BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                AB 422
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        CONCURRENCE IN SENATE AMENDMENTS
        AB 422 (Nazarian)
        As Amended July 2, 2013
        Majority vote
         
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        |ASSEMBLY:  |71-2 |(May 16, 2013)  |SENATE: |37-0 |(September 3,  |
        |           |     |                |        |     |2013)          |
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         Original Committee Reference:   HEALTH  

         SUMMARY  :  Adds information regarding health care coverage available  
        through the California Health Benefit Exchange (Exchange), known as  
        Covered California, to notifications that may be included at the  
        option of the school district or county superintendent on  
        applications for the School Lunch Program, effective January 1,  
        2014.  Information from the application may currently be used to  
        determine eligibility for the Healthy Families Program, county or  
        local-sponsored programs, as defined and as applicable, if the  
        parent has granted consent when a child does not meet eligibility  
        requirements for Medi-Cal.

         The Senate amendments  :

        1)Add authority to include the notice as part of the existing  
          parental notifications at the beginning of the first semester or  
          quarter of the regular school term, as specified;

        2)Require compliance with the federal Americans with Disabilities  
          Act of 1990; and, 

        3)Require, upon receipt of information provided on the School Lunch  
          Program application, for a pupil who is not already enrolled in a  
          health insurance affordability program, the county to treat the  
          School Lunch Program application as an application for a health  
          insurance affordability program.  For purposes of administration  
          of the Medi-Cal program, the application date shall be the date  
          that the School Lunch Program application is received by the  
          county human services department.  Provide that the county shall  
          take no further action if it determines that the pupil is already  
          enrolled in a health insurance affordability program.  

         FISCAL EFFECT  :  None









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         COMMENTS  :  According to the author, current law authorizes school  
        districts to provide families with notifications about the  
        availability of school lunch programs.  These notifications also  
        inform parents about the availability of low-cost health care  
        coverage for children.  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 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).  The Department of Health Care Services  
        Medi-Cal Eligibility Division indicates that the three counties  
        received applications through express enrollment for this school  
        year, with a total of 14 schools using the National School Lunch  
        Plan/Medi-Cal application.  In 2011-12, 74 applications were  
        submitted through the National School Lunch Program and granted  
        presumptive eligibility for Medi-Cal, of whom 27 (36%) became  
        Medi-Cal eligible. In 2012-13, 37 applications were submitted and  
        granted presumptive eligibility, of whom 21 (57%) became Medi-Cal  
        eligible. 

        The federal Patient Protection and Affordable Care Act (ACA) offers  
        individuals and families additional health care coverage options  
        including expanded Medi-Cal coverage and tax subsidies through the  
        Exchange.  Successful implementation 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% 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 this bill is a mechanism to inform and help determine  








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        eligibility of families into health care programs.  The author cites  
        the California Simulation of Insurance Markets (CalSIM) Study,  
        conducted by the UCLA Center for Health Policy Research and the UC  
        Berkeley Labor Center, which estimates that 1.42 million adults will  
        be eligible for coverage under the new Medi-Cal expansion.  An  
        additional 2.6 million adults will be eligible for tax credits to  
        purchase health insurance through Covered California.  Although  
        children and families may be eligible for these new coverage  
        options, many parents are unaware of health coverage options.  The  
        CalSIM model includes two scenarios to estimate take-up rates in  
        Medi-Cal and Covered California, a base model which assumes current  
        individual and market behaviors, and an enhanced model which assumes  
        additional outreach, enrollment, and simplification measures are in  
        place.  For example, under the base scenario 900,000 adults under 65  
        are predicted to enroll into Medi-Cal whereas under the enhanced  
        scenario with a more aggressive enrollment and outreach strategy  
        enrollment would reach 1.4 million by 2014.  An April 2013 Health  
        Tracking Poll from the Kaiser Family Foundation found that much of  
        the public remains confused about the ACA.  Four in 10 Americans  
        (42%) were unaware that the ACA is still the law of the land,  
        including 12% who believe the law has been repealed by Congress, 7%  
        who believe it has been overturned by the Supreme Court and 23% who  
        do not know whether or not the ACA remains law.  The poll further  
        found that about half of the public said they do not have enough  
        information about the health reform law to understand how it will  
        impact their own family, a share that rises among the uninsured and  
        low-income households.  

        The Exchange is also in the process of establishing an Assister's  
        Program that will include assister enrollment entities (AEEs) and  
        individual entities.  AEEs are entities and organizations eligible  
        to be trained and registered to provide in-person assistance to  
        consumers to help them apply for Covered California programs,  
        particularly entities that have access to Covered California's  
        targeted population.  Individual assisters are individuals who are  
        employed, trained, certified, and linked to AEEs to provide  
        in-person assistance to consumers and help them apply for Covered  
        California programs and are individuals who can provide assistance  
        in a culturally and linguistically appropriate manner to consumers.   
        A list of eligible entities will be established and Covered  
        California is looking to all opportunities to build a robust network  
        of In-Person Assisters, particularly those who have prior experience  
        with healthcare and providing application assistance.  School  
        districts are listed among the recommended proposed entities. 









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        Analysis Prepared by  :    Marjorie Swartz / HEALTH / (916) 319-2097 
        FN: 0001444