BILL ANALYSIS Ó
AB 2706
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Date of Hearing: April 23, 2014
ASSEMBLY COMMITTEE ON EDUCATION
Joan Buchanan, Chair
AB 2706 (Hernández) - As Amended: March 28, 2014
[Note: This bill is doubled referred to the Assembly Health
Committee and will be heard as it relates to issues under its
jurisdiction.]
SUBJECT : Schools: health care coverage
SUMMARY : Requires parents and guardians to make a written
disclosure stating whether their child, upon enrollment in a
public school, has health care coverage and the school, to which
the disclosure is made, to take specified actions, as
appropriate. Specifically, this bill :
1)Requires, commencing with the 2015-16 school year, all
parents, upon first enrolling their child in a public
school's, including a charter school's, transitional
kindergarten, kindergarten, or grade 1, to make a written
disclosure stating whether their child is either of the
following:
a) Covered by health care coverage and provide proof of
this coverage. If the pupil is covered, the parent or
guardian must also indicate whether he/she believes this
coverage constitutes the minimum essential coverage under
Section 500A of the federal Internal Revenue Code. The
parent or guardian may, alternatively, indicate that he/she
is not certain whether the coverage meets the minimum
essential coverage.
b) Not covered by health care coverage that constitutes the
minimum essential coverage under Section 500A of the
federal Internal Revenue Code. If the pupil is not
covered, the parent or guardian shall also disclose whether
he/she believes the pupil is exempt from the requirement to
maintain essential coverage.
2)Requires a public school to provide written notice to the
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parent or guardian that the information the parent or guardian
provides will only be used for the purpose of determining
whether the parent or guardian should be directed to other
resources for the purpose of obtaining health care coverage
for the pupil.
3)Requires the school district to make a reasonable effort to
direct the parent or guardian that has indicated his or her
pupil lacks the minimum health coverage to the resources
necessary to obtain affordable health care coverage for the
pupil.
4)Prohibits a school district from discriminating against a
pupil who does not have health care coverage or preventing a
pupil from enrolling based on his/her lack of health care
coverage or inability to show proof of coverage.
5)Permits the California Department of Education (CDE) to
develop a standardized template for this written disclosure.
6)Specifies that if the CDE does make such a template available,
this template must be available on the CDE's Web site, upon
request written copies must be made available to a school
district, and requires that the template include a statement
indicating that the information disclosed shall only be used
for the purpose of determining whether a parent or guardian of
a pupil should be directed to other resources for the purposes
of obtaining health care coverage for the pupil.
EXISTING LAW:
1) Requires, effective January 1, 2014, under the federal
Patient Protection and Affordable Care Act (ACA), an
individual to have the option to apply for state subsidy
programs, which include the state Medicaid program, the
state's Children's Health Insurance Program, enrollment in
a qualified health plan through a state exchange, and a
Basic Health Plan, if there is one, either in person, mail,
online, telephone, or other commonly available electronic
means.
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2) Requires, under the ACA, individuals to maintain health
insurance or pay a penalty, with exceptions for financial
hardship, religion, incarceration, and immigration status.
3) Creates the California Health Benefit Exchange, known as
Covered California, as an independent state entity governed
by a five-member board, to be a marketplace for
Californians to purchase health care coverage and as a way
to meet the personal responsibility requirements of the
ACA.
4) Permits school districts or county superintendents of
schools to incorporate into the School Lunch Program
application packet or notification of eligibility for the
School Lunch Program notification that the child may
qualify for free or reduced-cost health coverage under the
California Health Benefit Exchange.
FISCAL EFFECT : State-mandated local program
COMMENTS :
According to the author, due to the expansion of health care
coverage options under the ACA, millions of Californians are
newly eligible for health care coverage, with many being
children under the age 18.<1> There is great opportunity in 2014
to enroll these eligible children; however notable barriers
exist for eligible populations to enroll in Medi-Cal including
lack of awareness about the programs, difficult application or
re-enrollment processes, and stigmas associated with enrolling
in low-income health insurance and other public programs.<2>
While the ACA will dramatically reduce the number of uninsured
---------------------------
<1>"California Health Care Almanac Quick Reference Guide,
California's Uninsured: A Supplement to California HealthCare
Foundation's California's Uninsured: By the Numbers," California
HealthCare Foundation. May 2013.
<2> Laurel Lucia, Ken Jacobs, M. Miranda Dietz, Dave
Graham-Squire, Nadereh Pourat, and Dylan H. Roby. "After
Millions of Californians Gain Health Coverage Under the
Affordable Care Act, Who Will Remain Uninsured?" UCLA Center for
Health Policy Research, UC Berkeley Labor Center, CalSIM,
September 2012.
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Californians, a significant number of eligible children will be
left behind in the absence of proactive and practical solutions.
Disclosure of Health Care Coverage
This bill requires every parent or guardian to indicate whether
his or her child, upon enrollment in transitional kindergarten,
kindergarten, or grade 1, has the minimum essential coverage as
required by the ACA. The committee may wish to consider whether
the requirement that schools collect this information will have
unintended consequences. Specifically, a parent or guardian may
be concerned that the form requires disclosure of his/her, or
the child's, immigration status or may lead to other
consequences. Should the committee approve this measure,
committee staff recommends an amendment to delete the
requirement that a parent or guardian disclose whether the child
is covered by health insurance and whether the coverage meets
the minimum requirements under the ACA. Additionally, committee
staff recommends an amendment that expressly prohibits a school,
including a charter school, from using information relating to a
pupil's health care coverage or interest in learning about
health care coverage, in a manner that would bring harm to the
pupil or the pupil's family.
