BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 50
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|AUTHOR: |Mullin |
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|VERSION: |May 21, 2015 |
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|HEARING DATE: |July 8, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Medi-Cal: evidence-based home visiting programs.
SUMMARY :1) Requires the Department of Health Care Services to develop a
plan 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.
Existing law:
1)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
Children up to age 19 are eligible for Medi-Cal in families
with incomes up to 266% of the federal poverty level (FPL)
(266% of the FPL is at or below $52,641 annually for a family
of 3 in 2015) and pregnant women are eligible with family
incomes up to 322% of the FPL
2)Establishes the Nurse-Family Partnership (NFP) program, which
is administered by the Department of Public Health (DPH), to
provide grants for voluntary nurse home visiting programs for
expectant first-time mothers, their children, and their
families. Requires a county to satisfy specified requirements
in order to be eligible to receive a grant. The provisions of
the NPF program are subject to the normal Budget Act process
and are operative to the extent funds are appropriated.
This bill:
1)Requires DHCS to develop a plan on or before January 1, 2017,
to ensure that evidence-based home visiting programs are
offered and provided to Medi-Cal eligible pregnant and
parenting women. Requires DHCS to develop the plan in
consultation with stakeholders, including, but not limited to,
representatives from Medi-Cal managed care plans, public and
AB 50 (Mullin) Page 2 of ?
private hospitals, evidence-based home visiting programs, and
local governments, from diverse geographical regions of the
state.
2)Requires DHCS to consider all of the following in developing
the plan:
a) Establishing Medi-Cal coverage for evidence-based home
visiting program services;
b) Incentives for Medi-Cal providers to offer
evidence-based home visiting program services;
c) Other mechanisms to fund evidence-based home visiting
program services for Medi-Cal eligible pregnant and
parenting women; and,
d) Identifying among evidence-based home visiting programs
those with established evidence to improve health outcomes,
the experience of care, and cost savings to the health care
system.
1)Requires DHCS, in developing the plan, to prioritize the
identification of funding sources, other than General Fund
moneys, to fund evidence-based home visiting program services,
including local, federal, or private funds, or any other funds
made available for these program services.
2)Requires DHCS, on or before January 1, 2022, and every five
years thereafter, to report to the Legislature on
implementation progress and the effectiveness of
evidence-based home visiting services in improving maternal
and child health outcomes, the experience of care, and cost
savings to the Medi-Cal program and the state.
3)Defines an "evidence-based program" as a program that is based
on scientific evidence demonstrating that the program model is
effective, that is reviewed on site and compared to program
model standards by the model developer or the developer's
designee at least every five years to ensure that the program
continues to maintain fidelity with the program model, and
that has had demonstrated and replicated significant and
sustained positive outcomes that have been in one or more
well-designed and rigorous randomized controlled research
designs, and where the evaluation results have been published
in a peer-reviewed journal.
4)Defines an "evidence-based home visiting program" as a program
AB 50 (Mullin) Page 3 of ?
or initiative that does all of the following:
a) Meets, on or before April 1, 2015, the U.S. Department
of Health and Human Services Maternal, Infant, and Early
Childhood Home Visiting criteria, as specified;
b) Contains home visiting as a primary service delivery
strategy by providers satisfying home visiting program
requirements to provide services to families with a
pregnant or parenting woman who is eligible for medical
assistance;
c) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children
from prenatal to five years of age; and,
d) Targets participant outcomes that include all of the
following:
i. Improved maternal and child health.
ii. Prevention of child injuries, child
abuse or maltreatment, and reduction of emergency
department visits.
iii. Improvements in school readiness
and achievement.
iv. Reduction in crime or domestic
violence.
v. Improvements in family economic
self-sufficiency.
vi. Improvements in coordination of,
and referrals to, other community resources and
support.
vii. Improvements in parenting skills
related to child development.
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
AB 50 (Mullin) Page 4 of ?
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 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.
PRIOR
VOTES :
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|Assembly Floor: |79 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |16 - 0 |
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AB 50 (Mullin) Page 5 of ?
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COMMENTS :
1)Author's statement. According to the author, with rising
health care costs and an increasing Medi-Cal eligible
population across California, there is a need to strengthen
the capacity of our current healthcare system to address the
health needs of our most vulnerable populations at lower
costs. Evidence-based home visiting programs are proven
health-based interventions that can improve the health of
low-income families in the state, while helping reduce overall
costs to our system and improving system outcomes for the
state. Voluntary evidence-based home visiting programs - such
as NFP, Healthy Families America, Early Head Start (Home Based
Option), Parents as Teachers, and Home Instruction for Parents
of Preschool Youngsters - strengthen the critical parent-child
relationship and connect families with information and
resources during the pivotal time from pregnancy to age five.
With more than 37 years of evidence from randomized,
controlled trials and longitudinal follow-up studies, evidence
based home visiting programs have demonstrated sizeable,
sustained improvements in maternal health, child health and
development, economic stability of families, and helping break
intergenerational poverty. By establishing mechanisms for
Medi-Cal to increase the reach of home visiting programs, this
bill would substantially expand the scale of evidence-based
home visiting programs in California.
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. NFP
provides first-time, low-income mothers with home visitation
services by public health nurses. Typically beginning 18 to 28
weeks into their pregnancy, nurses work intensively with
mothers to improve prenatal, maternal, and early childhood
health and well-being, focusing on therapeutic relationships
with the family designed to improve family functioning in
health, home and neighborhood environment, family and friend
support, parental roles, and major life events. 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.
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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. A 1997 RAND study examined the benefits for
children and their families enrolled in early childhood
intervention programs. The study found that the NFP generated
increased tax revenues from increased employment and earnings,
decreased enrollment in public assistance programs, reduced
expenditures for education, health, and other services,
including special education, emergency room visits, and stays
in homeless shelters, and lowered criminal justice system
costs.
3)Prior legislation. 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.
AB 543 (Ma, 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."
AB 1829 (Ma, 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."
SB 1596 (Runner, Chapter 878, Statutes of 2006) establishes
the NFP program administered by the Department of Health
Services (now DPH).
AB 50 (Mullin) Page 7 of ?
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 states 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)Opposition. The California Right to Life Committee, Inc.
(CLRC) writes in opposition that the language in this bill
presumes to know better than families how to beget and raise
children. CLRC writes the mingling of public and private funds
does not represent a republican form of government guaranteed
by the U.S. Constitution. CLRC continues that this program is
very invasive of family life, and it sees the home-visitation
program as one of supposed helpful programs which is foisted
on the more vulnerable and less educated family members.
SUPPORT AND OPPOSITION :
Support: California Nurses Association
Children Now
First 5 Alameda County
First 5 Association of California
First 5 California
First 5 Solano Children and Families Commission
First 5 Sonoma County Commission
First 5 Tehama
March of Dimes California Chapter
Monterey County Board of Supervisors
Parents as Teachers
Prevent Child Abuse America
San Mateo County Board of Supervisors
Santa Clara County Board of Supervisors
Solano County Board of Supervisors
AB 50 (Mullin) Page 8 of ?
Oppose: California Right to Life Committee
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