BILL ANALYSIS
AB 543
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 543 (Ma) - As Amended: April 13, 2009
SUBJECT : Perinatal care: The Nurse-Family Partnership.
SUMMARY : Authorizes the use of Nurse-Family Partnership (NFP)
program grant moneys as a match for other grants administered by
the Department of Public Health (DPH), and extends, from January
1, 2009 to January 1, 2014, the sunset date of the California
Children and Families Account (Account). Specifically, this
bill :
1)Deletes a prohibition on the use of moneys received for the
NFP as a match for DPH-administered grants.
2)Deletes a condition which restricts DPH from distributing NFP
grants unless the Director of Finance determines that there
are sufficient funds from private donations in the Account.
3)Clarifies that no money from the General Fund (GF) may be used
for the NFP.
4)Authorizes DPH to accept federal grants or private funds for
the NFP.
5)Extends, from January 1, 2009 to January 1, 2014, the date on
which the Account ceases to exist, if the Account has
insufficient funds to implement the NFP program.
6)Prohibits the expenditure of funds from the Account unless the
State Public Health Officer (PHO), rather than the Director of
Finance, determines that at least $500,000 is available.
7)Specifies that if at least $500,000 is not available in the
Account on or before January 1, 2014, the funds in the Account
must be immediately distributed to each contributor and the
Account ceases to exist.
EXISTING LAW :
1)Establishes the NFP program, and requires DPH to administer
NFP for the purpose of making grants to eligible participating
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counties to provide voluntary registered nurse home visiting
services for expectant, first-time, low-income mothers and
their children and families.
2)Requires DPH to distribute NFP grants only if the Director of
Finance determines, in writing, that there are sufficient
funds from private donations in the Account. If, as of
January 1, 2009, the Director of Finance determines that the
funds in the Account are insufficient to implement the NFP
program, the account ceases to exist.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
intended to establish the NFP as a statewide pilot program for
five years. The NFP program matches first-time, low income
mothers in their first trimester of pregnancy to a registered
nurse, and assists them until their child is two years old.
The author states that the NFP had not received, by January 1,
2009, sufficient funds for the Director of Finance to certify
that the program could be implemented, as required in existing
law.
2)BACKGROUND . NFP originally began as a research study in
Elmira, New York, in the 1970s. Due to encouraging findings,
the United States Department of Justice (USDOJ) Office of
Juvenile Justice and Delinquency Prevention made NFP part of
their "Weed and Seed" initiative, funding the program in six
demonstration cities. Subsequent evaluations encouraged
further expansion of the program. NFP programs currently
operate in 23 states. Beginning 18 to 28 weeks into pregnancy
and through the first two years of the child's life, nurses
work with first-time, low-income mothers to improve prenatal,
maternal, and early childhood health and well-being, focusing
on therapeutic relationships with the family that are designed
to improve family functioning in areas of health, home and
neighborhood environment, family and friends support, parental
roles, and major life events.
3)EFFECTIVNESS OF THE NFP . In 2005, RAND reported in a study of
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costs and benefits of early childhood programs that by the
time a child in the NFP program had reached 15 years of age,
the NFP program cost over $9,000, but provided societal
benefits of about $26,300, for a benefit-to-cost ratio of 2.88
to one. A 1997 RAND study also examined the benefits for
children and their families enrolled in early childhood
intervention programs, including the original NFP in Elmira.
The study found that the NFP program generated increased tax
revenues from increased employment and earnings; decreased
welfare enrollment, including in Medicaid, Food Stamps, and
Aid to Families with Dependent Children; reduced expenditures
for education, health, and other services, including special
education, emergency room visits, and stays in homeless
shelters; and, lowered criminal justice system costs from
arrest, adjudication, and incarceration. The analysis
indicated a net savings to government programs of $18,611 per
family in 1996 dollars, which was over four times the cost of
the program.
4)California NFP program sites . According to the November 2008
NFP State Profile for California, the first California NFP
implementing agencies were launched in 1998 in Fresno, Los
Angeles, and Alameda Counties with funding from the U.S. DOJ's
Weed and Seed Strategy. As of March 2009, there are nine
California NFP program sites in the following eight county
health departments: Fresno, Kern, Los Angeles, Orange,
Riverside, Sacramento, San Diego (East and West), and San Luis
Obispo. The NFP sites in California have served approximately
9,000 families, of which 64% are Latino, 14% are non-Hispanic
white, 13% are African-American, 4% are Asian, 4% are
multiracial/other, and 1% are Native American. The median age
of the mothers is 18 years. Seventy-two percent are enrolled
in Medi-Cal, and the median annual household income is
$13,500.
