BILL NUMBER: AB 1114	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 15, 2015
	AMENDED IN ASSEMBLY  APRIL 16, 2015

INTRODUCED BY   Assembly Member Bonilla

                        FEBRUARY 27, 2015

   An act to amend Section 15926 of the Welfare and Institutions
Code, relating to public health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1114, as amended, Bonilla. Health care: eligibility and
enrollment.
   Existing law establishes  for  various programs
to provide health care coverage to persons with limited financial
resources, including the Medi-Cal program and the State's Children's
Health Insurance Program. Existing law establishes the California
Health Benefit Exchange (Exchange), pursuant to the federal Patient
Protection and Affordable Care Act (PPACA), and specifies the duties
and powers of the board governing the Exchange relative to
determining eligibility for enrollment in the Exchange and arranging
for coverage under qualified health plans, and facilitating the
purchase of qualified health plans through the Exchange. Existing
law, the Health Care Reform Eligibility, Enrollment, and Retention
Planning Act, operative as provided, requires the California Health
and Human Services Agency, in consultation with specified entities,
to establish standardized single, accessible, application forms and
related renewal procedures for state health subsidy programs, as
defined, in accordance with specified requirements relating to the
forms and notices developed for these purposes.
   This bill would  revise these provisions to include
letters, as well as forms and notices developed for purposes of
creating the standardized application and renewal process, and would
also specifically define the nature of these forms, letters, and
notices.   define the terms "forms   " and
  "notices" for these   purposes as application,
renewal, and other forms and letters needed to obtain or retain
eligibility, benefits, or services from an insurance affordability
program, and all notices affecting the legal rights of applicants,
beneficiaries, and enrolle   es. 
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 15926 of the Welfare and Institutions Code is
amended to read:
   15926.  (a) The following definitions apply for purposes of this
part:
   (1) "Accessible" means in compliance with Section 11135 of the
Government Code, Section 1557 of the PPACA, and regulations or
guidance adopted pursuant to these statutes.
   (2)  "Forms, letters,   "Forms  and
notices" means application, renewal, and other forms and letters
needed to obtain or retain eligibility, benefits, or services from an
insurance affordability program, and all notices affecting the legal
rights of applicants, beneficiaries, and enrollees.
   (3) "Limited-English-proficient" means not speaking English as one'
s primary language and having a limited ability to read, speak,
write, or understand English.
   (4) "Insurance affordability program" means a program that is one
of the following:
   (A) The Medi-Cal program under Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.).
   (B) The state's children's health insurance program (CHIP) under
Title XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa
et seq.).
   (C) A program that makes available to qualified individuals
coverage in a qualified health plan through the California Health
Benefit Exchange established pursuant to Title 22 (commencing with
Section 100500) of the Government Code with advance payment of the
premium tax credit established under Section 36B of the Internal
Revenue Code.
   (D) A program that makes available coverage in a qualified health
plan through the California Health Benefit Exchange established
pursuant to Title 22 (commencing with Section 100500) of the
Government Code with cost-sharing reductions established under
Section 1402 of PPACA and any subsequent amendments to that act.
   (b) An individual shall have the option to apply for insurance
affordability programs in person, by mail, online, by telephone, or
by other commonly available electronic means.
   (c) (1) A single, accessible, standardized paper, electronic, and
telephone application for insurance affordability programs shall be
developed by the department in consultation with MRMIB and the board
governing the Exchange as part of the stakeholder process described
in subdivision (b) of Section 15925. The application shall be used by
all entities authorized to make an eligibility determination for any
of the insurance affordability programs and by their agents.
   (2) The department may develop and require the use of supplemental
forms to collect additional information needed to determine
eligibility on a basis other than the financial methodologies
described in Section 1396a(e)(14) of Title 42 of the United States
Code, as added by the federal Patient Protection and Affordable Care
Act (Public Law 111-148), and as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152) and any
subsequent amendments, as provided under Section 435.907(c) of Title
42 of the Code of Federal Regulations.
   (3) The application shall be tested and operational by the date as
required by the federal Secretary of Health and Human Services.
