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SB-944 California Health Benefit Exchange: affordability assistance.(2021-2022)

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Date Published: 09/08/2022 09:00 PM
SB944:v97#DOCUMENT

Enrolled  September 08, 2022
Passed  IN  Senate  August 31, 2022
Passed  IN  Assembly  August 31, 2022
Amended  IN  Assembly  August 22, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill
No. 944

Introduced by Senator Pan
(Principal coauthor: Assembly Member Wood)
(Coauthor: Senator Rubio)

February 08, 2022

An act to amend Sections 100520.5 and 100800 of the Government Code, relating to the California Health Benefit Exchange.


LEGISLATIVE COUNSEL'S DIGEST


SB 944, Pan. California Health Benefit Exchange: affordability 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. Existing law requires the Exchange, in consultation with stakeholders and the Legislature, to develop options for providing cost-sharing reduction subsidies to reduce cost sharing for low- and middle-income Californians, and requires the Exchange to report the developed options on or before January 1, 2022. Existing law requires the options to include, among other things, options for all Covered California enrollees with income up to 400 percent of the federal poverty level to reduce cost sharing, including copays, deductibles, coinsurance, and maximum out-of-pocket costs.
This bill would require the Exchange to implement those options for providing health care affordability assistance. The bill would require the affordability assistance to reduce cost-sharing, including copays, coinsurance, and maximum out-of-pocket costs, if specified enhanced federal premium subsidies are made available for the 2023 and 2024 calendar years, and to eliminate deductibles for all benefits to the extent feasible. The bill would require the Exchange to adopt standard benefit designs consistent with these specifications.
Existing law requires the Exchange to administer a program of health care coverage financial assistance to help low-income and middle-income Californians. Existing law authorizes this program to provide financial assistance to California residents with household incomes at or below 600% of the federal poverty level, and to provide other appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households.
This bill would require the program to provide that financial assistance and other appropriate subsidies if funded through an appropriation.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 100520.5 of the Government Code is amended to read:

100520.5.
 (a) The Health Care Affordability Reserve Fund is hereby created in the State Treasury.
(b) Notwithstanding any other law, the Controller may use the funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund as provided in Sections 16310 and 16381.
(c) Upon the enactment of the Budget Act of 2021, and upon order of the Director of Finance, the Controller shall transfer three hundred thirty-three million four hundred thirty-nine thousand dollars ($333,439,000) from the General Fund to the Health Care Affordability Reserve Fund.
(d) Upon appropriation by the Legislature, the Health Care Affordability Reserve Fund shall be utilized, in addition to any other appropriations made by the Legislature for the same purpose, for the purpose of health care affordability programs operated by the California Health Benefit Exchange.
(e) The California Health Benefit Exchange has conducted, in consultation with stakeholders and the Legislature, a study to develop options for providing health care affordability assistance. It is the intent of the Legislature in adding this subdivision to enable the Exchange to implement that affordability assistance. It is further the intent of the Legislature that the affordability assistance both maximize federal financial assistance and be in addition to that assistance.
(1) The affordability assistance provided by the Exchange shall reduce cost sharing, including copays, coinsurance, and maximum out-of-pocket costs, if enhanced federal premium subsidies consistent with the federal American Rescue Plan Act of 2021 (Public Law 117-2) are made available for the 2023 and 2024 calendar years, and shall eliminate deductibles for all benefits to the extent feasible.
(2) The Exchange shall adopt standard benefit designs consistent with this subdivision.

SEC. 2.

 Section 100800 of the Government Code is amended to read:

100800.
 (a) The Exchange shall administer a program of financial assistance to help low-income and middle-income Californians access affordable health care coverage through the Exchange.
(b) The program, if funded through an appropriation in the annual Budget Act or an amount otherwise appropriated by the Legislature, shall provide financial assistance to California residents with household incomes at or below 600 percent of the federal poverty level, and shall provide other appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households.
(c) The Exchange shall adopt, and may amend, an annual program design for each coverage year to implement this section by resolution of the board of the Exchange. The resolution shall be adopted at a duly noticed meeting.
(1) A resolution adopted pursuant to this section shall not take effect until approved by the Director of Finance following 10 days notification in writing to the Joint Legislative Budget Committee.
(2) The requirements of paragraph (1) 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.
(3)  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.
(d) The program design adopted for a coverage year shall be based on funds appropriated to the program for that coverage year. An appropriation made for the program shall contain provisional language directing the Exchange to provide a certain proportion of the funds to specified income ranges as determined by the Legislature and may provide other parameters guiding the design of the program.
(e) The Exchange shall provide appropriate opportunities for stakeholders and the public to consult in the design of the program.