BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 376 (Lopez) - CalWORKs eligibility:  immunizations
          
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          |Version: June 19, 2015          |Policy Vote: HUMAN S. 5 - 0     |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: June 29, 2015     |Consultant: Jolie Onodera       |
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          This bill meets the criteria for referral to the Suspense File. 

          

          Bill  
          Summary:  AB 376 would, commencing July 1, 2016, require county  
          human services agencies to first review the California  
          Immunization Registry (CAIR) to verify that specified children  
          in the CalWORKs assistance unit have received all  
          age-appropriate immunizations prior to requiring CalWORKs  
          applicants and recipients to provide immunization records, as  
          specified.


          Fiscal  
          Impact:  
           Potentially significant one-time and ongoing  
            state-reimbursable county administrative costs (General Fund)  
            for training and verification of immunizations of each  
            applicable child in the CAIR for applicants and recipients  
            prior to requesting immunization records. The new workload  
            would be offset in part by replacing the existing workload for  
            cases that provide and require verification of paper  
            documentation, as well as administrative cost savings for  







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            those cases found in the CAIR that would no longer require a  
            follow-up request for documentation. The net increase in  
            ongoing administrative costs is estimated at $360,000 to $1  
            million (General Fund).
           Potentially significant decrease in CalWORKs sanctions for  
            failure to provide immunization records, resulting in  
            increased ongoing CalWORKs grant costs of about $1.5 million  
            (General Fund). DSS data indicates approximately 32 percent of  
            cases sanctioned for not providing the required documentation  
            were sanctioned for one month (and are assumed to otherwise  
            have the immunizations complete). This estimate assumes 38  
            percent of those cases sanctioned for one month would have  
            information available in the CAIR that would potentially  
            result in averted sanctions.  
           Potentially significant one-time costs (General Fund) for  
            reprogramming of the Statewide Automated Welfare System  
            (SAWS).


          Background:  Existing law provides that all applicants for or recipients of  
          CalWORKs are required to provide documentation within 30 or 45  
          days of determination of aid, as specified, that each child in  
          the assistance unit who is not required to be enrolled in school  
          has received all age-appropriate immunizations, unless it has  
          been medically determined  that an immunization for the child is  
          not appropriate or the applicant or recipient has filed with the  
          county welfare department an affidavit that the immunizations  
          are contrary to the applicant's or recipient's beliefs. If the  
          county determines that good cause exists for not providing the  
          required documentation due to lack of reasonable access to  
          immunization services, the period is extended for an additional  
          30 days. (Welfare and Institutions Code  11265.8.)
          Under existing law, if the documentation is not provided within  
          the required time period, the needs of all parents or caretaker  
          relatives in the assistance unit are not to be considered in  
          determining the grant to the assistance unit until the required  
          documentation is provided.


          Existing law provides that local health officers may operate  
          immunization information systems in conjunction with the  
          Immunization Branch of the State Department of Public Health  
          (DPH). (Health and Safety Code  120440). For those counties  
          that do operate the CAIR, it is optional on the part of medical  








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          providers in that county to submit the immunization information  
          for all patients. According to the DPH, the annual cost to  
          operate the statewide system is $2.9 million utilizing funds  
          from the federal Centers for Disease Control (CDC) Immunization  
          grants.


          Proposed  
          Law:  This bill would, commencing July 1, 2016, require that in  
          lieu of initially requesting verification of age-appropriate  
          immunizations, the county shall first verify whether each child  
          has received all age-appropriate immunizations by reviewing the  
          California Immunization Registry. If the registry does not  
          contain records of these immunizations, the county shall require  
          the applicant or recipient to provide documentation that the  
          immunizations have been performed, unless the applicant or  
          recipient has filed an affidavit that the immunizations are  
          contrary to his or her beliefs or has supplied documentation  
          that it has been medically determined that an immunization is  
          not appropriate. 


          Staff  
          Comments:  By placing new duties on county human services  
          agencies, this bill creates a state-mandated local program.  
          While it has been indicated that approximately one third to one  
          half of counties currently utilize the CAIR, by statutorily  
          requiring county agencies to use CAIR to verify immunization for  
          all children not required to be enrolled in school for all  
          applicants and recipients, this bill could result in a  
          reimbursable state mandate for costs associated with statewide  
          usage of the CAIR, which could include one-time costs for  
          training and ongoing costs for the administrative time required  
          to check the system for verification of each applicable child.  
          The new workload would replace in part the existing process of  
          verifying paper immunization records for those cases that  
          currently provide documentation and are not sanctioned. 
          The net increase in ongoing administrative costs are estimated  
          at $360,000 to $1 million (General Fund) assuming new county  
          administrative workload of three to five minutes per child to  
          query the CAIR for those cases that are sanctioned. No  
          additional net costs for counties to verify immunization in the  
          CAIR for the population that currently provides documented proof  
          of immunization is estimated, as the county administrative time  








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          would be replaced from verifying physical documentation to  
          verifying web-based documentation.


          The DSS has indicated over 2,400 cases per month are sanctioned  
          for one month for not providing the required documentation. To  
          the extent utilization of the CAIR results in fewer CalWORKs  
          sanctions for failure to provide immunization records, the  
          provisions of this measure could result in increased ongoing  
          CalWORKs grant costs of about $1.5 million (General Fund). This  
          cost estimate assumes 38 percent of those cases would have  
          information available in the CAIR that would potentially result  
          in averted sanctions.  


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