BILL ANALYSIS Ó
AB 376
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GOVERNOR'S VETO
AB
376 (Lopez)
As Enrolled September 10, 2015
2/3 vote
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|ASSEMBLY: | 77-0 |(May 7, 2015) |SENATE: |40-0 |(September 3, |
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|ASSEMBLY: | 78-0 |(September 8, | | | |
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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 six in California Work
Opportunity and Responsibility to Kids (CalWORKs) families.
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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
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 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.)
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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
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)
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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
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
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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
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,
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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
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
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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."
GOVERNOR'S VETO MESSAGE:
This bill would allow counties to use the California
Immunization Registry to verify that immunization requirements
for the California Work Opportunity and Responsibility to Kids
program have been met prior to requesting this information from
applicants. Counties already have access to this Registry and
many already use it. Accordingly, this bill is unnecessary.
Analysis Prepared by:
Daphne Hunt / HUM. S. / (916) 319-2089 FN:
0002529
AB 376
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