BILL ANALYSIS                                                                                                                                                                                                    



          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     |
          |          |                       |Date:      |                 |
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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  







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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  








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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  








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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.



                           ------------------------------------------ 
                          |  Total Adults Penalized for Failure to   |
                          |    Provide Immunization Documentation    |
                          |                                          |
                          |                                          |
                           ------------------------------------------ 
                          |-------------+-------------+-------------|
                          |  Calendar   |  Calendar   |  Calendar   |
                          |  Year 2014  |  Year 2013  |  Year 2012  |
                          |             |             |             |
                          |             |             |             |
                          |-------------+-------------+-------------|
                          |   99,361    |   83,759    |   109,238   |
                          |             |             |             |
                          |             |             |             |
                          |-------------+-------------+-------------|
                          |             |             |             |
                          |             |             |             |
                          |             |             |             |
                          |             |             |             |
                           ----------------------------------------- 

          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.      

                                      -- END --