BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                        AB 376|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |

                                   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


           ASSEMBLY FLOOR:  77-0, 5/7/15 (Consent) - See last page for  

           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  


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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.


          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  
          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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