BILL ANALYSIS Ó
AB 766
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Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 766
(Ridley-Thomas) - As Introduced February 25, 2015
SUBJECT: Public School Health Center Support Program.
SUMMARY: Requires the Department of Public Health (DPH) to give
preference to schools with a high percentage of children and
youth who receive free or low-cost health coverage through
Medi-Cal or Covered California when developing a request for
proposal (RFP) for grant funding for Public School Health Center
Support Programs (PSHCSP).
EXISTING LAW:
1)Requires DPH to establish the PSHCSP, in collaboration with
the Department of Education (CDE), to perform specified
functions relating to the establishment, retention, or
expansion of school-based health centers (SBHCs) in
California.
2)Establishes a grant program administered by DPH to provide
technical assistance and funding to SBHCs, to the extent funds
are appropriated for implementation of the PSHCSP. Provides
for planning, facilities and startup, and sustainability
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grants, as specified.
3)Requires DPH to develop an RFP process to determine which
proposals shall receive grant funding and requires the RFP
process to prioritize the following:
a) Schools in areas designated as federally medically
underserved areas or in areas with medically underserved
populations;
b) Schools with a high percentage of low-income and
uninsured children and youth;
c) Schools with large numbers of limited English proficient
students;
d) Schools in areas with a shortage of health
professionals; and,
e) Low-performing schools as measured by the Academic
Performance Index.
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4)Defines an SBHC as a center or program located at or near a
local educational agency (LEA) that provides age-appropriate
health care services at the program site or through referrals.
5)Defines a LEA as a school, school district, charter school, or
county office of education, as specified.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, children from
lower socioeconomic backgrounds have poorer health outcomes.
These health disparities are due, in part, to barriers in
accessing medical care and using primary care services.
Recent expansions in insurance coverage under the Patient
Protection and Affordable Care Act (ACA), Medi-Cal, and the
Children's Health Insurance Program (CHIP) have improved
access to health care for this population. Yet, even with the
expansion of health insurance, children from low-income
households are not guaranteed access to health care services.
The author states that children from low-income households who
have insurance through a public health program still face
problems with gaining access to health care services and
finding providers. Children from low-income households who
have private insurance also have problems finding providers
that accept their insurance and with unaffordable medical
costs. Additionally, some parents feel unwelcome at medical
practices, unable to take time off work for health care
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appointments, or unable to travel long distances to seek care
for their children.
The author concludes that SBHCs provide a health care delivery
model that can help to address some of the barriers to health
care services that insured children from low-income households
face. SBHCs provide improved access to medical care because
they are conveniently located and provide a patient-friendly
environment.
2)BACKGROUND. SBHCs provide a broad array of primary care and
preventive services, including comprehensive health
assessments; prescriptions for medications; treatment for
acute illness; asthma treatment; oral health education; and
dental screenings. SBHCs have mental health providers on
staff to offer mental health assessments, crisis intervention,
brief and long-term therapy, and other services. SBHCs are
the primary, and occasionally only, available health care for
many children and adolescents who otherwise would have no
access. The National School-Based Health Alliance states that
Congress recognized the importance of SBHCs as a key link in
the nation's health care safety net by providing $50 million a
year for four years in one-time funding for construction,
renovation, and equipment for SBHCs in the ACA and more than
350 applicants from around the nation are seeking funding
through the first round of competitive grants created under
the law.
There are approximately 200 SBHCs in California. Half of SBHC's
are in high schools, a third are in elementary schools and the
remainder are in middle schools or in mobile medical vans.
Many SBHCs are located in schools serving some of the state's
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most vulnerable children and on campuses with SBHCs, about 70%
of students receive free or reduced price meals. According to
the California School-Based Health Alliance (CSBHA), 13,500
children have gained access to health care in their school
since 2012, through the expansion of SBHCs. SBHCs are
administered by a variety of organizations, including school
districts, Federally Qualified Health Centers, county health
departments, hospitals, community-based agencies, and private
physician groups. They are financed through grants from
state, local, and private sources as well as reimbursements
from public programs, such as the Child Health and Disability
Prevention Program and Medi-Cal. According to CSBHA, more
than half of SHCs recover less than 50% of their operating
costs from billing sources.
3)SUPPORT. The California Pan-Ethnic Health Network (CPEHN),
states in support of the bill that children from lower
socioeconomic backgrounds have poorer health outcomes. These
health disparities are due, in part, to barriers in accessing
medical care and using primary care services. Recent
expansions in insurance coverage under the ACA, Medi-Cal, and
CHIP have improved access to health care for this population.
CPEHN notes that even with the expansion of health insurance,
children from low-income households are not guaranteed access
to health care services. According to CPEHN, this bill
ensures that grant funding considers schools that have a high
percentage of youth who may come from low-income households
and face more challenges accessing health care services.
The California Black Health Network (CBHN) states in support
of the bill that boys and young men of color are
disproportionately affected by violence and trauma, which can
lead to disparities in health outcomes. For instance, boys
and young men of color are more likely than white to
characterize their health as "poor" or "fair". CBHN believes
that SBHCs can specifically help boys and young men of color
through the range of services offered that are locally
designed to meet the specific needs of the student population.
