Existing law establishes the Office of Statewide Health Planning and Development in the California Health and Human Services Agency. The office is vested with all the duties, powers, purposes, responsibilities, and jurisdiction of the State Department of Public Health relating to health planning and research development.

This bill would make a technical, nonsubstantive change to one of those provisions.

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2017 - 2018 Regular Session

AB 2718 (Friedman) - Medi-Cal: CalWORKs: eligibility

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

Assembly Bill 2718 requires, commencing January 1, 2019, the Department of Health Care Services to implement the federal Medicaid option to extend eligibility for Transitional Medi-Cal (TMC) from six months to 12 months, and prohibits charging premiums or having an income eligibility limit on the second six months of coverage.

Fiscal Impact:

Staff notes the following figures were used during the budget deliberation process:

• For fiscal year (FY) 2018-19, as the bill prescribes a start date of January 1, 2019, first year costs are half-year, of approximately $1.5 million General Fund, and full-year annualized costs approximately $6 million ($3.2 million General Fund).

In addition, automation changes to the Statewide Automated Welfare System (SAWS) and Medi-Cal Eligibility Data System (MEDS), and the CalHEERS eligibility system are projected to be approximately $1 million, at least (General Fund/federal).

Background:

1. Established in 1988, TMC allows families who are leaving the CalWORKs program, or are no longer eligible for Medi-Cal due to increased earnings, to keep their Medi-Cal benefits for up to one year. TMC is only available to parents, caretaker relatives, and children who are enrolled in the Modified Adjusted Gross Income (MAGI) Parents and Caretaker Relatives, MAGI Children or CalWORKs-linked Medi-Cal programs. Specifically, to qualify for TMC, a family must be losing CalWORKs or Medi-Cal eligibility as a Parent/Caretaker Relative or the MAGI Medi-Cal Children’s aid codes for one of the following reasons: increased earnings from employment; loss of earned income disregards; or increased hours of employment.

A family must have received CalWORKs or Medi-Cal for at least three months of the six months immediately prior to the month in which the family became ineligible. To be eligible a family must have a child living in the home who is under age 18, or under 19 if the child is enrolled in school and expected to graduate before her 19^th birthday. There is no age limit for a parent or caretaker relative to receive TMC. For the first six months of TMC, there is no income limit. After the initial six months, the family can stay on TMC if its countable income is below 185 percent of the Federal Poverty Level, which is around $22,459 for an individual and $30,451 for a couple in 2018.. The federal matching assistance percentage (FMAP) for TMC is the regular Medi-Cal FMAP, which is typically 50 percent federal and 50 percent state funds. TMC caseload consists of individuals eligible under the first six months of the program who have full scope coverage (20,653 individuals as of June 2017) and limited scope coverage (3,169 individuals), and people enrolled in the second six months with full scope coverage (3,868 individuals) and limited scope coverage (415 individuals).

Proposed Law:

This bill requires DHCS, effective January 1, 2019, to implement the federal Medicaid option to extend eligibility for TMC from six months to 12 months, and prohibits charging premiums or having an income eligibility limit on the second six months of coverage.

Related Legislation:

The Legislature recently deliberated similar proposals, including:

• SB 974 (Lara) would extend Medi-Cal eligibility for full scope benefits to undocumented adults age 65 and above. SB 974 is pending consideration in Assembly Appropriations Committee.
• SB 1108 (Hernandez) prohibits DHCS from seeking or obtaining a Medicaid demonstration project or waiver to require work or community engagement activities as a condition of Medi-Cal eligibility or coverage, to require waiting periods, time limits, or coverage lockouts, as specified, or to require any other condition of Medi-Cal eligibility or coverage not required by any other provision of state law or federal statute or regulation. SB 1108 is pending consideration in Assembly Appropriations Committee.
• AB 2430 (Arambula) increases income eligibility in the Aged and Disabled Program (A&D Program) from 100% of the FPL, plus the individual or couple standard disregard, to 138% of the FPL. AB 2430 is set for hearing on July 2, 2018, in this Committee.
• AB 2965 (Arambula) extends eligibility for full-scope Medi-Cal benefits to undocumented adults ages 19-25 and under who are otherwise eligible for those benefits but for their immigration status. AB 2965 is pending consideration in this Committee.

