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AB-1208 California Health Benefit Exchange: Health Care Affordability Reserve Fund.(2023-2024)

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Date Published: 03/29/2023 09:00 PM
AB1208:v98#DOCUMENT

Amended  IN  Assembly  March 29, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 1208

Introduced by Assembly Member Schiavo

February 16, 2023

An act to amend Sections 100520.5, 100800 100800, and 100805 of the Government Code, relating to health insurance.


LEGISLATIVE COUNSEL'S DIGEST


AB 1208, as amended, Schiavo. California Health Benefit Exchange: Health Care Affordabiity Affordability Reserve Fund.
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, 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 to administer a program of financial assistance to help low- and middle-income Californians, by providing financial assistance to residents with household incomes at or below 600% of the federal poverty level, including appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households. Existing law requires a premium assistance subsidy provided by the program to be able to be advanced to a program participant and remitted by the Exchange to a qualified health plan issuer, based on specified factors.
Existing law establishes the Health Care Affordability Reserve Fund, and authorizes the Controller to use funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund. Existing law requires the fund to be used, upon appropriation by the Legislature, for the purpose of health care affordability programs operated by the Exchange. Existing law requires the Exchange to consult with the Legislature and stakeholders to develop options to reduce cost sharing for low- and middle-income Californians, as specified.
This bill would delete the qualification making assistance under the program available to residents with household incomes at or below 600% of the federal poverty level. The bill would require the Exchange to annually update the proposed program design for cost-sharing reduction, as specified, and would require the Exchange, in developing benefit designs, to maximize the number of low- and middle-income Californians with zero deductibles. The bill would provide that the premium assistance subsidy program would not be operative in any year in which federal premium subsidies are equal to or greater than those provided for the 2023 program year. year, and would require the program to include subsidies for cost sharing and maximum out-of-pocket limits until January 1, 2029, if federal premium subsidies continue at the level for the 2023 coverage year. The bill would make related conforming changes and delete obsolete provisions.
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 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.
(d) (1)The California Health Benefit Exchange shall, in consultation with stakeholders and the Legislature, develop options for providing cost sharing reduction subsidies to reduce cost sharing for low- and middle-income Californians, and shall annually update the proposed program design. Cost sharing shall include copays and maximum out of pocket as well as coinsurance, if any, and deductibles, if any. In developing the benefit designs under this section, the Exchange shall maximize the number of low- and middle-income Californians with zero deductibles.

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 obtain affordable health care coverage through the Exchange.
(b) (1) The program may provide financial assistance, including assistance to California residents with household incomes at or below 600 percent of the federal poverty level, and may provide other appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households. These
(2) Until January 1, 2029, subsidies pursuant to paragraph (1) shall include subsidies for cost sharing, including copayments, deductibles, and maximum out-of-pocket limits if federal premium subsidies continue at the level for the 2023 coverage year.
(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 notice is provided to the Director of Finance by the Exchange, 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 made available in the Health Care Affordability Reserve Fund established pursuant to Section 100520.5, and may also include other funds, as appropriated for the program for that coverage year. The Legislature 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.

SEC. 3.

 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) This section shall not be operative in any year in which federal premium subsidies are equal to or greater than those provided for the 2023 program year.