ABX 1 1 Section Guide Section Number Law Section What it does 1 Section 1: Intent Language 2 Section 12698.30 Insurance Code States findings and declarations of the legislature in enacting the bill. Amends current law to require private insurers to include specified pregnancy coverage for subscribers. 3&4 14005.30 Welfare & Institutions Code (All additional sections are WIC) 5 14005.36 6&7 14005.37 8 14005.38 9 14005.60 10 14005.61 11 14005.64 1931(b) eligibility: Sec 3 sunsets current 1931(b) statute as of January 1, 2014. Sec 4 takes effect January 1, 2014, and requires use of MAGI process for income and household calculation for 1931(b) families. Eliminates deprivation and asset tests. Makes changes to current law allowing counties to use updated information received by a managed care plan to update a client’s case file. Redetermination section: Sec 6 sunsets current redetermination statute as of January 1, 2014. Sec 7 takes effect January 1, 2014 and provides details on new annual redetermination process as well as redeterminations due to a change of circumstances. This includes the new ex parte process for annual redeterminations as well as some changes to the existing SB 87 process to conform with federal ACA regulations. Sunsets current section that requires annual redeterminations. Annual renewal details will be in 14005.37 and this section will be duplicative. MAGI expansion: Provides for the MAGI expansion to childless adults up to 133% percent of FPL (the 5% income disregard is located in Sec 11), effective January 1, 2014. LIHP transition: Sets forth requirements for LIHP transition into Medi-Cal for those under 133% FPL. Includes details on managed care transition procedures and noticing. Requires the provision of application information to those over 133% FPL. MAGI eligibility details: Provides further detail on the MAGI determination, including specifically prohibiting an asset test and providing for the 5% income disregard. Requires the department to set MAGI income thresholds for groups that are eligible for Medi-Cal today, and to work with stakeholders to present options prior to making a decision on how to set the thresholds. Comments Medi-Cal pregnancy coverage details will be included in a separate bill later on – details could not be agreed upon prior to bill being passed. Federal regs give states two options for setting the MAGI conversion threshold. ABX 1 1 Section Guide 12 14011.16 13 14011.17 14 14012 15 14013.3 16 14015.5 17 14015.7 18 14015.8 19 & 20 14016.5 21 & 22 14016.6 Repeals mid-year status reporting requirement effective January 1, 2014. Repeals mid-year status reporting requirement effective January 1, 2014. Sunsets current section that requires annual redeterminations. Annual renewal details will be in 14005.37 and this section will be duplicative. Verification section: Adds section to law setting forth verification requirements and defining “reasonable compatibility” for purposes of verifying whether self-reported information is compatible with information received electronically. Requires development of a verification plan with stakeholder involvement and public posting. Medi-Cal eligibility determination: Restates current law that counties perform Medi-Cal eligibility determinations and conduct case management. Allows for an exception if someone applies online via CalHEERS and no further follow up is necessary by staff. In that circumstance, CalHEERS can find someone eligible for Medi-Cal without a county staff review. Also authorizes the Exchange to provide information regarding plan selection to someone found eligible for MAGI Medi-Cal and record a plan choice in CalHEERS. Quick sort transfer/warm handoff: Sets forth the details of the agreed-upon quick sort and warm handoff process for individuals who call into the Covered California service center and are identified as needing an eligibility determination. Data sharing: Allows for data to be shared among entities conducting eligibility determinations for the purposes of performing their respective statutory duties. Managed care enrollment: Sec 19 sunsets current law regarding managed care enrollment. Sec 20 updates the section to include provisions for assisters and counties to help with plan selection after training is provided to the staff who will be doing this. Managed care enrollment: Updates provisions regarding a training program for staff who will assist with managed care plan selection. Sec 21 sunsets current law and Sec 22 re-enacts with changes. If staff follow up is necessary for an application filed online, the case would be referred to the county for the review. Have flagged clean up need here that counties may not designate specialized staff to handle these duties, though current law references this. ABX 1 1 Section Guide 23 14055 24 14102.5 25 14103 26 15926 27 28 Uncodified Uncodified Caretaker relative: Defines caretaker relative consistent with ACA, effective January 1, 2014. Data reporting: Sets forth requirements for development of data reports, to be pulled from MEDS, SAWS, and CalHEERS on a quarterly basis. Includes specific data elements to be pulled. Takes effect January 1, 2014. Tie back: States that if the federal participation rate drops below 90 percent, the reduction shall be addressed in a timely manner by the budget committees. If federal participation drops below 70 percent prior to January 1, 2018, the expansion to childless adults will cease 12 months following the effective date of the federal law or other change that effectuates the drop in federal participation. AB 1296 Clean Up: Makes conforming and technical changes to AB 1296, a Western Center-sponsored bill that, among other things, required the development of a single streamlined application for health insurance affordability programs. Makes clear that applications currently in existence can be accepted after January 1, 2014 (with a phase out by January 1, 2016) and additional supplemental information collected. Standard mandate language. Double-joins the bill to SBX1 1 such that both bills must be enacted in order for either to take effect.