Bill Text: CA SB703 | 2011-2012 | Regular Session | Amended
Bill Title: Health care coverage: Basic Health Program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2012-08-16 - Set, second hearing. Held in committee and under submission. [SB703 Detail]
Download: California-2011-SB703-Amended.html
BILL NUMBER: SB 703 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 25, 2012
AMENDED IN ASSEMBLY JULY 12, 2011
AMENDED IN ASSEMBLY JUNE 28, 2011
AMENDED IN SENATE MAY 31, 2011
AMENDED IN SENATE MARCH 30, 2011
AMENDED IN SENATE MARCH 24, 2011
INTRODUCED BY Senator Hernandez
FEBRUARY 18, 2011
An act to add Part 6.25 (commencing with Section 12694.1)
to Division 2 of the Insurance Code Title 24
(commencing with Section 100700) to the Government Code ,
relating to health care coverage, and making an appropriation
therefor.
LEGISLATIVE COUNSEL'S DIGEST
SB 703, as amended, Hernandez. Health care coverage: Basic Health
Program.
Existing law, the federal Patient Protection and Affordable Care
Act, requires each state to, by January 1, 2014, establish an
American Health Benefit Exchange that makes available qualified
health plans to qualified individuals and small employers.
Existing state law establishes the California Health Benefit
Exchange within state government to facilitate enrollment of
qualified individuals in qualified health plans and to assist
qualified employers in facilitating the enrollment of their employees
in qualified health plans . The federal Patient Protection and
Affordable Care Act also authorizes the establishment of a basic
health program under which a state may enter into contracts to offer
one or more standard health plans providing a minimum level of
essential benefits to eligible individuals instead of offering those
individuals coverage through an Exchange, if specified criteria are
met.
Existing law establishes the Managed Risk Medical Insurance Board
(MRMIB) and makes it responsible for administering the California
Major Risk Medical Insurance Program and the Healthy Families Program
to provide health care coverage to certain residents of the state
who are unable to secure adequate coverage, subject to specified
eligibility requirements.
Under existing law, the State Department of Health Care Services
(department) administers various programs to provide health care
coverage to persons with limited financial resources, including the
Medi-Cal program.
This bill would establish in state government a Basic Health
Program, to be administered by MRMIB the
department . The bill would require MRMIB
the department to enter into a contract with the United
States Secretary of Health and Human Services to implement the Basic
Health Program, and would set forth the powers and the duties of
MRMIB the department relative to
determining eligibility for enrollment, setting premiums for
coverage, and selecting participating health plans under the Basic
Health Program, subject to requirements under federal law. The bill
would require the board department to
permit enrollment in the Basic Health Program on January 1, 2014. The
bill would create the Basic Health Program Trust Fund for those
purposes and would make moneys in the fund subject to appropriation
by the Legislature, except that if the annual Budget Act is not
enacted by a certain date, the bill would authorize the
board department to transfer specified funds
from the trust fund to health plans in order to comply with certain
requirements, thereby making an appropriation. The bill would require
the Basic Health Program to be funded by federal funds, private
donations, premiums paid by eligible individuals, and other
non-General Fund moneys available for that purpose. Notwithstanding
those provisions, the bill would authorize the board
department to obtain loans from the General Fund
for initial start-up startup expenses,
to be repaid by July 1, 2016, and would establish a procedure for
continued coverage of individuals under the California Health Benefit
Exchange if costs of the Basic Health Program exceed moneys
available from specified sources. The bill would require the
board department to request an evaluation of
the Basic Health Program and to seek funding for the evaluation from
an unspecified independent nonprofit private foundation.
