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Bridge Plan Legislation – Summary of SB X1 3 (Hernandez)

Download the PDF here: Summary of SB X1 3 Summary of SB X1 3.pdf

 

SB X1 3 (Hernandez) sets the rules for Bridge Plans (Medi-Cal managed care plans) that can offer low cost continuation coverage in the Exchange for individuals losing Medi-Cal eligibility, and whole family coverage for families where the children are on Medi-Cal and the parents eligible for the Exchange. In essence, this is the narrow Bridge, which would offer coverage for between 700,000 and 800,000 individuals.

Section 1:  The legislature’s intent is to offer a lower cost plan for lower income individuals and families who are Exchange eligible.

Section 2: Government Code § 100501
Defines a bridge plan as a Knox Keene or Department of Insurance licensed individual produce offered through the Exchange. Defines members of a MAGI (modified adjusted gross income) household as those members whose incomes would be included in the calculation of MAGI eligibility. This section sunsets after 5 years from federal approval of the Bridge Plan option.

Section 3: Government Code § 100501
Same definitions but without the Bridge Plan and MAGI household definitions after the authority for the Bridge plans expires.

Section 4: Government Code § 100503
Exempts Bridge Plans from the requirements to sell all four levels of coverage plus catastrophic and from the duty to fairly and affirmatively market to all eligible for the Exchange. Requires the annual report to the Legislature to describe the overlap between the networks of the Bridge Plans and the Medi-Cal managed care plans. Evaluate the performance of the Bridge plans after 3 years of experience to assess price savings to customers, continuity of care, customer satisfaction and degree of participation. Sunsets after 5 years.

Section 5: Government Code § 100503
Same requirements but without the Bridge Plan after the authority for the Bridge plans expires.

Section 6: Government Code § 100504.5
Requires the Exchange to contract with Bridge Plans if they meet the following requirements:

  • Medi-Cal managed care plan
  • Meet QHP (qualified health plan) requirements
  • Enroll only the target populations under W&I §14005.70
  • 85% medical loss ratio
  • Similar provider network to Medi-Cal managed care

Sunsets after 5 years

Section 7: Government Code § 100504.6
Authority to adopt regulations to implement §100504.5
Sunsets after 5 years

Section 8: Health and Safety Code § 1366.6
Definitions section includes Bridge Plans. Bridge plans exempt from requirements to sell all levels of benefits.
Sunsets after 5 years

Section 9: Health and Safety Code § 1366.6
Same definitions but without the Bridge Plan definitions after the authority for the Bridge plans expires.

Section 10: Health and Safety Code § 1399.864
Bridge plans must file for a material modification under Knox Keene or a license expansion under DOI (Department of Insurance). Deemed to comply in the interim after filing until the regulator makes its decision.
Medical loss ratio of 85%
No duty to fairly and affirmatively market except to the target markets.
Must offer initial annual open enrollment of 6 months, annual open enrollment and special enrollment — same requirements as all other plans.
Sunsets after 5 years

Section 11: Insurance Code §10112.3
Same as Section 8: Health and Safety Code § 1366.6
Sunsets after 5 years

Section 12 Insurance Code §10112.3
Same as Section 9: Health and Safety Code § 1366.6

Section 13: Insurance Code §10961
Same as Section 10: Health and Safety Code § 1399.864
Sunsets after 5 years

Section 14: Welfare and Institutions Code §14005.70
Only the following groups can be eligible for Bridge Plans:

  • An individual or family who loses Medi-cal coverage, but has income less than 250% of FPL
  • A parent or caretaker relative of a Medi-Cal child
  • Other members of a MAGI household in which there are Medi-cal or Healthy Family enrollees

Individuals or families may only enroll in Bridge Plans to maintain continuity of the plan in which they or their family members are already enrolled
Bridge plans must lower than or equal in price to the lowest cost silver plan.
Bridge plans can only limit enrollment of persons in their target populations if they have insufficient provider capacity

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