BILL ANALYSIS Ó AB 376 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 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 AB 376 Page 2 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 AB 376 Page 3 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 documentation. 2)Potentially significant decrease in CalWORKs sanctions for failure to provide immunization records, resulting in AB 376 Page 4 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 (SAWS). COMMENTS: 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 AB 376 Page 5 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 AB 376 Page 6 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: 0001955 AB 376 Page 7