BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 376|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 376
Author: Lopez (D)
Amended: 8/31/15 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/9/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
ASSEMBLY FLOOR: 77-0, 5/7/15 (Consent) - See last page for
vote
SUBJECT: CalWORKs eligibility: immunizations.
SOURCE: Coalition of California Welfare Rights Organizations
DIGEST: This bill allows a county to attempt to verify through
the California Immunization Registry that each child under age
six in a CalWORKs (California Work Opportunity and
Responsibility to Kids) 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.
ANALYSIS: Existing federal law establishes 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.)
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Existing state law:
1)Establishes in state law the 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 10530)
2)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)
3)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)
4)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)
5)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)
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6)Allows local health officers to operate immunization
information systems containing individuals' vaccination
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. It also
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 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:
1)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.
2)Permits a county to 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, and with
defined exceptions.
Background
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 one million children. Federal funding
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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 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 required documentation due to lack
of reasonable access to immunization services.
Data compiled by the California Department of Social Services
(CDSS), 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 six.
------------------------------------------
| |
| Total Adults Penalized for Failure to |
| Provide |
| |
| Immunization Documentation |
------------------------------------------
|-------------+-------------+-------------|
| | | |
| Calendar | Calendar | Calendar |
| Year 2014 | Year 2013 | Year 2012 |
| | | |
|-------------+-------------+-------------|
| | | |
| 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 six, 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
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 a parent's refusal to share information, or because
of 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
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According to the Senate Appropriations Committee, this bill will
result in potentially significant one-time and ongoing
non-reimbursable county administrative costs (Local Funds) 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 those cases found in the CAIR
that would no longer require a follow-up request for
documentation.
The analysis also identified a 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). According to CDSS data
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. Additionally, the
Appropriations Committee identified potentially significant
one-time costs (General Fund) for reprogramming of the Statewide
Automated Welfare System.
SUPPORT: (Verified8/28/15)
Coalition of California Welfare Rights Organizations (source)
California Immigrant Policy Center
County Welfare Directors Association of California
Western Center on Law and Poverty
OPPOSITION: (Verified8/28/15)
None received
ARGUMENTS IN SUPPORT: According to the author, this bill
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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 permits the county to 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 must request
verification of immunization within 30 days.
This bill's sponsor, the Coalition of California Welfare Rights
Organizations, writes that this bill will "allow the county to
use current technology to simplify the CalWORKs administrative
process, saving taxpayer administrative dollars and simplifying
the process for the beneficiaries of the CalWORKs program."
ASSEMBLY FLOOR: 77-0, 5/7/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau,
Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly,
Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark
Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams,
Wood, Atkins
NO VOTE RECORDED: Campos, Roger Hernández, Steinorth
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
8/31/15 8:54:53
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