BILL ANALYSIS Ó
AB 50
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Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 50
(Mullin) - As Amended April 6, 2015
SUBJECT: Medi-Cal: nurse home visiting programs.
SUMMARY: Requires the Department of Health Care Services (DHCS)
to develop and implement a plan to ensure that Nurse-Family
Partnership and other evidence-based nurse home visiting
programs are offered to Medi-Cal eligible pregnant women.
Specifically, this bill:
1)Requires the Department of Health Care Services (DHCS) to
develop and implement, by January 1, 2017, a plan to ensure
that NFP and other evidence-based nurse home visiting programs
are offered to all Medi-Cal eligible pregnant women.
2)Requires DHCS, on or before January 1, 2022, and every five
years afterwards, to report to the Legislature on
implementation progress and the effectiveness of
evidence-based nurse home visiting services.
3)Defines a "nurse home visiting program" as a program that does
the following:
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a) Contains home visitations by a registered nurse to
households with a pregnant woman as a primary service;
b) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children
from prenatal to two years old; and,
c) Identifies participant outcomes that include improved
maternal and child health, improvements in school
readiness, reductions in crime or domestic violence, and
other outcomes as specified.
EXISTING LAW:
1)Establishes the NFP as a voluntary nurse home visiting grant
program for expectant first-time mothers, their children, and
their families, administered by the Department of Public
Health (DPH).
2)Requires DPH to develop a grant application and award grants
on a competitive basis to counties for the startup,
continuation, and expansion of NFP and requires a county, to
be eligible to receive an NFP grant, to agree to specific
staffing and service-related provisions.
3)Permits DPH to accept voluntary contributions, in cash or
in-kind, to pay for the costs in the implementation of the NFP
and requires private donations to be deposited into the
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California Families and Children Account, which is created and
continuously appropriated to DHCS under this bill.
4)Prohibits state funds from being used to implement this bill.
5)Allows DPH to distribute grants if the Director of the
Department of Finance (DOF) determines, in writing, that there
are sufficient funds from private donations available in the
account for expenditure for the purposes of the NFP.
Prohibits DPHs' administration costs from exceeding 5% of the
moneys in the account.
6)Permits DPH, in consultation with the NFP administrators, to
contract with one or more qualified organizations to assist
DPH in ensuring that grantees implement the program as
established under this bill and to conduct an annual
evaluation of the implementation of the grant program on a
statewide basis. Requires the first evaluation to be due 12
months after the award of grants.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill is
necessary to increase accessibility for nurse led home
visiting and help improve efficiency on this piece of our
system of care. This bill helps to address the rising costs
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of Medi-Cal and potential burdens of rising Medi-Cal
enrollment. With increased Medi-Cal enrollments come the
societal savings, care coordination, case management, and
healthcare outcomes that NFP and other evidence-based nurse
home visiting programs, provide for the consistent solutions
resonating among stakeholders. These measures will help
improve HEDIS measures, access to services, and reduce costs
while further increasing savings. It is the responsibility of
the Legislature and in the best interest of all California
citizens to prioritize efficiency and effectiveness in the
consideration of fiscal expenditures.
2)BACKGROUND. The first California NFP implementing agencies
were launched in 1996 in Fresno, Los Angeles, and Alameda
Counties using Federal Department of Justice funding. The
successful implementation of these initial NFP pilot sites
demonstrated to other California communities that it was
possible to replicate a scientific-based health strategy while
also tailoring the program to meet the needs of each
community. NFP seeks to continue to build new partnerships
with medical managed care entities, school districts, military
bases, clinics and hospitals in order to serve the thousands
more eligible families in California that could benefit from
NFP's evidenced-based outcomes model.
The NFP sites in California have served approximately 9,000
families, of which the majority are Latino. The median age of
the mothers is 18 years. Seventy-two percent are enrolled in
Medi-Cal, and the median annual household income is $13,500.
