Section 100523 - [Effective 1/1/2025] Financial assistance; California Health Benefit Exchange(a) Beginning July 1, 2023, the Exchange shall administer a program of financial assistance to help Californians obtain and maintain health benefits through the Exchange if they lose their employer-provided health care coverage as a result of a labor dispute.(1) An individual who has lost minimum essential coverage from an employer or joint labor management trust fund as a result of a strike, lockout, or labor dispute is a qualified individual for purposes of financial assistance, including premium assistance and cost-sharing reduction subsidies, provided that the individual meets all eligibility requirements specified in Section 36B of the Internal Revenue Code and Section 18071 of Title 42 of the United States Code, except for the income requirements of those sections. Any household income of the qualified individual above 138.1 percent of the federal poverty level for a family of the qualified individual's size shall not be taken into account for the qualified individual and the members of their tax household. Consistent with existing federal law and rules, an individual shall be screened for eligibility for the federal Medicaid program.(2) An individual described in paragraph (1) shall receive subsidies for health insurance premiums and cost-sharing reductions that provide the same assistance that is provided to other individuals with household incomes of 138.1 percent of the federal poverty level who qualify for financial assistance through the Exchange. The cost-sharing reductions shall use a standard benefit design that has an actuarial value of 94 percent or greater, and, effective January 1, 2024, the program design shall have zero deductibles for any covered benefit if the standard benefit design for this income has zero deductibles.(3) An individual shall be a qualified individual for purposes of financial assistance, including premium assistance and cost-sharing reduction subsidies, under this section if all of the following are met: (A) The individual loses minimum essential coverage from an employer as a result of a strike, lockout, or labor dispute.(B) The employer that provided the minimum essential coverage to the individual is involved in the strike, lockout, or labor dispute.(C) The individual provides a self-attestation confirming that they lost minimum essential coverage from an employer as a result of a strike, lockout, or labor dispute, and that the employer that provided them the minimum essential coverage is involved in the strike, lockout, or labor dispute.(4) If further documentation is required, the Exchange shall contact the affected collective bargaining agent and may contact the employer.(b) Notwithstanding Sections 1399.848 and 1399.849 of the Health and Safety Code, and Sections 10965.3 and 10965.4 of the Insurance Code, the effective date of coverage shall be the first day of the month of application submission and plan selection or the first day of the following month, at the discretion of the qualified individual.(c)(1) The Exchange, on a monthly basis, shall notify an enrollee receiving financial assistance pursuant to this section that the enrollee is required to notify the Exchange if their household income changes or minimum essential coverage provided by the enrollee's employer is reinstated. The notice shall include information on the potential state and federal income tax consequences of any amount received as a subsidy provided under this section.(2) Upon resolution of a strike, lockout, or labor dispute, an individual shall no longer be eligible for financial assistance under this section when the Exchange verifies that employer-provided minimum essential coverage from the employer has been reinstated for that individual and dependents and only after prior notification to the qualified individual of loss of financial assistance under this section.(d) An employer or labor organization shall notify the Exchange before employer-provided coverage is affected by a strike, lockout, or labor dispute pursuant to a process established by the Exchange. The Exchange may contact an employer, labor organization, or other appropriate representative to determine the status of a strike, lockout, or labor dispute, its impact to coverage, and any other information necessary to determine eligibility for financial assistance under this section.(e)(1) The Exchange shall maximize federal affordability assistance for an individual enrolled pursuant to this section and shall use state affordability assistance funds for financial assistance not otherwise available under federal law.(2) Financial assistance provided pursuant to this section shall be funded upon appropriation by the Legislature.(f) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include any amount received as a state subsidy provided under this section.(g) The following definitions apply for purposes of this section: (1) "Employer-provided coverage" means coverage provided by an employer, a "multiemployer health plan," as defined in Section 1002(37)(A) of Title 29 of the United States Code, or a joint labor-management trust.(2) "Labor dispute" has the same meaning as set forth in clauses (i), (ii), and (iii) of paragraph (4) of subdivision (b) of Section 527.3 of the Code of Civil Procedure.(3) "Labor organization" has the same meaning as defined in Section 1117 of the Labor Code.(4) "Lockout" has the same meaning as defined in Section 1132.8 of the Labor Code.(5) "Strike" has the same meaning as defined in Section 1132.6 of the Labor Code.Amended by Stats 2024 ch 841 (AB 2749),s 1, eff. 1/1/2025.Added by Stats 2022 ch 695 (AB 2530),s 1, eff. 1/1/2023.This section is set out more than once due to postponed, multiple, or conflicting amendments.