Staff Comments:

The policy proposed in this bill, extending from six months to 12 months the eligibility for TMC, was part of the 2018-19 Conference Committee; however, the extension was not funded in the final budget agreement.

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SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 2718

SUBJECT: Medi-Cal: CalWORKs: eligibility.

SUMMARY:

Requires the Department of Health Care Services to implement the federal Medicaid option to extend eligibility for Transitional Medi-Cal from six months to 12 months, and prohibits charging premiums or having an income eligibility limit on the second six months of coverage.

Existing law:

1. Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which low income individuals are eligible for medical coverage. [WIC §14000, et seq.]
2. Makes a family who was receiving CalWORKS in at least three of the six months immediately preceding the month in which that family became ineligible for that assistance due to increased hours of employment, income from employment, or the loss of earned income disregards, eligible for Medi-Cal funded health care services during the immediately succeeding six-month period. This coverage is referred to as Transitional Medi-Cal (TMC). [42 U.S.C. §1396r-6; WIC §14005.8]
3. Requires DHCS, in conformance with federal law, to offer beneficiaries covered under TMC the option of remaining eligible for Medi-Cal for an additional extension period of six months, and requires health services to be continued in as automatic a manner as permitted by federal law, and without any unnecessary paperwork. [WIC §14005.8]
4. Permits DHCS, under TMC and consistent with federal and whenever DHCS determine it to be cost-effective, elect to pay a family’s expenses for premiums, deductibles, coinsurance, or similar costs for health insurance or other health coverage offered by an employer of the caretaker relative or by an employer of the absent parent of the dependent child. [WIC §14005.8]
5. Requires, during the additional six-month TMC extension period, if DHCS elects to pay health premiums and this coverage exists, the beneficiary to be given the opportunity to express his or her preference between continuing the Medi-Cal coverage or obtaining private health insurance. [WIC §14005.8]
6. Permits DHCS, during the additional TMC six-month extension period, to impose a premium for the health insurance or other health coverage consistent with federal Medicaid law if DHCS determines that the imposition of a premium is cost-effective. [WIC §14005.8]
7. Establishes, under the Affordable Care Act (ACA), an advanced and refundable tax credit for qualified individuals under 400% of the FPL who are ineligible for Medicaid who purchase a qualified health plan through a health benefit exchange and cost sharing reductions for qualified individuals with incomes below 250% of the FPL who choose specified plans. [26 U.S.C. 36B §1402 and 42 U.S.C. §18071]

This bill: Requires DHCS to implement the federal Medicaid option to extend eligibility for TMC from six months to 12 months, and prohibits charging premiums or having an income eligibility limit on the second six months of coverage.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

1. Medi-Cal benefits costs projected to be approximately $6 million annually (General Fund (GF)/federal). This bill will allow an estimated 22,000 people to stay on the program for an additional six months. To the extent people receive and report job-based coverage during this period, monthly caseload could be slightly smaller.
2. Systems changes to the Statewide Automated Welfare System (SAWS) and Medi-Cal Eligibility Data System (MEDS), and the CalHEERS eligibility system, estimated at approximately $1 million, at least (GF/federal).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, even as families transition out of CalWORKs as their income grows from employment, accessing and retaining access to meaningful health care coverage is a considerable barrier. When the cheapest Covered California plan still requires an individual deductible of $6,300 and a family deductible of $12,600, coupled with the burden of housing and living expenses, essential health care services can grow out of reach. Keeping Californians healthy depends upon access to affordable, quality health care. For families still struggling to make ends meet after leaving CalWORKs, Medi-Cal provides a safety net of health care coverage. AB 2718 aligns California with federal law and allows families to retain access to Medi-Cal coverage for 12 months as they transition off of CalWORKs.
2. Transitional Medi-Cal. Established in 1988, TMC allows families who are leaving welfare or are no longer eligible for Medi-Cal due to increased earnings to keep their Medi-Cal benefits for up to one year. The purpose of TMC was to encourage families leaving welfare to work and remain employed by continuing their Medi-Cal coverage. TMC is only available to parents, caretaker relatives, and children who are enrolled in the Modified Adjusted Gross Income (MAGI) Parents and Caretaker Relatives, MAGI Children or CalWORKs-linked Medi-Cal programs. This is because TMC is available to families who receive Medi-Cal under the provisions of Section 1931(b) of the Medicaid statute, which the Affordable Care Act (ACA) consolidated into the MAGI Parent/Caretaker Relative and Children’s categories, or through CalWORKs.
   
