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---
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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
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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
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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
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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.
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