BILL ANALYSIS Ó
AB 50
Page 1
ASSEMBLY THIRD READING
AB
50 (Mullin)
As Amended May 21, 2015
Majority vote
-------------------------------------------------------------------
|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+---------------------+---------------------|
|Health |16-0 |Bonta, Maienschein, | |
| | |Burke, Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+---------------------+---------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
AB 50
Page 2
| | |Weber, Wood | |
| | | | |
| | | | |
-------------------------------------------------------------------
SUMMARY: This bill requires the Department of Health Care
Services (DHCS) to develop a plan, in consultation with
stakeholders, on or before January 1, 2017, to ensure that
evidence-based home visiting programs, as defined, are offered and
provided to Medi-Cal eligible pregnant and parenting women, as
specified. It also requires DHCS, in developing the plan, to
prioritize the identification of funding sources for home visiting
services other than state General Fund, including local, federal,
private, or other funds.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Costs to DHCS in the range of $200,000 to develop the specified
plan in consultation with stakeholders.
2)Unknown, significant cost pressure to provide home visiting
services through Medi-Cal FFS or managed care (unspecified
local/private/potentially General Fund/federal funds). For
example, if an additional 1,000 additional women were served,
costs would be $5 million to $12 million for services, depending
on the program model. Various home visiting program models may
meet the bill's criteria.
The funding source is not specified, but the author points out
counties, managed care plans, hospitals, foundations, and local
First 5 programs all may have interest in funding the program if
a structure was in place to accommodate service delivery and
leverage federal funds - meaning local or private funding
AB 50
Page 3
coupled with federal funds may be a viable approach. The state
is pursuing an 1115 waiver from the federal government, through
which other states have received approval for federal matching
funds for home visiting.
3)Home visiting programs have a strong evidence base of outcomes
based on randomized controlled trials. To the extent the
delivery of home visiting programs is expanded, and assuming the
most successful programs are selected:
a) Some level of reduced state costs associated with fewer
pre-term deliveries, high-risk pregnancies, and childhood
injuries in Medi-Cal, and likely reductions in beneficiaries
of California Work Opportunity and Responsibility to Kids
Program benefits based on better labor market outcomes and
less welfare participation among service recipients.
b) Cost savings may accrue to counties or school districts
based on documented reductions in child abuse and fewer youth
crimes, reduced youth substance abuse, and fewer remedial
school services.
COMMENTS: 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 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 Nurse Family Partnership
(NFP) and other evidence-based nurse home visiting programs,
provide for the consistent solutions resonating among
stakeholders. These measures will help improve Healthcare
Effectiveness Data and Information Set measures, access to
services, and reduce costs while further increasing savings. It
is the responsibility of the Legislature and in the best interest
AB 50
Page 4
of all California citizens to prioritize efficiency and
effectiveness in the consideration of fiscal expenditures.
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.
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
AB 50
Page 5
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.
This bill has no known opposition.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0000648