Vote: majority. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Part 6.25 (commencing with Section
12694.1) is added to Division 2 of the Insurance Code, to read:
PART 6.25. BASIC HEALTH PROGRAM
12694.1. It is the intent of the Legislature to establish a Basic
SECTION 1. Title 24 (commencing with Section
100700) is added to the Government Code , to
read:
TITLE 24. BASIC HEALTH PROGRAM
100700. It is the intent of the Legislature to
establish a Basic Health Program option to implement the option
contained in Section 1331 of the federal Patient Protection and
Affordable Care Act (PPACA). The Legislature finds and declares that
Section 1331 of PPACA creating the Basic Health Program does the
following:
(a) Requires eligible individuals and their dependents enrolled in
the Basic Health Program be provided a health plan containing the
essential health benefits at a monthly premium price that does not
exceed the amount of the premium that the eligible individual would
have been required to pay if the individual had enrolled in the
applicable second lowest cost silver plan offered to the individual
through the California Health Benefit Exchange.
(b) (1) Prohibits the cost sharing an eligible individual is
required to pay under the Basic Health Program from exceeding the
cost sharing required under a platinum plan for individuals with a
household income at or below 150 percent of the federal poverty level
for the size of the family involved.
(2) Prohibits the cost sharing an eligible individual is required
to pay under the Basic Health Program from exceeding the cost sharing
required under a gold plan for an individual with a household income
above 150 percent of the federal poverty level but at or below 200
percent of the federal poverty level for the size of the family
involved.
(3) Requires balancing better affordability for consumers with
paying rates that support adequate access to providers and
strengthens the financial viability of the safety net.
(c) Requires the medical loss ratio for products in the Basic
Health Program to be 85 percent, instead of 80 percent, in the
individual and small group market.
12694.15. 100701. For purposes of
this part title , the following
definitions shall apply:
(a) "Basic Health Program" means the program authorized by Section
1331 of PPACA.
(b) "Board" means the Managed Risk Medical Insurance Board.
(c)
(b) "County organized health system" means a licensed
health care service plan established pursuant to Section 14087.51 or
14087.54 of the Welfare and Institutions Code or Chapter 3
(commencing with Section 101675) of Part 4 of Division 101 of the
Health and Safety Code.
(d)
(c) "Department" means the State Department of Health
Care Services.
(e)
(d) "Eligible individual" shall have the same meaning
as set forth in subdivision (e) of Section 1331 of PPACA.
(f)
(e) "Essential health benefits" shall have the same
meaning as set forth in Section 1302 of PPACA.
(g)
(f) "Fund" means the Basic Health Program Trust Fund
established by Section 12694.955 100721
.
(h)
(g) "Health plan" means a private health insurer
holding a valid outstanding certificate of authority from the
Insurance Commissioner or a health care service plan, as defined
under subdivision (f) of Section 1345 of the Health and Safety Code,
licensed by the Department of Managed Health Care.
(i)
(h) "Local initiative" means a licensed health care
service plan established pursuant to Section 14018.7, 14087.31,
14087.35, 14087.36, 14087.38, or 14087.96 of the Welfare and
Institutions Code.
(j)
(i) "Patient Protection and Affordable Care Act" or
"PPACA" means Public Law 111-148, as amended by the federal Health
Care and Education Reconciliation Act of 2010 (Public Law 111-152),
and any amendments to, or regulations or guidance issued under, those
acts.
12694.2. 100702. The Basic Health
Program is hereby created and shall be administered by the
Managed Risk Medical Insurance Board. department.
12694.25. 100703. The board
department shall enter into a contract with the
United States Secretary of Health and Human Services to implement a
Basic Health Program to provide coverage to eligible individuals.
100703.5. The department shall consult with stakeholders in
implementing and administering the Basic Health Program.
12694.26. 100704. The
board department shall permit enrollment in the
Basic Health Program on January 1, 2014.
12694.3. 100705. (a) The
board shall administer the Basic Health Program in conjunction with
the Healthy Families Program, and department
shall provide an eligibility and enrollment process that allows an
individual, or his or her natural or adoptive parent, legal guardian,
caretaker relative, foster parent, or stepparent with whom the child
resides, to enroll in the Basic Health Program at the same time an
individual, or his or her natural or adoptive parent, legal guardian,
caretaker relative, foster parent, or stepparent with whom the child
resides, applies for enrollment in the Healthy Families Program. An
individual may enroll in the same health plan, or a different health
plan, than his or her child or children who are enrolled in the
Healthy Families Program.
