By Mary Nguyen, Olivia Bundschuh, and Shirley Lam
2022 Introduced Legislation
Overview: The deadline for introducing legislation for the first year of the 2022-2023 legislative session was February 18, 2022. Similar to Governor Newsom’s Fiscal Year (FY) 2022-23 Budget Proposal, legislation introduced this year focuses on transforming and increasing health coverage with an emphasis on behavioral health, harnessing key ideas from lessons learned during the pandemic to improve the health of Californians and promote an equitable health care system.
Summary and Policy Areas: This blog summarizes introduced legislation that proposes solutions relating to ITUP’s three priority policy issues: health care coverage and access, delivery system transformation, and the future of health.
Additionally, we noted which bills address:
Legislative Bill Process Guide: At the end of this blog, we also include important technical information, helpful links, and dates that can be used to follow these bills throughout the legislative process.
Note: this is not a comprehensive list of all the health and health care-related bills that were introduced. If you have questions about a bill not listed here, please feel free to contact us at [email protected]
Health Care Coverage and Access
Elimination of Medi-Cal Premiums and Contributions: AB 1995 (Arambula) removes requirements that impose premiums and subscriber contributions for certain Medi-Cal members, including pregnant and postpartum mothers, children, and employed individuals living with disabilities.
Medi-Cal: Out-of-Pocket Costs: AB 1937 (Patterson) allows pregnant Medi-Cal members to be reimbursed up to $1,000 for out-of-pocket pregnancy related costs, including the cost of birthing classes, hiring a doula, midwife care, purchasing a new car seat, crib, or other similar item. AB 1937 requires submission of a reimbursement request within 3 months following the end of pregnancy.
Medi-Cal: Income Level for Maintenance: AB 1900 (Arambula) increases the income level, upon federal approval, for maintenance per month to be equal to that income limit for Medi-Cal without a share of cost, generally 138 percent of the federal poverty level (FPL), for low-income individuals who are aged 65 years or older and those living with disabilities. [i] A ‘maintenance need level’, currently set at $600 per month, is the determined amount of income needed to pay for non-medical necessities like food, clothes, and housing. The remaining amount of an individual’s income in this Medi-Cal eligibility category must contribute to a Medi-Cal share of cost, which is like an out-of-pocket deductible that needs to be met monthly before Medi-Cal covers their medical costs. AB 1900 increase the amount of income a person has for these non-medical needs and creates a more affordable share of cost. See ITUP’s Health Insurance Basics fact sheet for common definitions of health insurance terms.
Covered California Affordability Assistance: This year, there are two bills, AB 1878 (Wood) and SB 944 (Pan) that require Covered California to implement solutions to provide income-based affordability assistance. These bills require the reduction of cost-sharing, including copays, coinsurance, and maximum out-of-pocket limits, and to eliminate deductibles for all benefits. (See ITUP’s Health Insurance Basics fact sheet for helpful explainers and definitions.) In December 2021, Covered California released a report, “Bringing Care within Reach”, that identifies options for the affordability options to be implemented under the requirements of this bill.
Coverage Enrollment and Benefits
Health Care Coverage: Treatment for Infertility: AB 2029 (Wicks) requires, after January 1, 2023, health care plans and health insurance policies to provide coverage for the diagnosis and treatment of infertility and fertility services. The bill revises the definition of infertility and removes the exclusion of in vitro fertilization (IVF) from coverage. AB 2029 also removes the previous religious exemption thereby imposing these requirements on previously exempted employers, plans, and policies.
Parolee Substance Use Disorder Treatment: AB 2733 (Choi) requires the California Department of Corrections and Rehabilitations (CDCR) to conduct parolee referrals for substance use disorder treatment (SUDT) for inmates preparing for reentry and parolees already in the community. This bill requires CDCR to facilitate enrollment into the Medi-Cal program for all eligible inmates entering parole. Additionally, AB 2733 requires CDCR to refer all parolees with SUDT needs to Medi-Cal providers certified to provide Drug Medi-Cal (DMC) or DMC-Organized Delivery System (DMC-ODS) services.
