the regular enrollment period for coverage by a qualified health plan offered through the Exchange.
(d) “Program” means the Affordable Care Access Plus Program established pursuant to Section 100800.
(e) “Program participant” means an individual eligible to receive financial assistance pursuant to this title and who applies for and receives that assistance pursuant to the program design.
(f) “Qualified health plan” has the same meaning as defined in Section 1301 of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152).

100803.
 (a) The Exchange shall promulgate rules and regulations to implement this title.
(b) Until January 1, 2022, any rules and regulations necessary to implement this title may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2). The adoption of emergency regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2, including subdivisions (e) and (h) of Section 11346.1, an emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the board pursuant to Chapter 3.5 (commencing with Section 11340) of Part I of Division 3 of Title 2 within five years of the initial adoption of the emergency regulation. An emergency regulation adopted pursuant to this section shall be discussed by the board during at least one properly noticed board meeting before the board meeting at which the board adopts the regulation. Notwithstanding subdivision (h) of Section 11346.1, until January 1, 2027, the Office of Administrative Law may approve more than two readoptions of an emergency regulation adopted pursuant to this section.
(c) In construing this title, the regulations promulgated by the Exchange under Title 10 of the California Code of Regulations shall apply to the extent that those regulations do not conflict with this title, the program design adopted pursuant to Section 100800, and regulations promulgated by the Exchange pursuant to this section.

100804.
 The appeals process described in Section 100506 to Section 100506.5, inclusive, shall apply to this title.

100805.
 This title shall not be construed to create an entitlement program of any kind.

SECTION 1.Section 100503.5 is added to the Government Code, to read:
100503.5.

(a)Notwithstanding Section 100520, the Exchange shall implement this section only to the extent that the Legislature appropriates funding for this purpose.

(b)The Exchange shall administer financial assistance to help low-income and middle-income Californians access affordable healthcare coverage with respect to individual coverage that is made available through the Exchange, as follows:

(1)Implement a maximum premium contribution for an individual whose income is not more than 400 percent of the federal poverty level and who is not eligible for Medi-Cal that is equal to or lower than 8 percent of an enrollee’s annual household income.

(2)Implement a maximum premium contribution for individuals whose income exceeds 400 percent of the federal poverty level that is equal to the maximum premium contribution prescribed by the federal act for an individual whose income is 400 percent of the federal poverty level.

(3)Reduce copays and deductibles for any individual whose income is between 200 percent and 400 percent of the federal poverty level.

(4)Administer financial assistance in a manner that maximizes federally funded subsidies for Californians to the greatest extent possible.

(c)For purposes of this section, “financial assistance” includes direct premium assistance and assistance with copays and deductibles.