State Implementation Timeline

California

Reform Effective Date Description State Action

Medicare is a government administered health
coverage program provided to Americans over
the age of 65. While it is a national program,
there is wide variation among the states in terms
Medicare Ongoing
of health needs and Medicare spending. One of
the main changes through the implementation
effort is to close the “doughnut hole” – a current
gap in drug coverage.
June 1, 2010 – AB 2477 Would eliminate Mid-Year
Status Reporting (MSR), which requires re-
Medi-Cal is the name given to California’s
enrollment of children under 19 years old into
Medicaid program. Efforts through
Medi-Cal Ongoing Medi-Cal every 6 months. Instead, re-enrollment
implementation will extend coverage to many
will be required either after a 12-month period of
individuals and families.
the date of last enrollment or when the child
exceeds 19 years old. In Senate. Read first time.
SCHIP (State Children’s Health Insurance Plan)
refers to a program administered by the
Department of Health and Human Services to
help states provide quality health coverage to
SCHIP Ongoing
children. Children receiving CHIP can continue to
receive this service (or Medicaid, as applicable)
until 2019, at which point they may be able to
join the Exchange market.

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 State Implementation Timeline
California

Reform Effective Date Description State Action

“Preventive Care” refers to services and
programs designed to prevent the onset of
diseases. The PPACA contains a wealth of
funding for new preventive programs, both at
the Federal and state levels. All new group May 26, 2010 – SB 220 Referred to Commissioner
health plans and plans in the individual market on Health. Read second time.
must provide first dollar coverage for preventive March 11, 2010 – SB 220 Would require certain
Preventive Care Ongoing services (Effective September 2010). Provides a health insurers who provide outpatient
free, annual wellness visit and personalized prescription drug benefits to also provide
prevention plan services for Medicare coverage for tobacco cessation services and
beneficiaries and eliminates cost-sharing for would impose limits on copayments.
preventive services (Effective January 1, 2011).
State Medicaid programs to cover tobacco
cessation services for pregnant women.
(Effective Fiscal Year 2011).
“Mental Health” refers to a state of well-being in
which the individual realizes his or her own
abilities, can cope with the normal stresses of
life, can work productively and fruitfully, and is June 1, 2010 – AB 1600 Would require most
Mental Health Care Ongoing able to make a contribution to his or her health plans to provide coverage for diagnosis and
community. The PPACA has provisions for mental treatment of mental illness. In Senate.
health, including coverage of mental health
services under the essential health benefits plan
(Section 1302, Effective January 1, 2014)
June 2, 2010 – AB 2578 Read third time, passed,
HHS is developing standards for reviewing and to Senate
“unreasonable” premium increases and February 19, 2010 – AB 2578 Would require the
requirements for carriers to submit justification approval by the Department of Managed Health
Rate Review March 23, 2010 information to the Secretary and post on their Care or the Department of Insurance of an
website. States that meet the minimum increase in the amount of the premium,
standards for rate review may apply for grants - copayment, coinsurance, or deductible during
$250 million over 5 years is available. specified time periods that would be effective
starting in 2012. .

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 State Implementation Timeline
California

Reform Effective Date Description State Action

HHS shall request that NAIC develop the
Standardized standardized definitions and uniform
Definitions and Uniform March 23, 2010 explanations of coverage in conjunction with a
Explanation of Coverage working group that includes consumer and
industry groups.
ACA makes available $30 million in the first fiscal
year for states to establish and operate
State Ombudsman March 23, 2010
independent offices of consumer assistance and
health insurance ombudsman programs.
To alleviate state administrative burdens, HHS
Fraud Reporting Form March 23, 2010 will work with states and stakeholders to
develop a standardized fraud reporting form.
Creates temporary reinsurance for employers
Temporary Reinsurance
providing reimbursement to businesses who
Program for Early June 1, 2010
provide coverage to retirees aged 55 and older
Retirees
who are not yet eligible for Medicare.
High Risk Pool Contract Deadline for State HHS to submit contracts to
June 1, 2010
Submission Federal HHS for evaluation for contract awards.
Seniors at the “doughnut hole” will receive a
$250 dollars rebate for medication coverage. As
Medicare Rebate June 15, 2010 seniors start hitting this gap they will receive
automatically this check from the Health &
Human Services (HSS) department.

