BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 422 AUTHOR: Nazarian AMENDED: June 3, 2013 HEARING DATE: June 26, 2013 CONSULTANT: Bain SUBJECT : School lunch program applications: health care notice. SUMMARY : Requires the notification schools are authorized to include with information about the school lunch program, to advise the applicant that he/she may be eligible for reduced-cost comprehensive health care coverage through the California Health Benefit Exchange and provide the applicant with the contact information for California Health Benefit Exchange, including its Internet Web site and telephone number. Existing law: 1.Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), which provides health benefits to children up to 250 percent of the federal poverty level (FPL). 2.Requires the governing board of a school district and the county superintendent of schools to make applications for free or reduced price meals available to students at all times during each regular school day. 3.Requires each county to participate in a statewide pilot project to determine Medi-Cal eligibility and enroll (if eligible) any child six years of age or older currently enrolled in school who is eligible for free meals under the National School Lunch Program, upon receipt of proof of participation in the National School Lunch Program and a signed Medi-Cal application. 4.Authorizes, at the option of the school district or county superintendent, and to the extent necessary to implement express enrollment into the Medi-Cal program, the following information to be incorporated into the School Lunch Program application packet or notification of eligibility for the School Lunch Program using simple and culturally appropriate language: Continued--- AB 422 | Page 2 a. A notification that if a child qualifies for free school lunches, then the child may qualify for free or reduced-cost health coverage; b. A request for the applicant's consent for the child to participate in the Medi-Cal program, if eligible for free school lunches, and to have the information on the school lunch application shared with the entity designated by DHCS to make an accelerated determination and the local agency that determines eligibility under the Medi-Cal program; c. A notification that the school district will not forward the school lunch application to the entity designated by the DHCS to make an accelerated determination and the local agency that determines eligibility under the Medi-Cal program, without the consent of the child's parent or guardian; d. A notification that the school lunch application information will only be used by the entity designated by DHCS to make an accelerated determination and the state and local agencies that administer the Medi-Cal program for purposes directly related to the administration of the program and will not be shared with other government agencies for any purpose other than the administration of the Medi-Cal program; and, e. Information regarding the Medi-Cal program, including available services, program requirements, rights and responsibilities, and privacy and confidentiality requirements. This bill: 1.Requires, effective January 1, 2014, the notification that schools are authorized to include with information about the school lunch program, to do all of the following: a. Advise the applicant that the he/she may be eligible for reduced-cost comprehensive health care coverage through Covered California; b. Advise that, if the applicant's family income is low, the applicant may be eligible for no-cost coverage through Medi-Cal; AB 422 | Page 3 c. Provide the applicant with the contact information for Covered California, including its Internet Web site and telephone number; and, d. Comply with the federal Americans with Disabilities Act and any other applicable federal or state disabled access law. 2.Permits a school district to also include the notifications in this bill at the beginning of the first semester or quarter of the regular school term with an existing notification requirement on school-related issues. FISCAL EFFECT : This bill is keyed non-fiscal. PRIOR VOTES : Assembly Health: 19- 0 Assembly Floor: 72- 2 Senate Education: 9- 0 COMMENTS : 1.Author's statement. Successful implementation of the Affordable Care Act (ACA) will rely heavily on increasing public awareness. According to the UCLA Center for Health Policy Research, it is estimated that two out of three uninsured children are eligible for public health coverage programs but are not enrolled. Furthermore, health problems are more likely to escalate, due to the lack of health insurance, consequently affecting a child's ability to learn and parents' ability to work. According to The Children's Partnership, 63 percent of California children who newly enroll in a health care coverage program demonstrate improvements in academic performance and pay closer attention in class. The ACA provides expanded health care coverage to millions of Californians and AB 422 is a mechanism to inform and help determine eligibility of families into health care programs. 