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SB-65 California Health Benefit Exchange: financial assistance.(2019-2020)

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Date Published: 01/08/2019 09:00 PM
SB65:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 65


Introduced by Senator Pan

January 08, 2019


An act to add Section 100503.5 to the Government Code, relating to healthcare coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 65, as introduced, Pan. California Health Benefit Exchange: 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 financial assistance 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.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


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.