This bill requires all parents and guardians upon first
enrolling their child in a public school's transitional
kindergarten, kindergarten, and grade 1, to indirectly disclose
information relating to the pupil's health care coverage. If
the committee approves this measure, committee staff recommends
an amendment that encourages, rather than requires, a school or
charter school to solicit information from parents relating to
the pupil's health care coverage. In the absence of such an
amendment, parents may be discouraged from enrolling their child
in non-compulsory programs such as transitional kindergarten or
kindergarten if he or she fears being uninsured will adversely
affect their ability to enroll their child. Further, should the
committee approve this measure, committee staff recommends an
amendment that would encourage a school, including a charter
school, to provide the information to all students, not just
those in transitional kindergarten, kindergarten, and grade 1.
Whether mandated or encouraged, any request for information
should be accompanied by assurances to families that the school
will protect, and only disclose as specified, the pupil and
family's private information. Therefore, if the committee
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approves this measure, committee staff also recommends an
amendment that specifies the information that must be on such a
form, should a school or charter school choose to distribute
this form. Specifically, the amendment requires a disclosure
that the information provided by the parent or guardian on this
form will only be shared for this limited purpose, requires the
form to request the parent or guardian's contact information and
his or her consent to share that information with individuals or
entities who assist with health care coverage enrollment,
require this consent to be signed and dated by the parent or
legal guardian, and require that the form include the following
language:
Affordable health care coverage options may
be available to you and your child. Please
indicate if you would like a person
qualified to assist you with health care
coverage enrollment to contact you and
provide information to you about affordable
health care coverage options and enrollment
assistance. Your name and contact
information will only be shared for this
purpose.
The committee may also wish to consider whether this bill places
unreasonable and unsustainable expectations on parents,
guardians, and school employees. This bill requires a parent or
guardian to determine whether the pupil's health care coverage
meets the statutory requirements of the ACA and similarly
requires schools to provide guidance to those parents or
guardians who may need assistance in completing this disclosure.
School employees do not necessarily have any specialized
knowledge or training in this area and this bill does not
provide a system or funding source for these employees to
receive such training. Should the committee approve this
measure, committee staff recommends an amendment that identifies
the persons or entities to which a school or charter school can
disclose a parent or guardian's contact information for the
purpose of providing the parent or legal guardian information
about health care coverage options and enrollment assistance.
While the intent of the bill may be to simply use schools as a
place to identify uninsured or underinsured children and match
their families with resources, there may be more effective means
by which to achieve this goal. For example, the committee may
wish to consider whether schools should instead be required to
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distribute resources from existing community organizations
designed to assist families with enrollment options or partner
with local community health centers where other health services
required by statute (such as oral health examination and
vaccines) are performed. Should the committee approve this
measure, committee staff recommends an amendment that encourages
schools and charter schools to distribute a fact sheet on health
care coverage options for children and families, as an
alternative to, or in addition to, the option to solicit
information from families by means of the form previously
discussed.
While schools can be partners in community efforts to enroll
children in health care programs, ultimately, compliance with
the ACA is an issue that must be addressed outside of the
schools. Therefore, should the committee approve this measure,
committee staff recommends an amendment that makes the terms of
this bill operative only for the 2015-16 and 2016-17 school
years, with language that would make this section inoperative on
July 1, 2017 and repeal this section on January 1, 2018.
Finally, the committee may wish to consider whether compliance
with this bill will violate the laws relating to student
privacy. The information included in this questionnaire will
contain personally identifiable information that is intended to
be shared with entities for the purpose of providing health care
coverage information. Therefore, should the committee approve
this measure, committee staff recommends an amendment that makes
the form identified in this bill a pupil record, as defined, and
protects the form from disclosure to the public.
Arguments in Support
According to the author, this bill seeks to reduce the number of
eligible, but uninsured children by requiring parents or legal
guardians to show proof of health coverage for children being
enrolled into transitional kindergarten, kindergarten, and grade
1. Parents and guardians of children without health insurance at
the time of school enrollment will be referred to qualified
community enrollment entities and counselors who can assist them
in enrolling in an affordable health plan. In so doing,
California can ensure more of California's young students will
obtain coverage and the potential for greater educational
achievement that comes with it.
Arguments in Opposition
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In order for a child to succeed in school, the child, and
his/her parent or guardian must feel safe within the school
community. Any communication from the school that may
jeopardize a parent's or child's sense of belonging, or deter
them from enrolling must be scrutinized. The permissive nature
of the Education Code already permits a school to make the
resources in this bill available to families, but to mandate
such actions may have unforeseen consequences. While some
schools may already ask for disclosure of health coverage
information on emergency contact forms, or similar documents, it
is important to note that such disclosures were optional and in
place prior to the enactment of ACA. Because ACA expressly
exempts undocumented people from its requirements, this bill's
reference to health coverage in light of the implementation of
ACA, may, in fact, have a different effect than boilerplate
language seen on an emergency health forms of the past.
Previous Legislation
AB 422 (Nazarian), Chapter 444, Statutes of 2013, adds
information regarding health care coverage available through
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.
REGISTERED SUPPORT / OPPOSITION :
Support
California Children's Health Coverage Coalition (Support as
proposed to be amended)
California Coverage & and Health Initiatives (Support as
proposed to be amended)
California Immigrant Policy Center (Support as proposed to be
amended)
California Pan-Ethnic Health Network (Support as proposed to be
amended)
California School-Based Health Alliance
Children Now
Children's Defense Fund-California (Support as proposed to be
amended)
El Monte Union High School District
El Rancho Unified School District
Lynwood Unified School District
Public Counsel (Support if amended)
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Opposition
None on file
Analysis Prepared by : Jill Rice / ED. / (916) 319-2087