BILL ANALYSIS
AB 543
Page 1
CORRECTED- 06/19/09- PER COMMITTEE CONSULTANT
ASSEMBLY THIRD READING
AB 543 (Ma)
As Amended June 1, 2009
Majority vote
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De La Torre, De | |Charles Calderon, Davis, |
| |Leon, Emmerson, Hall, | |Duvall, Fuentes, Hall, |
| |Hayashi, Hernandez, | |Harkey, Miller, |
| |Bonnie Lowenthal, Nava, | |John A. Perez, Price, |
| |V. Manuel Perez, Salas, | |Skinner, Solorio, Audra |
| | Audra | |Strickland, Torlakson, |
| |Strickland | |Krekorian |
| | | | |
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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 Program as a match for DPH-administered grants.
2)Deletes a condition which restricts DPH from distributing NFP
Program 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 Program.
4)Authorizes DPH to accept federal grants or voluntary
contributions for the NFP Program.
5)Extends, from January 1, 2009 to January 1, 2014, the date on
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which the Account ceases to exist, if the Account has
insufficient funds to implement the NFP Program.
6)Requires the State Public Health Officer, rather than the
Director of Finance, to determine whether at least $500,000 is
available in the Account, and, once that amount is available,
to distribute the funds.
7)Specifies that if the State Public Health Officer determines
that at least $500,000 is not in the Account on or before
January 1, 2014, the funds must be immediately returned to
each contributor and the Account ceases to exist.
EXISTING LAW :
1)Establishes the NFP Program, and requires DPH to administer
the NFP Program for the purpose of making grants to eligible
participating 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 Program 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 : According to the Assembly Appropriations
Committee, this bill prohibits the use of general fund (GF) for
the NFP grant program. The sponsors of this bill have shown
outside support in the form of a recent $500,000 grant from a
foundation as well as inclusion in the recent federal budget.
These new sources of funding, combined with a recent amendment
requiring DPH to make the determination of non- GF support,
reduces GF pressures accordingly.
COMMENTS : The author states this bill is intended to establish
the NFP Program 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. According to the
author, the NFP Program had not received, by January 1, 2009,
sufficient funds for the Director of Finance to certify that the
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program could be implemented, as required in existing law.
NFP Program originally began as a research study in Elmira, New
York, in the 1970s. Due to encouraging findings, the United
States Department of Justice Office of Juvenile Justice and
Delinquency Prevention funded NFP Programs in six demonstration
cities. Subsequent evaluations led to further expansion of the
program. NFP programs currently operate in 23 states. NFP
nurses work with pregnant women 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.
In 2005, RAND Institute reported in a study 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 the original NFP
Program in Elmira and found that the NFP Program generated
increased tax revenues from increased employment and earnings;
decreased welfare enrollment; reduced expenditures for
education, health, and other services; 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.
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 Program 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 mother is 18 years. Seventy-two percent
are enrolled in Medi-Cal, and the median annual household income
is $13,500. Funding for the California NFP Program sites 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
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Foundation.
The California NFP Program has documented 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. Although the NFP Program
enrolls women who are at higher risk for poor birth outcomes,
only 8% of NFP Program babies were born premature, compared to
the overall 2004 California rate of 11%. Additionally, NFP
Program participants are very likely to initiate breastfeeding,
and 89% of NFP Program children had received all recommended
immunizations by 24 months, compared with roughly 75% statewide.
Fight Crime: Invest in Kids - California (Fight Crime), the
Child Abuse Prevention Center, and several individuals write in
support that programs like the NFP Program are proven to prevent
child abuse and neglect. Fight Crime also writes that in light
of the Obama Administration making federal investments in the
NFP Program 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 Program to families in
need. The County of San Diego writes in support that its NFP
Program is funded primarily by sales tax and vehicle license
fees, which are decreasing due to the current economic crisis
and that this bill would provide an opportunity for the county
to apply for new grant funding available for the NFP Program
from the federal government. The American Federation of State,
County, and Municipal Employees, AFL-CIO and the Junior Leagues
of California State Public Affairs Committee also support this
bill.
Great Kids, Inc. writes in opposition that a variety of
evidence-based, effective home visitation programs reduce child
abuse and neglect, and allowing a variety of models allows more
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 address nurse workforce
shortages, and ensure community fit.
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Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0001306