The California NFP has documented outcomes for enrollees, and
demonstrated a 23% reduction in cigarette smoking during
pregnancy. In addition, of those mothers who entered the
program without a high school diploma or General Educational
Development Test (GED), 42% had earned their diploma or GED,
25% continued to work toward their diploma or GED, and 15%
were pursuing education beyond high school, by the time their
infants were 24 months old.
3)MATERNAL, INFANT, EARLY CHILDHOOD HOME VISITING PROGRAM.
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Maternal, Infant, and Early Childhood Home Visiting (MIECHV)
is a federal program that supports pregnant women and families
and helps at-risk parents of children from birth to
kindergarten entry tap the resources and hone the skills they
need to raise children who are physically, socially and
emotionally healthy and ready to learn. The Federal Health
Resources and Services Administration, in close partnership
with the Administration for Children and Families, funds
States, territories and tribal entities to develop and
implement voluntary, evidence-based home visiting programs
using models that are proven to improve child health and to be
cost effective. On February 19, 2015, the Department of
Health and Human Services announced $386 million in grant
awards to states, territories, and nonprofit organizations to
support the MEICHV Program. California NFP programs are
partially funded by MEICHV funding.
4)SUPPORT. Children Now states in support that voluntary early
childhood home visiting programs strengthen the critical
parent-child relationship and connect families with
information and resources during the pivotal time from
pregnancy to age five. Extensive research has shown that
voluntary home visiting programs increase family
self-sufficiency, positive parenting practices, and maternal
and child health. Children Now notes that nationally, as well
as in California, there is a diverse array of home visiting
program models in use, including both nationally-known,
intensive program models, as well as locally designed programs
intended to engage isolated populations or address other
specific local priorities. Many experts hail home visiting
program diversity as essential to providing parents with
choices, and ensuring that programs are well matched with
local needs and strengths. Children Now concludes that it
believes this bill can help promote a broad range of home
visiting models, reflective of the diverse needs of families
and young children in our state.
5)PREVIOUS LEGISLATION.
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a) ACR 155 (Bocanegra), Chapter 144, Statutes of 2014,
urges the Governor to identify evidence-based solutions to
reduce children's exposure to adverse childhood
experiences, address the impacts of those experiences, and
invest in preventive health care, mental health and,
wellness interventions.
b) AB 543 (Ma) of 2010 would have extended, from January 1,
2009 to January 1, 2014, the sunset of the California
Children and Families Account (Account). Governor
Schwarzenegger vetoed AB 543 stating: "Since the
Nurse-Family Partnership program was signed into law in
2006, there have been no private or federal funds received
by the state for this program. Since there are no funds to
appropriate, there is no need to extend the sunset date for
the program's fund account."
c) AB 1829 (Ma) of 2008 would have extended, from January
1, 2009, to January 1, 2011, the sunset of the Account.
Governor Schwarzenegger vetoed AB 1829, stating: "The
historic delay in passing the 2008-2009 State Budget has
forced me to prioritize the bills sent to my desk at the
end of the year's legislative session. Given the delay, I
am only signing bills that are the highest priority for
California. This bill does not meet that standard and I
cannot sign it at this time."
d) SB 1596 (Runner), Chapter 878, Statutes of 2006,
establishes the NFP program administered by the Department
of Health Services (now DPH).
6)POLICY COMMENTS. The NFP is existing law in the Health and
Safety code. This bill establishes new requirements for
evidence-based nurse home visiting programs in the Welfare and
Institutions code section. This is duplicative and
unnecessary in order to meet the intent of expanding access to
evidence-based nurse home visiting programs. Instead of
adding a new section, the Committee may recommend broadening
the provisions that currently govern NFP Programs in Health
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and Safety code to include other evidence-based nurse home
visiting programs.
REGISTERED SUPPORT / OPPOSITION:
Support
American Nurses Association\California
California Right to Life Committee
Children Now
Parents as Teachers
Prevent Child Abuse America
Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097
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