(b) In implementing the requirements of this section, and
consistent with the requirements of Section 1331 of PPACA, the
board department may do all of the
following:
(1) Determine eligibility criteria for the Basic Health Program.
(2) Determine the participation requirements of eligible
individuals applying for coverage in the Basic Health Program.
(3) Determine the participation requirements of participating
health plans.
(4) Determine when the coverage of eligible individuals begins and
the extent and scope of coverage.
(5) Determine, through negotiation with health plans, premium and
cost-sharing amounts.
(6) Collect premiums.
(7) Provide or make available subsidized coverage through
participating health plans.
(8) Provide for the processing of applications and the enrollment
of eligible individuals.
(9) Determine and approve the benefit designs and cost sharing
required by health plans participating in the Basic Health Program.
(10) Enter into contracts.
(11) Employ necessary staff.
(12) Authorize expenditures from the fund to pay program expenses
that exceed eligible individual premium contributions and to
administer the Basic Health Program, as necessary.
(13) Maintain enrollment and expenditures to ensure that
expenditures do not exceed amounts available in the fund, and, if
sufficient funds are not available to cover the estimated cost of
program expenditures, the board department
shall institute appropriate measures to reduce costs.
(14) Issue rules and regulations, as necessary. Until January 1,
2016, any rules and regulations issued pursuant to this subdivision
may be adopted as emergency regulations in accordance with the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government
Code) 2) . The adoption of these regulations
shall be deemed an emergency and necessary for the immediate
preservation of the public peace, health, and safety or general
welfare. The regulations shall become effective immediately upon
filing with the Secretary of State.
(15) Make application assistance payments to individuals who have
successfully completed the requirements of a Certified Application
Assistant in the Healthy Families Program and who successfully enroll
eligible individuals in Basic Health Program coverage.
(16) Exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed by this
part title and Section 1331 of PPACA.
12694.35. 100706. In implementing
this part title , eligibility for
coverage under, and the benefits, premiums, and cost sharing in, the
Basic Health Program, shall meet the requirements of Section 1331 of
PPACA. The board department may
determine the benefits, if any, to offer Basic Health Program
participants that are in addition to the essential health benefits
package required by Section 1302 of PPACA, including benefits
provided through specialized health care service plans, as defined in
subdivision (o) of Section 1345 of the Health and Safety Code, and
specialized health insurance policies, as defined in Section 106
of the Insurance Code , to the extent that PPACA authorizes
the inclusion of such plans or policies in the Basic Health Program.
To the extent authorized by federal law, the board
department shall determine whether benefits provided
through specialized health care service plans and specialized health
insurance policies are made available through the Basic Health
Program as part of a benefit package made available through
health plans or as an additional product to be purchased by
individuals receiving , including whether these
benefits are available as additional products to be purchased by
individuals receiving coverage through the Basic Health
Program.
12694.4. 100707. The Basic Health
Program shall be administered without regard to gender, race, creed,
color, sexual orientation, health status, disability, or occupation.
12694.45. 100708. (a) The
board department shall use appropriate and
efficient means to notify eligible individuals of the availability of
health coverage from the Basic Health Program.
(b) The board department , in
conjunction with the department Managed Risk
Medical Insurance Board , shall conduct a community outreach
and education campaign to assist in notifying eligible individuals of
the availability of health coverage through the Basic Health
Program. The board and the department and the
Managed Risk Medical Insurance Board shall seek federal funding
and funding from private entities, including foundation funding, for
this purpose. The department and the California Health
Benefit Exchange Managed Risk Medical Insurance Board
shall include information on the availability of coverage
through the Basic Health Program in all eligibility outreach efforts,
and the board department shall also
include information on the availability of coverage in the Medi-Cal
program and the California Health Benefit Exchange.
