BILL ANALYSIS                                                                                                                                                                                                    

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          376 (Lopez)

          As Amended  August 31, 2015

          Majority vote

          |ASSEMBLY:  | 77-0 |(May 7,2015)   |SENATE: |40-0  |(September 3,    |
          |           |      |               |        |      |2015)            |
          |           |      |               |        |      |                 |
          |           |      |               |        |      |                 |

          Original Committee Reference:  HUM. S.

          SUMMARY:  Permits counties to access an internet-based  
          computerized information system to verify, when possible,  
          immunization of children under the age of 6 in CalWORKs  
          families.  Specifically, this bill:

          1)Permits county welfare departments to first search the  
            California Immunization Registry (CAIR) to verify immunization  
            of children not required to be enrolled in school prior to  
            requesting applicants for or recipients of CalWORKs to submit  
            vaccination documentation for those children.

          2)Stipulates that no continuous appropriation shall be made from  
            the General Fund to counties in order to implement this act.

          The Senate amendments remove the requirement that county welfare  


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          departments first search the CAIR for immunization records prior  
          to requesting vaccination documentation from clients, and  
          instead permit counties to use the CAIR in lieu of initially  
          requesting documentation.

          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 designed to provide cash assistance and other  
            supports and services to low-income families.  (42 United  
            States Code Section 601 et seq.)

          2)Establishes the state's TANF program, the California Work  
            Opportunity and Responsibility to Kids (CalWORKs) program.   
            CalWORKs provides cash assistance and other supports and  
            services to low-income families and is administered by the  
            counties.  (Welfare and Institutions Code (WIC) Section 11200  
            et seq.)

          3)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.  Provides exemptions in cases where it has been  
            determined that immunizations are not medically appropriate,  
            or when an affidavit attesting that immunizations are contrary  
            to the applicant's or recipient's beliefs has been filed with  
            the county welfare department.  (WIC Section 11265.8)

          4)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 Section 11265.8)

          5)Directs the Department of Public Health, in consultation with  


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            the Department of Education, to adopt and enforce regulations  
            to carry out the stated legislative intent to fully immunize  
            appropriate age groups against certain childhood diseases,  
            including diphtheria, measles, mumps, and others, as  
            specified.  Allows for certain medical and personal-belief  
            exemptions to immunization requirements, provided  
            documentation is supplied, as specified.  (Health and Safety  
            Code (HSC) Section 120325 et seq.)

          6)Allows local health officers to, either separately or jointly  
            with other jurisdictions and in conjunction with the  
            Department of Public Health's Immunization Branch, operate  
            immunization information systems containing individuals'  
            vaccination information.  Further allows the information in  
            these systems to be shared with specified entities, including  
            with 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  
            Section 120440)

          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee, this bill may result in the following costs:

          1)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  

          2)Potentially significant decrease in CalWORKs sanctions for  
            failure to provide immunization records, resulting in  


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            increased ongoing CalWORKs grant costs of about $1.5 million  
            (General Fund).  Department of Social Services data indicates  
            approximately 32% 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% of those cases sanctioned for one month  
            would have information available in the CAIR that would  
            potentially result in averted sanctions.  

          3)Potentially significant one-time costs (General Fund) for  
            reprogramming of the Statewide Automated Welfare System  


          CalWORKs immunization requirements:  AB 1542 (Ducheny), Chapter  
          270, Statutes of 1997, created the CalWORKs program as  
          California's implementation of federal welfare reform.   
          Alongside many other changes, this bill added to the Welfare and  
          Institutions Code Section 11265.8, requiring that all applicants  
          for and recipients of CalWORKs benefits provide documentation  
          that any children in the assistance unit under the age of 6 not  
          required to be enrolled in school have received all  
          age-appropriate immunizations.  Applicants and recipients who  
          file an affidavit with the county stating that immunizations are  
          against their  beliefs, or who supply documentation stating that  
          it has been medically determined that immunizations are  
          inappropriate, are exempt from this requirement.  Applicants and  
          recipients are to be notified of their obligation to provide  
          proof of immunization, and must also receive information on:   
          the relevant childhood immunization schedules, how to obtain  
          immunizations using Medi-Cal or through a county public health  
          clinic or other available sources, as appropriate, and a  
          statement explaining the personal belief exemption. 

          Parents and caretaker relatives are allowed either 30 or 45  
          days, depending on their individual situations, to supply  
          documentation of immunization; an additional 30 days may be  


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          granted if the county finds that good cause exists for not  
          submitting verification in the timeframe allowed.  If  
          documentation is not provided within the required time period, a  
          parent's or caretaker relative's needs will not be considered in  
          determining the grant amount for the assistance unit until the  
          required documentation is supplied.  For the past three years,  
          the numbers of adults penalized for not providing timely  
          verification of immunization have been:  99,361 (2014), 83,759  
          (2013), and 109,238 (2012). 

          California Immunization Registry:  All 50 states have  
          immunization registries.  The California Immunization Registry  
          (CAIR) is a secure and confidential statewide computerized  
          information system consisting of nine separate regional  
          registries.  These regions, most of which are multi-county,  
          cover 57 of California's 58 counties; Imperial County operates  
          its own registry that is not part of the CAIR system.  Seven of  
          the nine CAIR regions currently use the same software, while San  
          Diego County and the greater San Joaquin Valley use different  
          software.  The current regional structure of CAIR only enables  
          authorized users to access immunization data within their  
          defined region; however, look-up access to other regional  
          registries is available to state or county governmental agencies  
          upon request.  It is expected that CAIR will eventually allow  
          any CAIR user to access immunization data across the state by  
          integrating its regional databases.  This effort, the "CAIR 2.0  
          Project," is currently underway and integration is expected to  
          be completed by the summer of 2017.

          Use of CAIR is voluntary.  Health care providers are allowed to  
          enter immunization records into a registry, provided the  
          individual or the individual's parent has been notified about  
          the registry and the right to "lock" his or her (or his or her  
          child's) information in CAIR so that no users other than his or  
          her health care provider may access them.  Users must sign a  
          confidentiality agreement to access CAIR; a user ID and password  
          are needed to log in to the registry.  Authorized users include  
          health care providers and plans, schools, county welfare  
          departments, foster care agencies, family child care homes and  
          child care facilities.  Counties were recently polled on their  


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          use of CAIR; of the 23 counties that responded, nine currently  
          use it to some extent, but it appears that most seek  
          verification from the client before logging into the system. 

          Almost 2.9 million children under the age of 6 (96.7% of the  
          total age-group population in the state) have immunization  
          records contained in CAIR, with almost 1.9 million children  
          under the age of 6 (63.5% of the total age-group population)  
          having at least two immunization doses recorded.

          Need for the bill:  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.   
          This bill would require that the county first review the  
          California State registry of immunizations, which is maintained  
          by the Department of Public Health before asking the family to  
          provide the records.  If the registry indicates that the  
          children have not met the immunization requirements, then the  
          county can request verification of immunization."

          Analysis Prepared by:                                             
                          Daphne Hunt / HUM. S. / (916) 319-2089  FN:  


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