Long-Term Services and Supports Benefit Program: AB 2813 (Santiago) requires the Department of Aging and the California Health and Human Services Agency (CalHHS) to establish and administer a Long-Term Services and Supports Benefit Program to provide supportive care to aging Californians and those with physical disabilities. This bill establishes a Long-Term Services and Supports Benefit Program fund and requires the Department of Aging and an unspecified board to administer the program using proceeds from the fund. To be eligible for the benefits from this program, the bill requires individuals to have paid into the fund for an unspecified number of years.
Health Care Delivery System Transformation
Addressing Health Care Costs, Quality, and Market Competition
California Health Care Quality and Affordability Act: AB 1130 (Wood) establishes the Office of Health Care Affordability within the Department of Health Care Access and Information (HCAI). This bill requires the Office of Health Care Affordability to analyze the health care market, develop policies for lowering health care costs for consumers and purchasers, set and enforce cost targets, and create a strategy for controlling health care costs and ensuring affordability. AB 1130 also requires the Office of Health Care Affordability to set priority standards for various health care metrics relating to health care quality and equity, alternative payment methods, primary care behavioral investments, and health care workforce stability. This bill requires, by June 1, 2025, and annually thereafter, a report on baseline health care spending trends and underlying factors, along with policy recommendations, to be produced and a public meeting on the report to be held by June 1, 2026. This bill requires health care service plans and health insurers, in submitting rates for review, to demonstrate the impact of any changes in the health care cost growth rate resulting from the health care cost targets.
Public Hospital Financing Advisory Group: AB 1894 (Rivas) establishes an advisory group to investigate the financial challenges faced by public hospitals and identify strategies to stabilize hospital finances. This bill also requires, by July 1, 2023, the Department of Health Care Services (DHCS) to submit a report with the advisory board’s findings to the Legislature.
Skilled Nursing Facilities: Direct Care Spending Requirement: AB 2079 (Wood) requires, by July 1, 2023, a direct care spending, reporting, and rebate requirement to be established for skilled nursing facilities (SNF). Under the direct care spending requirement, this bill requires that a minimum of 85% of a SNF’s total revenues from each and all payer sources in each fiscal year be expended on residents’ direct care. AB 2079 requires a SNF to report total revenues collected to the HCAI by June 30 of each calendar year. In addition, the bill requires DHCS to conduct an audit of the financial information reported by the facilities every 3 years, at the same time as the SNF’s Medi-Cal audit. If a SNF fails to comply with the direct care spending requirement, AB 2079 requires that SNF to issue a pro rata dividend or credit to the state and to all individuals and entities making payments to the facility for resident services. AB 2079 requires the California Department of Public Health (CDPH) to ensure that payments are made and to impose sanctions on SNF. CDPH also has the authority, under this bill, to withhold certification from SNFs for failure to disclose information under the direct spending requirement.
Health Care Consolidation and Contracting Fairness Act of 2022: AB 2080 (Wood) prohibits a contract issued, amended, or renewed on or after January 1, 2023, between a health plan, insurer, provider, or facility, from containing terms that restrict the health plan or insurer from steering an enrollee to another provider or facility or require the health plan or insurer to contract with other affiliated providers or facilities. The bill authorizes the appropriate regulatory agency to refer a contract to the Attorney General. It authorizes the Attorney General or state entity charged with reviewing health care market competition to review a health care practitioner’s entrance into a contract that contains specified terms. This bill additionally requires a health plan that intends to acquire or obtain control of an entity to give notice to, and secure prior approval from, the director of Department of Managed Health Care (DMHC). The bill authorizes the DMHC director to disapprove a transaction or agreement if it would substantially lessen competition in the health system or among a particular category of health care providers and would require the director to provide information related to competition to the Attorney General. This bill requires a medical group, hospital or hospital system, health care service plan, health insurer, or pharmacy benefit manager to provide written notice to the Attorney General at least 90 days before entering an agreement to make a specified material change with a value of $5 million or more. The bill requires the Attorney General to conduct one or more public meetings before issuing a written decision on a major transaction. The bill prohibits an entity from entering into an agreement without the Attorney General’s written consent.
