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SB-65 Health care coverage: financial assistance.(2019-2020)

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Date Published: 01/23/2020 09:00 PM
SB65:v96#DOCUMENT

Amended  IN  Assembly  January 23, 2020
Amended  IN  Assembly  July 03, 2019
Amended  IN  Senate  April 03, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 65

Introduced by Senator Pan

January 08, 2019

An act to add and repeal Section 100509 of amend Section 100805 of, and to add Section 100804 to, the Government Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 65, as amended, Pan. Health care coverage: financial assistance.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various healthcare coverage market reforms. Among other things, the PPACA requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers and requires that state entity to meet certain other requirements. Existing law creates the California Health Benefit Exchange (the Exchange), also known as Covered California, for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the PPACA. Until January 1, 2023, existing law requires the Exchange, among other duties, to administer an individual market assistance program to provide health care coverage financial assistance to California residents assistance, including premium assistance subsidies, to program participants with household incomes at or below 600% of the federal poverty level.

This bill would, until January 1, 2023, require the board of the Exchange to develop and prepare one or more reports to be issued at least quarterly and to be made publicly available within 30 days following the end of each quarter for the purpose of informing the California Health and Human Services Agency, the Legislature, and the public about the enrollment process for the individual market assistance program. The bill would require the reports to contain specified information, including, among other things, the number of applications received for the program, the disposition of those applications, and the total number of grievances and appeals filed by applicants and enrollees.

This bill would reduce premiums to zero for program participants with household incomes at or below 138% of the federal poverty level, and would specify the premium assistance subsidy amount for program participants with household incomes of 139% to 600%, inclusive, of the federal poverty level. The bill would require the financial assistance administered by the Exchange to include cost-sharing reduction assistance to reduce the copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing of a program participant with a household income of 200% to 400%, inclusive, of the federal poverty level.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 100804 is added to the Government Code, to read:

100804.
 (a) Financial assistance administered pursuant to Section 100800 shall include cost-sharing reduction assistance to reduce a program participant’s copays, deductibles, coinsurance, out-of-pocket maximums, and other cost sharing. Cost-sharing reduction assistance 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.
(b) (1) Cost-sharing reduction assistance shall be in addition to premium assistance provided pursuant to this title.
(2) Cost-sharing reduction assistance shall be in addition to cost-sharing reduction assistance provided by the federal government, and shall not be subject to the income requirements of federal cost-sharing reduction assistance.
(3) Cost-sharing reduction assistance shall be provided to program participants with a household income of 200 percent to 400 percent, inclusive, of the federal poverty level, and shall have a value consistent with the standard gold benefit design, with an actuarial value of 80 percent with respect to essential benefits.
(c) Cost-sharing reduction assistance 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 cost-sharing reduction assistance shall not be subject to the income requirements of that section.
(d) Consistent with federal law, cost-sharing reduction assistance shall not be subject to reconciliation through the personal income tax. Eligibility for cost-sharing reduction assistance shall be determined at the time of application.

SEC. 2.

 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) The premium assistance subsidy shall provide the following assistance:
(1) For a program participant with a household income at or below 138 percent of federal poverty level, the premium assistance subsidy shall reduce the premiums to zero.
(2) For a program participant with a household income of 139 percent to 400 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to no more than 8 percent of the household income.
(3) For a program participant with a household income of 401 percent to 600 percent, inclusive, of the federal poverty level, the premium assistance subsidy shall be scaled based on income to reduce the premiums to 8 percent to 15 percent, inclusive, of the household income.

SECTION 1.Section 100509 is added to the Government Code, to read:
100509.

(a)The board shall develop and prepare one or more reports that shall be issued at least quarterly and be made publicly available within 30 days following the end of each quarter for the purpose of informing the California Health and Human Services Agency, the Legislature, and the public about the enrollment process for the individual market assistance program pursuant to Title 25 (commencing with Section 10800). The reports shall include, but not be limited to, the following information:

(1)The number of applications received for the individual market assistance program.

(2)The number of applicants included on those applications.

(3)Aggregate applicant demographics, including, but not limited to, gender, age, race, ethnicity, and primary language.

(4)The disposition of applications, including all of the following:

(A)The number of eligibility determinations that resulted in approval for financial assistance.

(B)The program or programs for which the applicants were determined eligible.

(C)The number of applicants that were denied financial assistance and the reason or reasons for the denials.

(5)The number of program participants in the following categories:

(A)Between 401 percent to 600 percent, inclusive, of the federal poverty level.

(B)Between 139 percent to 400 percent, inclusive, of the federal poverty level.

(C)At or below 138 percent of the federal poverty level.

(6)The amount of the financial assistance provided to program participants in each of the federal poverty levels described in paragraph (5).

(7)The number of program participants subject to reconciliation in each of the federal poverty levels described in paragraph (5).

(8)The health plans selected by applicants as reported by the program.

(9)The total number of grievances and appeals filed by applicants and enrollees, the bases for the grievances, and the outcomes of the appeals.

(10)Any other information the board determines to be relevant to the individual market assistance program design.

(b)The report required to be submitted to the Legislature pursuant to subdivision (a) shall be submitted in compliance with Section 9795.

(c)This section shall remain in effect only until January 1, 2023, and as of that date is repealed.