BILL ANALYSIS                                                                                                                                                                                                    




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                          AB 499 (Atkins)
          
          Hearing Date: 08/25/2011        Amended: As Introduced
          Consultant: Jolie Onodera       Policy Vote: Judiciary 3-1
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          ____
          BILL SUMMARY: AB 499 would authorize a minor who is 12 years of 
          age or older to consent to medical care related to the 
          prevention of a sexually transmitted disease.
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          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2011-12      2012-13       2013-14     Fund
           
          Medi-Cal vaccination   $1,200 - $2,500 per 5 to 10 
          percentFed/General*
          administrative fee     of eligible cases

          Post-exposure          Unknown; potentially significant costs 
          ofFed/General*         
          prophylactic HIV treatment        $750 to $1,550 per 1,000 cases

          Healthy Families Program          Unknown; potential cost pressure 
          on                     Fed/General
          impact                 plan rates

          Preventive services    Potential future cost savings   
          Fed/General*
                                 in diagnosis and treatment costs
                                                                 
          *Costs shared 50 percent General Fund, 50 percent federal funds.
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          STAFF COMMENTS: SUSPENSE FILE. 

          Existing law authorizes a minor who is 12 years of age or older 
          to consent to medical care related to the diagnosis or treatment 
          of an infectious, contagious, or communicable disease if it is 
          related to a sexually transmitted disease. This bill would 
          additionally authorize a minor who is 12 years of age or older 
          to consent to medical care related to the prevention of a 








          AB 499 (Atkins)
          Page 1


          sexually transmitted disease.

          Time-critical preventive services for sexually transmitted 
          diseases include the hepatitis B vaccine, post-exposure 
          prophylactic (PEP) HIV medication (which must be administered 
          within 72 hours of exposure), and the human papilloma virus 
          (HPV) vaccine which, if given prior to exposure, may 
          significantly reduce the risk of certain cancers. As this bill 
          could result in the administration of vaccinations for hepatitis 
          B and the HPV to Medi-Cal beneficiaries between the ages of 
          12-17 inclusive that would otherwise not have received these 
          vaccinations, there could be increased costs to the Medi-Cal 
          program, which pays a $9 administrative fee to physicians who 
          administer the vaccines to Medi-Cal beneficiaries. All other 
          costs related to vaccines for Medi-Cal beneficiaries under age 
          19 are paid for by the federally funded Vaccines for Children 
          Program. 

          Based on Medi-Cal counts as of January 2010, it is assumed there 
          are over 466,000 females and 457,000 males (923,000 total) aged 
          12 through 17 who are Medi-Cal beneficiaries. Although the main 
          focus of HPV prevention has been on young women, there has been 
          recent research indicating the case for also routinely 
          vaccinating young men for the HPV as well. As a result, there 
          could be costs to administer vaccinations for both young women 
          and men.

          For the 923,000 minors aged 12 through 17, a five to ten percent 
          immunization rate for HPV, which is a three-dose series, would 
          result in administrative costs ranging from $1.2 million to $2.5 
          million in total funds, fifty percent of which would be a cost 
          to the General Fund. 

          In addition to immunizations, preventive services for sexually 
          transmitted diseases include the administration of PEP HIV 
          medication, which must be given within 72 hours of exposure to 
          be effective. As these medications are administered orally by 
          prescription, there would be no costs associated with a Medi-Cal 
          administrative fee for these medications. PEP medication costs 
          are estimated at $400 to $1,200 per patient for a 28-day course, 
          which is the typical time for treatment. Additional treatment 
          costs associated with the administration of PEP medication could 
          cost over $350 per individual and would include the accompanying 
          office visit, required HIV informed consent counseling, and HIV 








          AB 499 (Atkins)
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          blood testing to evaluate the patient's HIV status pre- and 
          post-administration of the medication. To the extent Medi-Cal 
          covers these services, all costs would be shared 50 percent 
          federal funds and 50 percent General Fund. It is unknown at this 
          time if the PEP medication and services would be allowable 
          Medi-Cal costs without parental consent. If costs are not 
          allowable, the PEP medication and treatment costs would be 100 
          percent state-funded. The number of potential cases who would be 
          impacted is unknown, but the estimated cost per 1,000 
          individuals is estimated at $750,000 to $1,550,000. 

          The Healthy Families Program (HFP), administered by the Managed 
          Risk Medical Insurance Board (MRMIB) provides low-cost health 
          coverage to over 870,000 children up to the age of 19 whose 
          families' income meet eligibility requirements and are not 
          eligible for Medi-Cal. As the costs for vaccinations for 
          children covered under the HFP are not eligible under the 
          federal vaccination program, costs for vaccinations are 
          negotiated into the plan rates. To the extent this bill results 
          in increased vaccinations and preventative STD services provided 
          to HFP recipients could increase utilization rates and create 
          future cost pressure on HFP plan rates.

          According to the Department of Health Care Services, Medi-Cal 
          expenditures of $379 million were incurred in 2009-10 for the 
          Minor Consent Program, which serves on average 130,600 
          individuals between the ages of 12 and 19, and provides over 
          128,000 minors with family planning and/or sexually transmitted 
          disease diagnosis and treatment services. Due to the 
          authorization of preventive services to minors provided for in 
          this bill, there could be substantial future cost savings to the 
          Medi-Cal and HFP programs in the millions of dollars to the 
          extent that immunizations and other medical care lead to 
          decreased incidences of disease, diagnosis, and treatment costs.