BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair AB 395 (Pan) Hearing Date: 8/25/2011 Amended: 5/27/2011 Consultant: Katie Johnson Policy Vote: Health 9-0 _________________________________________________________________ ____ 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. _________________________________________________________________ ____ 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 _________________________________________________________________ ____ STAFF COMMENTS: 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 annually for 3 years to add SCID to the screening program. In AB 395 (Pan) Page 1 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 percent General Fund and 50 percent county. AB 395 (Pan) Page 2 CDPH is currently receiving funding for a SCID screening pilot program that has identified 20 babies with SCID or related lymphopenias.