Transforming California’s Behavioral Health System
Building the Behavioral Health Workforce: Peer Support Specialist: SB 964 (Weiner) requires Medi-Cal plans to classify certified peer support specialists as providers and to include peer support specialist services as a distinct service type under the Medi-Cal program. In addition, this bill requires public universities to develop two additional degree programs with an emphasis in behavioral health. SB 964 also establishes the Behavioral Health Workforce Preservation and Restoration Fund as a fund in the state treasury, to be administered by the HCAI for the purpose of stabilizing the current licensed clinical behavioral health workforce.
Behavioral Health Services: Existing and Projected Needs: SB 1238 (Eggman) requires DHCS, in consultation with local council of governments, to determine existing and projected needs for behavioral health services in each region and would require local governments to report data requested by DHCS.
Mental Health Services: Gravely Disabled: AB 2020 (Gallagher) changes the definition of “gravely disabled” to a condition in which a person, as a result of a mental health disorder, is incapable of making informed decisions about, or providing for, their own basic personal needs for food, clothing, shelter, or medical care without significant supervision and assistance from another person. The changes in definition emphasize informed decision making as the main criteria for “gravely disabled”.
Substance Abuse Treatment: Certification: AB 1860 (Ward) exempts graduate student interns participating in supervised internships affiliated with graduate university programs in psychology, social work, marriage and family therapy, or counseling, and who are completing supervised practicum hours within alcoholism or drug abuse recover and treatment programs, from the Substance Abuse Treatment certification requirement.
Pupil Health: Peer-to-Peer Mental Health Program: AB 1969 (Gipson) requires all schools that develop a peer-to-peer mental health program to provide mental health training, in partnership with community-based organizations, to all pupil mental health advisors who participate in the program. This bill also requires the California Department of Education to award grants to community-based organizations, with the condition that 40% of the pupils enrolled in the program are either classified as English learners or are eligible for free or reduced-price meals.
Improving Perinatal Health Care Delivery
Medi-Cal Comprehensive Perinatal Services: AB 1930 (Arambula) requires DHCS to cover additional comprehensive perinatal assessments, individualized care plans, and services for during and up to 60 days following pregnancy for Medi-Cal members, the scope of which will be determined by DHCS, CDPH, and outside stakeholders. This bill also requires DHCS to seek federal approvals to allow non-licensed health workers to render preventive services in non-medical settings under the supervision of an enrolled Medi-Cal provider or licensed practitioner.
Reproductive Health Care Pilot Program: AB 2320 (Garcia) requires DHCS, until January 1, 2028, to establish and administer a pilot program to direct funds to community health clinics that provide reproductive health care services in five counties. This bill requires a participating health clinic to implement staff training on reproductive justice and trauma-informed care, to improve spoken language translations for non-English speakers, to build sustainable partnerships and in-service trainings to improve health care delivery for marginalized patients, and to produce annual reports to DHCS over 2 years regarding its efforts and progress with those activities.
Grounding Health in Equity and Community
Medi-Cal Community Health Navigator Program: AB 2680 (Arambula) requires DHCS to create the Community Health Navigator Program to promote Medi-Cal enrollment and engagement by providing grants to community-based organizations. The bill requires DHCS to provide training and technical assistance to grant recipients and to partner with Covered California and participating counties on an approach for outreach, enrollment, retention, and access for individuals eligible for Medi-Cal.
Medi-Cal Benefit: Community Health Workers and Promotores: AB 2697 (Aguiar-Curry) states intent to enact future legislation that determines components of the community health worker and promotores Medi-Cal benefit regarding eligibility, reimbursement, and covered services. This bill also states objectives to create an advisory structure and develop the supportive structures needed for community health workers to serve their communities. To learn more about the role of community health workers, check out an ITUP Fact Sheet on Community Health Workers and California’s Health Care Delivery System.
Gender-Affirming Care: SB 923 (Weiner) requires, starting January 1, 2023, Medi-Cal managed care plans, Program of All-Inclusive Care for the Elderly (PACE) organizations, health care plans, and insurers to require its staff and contracted providers to complete an evidence-based training on providing trans-inclusive health care for transgender, gender nonconforming, or intersex individuals. This bill also requires that an individual provider complete an approved refresher course if a complaint against a provider for not providing trans-inclusive care has been filed and ruled in favor of the complainant. By July 31, 2023, SB 923 requires plans to include a list of in-network providers that offer and have provided gender-affirming services.