   To qualify for TMC, a family must be losing CalWORKs or Medi-Cal eligibility as a Parent/Caretaker Relative or the MAGI Medi-Cal Children’s aid codes for one of the following reasons:
3. Increased earnings from employment;
4. Loss of earned income disregards; or
5. Increased hours of employment.

A family must have received CalWORKs or Medi-Cal for at least three months of the six months immediately prior to the month in which the family became ineligible. To be eligible a family must have a child living in the home who is under age 18, or under 19 if the child is enrolled in school and expected to graduate before her 19^th birthday. There is no age limit for a parent or caretaker relative to receive TMC. For the first six months of TMC, there is no income limit. After the initial six months, the family can stay on TMC if its countable income is below 185% of the Federal Poverty Level (FPL) (at or below $22,459 for an individual and $30,451 for a couple in 2018). The federal matching assistance percentage (FMAP) for TMC is the regular Medi-Cal FMAP, which is typically 50% federal funds/50% state funds. TMC caseload consists of individuals eligible under the first six months of the program who have full scope coverage (20,653 individuals as of June 2017) and limited scope coverage (3,169 individuals), and people enrolled in the second six months with full scope coverage (3,868 individuals) and limited scope coverage (415 individuals). This bill would allow a person (both full scope and limited scope) to stay on TMC without an income limit for the second six months, and would prohibit DHCS from charging premiums for this extended period.

1. Parallel budget proposal. The extension of TMC proposed in this bill is part of the Conference Committee on the 2018-19 Budget. The Assembly Budget funded the TMC extension at $1.5 million GF in 2018-19, while the Senate Budget did not fund the TMC extension. The TMC extension was not funded in the final budget agreement.
2. Related legislation. SB 974 (Lara) would extend Medi-Cal eligibility for full scope benefits to undocumented adults age 65 and above. SB 974 is set for hearing in the Assembly Health Committee on June 19, 2018.
   
   SB 1108 (Hernandez) prohibits DHCS from seeking or obtaining a Medicaid demonstration project or waiver to require work or community engagement activities as a condition of Medi-Cal eligibility or coverage, to require waiting periods, time limits, or coverage lockouts, as specified, or to require any other condition of Medi-Cal eligibility or coverage not required by any other provision of state law or federal statute or regulation. SB 1108 is set for hearing in the Assembly Health Committee on June 26, 2018.
   
   AB 2430 (Arambula) increases income eligibility in the Aged and Disabled Program (A&D Program) from 100% of the FPL, plus the individual or couple standard disregard, to 138% of the FPL. AB 2430 is set for hearing on June 13, 2018 in this Committee.

AB 2965 (Arambula) extends eligibility for full-scope Medi-Cal benefits to undocumented adults ages 19-25 and under who are otherwise eligible for those benefits but for their immigration status. AB 2965 is scheduled for hearing on June 20, 2018 in this Committee.

1. Prior legislation. AB 894 (Allen, Chapter 1016, Statutes of 1989) enacted the TMC provisions that this bill amends to conform to the federal Family Support Act.
2. Support. Western Center on Law and Poverty (WCLP) writes in support that allowing families exiting CalWORKs to keep Medi-Cal for twelve months regardless of income would enable more families to move out of poverty by providing an additional buffer period when they do not have to worry about paying for health care premiums or out-of-pocket costs. Families who become eligible for tax subsidies on Covered California still face high out-of-pocket costs such as co-pays and deductibles. For those who were just on CalWORKs, they have almost no assets or savings to rely on. For example, the cheapest Covered California plan (the Bronze plan), has an individual deductible of $6,300 and a family deductible of $12,600. Most CalWORKs families can have no more than $2,250 in a bank account. Additionally, when families who have been on CalWORKs do find higher paying work that would make them ineligible for Medi-Cal, many families still have considerable debt to resolve despite the increase in income. The maximum cash assistance that a family of three may receive through CalWORKs is currently $714 – or 41% of the FPL – which is not enough to pay rent or provide for other necessities. Families need at least a year to recover once they are earning enough to be ineligible for CalWORKs and Medi-Cal. Finally, removing the six-month eligibility check also ensures that families who are not earning higher incomes do not fall through the cracks for failing to file additional paperwork. WCLP concludes that this bill is a necessary step to allow families moving off of CalWORKs to stabilize their income and still be able to access needed health care services.

