Bill Text: CA AB1208 | 2023-2024 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: California Health Benefit Exchange: Health Care Affordability Reserve Fund.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2024-02-01 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB1208 Detail]
Download: California-2023-AB1208-Introduced.html
access obtain affordable health care coverage through the Exchange.
Bill Title: California Health Benefit Exchange: Health Care Affordability Reserve Fund.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2024-02-01 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB1208 Detail]
Download: California-2023-AB1208-Introduced.html
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 1208
| Introduced by Assembly Member Schiavo |
February 16, 2023 |
An act to amend Sections 100520.5, 100800 and 100805 of the Government Code, relating to health insurance.
LEGISLATIVE COUNSEL'S DIGEST
AB 1208, as introduced, Schiavo.
California Health Benefit Exchange: Health Care Affordabiity Reserve Fund.
Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Existing law requires the Exchange to administer a program of financial assistance to help low- and middle-income Californians, by providing financial assistance to residents with household incomes at or below 600% of the federal poverty level, including appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households. Existing law requires a
premium assistance subsidy provided by the program to be able to be advanced to a program participant and remitted by the Exchange to a qualified health plan issuer, based on specified factors.
Existing law establishes the Health Care Affordability Reserve Fund, and authorizes the Controller to use funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund. Existing law requires the fund to be used, upon appropriation by the Legislature, for the purpose of health care affordability programs operated by the Exchange. Existing law requires the Exchange to consult with the Legislature and stakeholders to develop options to reduce cost sharing for low- and middle-income Californians, as specified.
This bill would delete the qualification making assistance under the program available to residents with household incomes at or below 600% of the federal poverty level. The bill would require the
Exchange to annually update the proposed program design for cost-sharing reduction, as specified, and would require the Exchange, in developing benefit designs, to maximize the number of low- and middle-income Californians with zero deductibles. The bill would provide that the premium assistance subsidy program would not be operative in any year in which federal premium subsidies are equal to or greater than those provided for the 2023 program year. The bill would make related conforming changes and delete obsolete provisions.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 100520.5 of the Government Code is amended to read:100520.5.
(a) The Health Care Affordability Reserve Fund is hereby created in the State Treasury.(b) Notwithstanding any other law, the Controller may use the funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund as provided in Sections 16310 and 16381.
(c)Upon the enactment of the Budget Act of 2021, and upon order of the Director of Finance, the Controller shall transfer three hundred thirty-three million four hundred thirty-nine thousand dollars ($333,439,000) from the General Fund to the Health Care Affordability Reserve Fund.
(d)
(c) Upon appropriation by the Legislature, the Health Care Affordability Reserve Fund shall be utilized, in addition to any other appropriations made by the Legislature for the same purpose, for the purpose of health care affordability programs operated by the California Health Benefit Exchange.
(e)
(d) (1) The California Health Benefit Exchange shall, in consultation with stakeholders and the Legislature, develop options for providing cost sharing reduction subsidies to reduce cost
sharing for low- and middle-income Californians. On or before January 1, 2022, the Exchange shall report those developed options to the Legislature, Governor, and the Healthy California for All Commission, established pursuant to Section 1001 of the Health and Safety Code, for consideration in the 2022–23 budget process.
Californians, and shall annually update the proposed program design. Cost sharing shall include copays and maximum out of pocket as well as coinsurance, if any, and deductibles, if any. In developing the benefit designs under this section, the Exchange shall maximize the number of low- and middle-income Californians with zero deductibles.
(2)In developing the options, the Exchange shall do all of the following:
(A)Include options for all Covered California enrollees with income up to 400 percent of the federal poverty level to reduce cost sharing, including copays, deductibles, coinsurance, and maximum out-of-pocket costs.
(B)Include options to provide zero deductibles for all Covered California enrollees with income under 400 percent of the federal poverty level and upgrading those with income between 200 percent and 400 percent, inclusive, of the federal poverty level to gold-tier cost sharing.
(C)Address any operational issues that might impede implementation of enhanced cost-sharing reductions for the 2023 calendar year.
(D)Maximize federal funding and address interactions with federal law regarding federal cost-sharing reduction subsidies.
(3)The Exchange shall make the report publicly available on its internet website.
(4)The Exchange shall submit the report in compliance with Section 9795 of the Government Code.
SEC. 2.
Section 100800 of the Government Code is amended to read:100800.
(a) The Exchange shall administer a program of financial assistance to help low-income and middle-income Californians(b) The program may provide financial assistance to California residents with household incomes at or below 600 percent of the federal poverty level, and may provide other assistance, including appropriate
subsidies designed to make health care coverage more accessible and affordable for individuals and households. These shall include subsidies for cost sharing, including copayments, deductibles, and maximum out-of-pocket limits if federal premium subsidies continue at the level for the 2023 coverage year.
(c) The Exchange shall adopt, and may amend, an annual program design for each coverage year to implement this section by resolution of the board of the Exchange. The resolution shall be adopted at a duly noticed meeting.
(1) A resolution adopted pursuant to this section shall not take effect until approved by
notice is provided to the Director of Finance by the Exchange, following 10 days notification in writing to the Joint Legislative Budget Committee.
(2) The requirements of paragraph (1) may be waived by the joint written consent of the Director of Finance and the Chair of the Joint Legislative Budget Committee to adopt a resolution that is deemed urgent. A resolution adopted pursuant to this paragraph shall take immediate effect.
(3) The Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) shall not apply to the program design or a resolution adopted pursuant to this section.
(d) The program
design adopted for a coverage year shall be based on funds appropriated to the program for that coverage year. An appropriation made for the program shall contain provisional language directing the Exchange to provide a certain proportion of the funds to specified income ranges as determined by the Legislature and
made available in the Health Care Affordability Reserve Fund established pursuant to Section 100520.5, and may also include other funds, as appropriated for the program for that coverage year. The Legislature may provide other parameters guiding the design of the program.
(e) The Exchange shall provide appropriate opportunities for stakeholders and the public to consult in the design of the program.
SEC. 3.
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) This section shall not be operative in any year in which federal premium subsidies are equal to or greater than those provided for the 2023 program year.
