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) Page 1 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) Page 2 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.