(c) The board department shall use
appropriate materials, which may include brochures, pamphlets,
fliers, posters, and other promotional items, to notify families of
the availability of coverage through the Basic Health Program.
12694.5. 100709. (a) The
board department shall ensure that written
enrollment information issued or provided by the Basic Health Program
is available to program subscribers and applicants in each of the
Medi-Cal threshold languages.
(b) The board department shall
ensure that telephone services provided to program subscribers and
applicants by the Basic Health Program are available in all of the
languages identified as Medi-Cal threshold languages.
(c) The board department shall
ensure that interpreter services are available between eligible
individuals and participating health plans in the Medi-Cal threshold
languages. The board department shall
ensure that subscribers are provided information within provider
network directories of available linguistically diverse providers.
(d) The board department shall
ensure that participating health plans, specialized health care
service plans, and specialized health insurance policies provide
documentation on how they provide linguistically and culturally
appropriate services, including marketing materials, to subscribers.
12694.55. 100710. No participating
health plan, specialized health care service plan, or specialized
health insurance policy shall, in an area served by the Basic Health
Program, directly, or through an employee, agent, or contractor,
provide an applicant with any marketing material relating to benefits
or rates provided under the Basic Health Program, unless the
material has been reviewed and approved by the board
department .
12694.57. 100711. The
board department may do the following:
(a) Amend Request that the Managed Risk
Medical Insurance Board amend existing Healthy Families Program
contracts to allow the parents of children enrolled in the Healthy
Families Program to enroll in the same plan as their child or
children through the Basic Health Program , subject to approval
and amendment by the board .
(b) Require, as a condition of participation in the Basic Health
Program, health plans to participate in the Healthy Families Program.
12694.6. 100712. (a) The
board department may establish geographic areas,
consistent with the geographic areas of the Healthy Families
Program, within which participating health plans may offer coverage
to subscribers.
(b) Nothing in this section shall restrict a county
organized county-organized health system, a
health plan, or a local initiative from providing services to Basic
Health Program subscribers in their licensed geographic service area.
12694.65. 100713. (a)
Notwithstanding any other provision of law, the board
department shall not be subject to licensure or
regulation by the Department of Insurance or the Department of
Managed Health Care.
(b) A participating health plan, specialized health care service
plan, or specialized health insurance policy that contracts with the
Basic Health Program and is regulated by the Insurance Commissioner
or the Department of Managed Health Care shall be licensed and in
good standing with its respective licensing agency. In its
application to the Basic Health Program, an applicant shall provide
assurance of its standing with the appropriate licensing agency.
12694.7. 100714. (a) The
board department shall contract with a broad
range of health plans in an area, if available, to ensure that
subscribers have a choice of health plans from among a reasonable
number and different types of competing health plans. The
board department shall develop and make
available objective criteria for health plan selection and provide
adequate notice of the application process to permit all health plans
a reasonable and fair opportunity to participate. The criteria and
application process shall allow participating health plans to comply
with their state and federal licensing and regulatory obligations,
except as otherwise provided in this part
title . Health plan selection shall be based on the criteria
developed by the board department .
(b) (1) In its selection of participating health plans, the
board department shall take all
reasonable steps to ensure that the range of choices of health plans
available to each applicant shall include health plans that include
in their provider networks, and have signed contracts with,
traditional and public and private safety net providers.
(2) A participating health plan shall annually submit to the
board department a report summarizing
its provider network. The report shall provide, as available,
information on the provider network as it relates to all of the
following:
(A) Geographic access for the subscribers.
(B) Linguistic services.
(C) The ethnic composition of providers.
(D) The number of subscribers who selected traditional and public
and private safety net providers.