2.Background. AB 59 (Cedillo), Chapter 894, Statutes of 2001, established a statewide pilot project to expedite enrollment into Medi-Cal for children receiving free lunches through the National School Lunch Program, referred to as expedited enrollment. A parent checks a box on the school lunch application that they wish to have their child determined eligible for Medi-Cal. The county (which performs Medi-Cal eligibility determinations) receives a copy of the school AB 422 | Page 4 lunch application for the child. Based on the information provided, a child can be found temporarily eligible for Medi-Cal benefits. The temporary eligibility lasts until a Medi-Cal determination has been completed, and the parent must sign and complete a form for the child to continue receiving Medi-Cal. If the child is not found temporarily eligible for Medi-Cal benefits, the child may be eligible for Medi-Cal once all information is reviewed (or previously, the child may have been eligible for the Healthy Families Program). DHCS Medi-Cal Eligibility Division indicates that the three counties received applications through express enrollment for this school year, with a total of fourteen schools using the National School Lunch Plan/Medi-Cal application. In 2011-12, 74 applications were submitted through the NSLP and granted presumptive eligibility for Medi-Cal, of whom 27 (36 percent) became Medi-Cal eligible. In 2012-13, 37 applications were submitted and granted presumptive eligibility, of whom 21 (57 percent) became Medi-Cal eligible. 3.Double referral. This bill was heard in the Senate Education Committee on June 12, 2013 and passed with a 9-0 vote. 4.Prior legislation. SB 1196 ( Cedillo), Chapter 729, Statutes of 2004, revised the process to permit the information from the School Lunch Program to also be used to actually determine eligibility for Healthy Families Program ( HFP) and any other county- or local-sponsored programs, if the parent has granted consent. SB 1196 also requires a county to forward a School Lunch Program application and any specified supplemental forms to the HFP or a county or local-sponsored health insurance program, if an applicant is determined to be ineligible for the full-scope, no-cost Medi-Cal. When a child is not eligible for full-scope, no-cost Medi-Cal, SB 1196 further requires the county to notify the parent or guardian that their child is ineligible for Medi-Cal and that the application has been forwarded to the HFP or a county- or local-sponsored health insurance program. 5.Support. This bill is sponsored by the California Pan-Ethnic Health Network (CPEHN) to require the notification provided to parents through local school districts to include updated information about new health care options. CPEHN states California's population is one of the most diverse in the country. Beginning in 2014, 1.42 million adults will be newly eligible for Medi-Cal as a result of the expansion through the AB 422 | Page 5 Affordable Care Act, 67 percent of whom will be from communities of color and 35 percent of whom will speak English less than very well. Last year, CPEHN worked with researchers from UC Berkeley on a series of group interviews with low-income, racial and ethnic populations, including adults with Limited English Proficiency, to learn how information about health coverage is obtained, shared and acted upon. The focus groups that CPEHN helped to conduct provide insight into how communities of color understand the benefits of the ACA and the barriers they face enrolling in current programs. The findings included that knowledge of the ACA varies among communities of color, and focus group participants suggested that multiple mediums should be utilized to reach their communities with accurate, accessible, and linguistically appropriate messages. Participants noted that community organizations, schools, and trusted community institutions such as churches, child care centers, libraries, and community health centers also need to play a role in educating and enrolling communities of color. This bill seeks to provide parents with critical, updated information about new health care options. 6.Amendments. The County Welfare Directors Association (CWDA) writes that its members often receive school lunch applications for children whose parents checked the box even though they already have Medi-Cal. CWDA indicates they have to deny the application, which takes time and work, and it has sent a denial Notice of Action to the parents, which is confusing to the families because the child already has Medi-Cal. CWDA suggests language to address this situation that would require the county to treat the application as an application for a health insurance affordability program (Medi-Cal, or subsidized coverage in the Covered California, the state's health benefit exchange). If the county determines the child is already enrolled in a health insurance affordability program, the county would take no further action. (g) Upon receipt of information on the School Lunch Program application pursuant to this section for a pupil who is not already enrolled in a health insurance affordability program, the county shall treat the application as an application for health insurance affordability programs. For purposes of administration of the Medi-Cal program, the application date shall be the date that the application is received by the AB 422 | Page 6 county human services department. If the county determines that the pupil is already enrolled in a health insurance affordability program, it shall not take any further action. The author has indicated that he is willing to accept this amendment. SUPPORT AND OPPOSITION : Support: California Pan-Ethnic Health Network (sponsor) Alameda County Board of Supervisors American Federation of State, County and Municipal Employees California Chiropractic Association California Coverage and Health Initiatives California Optometric Association California Primary Care Association California School Employees Association California School Health Centers Association California State Parent Teachers Association California Teachers Association Children Now Children's Defense Fund County Health Executives Association of California Health Access California Los Angeles Education Partnership Los Angeles Trust for Children's Health National Association of Social Workers PICO California Southside Coalition of Community Health Centers St. John's Well Child & Family Center The Children's Partnership Western Center on Law and Poverty Oppose: None received. -- END --