Bill Text: CA AB115 | 2009-2010 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Adult Health Coverage Expansion Program.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Vetoed) 2010-01-14 - Consideration of Governor's veto stricken from file. [AB115 Detail]

Download: California-2009-AB115-Introduced.html

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BILL NUMBER: AB 115	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Beall

                        JANUARY 14, 2009

   An act to amend Sections 131502, 131511, 131520, 131521, and
131540 of, and to add Sections 131532 and 131542 to, the Health and
Safety Code, relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 115, as introduced, Beall. Adult Health Coverage Expansion
Program.
   Existing law provides for the creation of the Adult Health
Coverage Expansion Program as a pilot program in Santa Clara County
to be administered by a local initiative in the county, at the option
of the local initiative. The program provides health care coverage
to eligible employees, as specified, of a small business, as defined,
that participates in the program, not to exceed 5,000 employees in
the county unless authorized by the Department of Managed Health
Care.
   This bill would authorize the local initiative to provide
complementary products, as defined, to provide health care services
coverage to the spouses or domestic partners or eligible dependent
children of program enrollees.
   Existing law defines a small business, for purposes of the pilot
program, as an entity located in Santa Clara County that employs 50
or fewer persons, with at least 35% of the employees earning less
than 350% of the federal poverty level for a family size of one.
   This bill would redefine small business as businesses employing 50
or fewer persons, with 25% of their employees earning less than 350%
of the federal poverty level.
   Existing law requires, for a small business to be eligible for the
program, that at least 50% of the employees be eligible for coverage
and that at least 50% of those eligible employees must choose to
participate.
   This bill would make eligible for the program any business where
at least 50% of the eligible employees choose to participate.
   Existing law requires the local initiative to establish copayment
levels and amounts, as specified.
   This bill would delete that requirement.
   The bill would provide that no General Fund moneys shall be used
for purposes of the program or any related complementary products.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) To facilitate the success of the Adult Health Coverage
Expansion Program (Division 113 (commencing with Section 131500) of
the Health and Safety Code, enacted by Chapter 677 of the Statutes of
2007), it would be appropriate to provide health care coverage
products, in addition to those authorized in the program, to cover
spouses, domestic partners, and eligible children of program
enrollees.
   (b) It is, therefore, the intent of the Legislature in enacting
this act to authorize the creation of a complementary product to be
offered in conjunction with the program, but as a separate product.
   (c) It is also the intent of the Legislature that any exemptions
from current law stated in Division 113 (commencing with Section
131500) of the Health and Safety Code shall only apply to the program
and products authorized by that division.
  SEC. 2.  Section 131502 of the Health and Safety Code is amended to
read:
   131502.  The following definitions apply for purposes of this
division: 
   (a) "Complementary product" means a health care coverage plan
offered by the local initiative that provides coverage for a spouse,
domestic partner, or eligible dependent children of a program
enrollee.  
   (a) 
    (b)  "Local initiative" has the same meaning as set
forth in Section 12693.08 of the Insurance Code. 
   (b) 
    (c)  "Program" means the Adult Health Coverage Expansion
Program. 
   (c) 
    (d)  "Small business" means an entity located in Santa
Clara County that employs 50 or fewer persons, with at least 
35   25  percent of the employees earning less
than 350 percent of the federal poverty level  for a family
size of one  , and that has not offered health care coverage
to its employees for, at minimum, 12 consecutive months, provided
that the provisions of any such prior coverage required the employer
to contribute at least 50 percent of the total amount of the premium
for that coverage. For purposes of the program authorized by this
division, a small business shall be a "small employer" pursuant to
Article 3.1 (commencing with Section 1357) of Chapter 2.2 of Division
2, subject to the provisions and exceptions of this division.
Notwithstanding the company affiliation and tax filing provision of
paragraph (1) of subdivision (l) of Section 1357, an individual
franchise outlet shall be considered a small business.
  SEC. 3.  Section 131511 of the Health and Safety Code is amended to
read:
   131511.  (a) In implementing the pilot program established
pursuant to this division, the local initiative in Santa Clara County
 and any complementary product offered, and only this local
initiative and complementary product,  shall not be subject to
the requirements of subdivision (a) of Section 1357.03. The program
 and any complementary product offered  shall be otherwise
subject to the requirements of Chapter 2.2 (commencing with Section
1340) of Division 2, including Article 3.1 (commencing with Section
1357) thereof, except as otherwise provided in this division, and
shall be subject to approval as to regulatory filings with the
Department of Managed Health Care as prescribed in Chapter 2.2
(commencing with Section 1340) of Division 2 and in implementing
regulations promulgated by the department.
   (b) Except in the case of a late enrollee or for satisfaction of a
preexisting condition clause in the case of initial coverage for an
eligible employee  or eligible dependent  , the local
initiative may not exclude any eligible employee  or eligible
dependent  who would otherwise be eligible for health care
coverage under this division on the basis of an actual or expected
health care condition. The local initiative  may 
 shall  not limit or exclude coverage for any eligible
employee  or eligible dependent  by type of illness,
treatment, medical condition, or accident, except for preexisting
conditions as permitted under Section 1357.06.
   (c) Coverage provided through the program  , or through a
complementary product,  to an eligible small business shall be
renewable with respect to all eligible employees  or eligible
dependents  at the option of the participating small business
 , subject to the local initiative's continued offering 
 of the pilot program  .
  SEC. 4.  Section 131520 of the Health and Safety Code is amended to
read:
   131520.   (a)    Notwithstanding subdivision (b)
of Section 1357, only an adult age 19 to 64 years, inclusive,
employed by a small business for a minimum of 20 hours per week is
eligible to participate in the program if he or she has a gross
annual income that is less than 350 percent of the federal poverty
level  for a family size of one  , and his or her
employer participates in the program. Dependents, spouses, and
domestic partners of employees are not eligible for the program 
, but may be covered by a complementary product  . 
   (b) Notwithstanding subdivision (b) of Section 1357, a
complementary product may contain eligibility requirements that apply
only to the spouse, domestic partner, or dependent children of the
program enrollee.  
   (c) Complementary products are exempt from the uniform
participation requirements of subdivision (b) of Section 1357.03.