SBHCs increase access to care and this bill would ensure that
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boys and young men of color from low-income households, who
may have issues with accessing care, are able to utilize SBHCs
in their communities. By broadening the requirement of the
PSHCSP grant funding to include schools with a high percentage
of children and youth who receive free or low-cost health
coverage through Medi-Cal, this bill will provide health care
to California's most vulnerable students.
4)OPPOSITION. The California Right to Life Committee (CRLC)
states in opposition that CRLC must continue to oppose any
publicly funded program which advocates and promotes abortions
and related services.
5)RELATED LEGISLATION.
a) SB 118 (Liu) renames the Public School Health Center
Support Program the School-Based Health and Education
Partnership Program and makes changes to the requirements
and funding levels. Creates a new type of grant to fund
interventions related to obesity, asthma, alcohol and
substance abuse, and mental health. SB 118 is pending a
hearing in the Senate Appropriations Committee.
b) AB 1025 (Thurmond) requires CDE to establish a
three-year pilot program to encourage inclusive practices
that integrate mental health, special education, and school
climate interventions following a multitiered framework.
AB 1025 is pending in the Assembly Education Committee.
c) AB 1133 (Achadjian) makes technical changes to existing
law regarding grants to LEAs to pay the state share of
costs of providing school-based early mental health
intervention and prevention services to eligible students.
AB 1133 is pending in the Assembly Health Committee.
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6)PREVIOUS LEGISLATION.
a) SB 596 (Yee) of 2014 would have required CDE to
establish a three-year pilot program in four schools to
provide school-based mental health services that leverage
cross-system resources and offer comprehensive multitiered
interventions; allocated a total of $600,000 in start-up
funding to each school selected to participate in the
program; and required CDE to submit a report to the
Legislature evaluating the success of the program. SB 596
was held at the Assembly Desk.
b) AB 1955 (Pan) of 2014 would have required the SPI to
establish the Healthy Kids, Healthy Minds Demonstration,
which would provide grants to LEAs for the purpose of
employing one full-time school nurse and one full-time
mental health professional, and ensured that the schools'
libraries were open one hour before and three hours after
the regular school day. AB 1955 was held on the Assembly
Appropriations Committee's suspense file.
c) AB 174 (Bonta) of 2013 would have required DPH to
establish a pilot grant program in Alameda County, to the
extent that funding was made available, to provide
resources to eligible applicants for activities and
services that directly address the mental health and
related needs of students impacted by trauma. AB 174 was
vetoed by Governor Brown, who stated in his veto message
that, while he supports the efforts of the bill, Alameda
County can establish such a program without state
intervention and may even be able to use existing funds to
do so. In addition, Governor Brown stated that all
counties, not just Alameda, should explore all funding
options, including Mental Health Services Act funds, to
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tailor programs that best meet local needs.
d) AB 1178 (Bocanegra) of 2013 would have established the
California Promise Neighborhood Initiative to provide
funding to schools that have formalized partnerships with
local agencies and community organizations to provide a
network of services to improve the health, safety,
education, and economic development of a defined area. AB
1178 was help on the Assembly Appropriations Committee
Suspense File.
e) SB 564 (Ridley-Thomas), Chapter 381, Statutes of 2008,
specified that an SBHC may conduct routine physical health,
mental health, and oral health assessments, and provide for
any services not offered onsite or through a referral
process. SB 564 also required DPH, to the extent funds are
appropriated for implementation of the PSHCSP, to establish
a grant program to provide technical assistance, and
funding for the expansion, renovation, and retrofitting of
existing SBHCs, and the development of new SBHCs, in
accordance with specified procedures.
f) AB 2560 (Ridley-Thomas), Chapter 334, Statutes of 2006,
required the Department of Health Services (DHS now DPH),
in cooperation with CDE, to establish the PSHCSP to perform
specified functions relating to the establishment,
retention, or expansion of SBHCs; required DHS to establish
standardized data collection procedures and collect
specified data from SBHCs on an ongoing basis; required
CDE, in collaboration with DHS, to coordinate programs
within CDE and programs within other specified departments
to support SBHCs and to provide technical assistance to
facilitate and encourage the establishment, retention, and
expansion of SBHCs; and required the program to provide a
biennial update to the appropriate policy and fiscal
committees of the Legislature containing specified
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information regarding SBHCs, beginning on or before January
1, 2009.
7)COMMITTEE AMENDMENTS. The PSHCSP grant was established to
provide financial assistance to SBHCs. State program
requirements, and the intent behind the program, specify that
the funding must be prioritized towards low-income and
underserved students. This bill broadens the requirements to
include prioritization based on Medi-Cal and Covered
California eligibility. Currently, families must be at 138%
of the federal poverty level or below to qualify for Medi-Cal.
In order to qualify for Covered California, families can earn
up to 400% of the federal poverty level. Given the already
limited scope of this program due to funding restrictions, it
would not be prudent to expand the criteria by which programs
are identified for funding to include Covered California
eligibility. The committee recommends the following amendment
to the bill:
On page 6, line (15), strike "or Covered California."
REGISTERED SUPPORT / OPPOSITION:
Support
California Black Health Network
California Pan-Ethnic Health Network
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National Association of Social Workers - California Chapter
Opposition
California Right to Life Committee, Inc.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097