Health care coverage: California Health Benefit Exchange.

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 employers. Existing state law establishes the California Health Benefit Exchange within state government, specifies the powers and duties of the board governing the Exchange relative to determining eligibility for enrollment in the Exchange and arranging for coverage under qualified health plans, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014. Existing law establishes a program for the treatment of breast and cervical cancer, administered by the State Department of Health Care Services, and a program for cancer screening administered by the State Department of Public Health. Existing law provides specified health care coverage to eligible individuals under the Healthy Families Program, the Access for Infants and Mothers Program, the California Major Risk Medical Insurance Program, and the Federal Temporary High Risk Pool, which are administered by the Managed Risk Medical Insurance Board. Existing law provides specified health care coverage to eligible individuals under the Medi-Cal program and the Family PACT program, which are administered by the State Department of Health Care Services. Existing law provides specified health care coverage to individuals under the AIDS Drug Assistance Program (ADAP) and the federal Ryan White HIV/AIDS Treatment Extension Act of 2009, which are administered by the State Department of Public Health. Existing law provides for the regulation and licensure of hospital facilities by the State Department of Public Health. This bill would, until June 30, 2013, require the State Department of Health Care Services, the State Department of Public Health, and the Managed Risk Medical Insurance Board, respectively, to disclose information on health care coverage through the California Health Benefit Exchange to every individual who has ceased to be enrolled under the programs described above, except that, with respect to the cancer treatment and screening programs, the Family PACT program, and the programs for treatment of HIV/AIDS, the disclosure would be made to each enrollee, and for the Family PACT Program, the disclosure would be made by Family PACT providers and on and after July 1, 2013, as specified. The bill would require certain hospitals, when billing, to include additional disclosures regarding health care coverage through the Exchange. On and after January 1, 2013, this bill would require the State Department of Health Care Services and the Managed Risk Medical Insurance Board to provide to the California Health Benefit Exchange specified information for each individual who has ceased to be enrolled under those programs, except the cancer treatment and screening programs, the Family PACT program, and the programs for treatment of HIV/AIDS, in a manner to be prescribed by the Exchange, for purposes of determining eligibility and completing enrollment in the Exchange, and to disclose that enrollment to those individuals. On and after January 1, 2013, with respect to the cancer treatment and screening programs, the programs for the treatment of HIV/AIDS, and the Family PACT program, this bill would require the State Department of Health Care Services or the State Department of Public Health to provide to the Exchange specified information for each enrollee in a manner to be prescribed by the Exchange for purposes of determining eligibility and completing enrollment in the Exchange. The bill would make the automatic enrollment of those individuals in the Exchange subject to the State Department of Health Care Services, the State Department of Public Health, and the Managed Risk Medical Insurance Board receiving approval from the United States Department of Health and Human Services to transfer the minimum information necessary to initiate an application for enrollment, as specified. The bill would require each affected individual to be given the opportunity to provide informed consent to commence eligibility determination and complete enrollment, but would provide that failure to consent or to respond would be construed to mean the individual is declining coverage.