SUPPORT AND OPPOSITION:

Support: Western Center on Law and Poverty

Oppose: None received

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ASSEMBLY THIRD READING

ATR Bill Id:AB 2718

Author:(Friedman)

As Amended Ver:

Majority vote

SUMMARY: Requires the Department of Health Care Services (DHCS), beginning on January 1, 2019, to implement an option under federal law to provide 12 months of Medi-Cal eligibility to families transitioning off of the California Work Opportunity and Responsibility to Kids (CalWORKs) Program (commonly referred to as Transitional Medi-Cal (TMC)). Deletes existing law which provides TMC to these beneficiaries for six months and an option to remain eligible for an additional six months if income requirements are met.

FISCAL EFFECT: According to the Assembly Appropriations Committee analysis:

1. Medi-Cal benefits costs projected to be approximately $6 million annually (General Fund (GF)/federal). This bill will allow an estimated 22,000 people to stay on the program for an additional six months. To the extent people receive and report job-based coverage during this period, monthly caseload could be slightly smaller.
2. Systems changes to the Statewide Automated Welfare System (SAWS) and Medi-Cal Eligibility Data System (MEDS), and the CalHEERS eligibility system, estimated at approximately $1 million, at least (GF/federal).
3. Potential administrative costs to DHCS of up to $125,000 for two years (GF/federal).

COMMENTS: According to the author, even as families transition out of CalWORKs as their income grows from employment, accessing and retaining access to meaningful health care coverage is a considerable barrier. When the cheapest Covered California plan still requires an individual deductible of $6,300 and a family deductible of $12,600, coupled with the burden of housing and living expenses, essential health care services can grow out of reach. Keeping Californians healthy depends upon access to affordable, quality health care. For families still struggling to make ends meet after leaving CalWORKs, Medi-Cal provides a safety net of health care coverage. This bill aligns California with federal law and allows families to retain access to Medi-Cal coverage for 12 months as they transition off of CalWORKs.

Authorized by federal law, TMC is a public program that temporarily extends Medi-Cal coverage for families who leave welfare or CalWORKs. Federal law requires states to provide up to 12 months of Medicaid coverage to families who leave CalWORKs due to new or increased earnings from employment. The first six months of TMC is available to these families, regardless of income provided they: 1) were on aid at least three of the last six months; 2) maintain residence in California; and, 3) have a child in the home. Families are eligible for an additional six months if their earned income is at or below 185% of the federal poverty level. TMC, like most Medi-Cal programs, is administered by DHCS but it is the individual county welfare offices that determine eligibility for the program.

This bill deletes the six months eligibility and six month extension and instead codifies the federal option to provide TMC for 12 months.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0003207

Date of Hearing: May 23, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2718

Author:(Friedman) – As Amended Ver:March 23, 2018

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires the Department of Health Care Services (DHCS) to implement an option under federal law to provide 12 months of Medi-Cal eligibility to families transitioning off of the California Work Opportunity and Responsibility to Kids (CalWORKs) program. (Current law allows a six-month eligibility period and additional six-month extension.)

FISCAL EFFECT:

1. Medi-Cal benefits costs projected to be approximately $6 million annually (GF/federal). This bill will allow an estimated 22,000 people to stay on the program for an additional six months. To the extent people receive and report job-based coverage during this period, monthly caseload could be slightly smaller.
2. Systems changes to the Statewide Automated Welfare System (SAWS) and Medi-Cal Eligibility Data System (MEDS), and the CalHEERS eligibility system, estimated at approximately $1 million, at least (GF/federal).
3. Potential administrative costs to DHCS of up to $125,000 for two years (GF/federal).

COMMENTS:

1. Purpose. According to the Western Center on Law and Poverty, allowing families exiting CalWORKs to keep Medi-Cal for 12 months regardless of income provides an additional buffer period when they do not have to worry about paying for health care premiums or out-of-pocket costs. This will enable families to move out of poverty.
2. Background. Persons receiving CalWORKS benefits are deemed categorically eligible for Medi-Cal. Transitional Medi-Cal, which temporarily extends Medi-Cal coverage for families who leave CalWORKs, provides up to 12 months of coverage to families who leave the program due to new or increased earnings from employment. For the first six months of Transitional Medi-Cal, there is no income limit. After the initial six months, the family can stay on Transitional Medi-Cal if its countable income is below 185% FPL. This bill deletes the six-month eligibility period plus the six-month extension, and instead codifies a federal option to provide Transitional Medi-Cal for 12 months.
3. Related Legislation. A number of bills being heard today in this committee address Medi-Cal eligibility and enrollment.

