The California Assembly passed legislation on June 1 to establish a California Health Benefits Exchange, to be fully operational by January 1, 2014. The California Exchange is to be managed by the state under an executive board to be appointed by the Governor and the Legislature. The legislation, which passed the Assembly by a 2-1 margin with the Governor’s support, also includes insurance reforms, to be effective September 23, 2010: it prohibits lifetime caps on health insurance benefits and allows annual caps only under limited circumstances; it prohibits pre-existing condition exclusions for children up to age 19; and it allows dependent children up to age 26 to remain on their parents’ health plans. The provisions and implementation schedules in the California Assembly legislation follow federal Patient Protection and Affordable Care Act (PPACA) requirements. Comparable legislation has been introduced in the California Senate. The California Assembly and the Senate are also considering several other bills delineating a wider range of state actions, based on and in some respects exceeding the requirements of the PPACA. These include expansion of Medi-Cal eligibility for all legal residents with incomes up to 133 percent of the federal poverty level, which would be required no later than January 1, 2014 but would be allowed to be phased-in at any time after state enactment; establishment upon state enactment of a temporary high-risk pool under PPACA requirements, alongside an existing high-risk pool that the California Managed Risk Medical Insurance Board already operates; a defined mental health benefit and a defined maternal health benefit under the California health insurance code, as of January 1, 2011; standardization of California health insurance enrollment applications and a state review of insurance policy rescissions/cancellations by January 1, 2012; and requirements that increases in private insurance premiums and cost-sharing be reviewed and approved by the California Department of Insurance or, for HMOs, the California Department of Managed Health Care, as of January 1, 2012.