   (4) The application form shall, to the extent not inconsistent
with federal statutes, regulations, and guidance, satisfy all of the
following criteria:
   (A) The form shall include simple, user-friendly language and
instructions.
   (B) The form may not ask for information related to a nonapplicant
that is not necessary to determine eligibility in the applicant's
particular circumstances.
   (C) The form may require only information necessary to support the
eligibility and enrollment processes for insurance affordability
programs.
   (D) The form may be used for, but shall not be limited to,
screening.
   (E) The form may ask, or be used otherwise to identify, if the
mother of an infant applicant under one year of age had coverage
through an insurance affordability program for the infant's birth,
for the purpose of automatically enrolling the infant into the
applicable program without the family having to complete the
application process for the infant.
   (F) The form may include questions that are voluntary for
applicants to answer regarding demographic data categories, including
race, ethnicity, primary language, disability status, and other
categories recognized by the federal Secretary of Health and Human
Services under Section 4302 of the PPACA.
   (G) Until January 1, 2016, the department shall instruct counties
to not reject an application that was in existence prior to January
1, 2014, but to accept the application and request any additional
information needed from the applicant in order to complete the
eligibility determination process. The department shall work with
counties and consumer advocates to develop the supplemental
questions.
   (d)  Nothing in this section shall   This
section does not  preclude the use of a provider-based
application form or enrollment procedures for insurance affordability
programs or other health programs that differs from the application
form described in subdivision (c), and related enrollment procedures.
 Nothing in this section shall   This section
does not  preclude the use of a joint application, developed by
the department and the State Department of Social Services, that
allows for an application to be made for multiple programs,
including, but not limited to, CalWORKs, CalFresh, and insurance
affordability programs.
   (e) The entity making the eligibility determination shall grant
eligibility immediately whenever possible and with the consent of the
applicant in accordance with the state and federal rules governing
insurance affordability programs.
   (f) (1) If the eligibility, enrollment, and retention system has
the ability to prepopulate an application form for insurance
affordability programs with personal information from available
electronic databases, an applicant shall be given the option, with
his or her informed consent, to have the application form
prepopulated. Before a prepopulated application is submitted to the
entity authorized to make eligibility determinations, the individual
shall be given the opportunity to provide additional eligibility
information and to correct any information retrieved from a database.

   (2)  All   An  insurance affordability
 programs   program  may accept
self-attestation, instead of requiring an individual to produce a
document, for age, date of birth, family size, household income,
state residence, pregnancy, and any other applicable criteria needed
to determine the eligibility of an applicant or recipient, to the
extent permitted by state and federal law.
   (3) An applicant or recipient shall have his or her information
electronically verified in the manner required by the PPACA and
implementing federal regulations and guidance and state law.
   (4) Before an eligibility determination is made, the individual
shall be given the opportunity to provide additional eligibility
information and to correct information.
   (5) The eligibility of an applicant shall not be delayed beyond
the timeliness standards as provided in Section 435.912 of Title 42
of the Code of Federal Regulations or denied for any insurance
affordability program unless the applicant is given a reasonable
opportunity, of at least the kind provided for under the Medi-Cal
program pursuant to Section 14007.5 and paragraph (7) of subdivision
(e) of Section 14011.2, to resolve discrepancies concerning any
information provided by a verifying entity.
   (6) To the extent federal financial participation is available, an
applicant shall be provided benefits in accordance with the rules of
the insurance affordability program, as implemented in federal
regulations and guidance, for which he or she otherwise qualifies
until a determination is made that he or she is not eligible and all
applicable notices have been provided.  Nothing in this
section shall   This section shall not  be
interpreted to grant presumptive eligibility if it is not otherwise
required by state law, and, if so required, then only to the extent
permitted by federal law.
   (g) The eligibility, enrollment, and retention system shall offer
an applicant and recipient assistance with his or her application or
renewal for an insurance affordability program in person, over the
telephone, by mail, online, or through other commonly available
electronic means and in a manner that is accessible to individuals
with disabilities and those who are limited-English proficient.
