BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                            Senator Kevin de León, Chair


          AB 419 (Lowenthal) - CalWORKs eligibility: hospitalization.
          
          Amended: As Introduced          Policy Vote: Human Services 6-0
          Urgency: No                     Mandate: Yes
          Hearing Date: July 1, 2013      Consultant: Jolie Onodera
          
          This bill does not meet the criteria for referral to the  
          Suspense File.


          Bill Summary: AB 419 would repeal the two-month cap on CalWORKs  
          aid payments to a child in a public hospital and instead would  
          provide that a child who is a patient in a public or private  
          hospital for medical or surgical care shall be considered  
          temporarily absent from the home, and therefore eligible for a  
          CalWORKs grant, for the duration of the hospital stay. 

          Fiscal Impact: 
              Minor one-time costs to the Department of Social Services  
              (DSS) to revise regulations consistent with the provisions  
              of this measure.
              Potential increase in CalWORKs program costs potentially in  
              the range of $16,000 to $40,000 (General Fund) per year.

          Background: Current law provides for the California Work  
          Opportunity and Responsibility to Kids (CalWORKs) program under  
          which each county provides cash assistance and other benefits to  
          qualified low-income families. Existing state law prohibits  
          CalWORKs aid payments to a child while he or she is a patient in  
          a public hospital, except with respect to temporary medical or  
          surgical care not exceeding two calendar months. This two-month  
          provision only applies to children who are absent from the home  
          and receiving care in a public hospital. In contrast,  
          CalWORKs-aided children in private hospitals are considered  
          temporarily absent from the home, and therefore eligible for a  
          CalWORKs grant, for the duration of the hospital stay.

          Federal law generally prohibits a state to which a TANF grant is  
          made from using any part of the grant to provide assistance for  
          a minor child who has been, or is expected by a parent of the  
          child to be, absent from the home for a period of 45 consecutive  
          days or, at the option of the state, such period of not less  








          AB 419 (Lowenthal)
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          than 30 days and not more than 180 consecutive days, as  
          specified in the state plan. Federal law, however, grants states  
          the authority to establish good cause exceptions to providing  
          benefits for minor children who are absent from the home for a  
          significant period, if such exceptions are provided for in the  
          state plan (42 USC § 608(10)).

          This bill seeks to create parity among patients in public and  
          private hospitals who are also recipients of CalWORKs aid.

          Proposed Law: This bill would repeal the existing limit on  
          CalWORKs aid to only two months when a child is absent from the  
          home and a patient in a public hospital. This bill removes the  
          two month cap and extends the payment of CalWORKs benefits to a  
          child while he or she is a patient in a public or private  
          hospital for the duration of the hospital stay.

          Staff Comments: To the extent the provisions of this bill result  
          in fewer families being removed from CalWORKs aid or having  
          their CalWORKs grant reduced due to a child requiring an  
          extended public hospital stay could result in increased CalWORKs  
          grants and services costs. 

          Based on information from the Office of Statewide Health  
          Planning and Development (OSHPD), 3,365 children in California  
          were hospitalized for longer than 60 days in 2011, and 1,644  
          children in California were hospitalized for longer than 60 days  
          from January through June 2012 (six months). This results in an  
          average of 3,325 children in California who are hospitalized for  
          longer than 60 days per year. Applying this number to 2010  
          Census data on the number of children in California (9.3  
          million) equates to a ratio of approximately 0.03 percent of  
          children in California who are hospitalized for longer than 60  
          days per year.

          It is unknown how many of the children hospitalized are also  
          CalWORKs recipients, and of those hospitalized, how many receive  
          treatment in public hospitals. However, based on information  
          from the California Public Hospitals and Health Systems, 30  
          percent of persons treated are Medi-Cal patients. Applying the  
          ratio noted above against the projected number of children in  
          CalWORKs results in an estimate of approximately 96 children per  
          year who would not be removed from the CalWORKs assistance unit  
          (AU) during their hospital stay. Additional information from  








          AB 419 (Lowenthal)
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          OSHPD regarding the average length of stay for children  
          hospitalized for longer than 60 days indicate an average length  
          of stay of approximately 100 days, or 40 days more than the 60  
          days allowable to retain eligibility for CalWORKs under existing  
          law.

          Estimated CalWORKs grant costs for 96 children assuming a grant  
          cost of $122 per month for an additional 40 days would equate to  
          approximately $16,000 per year. It is unknown how many of the  
          hospitalized children would be members of families of one child,  
          resulting in loss of CalWORKs eligibility for the entire family  
          upon a public hospital stay in excess of 60 days. To the extent  
          10 to 25 percent of the 96 children would have been a member of  
          a family with one child, resulting in lost eligibility for the  
          entire family, potential costs would increase to $25,000 to  
          $40,000 assuming extended CalWORKs grant and services costs for  
          the entire family.  

          The DSS would incur minor and absorbable one-time costs to  
          revise regulations to reflect the provisions of this measure.