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 State Implementation Timeline
California

Reform Effective Date Description State Action

June 1, 2010 – AB 1887 Read second time. To
third reading.
April 28, 2010 – AB 1887 Would require Managed
Risk Medical Insurance Board to establish a
PPACA calls for the development of Temporary
temporary high risk pool to provide health care
High Risk Pools which would provide insurance
coverage to specified individuals with pre-existing
to those individuals with a pre-existing condition
conditions and have not been covered under
High Risk Pools June 21, 2010 who have gone uninsured for six (6) months or
creditable coverage, as defined, for six months
more. States were given the option to operate
prior to applying for coverage in the pool to meet
the pools themselves or allow HHS to run the
specified requirements and would require
state pool.
premiums to be established at a standard rate for
a standard population. The Board would also be
required to apply for Federal funding to operate
the pool. Referred to Appropriations Committee.
Federal HHS awards contracts to State offices
High Risk Pool Contract
July 1, 2010 that have acceptable contract proposals to
Awards
operate high risk pools programs.
HHS shall develop a website through which
individuals and small businesses may receive
Web portal July 1, 2010 information about their coverage choices –
including public programs. Secretary must
develop in consultation with states.
All plans (including third party administrators
(TPAs)) must submit claims, financial,
Submission of enrollment, ratings, cost-sharing and other
September 23, 2010
Information information to the Secretary and the state
insurance department. There’s no timeline from
HHS on this project

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 State Implementation Timeline
California

Reform Effective Date Description State Action

June 1, 2010 – AB 2244 Prohibits, effective
January 1, 2011 for children, a health care service
plan or health insurer (collectively carriers)
notwithstanding any other provision of state law
or regulation, carriers from excluding or limiting
coverage due to any pre-existing conditions. In
Senate. Read first time.
Prohibits insurers denying coverage to children
Children Coverage with
September 23, 2010 under the age of 19 because of pre-existing June 1, 2010 – AB 1602 Read third time, passed,
Pre-Existing Conditions
conditions. and to Senate

May 12, 2010 – AB 1602, among other things,

Prohibits carriers from imposing pre-existing
condition exclusions for enrollees or insured
under 19 years of age. In committee: first hearing.
Referred to appropriations Committee,
suspended file.

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 State Implementation Timeline
California
Reform Effective Date Description
Limits on rescissions
No cost-sharing for preventive services
Restrictions on annual limits
No pre-existing conditions exclusions for
minors
Immediate Market Plan years begin on or Coverage for dependents under 26 year old
Reforms after September 23, 2010 Non-discrimination provisions – regulations
to be developed by HHS during April
Grandfathering details may also be
forthcoming
Appeals rights and patient protections may
come out by summer 2010
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State Action
June 2, 2010 – AB2470 Establishes standard
information and health history questions used by
health insurers on application forms, and required
insurers to complete medical underwriting and
review for accuracy before issuing a health plan
contract or policy. Read third time, passed, and to
Senate.
May 12, 2010 – AB1602 is in committee: first
hearing. Referred to appropriations Committee,
suspended file.
April 20, 2010 – AB 1602 Enacts the California
Patient Protection and Affordable Care Act to
implement reforms under the federal Patient
Protection and Affordable Care Act (Affordable
Care Act) in California. As such, prohibits group or
individual health care service plans or health
insurers (collectively carriers) from establishing
lifetime or unreasonable annual limits on the
dollar value of benefits. Requires carriers to
provide minimum coverage for specified
preventive services. Prohibits carriers from
imposing pre-existing condition exclusions for
enrollees or insured under 19 years of age.
Prohibits the limiting age for dependent health
care coverage to be less than 26 years of age.
Creates the California Health Benefit Exchange
(Exchange) for the purchase of health care
coverage.
April 21, 2010 – SB 1088 Would prohibit limiting
the age for dependent children covered by health
care service plan contracts and group health
insurance policies to less than 26 years of age to
conform to the federal law. Provides that no
employer is required to pay the cost of coverage
for dependents who are at least 23 years of age,
but less than 26. Authorizes subscribers and
insurers to elect to provide coverage to those
dependents by contributing the premium for that
coverage. From Senate Committee on Health.