   (h) (1) During the processing of an application, renewal, or a
transition due to a change in circumstances, an entity making
eligibility determinations for an insurance affordability program
shall ensure that an eligible applicant and recipient of insurance
affordability programs that meets all program eligibility
requirements and complies with all necessary requests for information
moves between programs without any breaks in coverage and without
being required to provide any forms, documents, or other information
or undergo verification that is duplicative or otherwise unnecessary.
The individual shall be informed about how to obtain information
about the status of his or her application, renewal, or transfer to
another program at any time, and the information shall be promptly
provided when requested.
   (2) The application or case of an individual screened as not
eligible for Medi-Cal on the basis of Modified Adjusted Gross Income
(MAGI) household income but who may be eligible on the basis of being
65 years of age or older, or on the basis of blindness or
disability, shall be forwarded to the Medi-Cal program for an
eligibility determination. During the period this application or case
is processed for a non-MAGI Medi-Cal eligibility determination, if
the applicant or recipient is otherwise eligible for an insurance
affordability program, he or she shall be determined eligible for
that program.
   (3) Renewal procedures shall include all available methods for
reporting renewal information, including, but not limited to,
face-to-face, telephone, mail, and online renewal or renewal through
other commonly available electronic means.
   (4) An applicant who is not eligible for an insurance
affordability program for a reason other than income eligibility, or
for any reason in the case of applicants and recipients residing in a
county that offers a health coverage program for individuals with
income above the maximum allowed for the Exchange premium tax
credits, shall be referred to the county health coverage program in
his or her county of residence.
   (i) Notwithstanding subdivisions (e), (f), and (j), before an
online applicant who appears to be eligible for the Exchange with a
premium tax credit or reduction in cost sharing, or both, may be
enrolled in the Exchange, both of the following shall occur:
   (1) The applicant shall be informed of the overpayment penalties
under the federal Comprehensive 1099 Taxpayer Protection and
Repayment of Exchange Subsidy Overpayments Act of 2011 (Public Law
112-9), if the individual's annual family income increases by a
specified amount or more, calculated on the basis of the individual's
current family size and current income, and that penalties are
avoided by prompt reporting of income increases throughout the year.
   (2) The applicant shall be informed of the penalty for failure to
have minimum essential health coverage.
   (j) The  department shall,   department,
 in coordination with MRMIB and the Exchange board,  shall
 streamline and coordinate all eligibility rules and
requirements among insurance affordability programs using the least
restrictive rules and requirements permitted by federal and state
law. This process shall include the consideration of methodologies
for determining income levels, assets, rules for household size,
citizenship and immigration status, and self-attestation and
verification requirements.
   (k) (1)  Forms, letters,   Forms  and
notices developed pursuant to this section shall be accessible and
standardized, as appropriate, and shall comply with federal and state
laws, regulations, and guidance prohibiting discrimination.
   (2)  Forms, letters,   Forms   
and notices developed pursuant to this section shall be developed
using plain language and shall be provided in a manner that affords
meaningful access to limited-English-proficient individuals, in
accordance with applicable state and federal law, and at a minimum,
provided in the same threshold languages as required for Medi-Cal
managed care plans.
   (l) The department, the California Health and Human Services
Agency, MRMIB, and the Exchange board shall establish a process for
receiving and acting on stakeholder suggestions regarding the
functionality of the eligibility systems supporting the Exchange,
including the activities of all entities providing eligibility
screening to ensure the correct eligibility rules and requirements
are being used. This process shall include consumers and their
advocates, be conducted no less than quarterly, and include the
recording, review, and analysis of potential defects or enhancements
of the eligibility systems. The process shall also include regular
updates on the work to analyze, prioritize, and implement corrections
to confirmed defects and proposed enhancements, and to monitor
screening.
   (m) In designing and implementing the eligibility, enrollment, and
retention system, the department, MRMIB, and the Exchange board
shall ensure that all privacy and confidentiality rights under the
PPACA and other federal and state laws are incorporated and followed,
including responses to security breaches.
   (n) Except as otherwise specified, this section shall be operative
on January 1, 2014.