AB 2430 (Arambula) expands income eligibility for Medi-Cal for aged, blind, or disabled individuals from a threshold that is effectively 124% of the federal poverty level, to 138% of the federal poverty level.

AB 2579 (Burke) creates a streamlined Medi-Cal enrollment gateway through the Women, Infants, and Children (WIC) program.

AB 2331 (Weber) contains multiple requirements intended to facilitate continuous Medi-Cal enrollment for regional center consumers.

AB 2965 (Arambula) provides Medi-Cal coverage regardless of immigration status.

1. Staff Comment. The author may wish to amend this bill to clarify it is contingent on the availability of federal financial participation.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 10, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2718

Author:(Friedman) – As Amended Ver:March 23, 2018

SUBJECT: Medi-Cal: CalWORKs: eligibility.

SUMMARY: Requires the Department of Health Care Services (DHCS), beginning on January 1, 2019, to implement an option under federal law to provide 12 months of Medi-Cal eligibility to families transitioning off of the California Work Opportunity and Responsibility to Kids (CalWORKs) Program (commonly referred to as Transitional Medi-Cal (TMC)). Deletes existing law which provides TMC to these beneficiaries for six months and an option to remain eligible for an additional six months if income requirements are met.

EXISTING LAW:

1. Establishes CalWORKs as a public assistance program that provides cash aid and services to eligible families that have a child(ren) in the home. Makes this program available in all 58 counties and is operated locally by county welfare departments.
2. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income patients receive health care benefits.
   
3. Requires a family who was receiving aid under the CalWORKS program in at least three of the six months immediately preceeding the month in which that family becomes ineligible for that assistance due to income from employment, or other specified reasons, to remain eligible for health care services under Medi-Cal during the immediately succeeding six month period.
4. Requires DHCS, in conformance with federal law to offer CalWORKS beneficiaries the option of remaining eligible for health care services under the Medi-Cal program for an additional period of six months.
5. Authorizes, under federal law, a state to elect to combine 3) and 4) above to a 12-month period.
6. Allows DHCS when it determines to be cost-effective, consistent with federal law, to elect to pay a family’s expenses for premiums, deductibles, coninsurance, or similar costs for health insurance, as specified.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, even as families transition out of CalWORKs as their income grows from employment, accessing and retaining access to meaningful health care coverage is a considerable barrier. When the cheapest Covered California plan still requires an individual deductible of $6,300 and a family deductible of $12,600, coupled with the burden of housing and living expenses, essential health care services can grow out of reach. Keeping Californians healthy depends upon access to affordable, quality health care. For families still struggling to make ends meet after leaving CalWORKs, Medi-Cal provides a safety net of health care coverage. This bill aligns California with federal law and allows families to retain access to Medi-Cal coverage for 12 months as they transition off of CalWORKs.
2. BACKGROUND. Authorized by federal law, TMC is a public program that temporarily extends Medi-Cal coverage for families who leave welfare or CalWORKs. Federal law requires states to provide up to 12 months of Medicaid coverage to families who leave CalWORKs due to new or increased earnings from employment. The first six months of TMC is available to these families, regardless of income provided they: a) were on aid at least three of the last six months; b) maintain residence in California; and, c) have a child in the home. Families are eligible for an additional six months if their earned income is at or below 185% of the Federal Poverty Level. TMC, like most Medi-Cal programs, is administered by DHCS but it is the individual county welfare offices that determine eligibility for the program.

This bill deletes the six months eligibility and six month extension and instead codifies the federal option to provide TMC for 12 months.

1. SUPPORT. According to the Western Center on Law and Poverty, allowing families exiting CalWORKs to keep Medi-Cal for twelve months regardless of income would enable families to move out of poverty by providing an additional buffer period when they do not have to worry about paying for health care premiums or out-of-pocket costs.

REGISTERED SUPPORT / OPPOSITION:

Support

Western Center on Law and Poverty

Opposition

None on file.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097