  SEC. 5.  Section 131521 of the Health and Safety Code is amended to
read:
   131521.  (a) A small business may apply to the local initiative
that administers the program to obtain coverage for its employees who
meet the requirements of Section 131520.
   (b) At least 50 percent of the  employees of an otherwise
eligible small business must meet the eligibility requirements of
Section 131520, and at least 50 percent of those  eligible
employees must choose to receive coverage through the program in
order for the small business to qualify to participate in the
program.  A person covered by a complementary product is not an
eligible employee for purposes   of this section. 
  SEC. 6.  Section 131532 is added to the Health and Safety Code, to
read:
   131532.  The health care services offered in a complementary
product may be, but are not required to be, the same as those offered
in the program.
  SEC. 7.  Section 131540 of the Health and Safety Code is amended to
read:
   131540.  (a) (1) The cost of the health care coverage provided
through the program shall be paid through a combination of
contributions paid by the  participating small 
business   businesses  , premiums paid by
participating employees, and  any  county, federal, state,
or private sector funding  made  available for this
purpose.
   (2) The local initiative may determine the amount of the employer
contribution for each participating eligible employee, which shall
not exceed one hundred fifty dollars ($150) per month, and the amount
of the employee premium, which shall not exceed seventy-five dollars
($75) per month. The local initiative may adjust employer
contribution and employee premium levels after the first year if
necessary for changes in health care costs.
   (3) The local initiative may structure the required employee
premium amounts according to a schedule that takes into account the
individual employee's age or income level, or  both, in a
manner similar, but not necessarily identical, to that described in
Section 12693.43 of the Insurance Code, pertaining to the Healthy
Families Program   both  . 
   (4) The local initiative shall establish copayment levels and
amounts in a manner substantially similar to that described in
Section 12693.615 of the Insurance Code, pertaining to the Healthy
Families Program.  
   (5) 
    (4)  For purposes of the program,  the term 
"applicable rate charged for a covered employee" in Section 1366.26
 means   shall mean  the total premium
amount paid to the health plan on behalf of an employee, including
amounts paid by the small business on behalf of the employee, the
premium paid by the employee, and any county, federal, state, or
private sector funding, which funding shall include the value of the
 discounted rates negotiated pursuant to subdivision (b)
  hospital-based services provided to enrollees in the
program  , as apportioned to the employee. The program shall
submit to the Department of Managed Health Care the procedures the
local initiative will use for purposes of establishing the rates to
be paid by a person eligible for continuation coverage under Section
1366.26, and the department shall only approve those procedures if it
determines that they are consistent with the requirements of the
Cal-COBRA program.
   (b) In order to enhance the affordability of coverage offered
through the program to eligible small businesses and employees, the
county and the local initiative shall negotiate discounted rates for
services provided to participants in the program by providers
operated by the county or by providers with whom, or with which, the
county has contracted to provide health care services. 
   (c) This section shall not apply to complementary products. 
  SEC. 8.  Section 131542 is added to the Health and Safety Code, to
read:
   131542.  Notwithstanding any other provision of law, no General
Fund moneys shall be used for purposes of funding the program or any
related complementary products.