BILL ANALYSIS Ó
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)
Page 2
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.