BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 50 (Mullin) - Medi-Cal: evidence-based home visiting
programs.
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|Version: May 21, 2015 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 50 would require the Department of Health Care
Services to develop a plan to ensure that evidence-based home
visitation programs are provided as a Medi-Cal benefit to
pregnant and parenting women.
Fiscal
Impact:
One-time costs, likely from $250,000 to $500,000 per year for
one to two years, to consult with stakeholders, review
existing programs and program evaluations, and develop a plan
for the provision of home visitation services in Medi-Cal by
the Department of Health Care Services (General Fund and
federal funds).
Unknown costs to provide home visitation services to Medi-Cal
beneficiaries (unknown fund source). The cost to provide home
visitation services will depend largely on how widely
available the program is made to Medi-Cal beneficiaries. For
AB 50 (Mullin) Page 1 of
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example, the Department could develop a program that is made
available to Medi-Cal beneficiaries who are most likely to
benefit from intensive interventions. Alternatively, the
Department could make a limited number of program slots
available on a first come first serve basis. Given that there
are almost 90,000 births to first time mothers in the Medi-Cal
program every year, it is not likely that the Department would
be able to offer home visitation services universally.
For example, if the Department offered access to a home
visitation program to 10,000 first time mothers per year, the
annual cost would be about $110 million per year, based on
average program costs and participant duration in the existing
program operated by the Department of Public Health.
The bill directs the Department to prioritize non-General Fund
sources of funding for the program. Whether such sources of
funding would be available in any significant amount is
unknown.
Potentially significant offsetting savings to participating
Medi-Cal beneficiaries (General Fund, federal funds, and local
funds). According to a program evaluation of the existing home
visitation programs offered in the state, there are
significant offsetting savings that accrue over time due to
program participation. That evaluation found that the average
program expenditure per participant of $12,000 (over multiple
years) was offset by about $11,000 in direct savings (mostly
to state and local governments) due to reduced health care
costs, child welfare spending, special education spending, and
criminal justice system costs. In addition, the evaluation
found overall social cost savings of about $40,000 per family,
mainly due to reductions in child mortality and child abuse
and improved health.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
AB 50 (Mullin) Page 2 of
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category of beneficiary.
The Department of Public Health manages two home visitation
programs for first time mothers in the state. Those programs are
funded with federal funds and are operated at the local level by
counties. The programs have a total capacity to serve about
2,200 families per year (although families can participate for
more than one year). About 85% of program participants qualify
for Medi-Cal. As noted above, an independent program evaluation
of one of the programs indicated that the overall, society-wide
benefits of the program are significantly larger than the direct
program costs.
Proposed Law:
AB 50 would require the Department of Health Care Services to
develop a plan to ensure that evidence-based home visitation
programs are provided as a Medi-Cal benefit to pregnant and
parenting women.
Specific provisions of the bill would:
Require the Department to develop a plan, before January 1,
2017 to ensure that evidence-based home visitation programs
are offered and provided to pregnant and parenting Medi-Cal
beneficiaries;
Require the Department to consider issues relating to funding
and other issues;
Require the Department to identify potential fund sources;
Require the Department to report every five years on program
implementation.
Staff
Comments: Based on the existing programs managed by the
Department of Public Health, there seems to be significant
opportunity to improve maternal and child health and social
outcomes at a relatively small net cost to the state, per
participant. However, whether or not those positive outcomes
will translate from a relatively small program into a much
larger, more widely available program in Medi-Cal is uncertain.
The bill would require the Department to plan for and then
implement such a home visitation program. The bill is not very
prescriptive in how the Department should offer such a benefit
in Medi-Cal. For example, participation could limited by
AB 50 (Mullin) Page 3 of
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specific eligibility criteria or simply based on a fixed number
of participants. The bill gives very broad authority to the
Department to develop and implement the program.
It would be more prudent for the Legislature to require the
Department to develop a plan for offering home visitation
services in Medi-Cal and then provide that information to the
Legislature. The Legislature could then evaluate the potential
costs and benefits of providing home visitation services in
Medi-Cal before actually authorizing implementation of the
program.
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