BILL ANALYSIS Ó
AB 376
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Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Kansen Chu, Chair
AB 376
(Lopez) - As Amended April 6, 2015
SUBJECT: CalWORKs eligibility: immunizations
SUMMARY: Requires counties to access an internet-based
computerized information system to verify, when possible,
immunization of children under the age of 6 in CalWORKs
families.
Specifically, this bill:
1)Requires county welfare departments to first search the
California Immunization Registry and find no records of
immunization prior to requesting applicants for or recipients
of CalWORKs to submit vaccination documentation for children
not required to be enrolled in school.
2)Stipulates that no continuous appropriation shall be made from
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the General Fund to counties in order to implement this act.
EXISTING LAW:
1)Establishes in federal law the Temporary Assistance for Needy
Families (TANF) program, which provides block grants to states
to develop and implement their own state welfare-to-work
programs designed to provide cash assistance and other
supports and services to low-income families. (42 USC § 601
et seq.)
2)Establishes the state's TANF program, the California Work
Opportunity and Responsibility to Kids (CalWORKs) program.
CalWORKs provides cash assistance and other supports and
services to low-income families and is administered by the
counties. (WIC 11200 et seq.)
3)Requires CalWORKs applicants and recipients to provide
documentation showing that all children in the assistance unit
who are not required to be enrolled in school have received
all age appropriate immunizations within 30 to 45 days, as
specified. Provides exemptions in cases where it has been
determined that immunizations are not medically appropriate,
or when an affidavit attesting that immunizations are contrary
to the applicant's or recipient's beliefs has been filed with
the county welfare department. (WIC 11265.8)
4)Prohibits an aid payment for any adult in the assistance unit
if required documentation of immunization is not provided
within the specified time period. (WIC 11265.8)
5)Directs the Department of Public Health, in consultation with
the Department of Education, to adopt and enforce regulations
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to carry out the stated legislative intent to fully immunize
appropriate age groups against certain childhood diseases,
including diphtheria, measles, mumps, and others, as
specified. Allows for certain medical and personal-belief
exemptions to immunization requirements, provided
documentation is supplied, as specified. (HSC 120325 et seq.)
6)Allows local health officers to, either separately or jointly
with other jurisdictions and in conjunction with the
Department of Public Health's Immunization Branch, operate
immunization information systems containing individuals'
vaccination information. Further allows the information in
these systems to be shared with specified entities, including
with county welfare departments for the purpose of assessing
the immunization histories of dependents of CalWORKs
participants. States that individuals have the right to
refuse the sharing of their information in these systems, and
requires that individuals be informed of this right. (HSC
120440)
FISCAL EFFECT: Unknown
COMMENTS:
CalWORKs immunization requirements: The Personal Responsibility
and Work Opportunity Reconciliation Act (PRWORA) of 1996 (P.L.
104-193) was the federal law adopting the "welfare reform" of
the late 1990s. It created the federal TANF program, which
offers block grants to states to design their own welfare
programs, provided they meet certain requirements, including
establishing work requirements and placing a lifetime limit of
five years on receipt of benefits. One of the many provisions
contained in PRWORA permits states to create "individual
responsibility plans" for participants that may, among other
things, require individuals to immunize their children.
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Twenty-four states including California require TANF
participants to submit documentation of immunization for young
children (data as of July 2013). AB 1542 (Ducheny), Chapter
270, Statutes of 1997, created the CalWORKs program as
California's implementation of federal welfare reform.
Alongside many other changes, this bill added Section 11265.8 to
the Welfare and Institutions Code, requiring that all applicants
for and recipients of CalWORKs benefits provide documentation
that any children in the assistance unit under the age of 6 not
required to be enrolled in school have received all
age-appropriate immunizations. Applicants and recipients who
file an affidavit with the county stating that immunizations are
against their beliefs, or who supply documentation stating that
it has been medically determined that immunizations are
inappropriate, are exempt from this requirement. Applicants and
recipients are to be notified of their obligation to provide
proof of immunization, and must also receive information on:
the relevant childhood immunization schedules, how to obtain
immunizations using Medi-Cal or through a county public health
clinic or other available sources, as appropriate, and a
statement explaining the personal belief exemption.
Parents and caretaker relatives are allowed either 30 or 45
days, depending on their individual situations, to supply
documentation of immunization; an additional 30 days may be
granted if the county finds that good cause exists for not
submitting verification in the timeframe allowed. If
documentation is not provided within the required time period, a
parent's or caretaker relative's needs will not be considered in
determining the grant amount for the assistance unit until the
required documentation is supplied. For the past three years,
the numbers of adults penalized for not providing timely
verification of immunization have been: 99,361 (2014), 83,759
(2013), and 109,238 (2012).
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California Immunization Registry: All 50 states have
immunization registries. The California Immunization Registry
(CAIR) is a secure and confidential statewide computerized
information system consisting of nine separate regional
registries. These regions, most of which are multi-county,
cover 57 of California's 58 counties; Imperial County operates
its own registry that is not part of the CAIR system. Seven of
the nine CAIR regions currently use the same software, while San
Diego County and the greater San Joaquin Valley use different
software. The current regional structure of CAIR only enables
authorized users to access immunization data within their
defined region; however, look-up access to other regional
registries is available to state or county governmental agencies
upon request. It is expected that CAIR will eventually allow
any CAIR user to access immunization data across the state by
integrating its regional databases. This effort, the "CAIR 2.0
Project," is currently underway and integration is expected to
be completed by the summer of 2017.
