BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 376
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|Author: |Lopez |
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|Version: |April 21, 2015 |Hearing |June 9, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Mareva Brown |
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Subject: CalWORKs eligibility: immunizations.
SUMMARY
This bill requires a county to attempt to verify through the
California Immunization Registry that each child under age 6 in
a CalWORKs assistance unit has received all age-appropriate
immunizations before requiring an applicant or recipient to
provide their child's immunization record, beginning July 1,
2016.
ABSTRACT
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 to provide cash assistance and
other supports and services to low- income families. (42
USC § 601 et seq.)
2) Establishes in state law the California Work Opportunity
and Responsibility to Kids (CalWORKs) program to provide
cash assistance and other social services for low-income
families through the TANF program. Under CalWORKs, each
county provides assistance through a combination of state,
county and federal TANF funds. (WIC 11200, et seq. WIC
AB 376 (Lopez) Page 2
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10530)
3) Establishes within the Communicable Disease Prevention
and Control Act specific childhood immunization
requirements and prohibits admission of a pupil of any
private or public elementary or secondary school, child
care center, day nursery, nursery school, family day care
home, or development center, unless, prior to his or her
first admission to that institution, he or she has been
fully immunized. (HSC 120325)
4) Directs the state Department of Public Health to adopt
and enforce regulations to carry out the stated legislative
intent to fully immunize appropriate age groups against
specified childhood diseases, including measles, mumps,
whooping cough, chicken pox and others, as well as any
other disease deemed appropriate by the department, taking
into consideration the recommendations of the Advisory
Committee on Immunization Practices of the United States
Department of Health and Human Services, the American
Academy of Pediatrics, and the American Academy of Family
Physicians. (HSC 120325)
5) 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, unless it has been medically determined
that an immunization is not appropriate, or 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)
6) 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)
7) Allows local health officers to operate immunization
information systems containing individuals' vaccination
AB 376 (Lopez) Page 3
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information in conjunction with the Department of Public
Health's Immunization Branch. Allows this immunization
information to be shared with other states and with
specified entities within California, including 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)
This bill:
1) Strikes existing statute requiring immunizations for
children in a CalWORKs assistance unit and replaces it with
rewritten statutory language mandating the same time
frames, sanctions and medical or personal belief
exemptions, but requires the following changes:
a. Removes the requirement that documentation be
provided to the county that age-appropriate
vaccinations are completed, and replaces it with the
requirement that all children in the unit receive
age-appropriate vaccines.
b. Requires that a county verify each child has
received required immunizations by obtaining a report
from the California Immunization Registry (CAIR), and
requires that if the registry does not contain records
the county must require the applicant or recipient to
provide documentation that the immunizations have been
performed, as specified.
FISCAL IMPACT
According to an Assembly Appropriations Committee analysis,
about one-third of counties already use CAIR for this purpose
and the costs to train additional staff to use CAIR are minor
and likely absorbable within existing county training budgets.
BACKGROUND AND DISCUSSION
Purpose of the bill:
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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, according to the
author. This bill requires that the county first review the
California State registry of immunizations, before asking the
family to provide the records, the author states. If the
registry indicates that the children have not met the
immunization requirements, then the county can request
verification of immunization within 30 days.
California Work Opportunity and Responsibility to Kids program
(CalWORKs)
California has the highest poverty rate in the nation - just
under one-quarter of residents are living at or below the
federal poverty level (FPL) according to the national
Supplemental Poverty Measure. These families earn no more than
$20,090 per year for a family of three. One of California's most
essential anti-poverty strategies is the CalWORKs program, which
provided cash assistance to approximately 540,000 families in
2014, including more than 1 million children. Federal funding
for CalWORKs comes from the TANF block grant. A grant to a
family of three in a high-cost California county is $704 per
month, or income at approximately 42 percent of the federal
poverty level (FPL).
Immunization requirements and sanctions
Current statute requires that parents or guardians of young
children within a CalWORKs assistance unit provide proof of
current immunization in order for any adult in the unit to
receive assistance. Adults have 30 days from the initial
application, and 45 days from a redetermination to submit
verification of immunizations, with a 30-day extension available
if a county determines there is good cause for not providing the
AB 376 (Lopez) Page 5
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required documentation due to lack of reasonable access to
immunization services.
Data compiled by the California Department of Social Services,
below, indicates that in nearly 100,000 of the 540,000 families
receiving assistance in 2014, the household's adults were
sanctioned for failing to provide immunization documentation for
children under age 6.
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| Total Adults Penalized for Failure to |
| Provide Immunization Documentation |
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| |
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| Calendar | Calendar | Calendar |
| Year 2014 | Year 2013 | Year 2012 |
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|-------------+-------------+-------------|
| 99,361 | 83,759 | 109,238 |
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California Immunization Registry
All 50 states have immunization registries. California's
registry is a statewide information system that includes nine
regional registries encompassing 57 of the state's 58 counties.
Almost 2.9 million children under the age of 6, or nearly 97
percent of the state's total population in that age group, have
at least one immunization record recorded in CAIR.
Use of the CAIR is voluntary, and requires parent disclosure
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before a child's health care provider can enter a child's
immunization information. Parents have the right to prevent
anyone other than their child's provider from accessing the
immunization records. The CAIR is designed to allow access to
immunization information for health care providers and plans,
schools, county welfare departments, foster care agencies,
family child care homes and child care facilities.
According to the County Welfare Directors Association (CWDA),
about half of the state's counties currently access the CAIR to
verify that required CalWORKs household immunizations have been
completed. At least some counties may seek independent
verification of immunizations from the client before logging
into the system. CWDA notes that not all children's
immunizations would be able to be verified through the CAIR
because of either parent refusal to share names, or misspelled
children's names.
Other hurdles to full use of the CAIR include technology:
Imperial County operates its own registry that is not part of
the CAIR system. Seven of the nine CAIR regions are using the
same software, but San Diego County and the greater San Joaquin
Valley use different software. Additionally, users can only
access immunization data in CAIR within their defined regions;
to verify whether a child has had an immunization in another
region of the state requires a separate request to the registry.
Efforts are underway to modernize the CAIR, including allowing
statewide access to data, and are expected to be completed by
the summer of 2017.
Related legislation:
AB 1542 (Ducheny), Chapter 270, Statutes of 1997, created the
CalWORKs program as California's implementation of federal
welfare reform and included the requirement that children in an
assistance unit under the age of 6 not required to be enrolled
in school have received all age-appropriate immunizations.
COMMENTS
Providing up-to-date immunization records can be a barrier to
aid for families who already are challenged by a lack of
resources. Using an available registry to verify immunization
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records for children can save clients time and may streamline
the application process for counties. CWDA reports that the
counties that use CAIR find the database to be useful. While the
CAIR is not 100 percent functional yet, with limitations around
accessing children's information in the database and use of
technology across the state's regions, the author argues that it
remains a valuable tool to help the poorest parents in this
state access the CalWORKs program.
PRIOR VOTES
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|Assembly Floor: |77 - |
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|Assembly Appropriations Committee: |17 - |
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|Assembly Human Services Committee: |7 - |
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POSITIONS
Support:
Coalition of California Welfare Rights Organizations
(Sponsor)
California Immigrant Policy Center
County Welfare Directors Association of California
Western Center on Law and Poverty
Oppose:
None received.
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