BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 395 (Pan)
Hearing Date: 8/15/2011 Amended: 5/27/2011
Consultant: Katie Johnson Policy Vote: Health 9-0
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BILL SUMMARY: AB 395 would expand the statewide screening of
newborns for diseases to include testing for severe combined
immunodeficiency (SCID) and other T-cell lymphopenias.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Increased CDPH $2,600 $5,300 $5,300 Special*
testing costs
Fee revenue ($2,600) ($5,300) ($5,300) Special*
Approximate Medi-Cal $650 $1,300 $1,300
General/**
fee payments $650 $1,300 $1,300 Federal
Potential publicly funded likely in the tens of
thousands to General/
health program cost hundreds of thousands of dollars Federal/
avoidance per child over time County
*Birth Defects Monitoring Program Fund
**Costs shared 50 percent federal funds, 50 percent General Fund
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would add severe combined immunodeficiency (SCID) and
other T-cell lymphopenias to the list of diseases for which the
Birth Defects Monitoring Program tests infants upon birth. The
California Department of Public Health (CDPH) would cover the
approximately $5.2 million ongoing cost of testing and
processing by increasing the screening fee $9.95 per infant.
Additionally, it would cost CDPH approximately $5.3 million
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annually for 3 years to add SCID to the screening program. In
order to pay for start-up costs, the increased screening fee
would need to be implemented commencing January 1, 2012. Unless
it screening could commence during start-up, it would likely
begin in the latter half of FY 2014-2015.
All public and private insurance carriers are required by law to
pay this fee on behalf of their members, including state payers
such as the Medi-Cal program, the Access for Infants and Mothers
program (AIM), and the California Public Employees Retirement
System (CalPERS). Medi-Cal covers about 46 percent of the births
in California and costs are shared 50 percent federal funds and
50 percent General Funds. Thus, Medi-Cal would pay approximately
half of the costs of the program--$650,000 in federal funds and
$650,000 in General Fund in FY 2011-2012 and $1.3 million in
federal funds and $1.3 million in General Fund annually
thereafter. Approximately 7,500 children are estimated to be
born to AIM mothers in FY 2011-2012; AIM would pay contribute
about $75,000 in fee revenue annually. Costs are shared 35
percent Proposition 99 funds and 65 percent federal funds as
well as supplemented by subscriber premiums. In 2010, there were
4,977 births to mothers covered by CalPERS; CalPERS plans and
insurers would pay approximately $49,500 in fees annually.
CalPERS costs are shared 55 percent General Fund and 45 percent
other funds.
Additionally, to the extent that an infant was identified as
having SCID or a T-cell lymphopenia, Medi-Cal would pay for
treatment, such as a bone marrow transplant and other treatment
expenses. If a child was treated successfully, there would be
cost avoidance to the extent that that same child would have
incurred treatment and hospitalization expenses to manage the
disease. In FY 2009-2010, Medi-Cal spent $1.063 million on 22
children with SCID and the Healthy Families Program spent
$588,000 for two children. Costs to treat children with a SCID
diagnosis are highly variable; therefore, the cost avoidance
associated with treating a child with SCID successfully would
vary too, likely from the tens of thousands to hundreds of
thousands of dollars per child.
The Healthy Families Program SCID costs are funded 65 percent
federal funds, 17.5 percent General Fund, and 17.5 percent
county funds through the California Children's Services (CCS)
program. CCS benefits for children who are CCS-only are paid 50
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percent General Fund and 50 percent county.
CDPH is currently receiving funding for a SCID screening pilot
program that has identified 20 babies with SCID or related
lymphopenias.