Advancing Health Equity with Data: SB 1033 (Pan) requires DMHC, no later than July 1, 2023, to revise the enforceable standards for health plans and providers in the collection and reporting of demographic data by age, sex, race, ethnicity, language, sexual orientation and gender identity, and disability state, as well as ongoing health-related social needs. SB 1033 also requires health plans and insurers to use best practices for data collection and use, assess the cultural, linguistic, and health-related social needs of their members with the purpose of identifying and addressing health disparities, improving health care quality and outcomes, and addressing population health. SB 1033 also requires DMHC to establish a program to provide technical assistance and other incentives to health plans and insurers to improve their data practices to lead to more equitable health outcomes. Health Equity
Future of Health
Addressing Equity and the Social Determinants of Health—Food Security, Workforce, Broadband Infrastructure, Climate Impacts and Resilience
California Antihunger Response and Employment Training Act of 2022: AB 1965 (Wicks) establishes the California Antihunger Response and Employment Training (CARET) program, which would provide the same benefits as the CalFresh program to an individual who is ineligible for CalFresh benefits or for whom CalFresh benefits have been discontinued due to an existing law that limits able-bodied adults without dependents to three months of CalFresh benefits. This bill helps to increase and expand access to food security resources.
Bringing Health Care into Communities Program: AB 2123 (Villapudua) establishes the Bringing Health Care into Communities Program, administered by the California Housing Finance Agency, to provide housing grants for mortgage payments to eligible health professionals living in health professional shortage areas for up to five years.
CalFresh: Income eligibility: Basic Allowance for Housing: AB 1828 (Chen, Mathis, and Nguyen) requires the California Department of Social Services (CDSS) to submit a request to the United States Department of Agriculture (USDA) to provide a waiver excluding the basic allowance for housing provided to specified uniformed service members from countable income in the determination of eligibility and benefit level for purposes of receiving CalFresh benefits. This bill requires CDSS to implement the requested waiver within 6 months of approval.
Reentry Housing and Workforce Development Program: AB 1816 (Bryan and Kalra) establishes the Reentry Housing and Workforce Development Program, administered by the Department of Housing and Community Development in the Business, Consumer Services, and Housing Agency, to provide five-year grants for innovative housing, housing-based services, and employment interventions that help recently incarcerated people obtain stable housing.
Broadband Infrastructure: Mapping: AB 2752 (Wood) requires the California Public Utilities Commission (CPUC), in collaboration with relevant state agencies and stakeholders, to maintain and update a statewide, publicly accessible, and interactive map showing the accessibility of broadband service in the state. The bill requires the CPUC to include information identifying the percentage of each census block that has broadband service meeting federal and state standards. AB 2752 also requires CPUC to additionally include all developed last-mile broadband service connections from the statewide open-access middle-mile broadband network on that interactive map.
Broadband: California Advanced Services Fund: AB 2749 (Quirk-Silva) expands the requirement for the CPUC to approve last-mile infrastructure projects to include projects in areas that include unserved households. Current law restricts access to funding for last mile broadband access projects to households that are unserved by existing broadband providers. For more broadband information, check out ITUP’s Broadband for Health fact sheet.
Environmental Equity: Access to Nature: AB 30 (Kalra) declares that safe and affordable access to nature and the benefits of nature is a human right. This bill requires all California state agencies and state departments, including their respective departments, boards, and commissions, to incorporate this state policy when revising, adopting, and establishing polices, regulations, and grant criteria pertinent to the uses of outdoor access to nature. Additionally, AB 30 mandates that state regulations relating to this policy prioritizes the voices and needs of communities of colors, indigenous communities, and economically disadvantaged communities.
Perinatal Health and Climate: AB 2420 (Arambula) states the intent of the Legislature to enact legislation that establishes a workgroup to review available literature on adverse effects of climate change on perinatal health.
COVID-19 Vaccination Requirements
Minors: Vaccine Consent: SB 866 (Weiner and Pan) permits minors 12 years and older to consent to vaccination when the vaccine is approved by the United States Food and Drug Administration (FDA) and meets the recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention. SB 866 builds on existing law, which currently allows minors 12 and over to make choices about their bodies concerning reproductive healthcare.
