Governor Schwarzenegger signed legislation on September 30 to establish the California Health Benefits Exchange (CHBE), which will become the centerpiece of California’s implementation of the federal health care reform law. Over 8 million California residents are expected to obtain health insurance coverage through the CHBE when it becomes fully operational in 2014. This California legislation (Assembly Bill 1602 and Senate Bill 900) creates an independent, five member board to oversee the operation of the exchange, which will offer standardized, detailed information on competing plans via a website and toll-free numbers to help consumers evaluate their options. Other bills signed by the Governor that help implement the federal law include S.B. 1088, which allows individuals to stay on their parents’ health insurance plans until age 26; A.B. 2244, which prohibits health plans from denying coverage to children with pre-existing health conditions; A.B. 2470, which prohibits health insurance rescissions due to consumers’ application errors, except in cases of application fraud or deliberate misrepresentation; S.B. 1163, which requires actuarial review and certification of health insurance rate increases; and A.B. 2345, which requires health insurance plans to cover specified preventive services without cost-sharing. Following those accomplishments, the California Assembly and Senate also passed legislation (A.B. 342 and S.B. 208) that would authorize the Department of Health Care Services to obtain final approval of waivers from the Centers for Medicare and Medicaid Services (CMS) for Medicare/Medicaid integration pilot projects in up to four counties in order to improve coordination between Medicare and Medi-Cal for dually entitled persons, to improve continuity of care, to increase the availability of home and community-based services, and to help the elderly and the disabled to remain in their own homes. The pilot projects could represent an extraordinary step forward in Medicare/Medicaid integration for dually entitled persons, and up to $10 billion in federal funding for California over a five year period.
About Tom Entrikin
A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.
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