BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 543
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AUTHOR: Ma
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AMENDED: June 1, 2009
HEARING DATE: July 8, 2009
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CONSULTANT:
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Tadeo/
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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).
Extends, from January 1, 2009 to January 1, 2014, the date
on which the California Families and Children Account
ceases to exist, if it has insufficient funds to implement
the NFP Program.
CHANGES TO EXISTING LAW
Existing law:
Establishes the NFP, administered and implemented by DPH,
for the purpose of making grants to eligible participating
counties for the provision of voluntary registered nurse
home visiting services for expectant, first-time,
low-income mothers and their children and families.
Requires DPH to distribute these grants only if the
Director of Finance determines, in writing, that there are
sufficient funds from private donations available in the
California Families and Children Account. Provides that,
if, as of January 1, 2009, the Director of Finance
Continued---
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determines that there are insufficient funds on deposit in
the account to implement the program, the account ceases to
exist.
This bill:
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 California Families and Children Account.
Instead requires the State Public Health Officer, rather
than the Director of Finance, to determine whether at least
$500,000 is available in the California Children and
Families Account, and, once that amount is available, to
distribute the funds. Specifies that if the State Public
Health Officer determines that at least $500,000 is not in
the California Families and Children Account on or before
January 1, 2014, the funds must be immediately returned to
each contributor and cease to exist.
Authorizes DPH to accept federal grants or voluntary
contributions for the NFP Program.
Authorizes the use of NFP grant moneys as a match for other
grants administered by DPH.
Clarifies that no money from the General Fund may be used
for the NFP Program.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of AB 543, total expenditures for this program of $5.4
million statewide (10 - 20 percent General Fund or state
special fund.) AB 543 prohibits the use of General Fund
for the NFP grant program.
The sponsors of the 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 requiring DPH to make the
determination of non-General Fund support, reduces General
Fund pressures accordingly.
BACKGROUND AND DISCUSSION
According to the author, AB 543 is intended to establish
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the NFP as a statewide pilot program for 5 years. 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.
According to the U.S. Department of Health and Human
Services Substance Abuse and Mental Health Services
Administration, NFP originally began as a research study in
Elmira, NY, in the late 1970s. Due to encouraging
findings, the U.S. Department of Justice Office of Juvenile
Justice and Delinquency Prevention made NFP part of their
"Weed and Seed" initiative, funding the program in six
demonstration cities. Currently, NFP programs operate in
23 states. Beginning with the first trimester of 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.
RAND Institute study
In a 2005 study of early childhood programs, the RAND
Institute reported 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 Institute 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.
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California NFP Program
The first NFP Program in California began in 1997 in
Fresno, currently there are nine 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. These NFP Program sites
have served approximately 9,000 families, of which 64
percent are Latino, 14 percent non-Hispanic white, 13
percent African-American, 4 percent Asian, 4 percent
multiracial/other, and 1 percent Native American. The
median age of the mother is 18 years, 72 percent are
enrolled in Medi-Cal, and the median annual household
income is $13,500.
Although the NFP Program enrolls women who are at higher
risk for poor birth outcomes, 92 percent of NFP Program
babies were born full term, according to the NFP Program
2008 state profile, and a 23 percent reduction in cigarette
smoking during pregnancy was documented. Eighty-six
percent of NFP Program mothers initiated breastfeeding, and
89 percent of NFP Program children had received all
recommended immunizations by 24 months, compared with
roughly 75 percent statewide.
Additionally, of those mothers who entered the program
without a high school diploma or General Educational
Development Test (GED), 42 percent had earned their diploma
or GED, 25 percent continued to work toward their diploma
or GED, and 15 percent were pursuing education beyond high
school, by the time their infants were 24 months old.
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 county general funds, Medi-Cal,
Proposition 10, Maternal & Child Health Funds, Tobacco
Settlement Funds, federal financial participation, and
private foundation funding.
Prior legislation
AB 1829 (Ma, 2008) would have extended, from January 1,
2009, to January 1, 2011, the sunset of the California
Families and Children Account. The Governor vetoed AB
1829, stating in his veto message that, given the delay in
passing the 2008-2009 state budget forced him to only sign
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bills that were the highest priority for California.
SB 1596 (Runner), Chapter 878, Statutes of 2006,
establishes the NFP program, to be administered by DPH.
Creates the California Families and Children Account and
sunsets the account if the Director of Finance determines
that there are insufficient funds on deposit to implement
the grant program as of January 1, 2009.
Arguments in support
Fight Crime: Invest in Kids California and the Child Abuse
Prevention Center state that programs like the NFP Program
are proven to prevent child abuse and neglect. Fight
Crime: Invest in Kids California adds 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 the NFP Program to
families in need. The County of San Diego states that its
NFP Program is funded primarily by sales tax and vehicle
license fees, which are decreasing due to the current
economic crisis and contends that AB 543 would provide an
opportunity for the county to apply for new grant funding
available for the NFP Program from the federal government.
Arguments in opposition
Great Kids, Inc. states that a variety of evidence-based,
effective home visitation programs reduce child abuse and
neglect, and all evidence-based evaluated home visiting
models should be included. Great Kids, Inc. contends that
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.
PRIOR ACTIONS
Assembly Floor: 78-0
Assembly Appropriations:17-0
Assembly Health: 18-0
POSITIONS
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Support: American Federation of State, County and
Municipal Employees, AFL-CIO
California Commission on the Status of
Women
Child Abuse Prevention Center
County of San Diego
Fight Crime: Invest in Kids California
Junior Leagues of California State Public Affairs
Committee
Oppose: Great Kids, Inc.
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