(c) (1) The board department shall
not rely solely on a determination by the Department of Managed
Health Care or the Insurance Commissioner of a health plan network's
adequacy or geographic access to providers in the awarding of
contracts under this part title . The
board department shall collect and
review demographic, census, and other data to provide to prospective
local initiatives, health plans, or specialized health plans, and
identify specific provider contracting target areas with significant
numbers of uninsured individuals with incomes that would make them
eligible for the Basic Health Program. The board
department shall give priority to those health plans, on a
county-by-county basis, that demonstrate that they have included in
their prospective plan networks significant numbers of providers in
these geographic areas.
(2) Targeted contracting areas are those ZIP Codes or groups of
ZIP Codes or census tracts or groups of census tracts that have a
percentage of eligible individuals that is greater than the overall
percentage of eligible individuals in that county.
(d) In each geographic area, the board
department shall designate a community provider plan that is
the participating health plan that has the highest percentage of
traditional and public and private safety net providers in its
network. Subscribers selecting such a health plan shall be given a
premium discount in an amount determined by the board
department .
(e) This section shall also apply to a specialized health care
service plan, as defined in subdivision (o) of Section 1345 of the
Health and Safety Code, and a specialized health insurance policy, as
defined in Section 106 of the Insurance Code , to the
extent that the inclusion of that plan or policy in the Basic Health
Program is authorized by PPACA.
12694.75. 100715. (a) After two
consecutive months of nonpayment of premiums by an eligible
individual enrolled in the Basic Health Program, and a reasonable
written notice period of not less than 30 days is provided to the
eligible individual, the eligible individual may be disenrolled from
the Basic Health Program for the failure to pay premiums. The
board department may conduct or
contract for collection actions to collect unpaid family
contributions.
(b) Subject to any additional requirements of federal law,
disenrollments shall be effective at the end of the second
consecutive month of nonpayment.
12694.8. 100716. The Basic Health
Program may place a lien on any compensation or benefits
, that are recovered or recoverable by
a subscriber or applicant, or from any party or parties responsible
for the compensation or benefits for which benefits have been
provided under a plan contract or policy issued under this
part title .
12694.85. 100717. The
board department shall establish and use a
competitive process to select participating health plans and any
other contractors under this part title
. Any contract entered into pursuant to this part
title shall be exempt from Chapter 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code, and shall
be exempt from the review or approval of any division of the
Department of General Services.
12694.855. 100718. (a) A health
care provider that is provided documentation of an individual's
enrollment in the Basic Health Program shall not seek reimbursement
or attempt to obtain payment for any covered services provided to
that individual other than from the participating health plan
covering that individual.
(b) Subdivision (a) shall not apply to any cost sharing required
for covered services provided to the individual under his or her
participating health plan.
(c) For purposes of this section, "health care provider" means any
professional person, organization, health facility, or any other
person or institution licensed by the state to deliver or furnish
health care services.
12694.9. 100719. To the extent
permitted by federal law, an eligible individual enrolled in the
Basic Health Program shall continue to be eligible for the program
for a period of 12 months from the month eligibility is established.
12694.95. 100720. The
board department shall do all of the following:
(a) Make use of a simple and easy to understand mail-in and
Internet application process.
(b) Permit individuals to learn, in a timely manner upon the
request of the individual, the amount of cost sharing, including, but
not limited to, deductibles, cost sharing, and coinsurance, under
the individual's health plan or coverage that the individual would be
responsible for paying with respect to the furnishing of a specific
product or service by a participating provider. At a minimum, this
information shall be made available to the individual through an
Internet Web site and through other means for individuals without
access to the Internet.
(c) Provide for the operation of a toll-free telephone hotline to
respond to requests for assistance.
(d) Maintain an Internet Web site through which eligible
individuals may obtain standardized comparative information on those
health plans.
(e) Utilize a standardized format for presenting health benefits
plan options offered through the Basic Health Program, including the
use of the uniform outline of coverage established under Section 2715
of the federal Public Health Service Act.
