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.