Employment: COVID-19 Vaccination Requirements: AB 1993 (Wicks, Aguiar-Curry, Low, Akilah Weber) requires employers to have each employee or independent contractor, who is eligible to receive the COVID-19 vaccine, to show proof to the employer, or an authorized agent, that the employee has been vaccinated against COVID-19. This bill establishes an exception from the vaccination requirement for a person who is ineligible to receive a COVID-19 vaccine due to a medical condition or disability or because of a sincerely held religious belief and would require compliance with various other state and federal laws. In addition, AB 1993 requires employers to affirm that each employee or independent contractor complied with these provisions, including at the time of hiring or contracting with that person.
COVID-19 Immunizations at Schools and Child Care Institutions: SB 871 (Pan) adds COVID-19 to the immunization requirements set by CDPH for schools and childcare institutions. This bill also removes personal belief exemptions from additional immunization requirements deemed appropriate by CDPH and makes full immunization against Hepatitis B a requirement to advance to the seventh-grade level.
What’s Next: Legislative Process Information
Below, we have highlighted key events and deadlines that are useful for tracking legislation. The 2022 Legislative calendars for the California Assembly and Senate include all deadlines that must be met in order for bills to be signed into law. The ‘house of origin’ or the ‘first house’ is the branch of the Legislature where the bill was introduced (ABs= Assembly Bills, the Assembly is the first house the bill must pass through; SBs= Senate Bills, the Senate is the first house the bill must pass through). Bills can be amended throughout the process.
Policy committees began hearing bills in March 2022. The committees are made up of a subset of assemblymembers or senators to hear bills on a specific policy topic, such as health. The committee chairs set bills for hearing dates throughout March and April, and public hearings are recorded and can be watched live, typically in person, but livestream video is available and preferred during the public health emergency. Assembly and Senate Health Committee hearings dates, agendas that list the bills being heard, and a link to where you can watch the hearings, can be found on each policy committee’s website. The deadline for bills to be discussed in committees is April 29, 2022, for fiscal bills (legislation that has a cost to the state), and May 6, 2022, for non-fiscal bills.
- Assembly Health Committee: Meets on Tuesdays at 1:30pm PST
- Senate Health Committee: Meets on Wednesdays at 1:00pm PST
Appropriations Committee Hearings
Once a bill passes in policy committee(s), the next step in the legislative process for most bills is a hearing in the Appropriations Committee. The Appropriations Committee reviews all bills that have a designated fiscal impact, and the deadline for bills to be heard in the house of origin appropriations committee this year is May 20, 2022. At this point in the Legislative process, many bills will be ‘held on suspense,’ which effectively means they will not move forward in the process. In the Assembly, any bill that has an annual cost of $150,000 or more, from any fund, gets placed on the suspense file. In the Senate, legislation with an annual cost of $50,000 General Fund or $150,000 federal funds or special funds, gets placed on the suspense file. Like the policy committees, the appropriation committees hold public hearings. Most bills get placed on the suspense file and are heard in committee close to the May 20, 2022, deadline.
- Assembly Appropriations Committee: Meets on Wednesdays at 9:00am PST
- Senate Appropriations Committee: Meets on Mondays at 9:00am PST
House of Origin Floor Vote
The last stop for a bill before the opposite house begins to weigh in on the policy, is the ‘floor vote’. This is where all Assemblymembers vote on AB bills and all Senators vote on SB bills. The deadline for bills to be voted on the house of origin floor this year is May 27, 2022.
Following a bill’s successful passage out of its house of origin, the entire process listed above is repeated in the opposite house (Ex. ABs will then go through the Legislative process in the Senate). The last day of this year’s legislative session, and subsequently, the last day a bill can pass through the entire process is August 31, 2022. Bills that successfully passed through the Legislature will either be signed or vetoed by Governor Newsom no later than September 30, 2022.
[i] The ‘medically needy’ aid category in the Medi-Cal program includes a very small number of Californians aged 65 or older or those who live with a disability and have monthly incomes above $1,596. For more information eligibility groups and other Medi-Cal facts, see California Health Care Foundation’s 2021 Medi-Cal Facts and Figures Almanac.