(f) Establish a process to inform individuals who lose eligibility
under the Basic Health Program of the availability of coverage
through Medi-Cal and the California Health Benefit Exchange, and to
transmit their eligibility-related information to those programs
electronically to facilitate enrollment.
12694.955. 100721. (a) The Basic
Health Program Trust Fund is hereby created in the State Treasury for
the purpose of this part title . All
federal funds received pursuant to Section 1331 of PPACA shall be
placed in the Basic Health Program Trust Fund. Moneys in the fund
shall be used for the purposes of this part
title , upon appropriation by the Legislature, except that if
the annual Budget Act is not enacted by June 30 of any fiscal year
preceding the fiscal year to which the budget would apply, the
board department may transfer federal
funds and premium payments from the Basic Health Program Trust Fund
to health plans contracting with the board
department to ensure that individuals receiving coverage
through the Basic Health Program are able to comply with the
requirement to maintain minimum essential coverage as described in
Section 1501 of PPACA. Any moneys in the fund that are unexpended or
unencumbered at the end of a fiscal year may be carried forward to
the next succeeding fiscal year.
(b) Notwithstanding any other provision of law, moneys deposited
in the fund shall not be loaned to, or borrowed by, any other special
fund or the General Fund, a county general fund, or any other county
fund.
(c) The board department shall
establish and maintain a prudent reserve in the fund.
(d) Notwithstanding Section 16305.7 of the Government
Code , all interest earned on the moneys that have been
deposited into the fund shall be retained in the fund and used for
purposes consistent with the fund.
(e) Subject to approval by the Department of Finance, and upon
notification to the committees of each house of the Legislature that
consider the budget and the committees of each house that consider
appropriations, the board department
may obtain loans from the General Fund for all necessary and
reasonable start-up startup and initial
expenses related to the administration of the fund and the Basic
Health Program. The board department
shall repay principal and interest, using the pooled money investment
account rate of interest, to the General Fund no later than July 1,
2016.
12694.957. 100722. (a) The
board department shall ensure that the
establishment, operation, and administrative functions of the Basic
Health Program do not exceed the combination of federal funds,
private donations, premiums paid by eligible individuals, and other
non-General Fund moneys available for this purpose. Except for loans
authorized pursuant to subdivision (e) of Section 12694.955
100721 , no state General Fund money shall be
used for any purpose under this part title
.
(b) The board department shall
negotiate contracts with health plans to provide or pay for benefits
to enrollees under this part title .
Each contract entered into pursuant to this part
title shall require the participating health plan to
assume full risk for the cost of care for the contract period. The
board department shall not contract
with any participating health plan if such a contract would result in
costs exceeding the funds available for purposes of this
part title , as described in subdivision (a).
The requirements of this subdivision shall also apply to contracts
with specialized health care service plans, as defined in subdivision
(o) of Section 1345 of the Health and Safety Code, and specialized
health insurance policies, as defined in Section 106 of the
Insurance Code , to the extent that the inclusion of such plans
or policies in the Basic Health Program is authorized by PPACA.
(c) In the event that the board department
reasonably expects that the cost of the Basic Health Program
will exceed the available funds specified in subdivision (a),
coverage for eligible individuals shall continue until the annual
redetermination of each eligible individual, after which time the
board department shall immediately
transfer the eligible individual to coverage in the California Health
Benefit Exchange. To the extent permitted by federal law, the
board department shall contract with
the federal government to allow federal funds made available under
paragraph (3) of subdivision subsection
(d) of Section 1331 of PPACA, relating to 95 percent of the premium
tax credits under Section 36B of the Internal Revenue Code of 1986,
and the cost-sharing reduction under Section 1402 of PPACA
, to be used for the costs of the board
department in implementing and administering this part
title .
12694.959. 100723. (a) The
board department shall request an evaluation of
the Basic Health Program. The board
department shall seek funding for the evaluation from an
independent nonprofit private foundation.