Reform Effective Date
Rebates begin for plan
Medical Loss Ratio year on or after January
Consumer Operated
and Oriented Plan (CO-
OP)
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State Implementation Timeline
California
Description State Action
PPACA requires health insurers to report on the
percentage of premiums that go to coverage of
medical expenses. HHS shall request the National
February 25, 2010 – SB 316 Would require a
Association of Insurance Commissioners (NAIC)
written disclosure of the ratio of premium costs to
develop uniform definitions and standardized
health services paid when presenting a plan
methodologies for calculating the medical loss
contract or policy for examination or sale to an
1, 2011 ratio to be used to determine rebates. Letter
individual purchaser or representative of a group
from Secretary to NAIC sent on April 12. The
of 50 or fewer individuals.
report is due December 31, 2010, but should be
completed much sooner to ensure smooth
implementation.
Funding is available for the development of CO-
OP programs or non-profit member-run health
July 1, 2013
insurance companies, which will offer qualified
programs under the Exchange.
 State Implementation Timeline
California
Reform Effective Date Description
Health Insurance Exchanges are marketplaces for
individuals and some employers to shop for
insurance coverage in a transparent, well
regulated system.
HHS shall develop minimums standards for state-
based Exchanges in consultation with the NAIC.
Exchanges January 1, 2014
HHS shall develop a uniform enrollment form
that must be used by the state Exchange. The
NAIC is asked to provide criteria for the form.
Insurers are required to offer an “essential
benefit plan” , prohibits annual limits and
establishes specific rate restrictions standards.
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State Action
May 28, 2010 – AB 2042 Prohibits insurers and
HMO’s to increase or change premiums, cost
sharing, or benefits more often that once a year.
Referred to Commission on Health.
May 28, 2010 – SB 1163 Would require health
plans to provide, in writing, specific reasons for
denial of coverage or charging higher rates than
the standard. Read second time. To third reading.
April 21, 2010 – SB 900 Would establish the State
Health Benefits Exchange within the State Health
and Human Services Agency and would require
the Exchange to implement specified functions
imposed by the federal Patient Protection and
Affordable Care Act in a consumer-friendly
manner, enter into contracts with health care
service plans and health insurers seeking to offer
coverage in the Exchange; and provide a choice in
each region of the state between five levels of
coverage. Creates the State Health Benefits
Exchange Fund. Set for hearing May 17.
January 5, 2010 – AB 1602 Companion bill to SB
900. Exchange to be effective on or before
January 1, 2014.
 State Implementation Timeline
California

Reform Effective Date Description State Action

Market reforms refer to changes in the way
April 27, 2010 – SB 890 Would require health care
insurance is sold and priced. There are a number
service plans and health insurers issuing individual
of important areas of market reforms, such as
coverage to make certain standard benefit plan
limiting insurance price variations for different
designs available to individuals with coverage
characteristics, guaranteed issue of insurance,
choice categories. Allows a subscriber or
etc.
policyholder to transfer coverage on the annual
Market Reforms January 1, 2014
renewal date. Would create an insurance market
State individual and group market regulations
reform commission. Relates to the minimum
must meet or exceed minimum federal
amount of fees and premiums spent on benefits.
standards by January 1, 2014, or federal law will
Relates to disclosures. Requires coverage for basic
preempt them. State laws that “do not prevent
health care services. Prohibits lifetime benefit
the application” of the federal rules are
limits. Committee hearing postponed.
preserved.
June 1, 2010 – AB 2244 Prohibits, effective
January 1, 2014 for adults, a health care service
plan or health insurer (collectively carriers)
Adult coverage with Prohibits exclusions of health insurance for
January 1, 2014 notwithstanding any other provision of state law
pre-existing conditions adults with pre-existing conditions.
or regulation, carriers from excluding or limiting
coverage due to any pre-existing conditions. In
Senate. Read first time.
Medigap refers to private coverage which may
be purchased by Medicare beneficiaries to
supplement their Medicare coverage.
Medigap Reform January 1, 2015
NAIC requested to add cost-sharing
requirements to Medigap Plans C and F, in
consultation with consumer and industry groups.
States may enter into compacts which allow
carriers to sell their products across state lines.
Interstate Compact July 1, 2016 The guidelines for these “health care choice
compacts” are to be developed by the NIAC no
later than July 1, 2013.

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 State Implementation Timeline
California

Executive Branch Implementation

Governors have the ability to issue “executive orders” which do not require legislative action. These orders do not change the law, yet
help to initiate actions to help the implementation process.

Gov. Arnold Schwarzenegger formed a task force lead by Health and Human Services Secretary Kim Belshé, to implement key provisions
and long-term reform programs. (Effective since April 27, 2010)

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