Use of CAIR is voluntary. Health care providers are allowed to
enter immunization records into a registry, provided the
individual or the individual's parent has been notified about
the registry and the right to "lock" his or her (or his or her
child's) information in CAIR so that no users other than his or
her health care provider may access them. Users must sign a
confidentiality agreement to access CAIR; a user ID and password
are needed to log in to the registry. Authorized users include
health care providers and plans, schools, county welfare
departments, foster care agencies, family child care homes and
child care facilities. Counties were recently polled on their
use of CAIR; of the 23 counties that responded, nine currently
use it to some extent, but it appears that most seek
verification from the client before logging into the system.
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Almost 2.9 million children under the age of 6 (96.7% of the
total age-group population in the state) have immunization
records contained in CAIR, with almost 1.9 million children
under the age of 6 (63.5% of the total age-group population)
having at least two immunization doses recorded.
Need for the bill: According to the author, "this bill will
help streamline and simplify an administrative process, which
will help families access the supports they need by using
current technology to verify immunization records. Currently,
CalWORKs requires an applicant or recipient to immunize their
minor children and provide proof of immunization. For our most
vulnerable populations, this extra step in the process to
receive benefits can add to an already stressful situation.
This bill would require that the county first review the
California State registry of immunizations, which is maintained
by the Department of Public Health before asking the family to
provide the records. If the registry indicates that the
children have not met the immunization requirements, then the
county can request verification of immunization."
Staff comments: Locating or obtaining immunization
documentation, and providing this information to the county, can
create an additional set of barriers for families who already
face numerous obstacles to securing services and supports as
they work to move out of poverty. Using CAIR to verify
children's immunization histories before requiring families to
locate or obtain related documentation will assist in the
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navigation of the CalWORKs eligibility and redetermination
process and, ultimately, reduce the number of families facing
reduced grant amounts resulting from tardy submission of
verification.
However, beyond facilitating access to documentation, more could
be done to facilitate access to the immunizations themselves.
Poverty can be correlated with limited access to a regular
source of affordable health care, contributing to reduced access
to age-appropriate vaccinations. National data for 2013 from
Centers for Disease Control indicate that, for children 19 to 35
months old, 71% living in families with incomes below the
poverty level had received specified vaccinations, compared to
80% of those living in families with incomes above the poverty
line. Options exist for counties to help families access
immunization services, such as requiring counties to provide
information on local free vaccination clinics prior to
penalizing the family by reducing their grant amount. One
example of facilitated access exists in Virginia: there,
sanctions may not be imposed on families until the reason for
failing to comply with the immunization requirement has been
identified and any barriers to accessing immunizations have been
removed (45 Code of Virginia 63.2-603). Should this bill move
forward, the author may wish to include provisions that further
assist CalWORKs applicants and recipients in obtaining necessary
vaccinations for their children.
Recommended amendments:
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1)In order to make clear that parents and caretaker relatives
are able to secure a personal-belief exemption at any point
prior to immunization documentation being due, committee staff
recommends the following amendments to paragraph (a)(2),
beginning on page 2 of the bill:
11 (2) If an applicant or recipient has not filed an
affidavit has not
12 been filed with the county welfare department, the The
county shall
13 verify on behalf of any applicant or recipient required to
provide
14 documentation that the immunizations have been performed
each
15 child in the assistance unit not required to be enrolled
in school
16 has received all age-appropriate immunizations by
obtaining a
17 report from the California Immunization Registry
established
18 pursuant to Section 120440 of the Health and Safety Code.
If the
19 registry does not contain records of these immunizations,
the
20 county shall require the applicant or recipient to provide
21 documentation that the immunizations have been performed ,
or
22 are not medically appropriate, , unless the applicant or
recipient has filed an affidavit that the immunizations are
contrary to his or her beliefs or supplied documentation that it
has been medicially medically
23 determined that an immunization is not appropriate within
30 days
24 of the determination of eligibility for Medi-Cal benefits
under
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1 Chapter 7 (commencing with Section 14000), or 45 days for
2 applicants already eligible for benefits under Chapter 7
3 (commencing with Section 14000), or within 45 days of a full
or
4 financial redetermination of eligibility for aid under this
chapter.
2)Additionally, in order to ensure that DSS and the counties
have ample time for proper implementation, committee staff
further recommends that the bill become effective on July 1,
2016.
REGISTERED SUPPORT / OPPOSITION:
Support
Coalition of California Welfare Rights Organizations, Inc. -
sponsor
California Alternative Payment Program Association (CAPPA)
California Immigrant Policy Center
San Diego Hunger Coalition
Western Center on Law and Poverty
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Opposition
None on file.
Analysis Prepared by:Daphne Hunt / HUM. S. / (916) 319-2089