(b) The purpose of the evaluation is to determine the extent to
which the Basic Health Program has achieved objectives to provide
low-income Californians with equal or better benefit levels, and less
expensive premiums and lower cost sharing than would be available in
the California Health Benefit Exchange. In addition, the evaluation
is intended to assess the impact of the Basic Health Program on all
of the following:
(1) The viability of the California Health Benefit Exchange
(Exchange).
(2) Providers, health plans, and insurers that serve the Medi-Cal
program and the Healthy Families Program.
(3) Continuity of care and coverage for individuals moving from
the Medi-Cal program to the Basic Health Program and from the Basic
Health Program to the Exchange.
(c) Components of the evaluation may include, but are not limited
to, the following:
(1) A determination of the extent to which individuals served
through the Basic Health Program have lower premiums, additional
benefits, or lower cost sharing than they would otherwise have
received in the Exchange.
(2) A determination of the extent to which individuals served
through the Basic Health Program have a choice of quality health
coverage options and adequate provider access and networks.
(3) A determination of the extent to which Basic Health Program
administrators have been able to coordinate the contracting of health
plans and health insurance or the purchasing of other services with
the Medi-Cal program, Healthy Families Program, and the Exchange.
(4) A determination of the extent to which the Exchange is
attracting competitive health plan participation and offers premium
rate structures, and a determination as to the impact the inclusion
of the Basic Health Program population would have on the Exchange.
(d) The evaluation shall include, but is not limited to, all of
the following:
(1) Enrollment in the Exchange and enrollment in the Basic Health
Program, including actual enrollment as compared to the estimated
number of individuals eligible for the Exchange and the Basic Health
Program, the number of individuals enrolled in the Exchange with
family incomes between 300 percent and 400 percent of the federal
poverty level, and the number of individuals enrolled in the Exchange
with family incomes above 400 percent of the federal poverty level.
(2) The average cost per person of the individuals enrolled in the
Exchange as compared to the average cost per person of individuals
enrolled in the Basic Health Program.
(3) The impact of the Basic Health Program on the funding
available for Exchange administrative costs.
(4) The impact of the Basic Health Program on premiums in the
Exchange and the impact of the Exchange on premiums in the Basic
Health Program.
(5) The impact of the Basic Health Program on the Exchange's
ability to selectively contract with health plans.
(6) The average premium and average cost sharing per person
enrolled in the Basic Health Program and the Exchange.
(7) The number of plans participating in the Basic Health Program
and the Exchange, including whether and to what extent health plans
in the Medi-Cal program participate in the Basic Health Program in
counties with Medi-Cal managed care.
(8) The number of individuals enrolling in the Basic Health
Program who, in the month immediately preceding Basic Health Program
enrollment, were enrolled in the Medi-Cal program.
(9) The number of individuals enrolled in the Medi-Cal program
who, in the month immediately preceding Medi-Cal enrollment, were
enrolled in the Basic Health Program.
(10) The number of individuals enrolled in the Exchange who, in
the month immediately preceding Exchange enrollment, were enrolled in
the Basic Health Program.
(11) The number of individuals enrolled in the Basic Health
Program who, in the month immediately preceding enrollment in the
Basic Health Program, were enrolled in the Exchange.
(12) The average amount of federal funding received by the state
per person by year, broken down by federal funding for premiums and
federal funds for cost-sharing subsidies, for individuals enrolled in
the Basic Health Program.
(13) Whether implementation of the Basic Health Program has
resulted in diminished access to health care providers for Medi-Cal
beneficiaries or diminished provider participation in the Medi-Cal
program.
(e) The Legislature hereby requests the results of the evaluation
to be furnished to the appropriate policy and fiscal committees of
the Legislature by July 1, 2017.
(f) The California Health Benefit Exchange, the Basic Health
Program, the Medi-Cal program, and the Health
Healthy Families Program shall provide, in a timely manner,
the data necessary for the evaluation requested by this section.
