Bill Text: CA AB115 | 2009-2010 | Regular Session | Enrolled
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-Enrolled.html
BILL NUMBER: AB 115 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 24, 2009
PASSED THE ASSEMBLY AUGUST 27, 2009
AMENDED IN SENATE JUNE 24, 2009
AMENDED IN SENATE JUNE 11, 2009
AMENDED IN ASSEMBLY APRIL 13, 2009
INTRODUCED BY Assembly Member Beall
(Principal coauthor: Senator Alquist)
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, 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 similar
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 an entity that employs
50 or fewer persons, with at least 25% of the 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.
Existing law requires that the cost of the program be paid through
a combination of small business contributions, employee premiums,
county, federal, state, and private funding made available for this
purpose.
The bill would, instead, require that the cost be paid through a
combination of small business contributions, employee premiums, and
any additional local funds available for the program. The bill would
require that employer complementary products be optional and would
provide that no state or federal funds be used to pay for
complementary products, and that no General Fund moneys shall be used
for purposes of the program or any related complementary products.
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.
(b) "Local initiative" has the same meaning as set forth in
Section 12693.08 of the Insurance Code.
(c) "Program" means the Adult Health Coverage Expansion Program.
(d) "Small business" means an entity located in Santa Clara County
that employs 50 or fewer persons, with at least 25 percent of the
employees earning less than 350 percent of the federal poverty level,
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 an 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 shall not limit or exclude coverage for an 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, 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 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 shall be similar to those in the employee product, however,
the discounted rate may be, but is not required to be, the same as
that 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 businesses, premiums
paid by participating employees, and any additional local funds
available for the program. Complementary products shall be paid for
by the individuals receiving benefits through the complementary
products. Employer contributions for the complementary products are
optional. No federal or state funds shall be used to contribute to
the payment for complementary products.
(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.
(4) For purposes of the program, the term "applicable rate charged
for a covered employee" in Section 1366.26 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 local funding,
which funding shall include the value of the 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
related complementary products.