The California NFP has documented outcomes for enrollees, and
demonstrated a 23% reduction in cigarette smoking during
pregnancy. In addition, of those mothers who entered the
program without a high school diploma or General Educational
Development Test (GED), 42% had earned their diploma or GED,
25% continued to work toward their diploma or GED, and 15%
were pursuing education beyond high school, by the time their
infants were 24 months old. The NFP program enrolls women who
are at higher risk for poor birth outcomes than the general
population. Despite this, only 8% of NFP babies were
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premature, compared to the overall 2004 California rate of 11%
percent. Additionally, 86% of the mothers initiated
breastfeeding, 35% were still breastfeeding when their
children were six months old, and 89% of NFP children had
received all recommended immunizations by 24 months, compared
with roughly 75% statewide.
The average annual program budget is $600,000, which covers
funding for four nurses and a half-time administrator.
Funding for the program is fragmented and varies by county,
but generally comes from Medi-Cal, county general funds,
Proposition 10 (1998 Children and Families First Act),
Maternal and Child Health Program Funds, Tobacco Settlement
Funds, and The California Wellness Foundation.
5)SUPPORT . NFP, the sponsor of this bill, writes in support
that the NFP model is recognized as the only evidence-based
visitation program with proven, clinical, multi-generational
outcomes. NFP cites a Washington State study that concludes
NFP generates benefits of $17,180 per youth. Fight Crime:
Invest in Kids - California (Fight Crime), the Child Abuse
Prevention Center, and several individuals write in support
that programs like NFP are proven through rigorous research to
prevent child abuse and neglect. Fight Crime also writes that
in light of the Obama Administration making federal
investments in NFP a high budget priority, extending the
program and allowing the use of federal funds is justified in
order to create more opportunities to provide NFP to families
in need. The American Federation of State, County, and
Municipal Employees, AFL-CIO writes it supports helping
low-income families have the same access to perinatal care as
those who can afford such services. The Junior Leagues of
California State Public Affairs Committee write in support
that this bill complements the two local Junior League
projects, and that communities depend on the improved health
status of newborns and their first-time mothers.
6)OPPOSITION . Great Kids, Inc. writes in opposition that there
are a variety of evidence-based, effective home visitation
programs that have been shown to reduce child abuse and
neglect, and that allowing a variety of models allows more of
America's most vulnerable families to be served. Great Kids,
Inc. further contends a variety of professionals can
effectively provide home visiting services to prevent child
abuse and neglect, serve more families with less money, help
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address nurse workforce shortages, and ensure community fit.
7)PREVIOUS LEGISLATION .
a) AB 1829 (Ma) of 2008 would have extended, from January
1, 2009, to January 1, 2011, the sunset of the Account.
Governor Schwarzenegger vetoed AB 1829, stating: "The
historic delay in passing the 2008-2009 State Budget has
forced me to prioritize the bills sent to my desk at the
end of the year's legislative session. Given the delay, I
am only signing bills that are the highest priority for
California. This bill does not meet that standard and I
cannot sign it at this time."
b) SB 1596 (Runner), Chapter 878, Statutes of 2006
establishes the NFP program to be administered by the
Department of Health Services (now DPH).
8)POLICY QUESTION . As drafted, this bill prohibits expenditure
of funds until the State Public Health Officer (PHO)
determines the Account has at least $500,000, and gives the
PHO until January 1, 2014 to make that determination. Should
this bill instead require the PHO to disburse funds from the
Account as soon as $500,000 is available?
9)TECHNICAL AMENDMENT . On page 4, lines 19 to 22, the following
language is suggested: "at least five hundred thousand dollars
($500,000), including both federal and private funds, is
available in the account."
REGISTERED SUPPORT / OPPOSITION :
Support
Nurse Family Partnership (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
Child Abuse Prevention Center
Fight Crime: Invest in Kids - California
Junior Leagues of California State Public Affairs Committee
Four individuals
Opposition
AB 543
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Great Kids, Inc.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097