BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 959 (Chiu) - Lesbian, Gay, Bisexual, and Transgender  
          Disparities Reduction Act
          
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          |Version: July 7, 2015           |Policy Vote: G.O. 12 - 1        |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 17, 2015   |Consultant: Mark McKenzie       |
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          This bill meets the criteria for referral to the Suspense File. 


          Bill  
          Summary:  AB 959 would require the Department of Health Care  
          Services (DHCS), the Department of Public Health (DPH), the  
          Department of Social Services (DSS), and the Department of Aging  
          (CDA) to collect voluntary self-identification information on  
          sexual orientation and gender identity, beginning no later than  
          January 1, 2017, when collecting demographic data.


          Fiscal  
          Impact:  
           DHCS: This department indicates costs to implement the bill  
            would be "indeterminate."  DHCS is currently engaged in  
            dialogue with the federal Centers for Medicare and Medicaid  
            Services (CMS) regarding the placement of sexual orientation  
            and gender identity information on the paper and online single  
            streamline application (SSApp).  If CMS approves these  
            efforts, costs to update the SSApp would not be attributable  
            to this bill, but these costs would be accelerated as a result  







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            of the bill.  In addition, staff estimates that DHCS could  
            incur significant costs to modify various other databases and  
            eligibility systems to provide for the collection of this  
            information.  (General Fund, federal funds, and/or special  
            funds).

           DPH: DPH administers two programs that would be impacted by  
            the bill.  
               o      Under its Center for Health Statistics and  
                 Information (CHSI), DPH estimates one-time costs of  
                 approximately $165,000 (General Fund) to make programming  
                 changes to Birth and Death Registration systems.  Ongoing  
                 costs for CHSI-related activities would be minor and  
                 absorbable. 
               o      Under its Genetic Disease Screening Program (GDSP),  
                 DPH estimates one-time programming costs of approximately  
                 $160,000 (General Fund) to update the Screening  
                 Information System.  There would also be ongoing costs of  
                 approximately $105,000 (General Fund) related to printing  
                 an enlarged form, but only some of these ongoing costs  
                 can be attributed to this bill. (see staff comments)

           DSS: Unknown costs to DSS.  The department was unable to  
            provide information for purposes of this analysis.  Staff  
            estimates that there could be significant one-time costs to  
            the extent that county welfare department information  
            technology systems would need programming changes to provide  
            for the collection of sexual orientation and gender identity  
            information. (General Fund)

           CDA: The CDA indicates minor and absorbable costs to implement  
            the bill, but was unable to provide information about whether  
            specified information technology systems related to federal  
            aging programs have current functionality for collecting  
            demographic information on sexual orientation and gender  
            identity.  There could be significant costs if these systems  
            would need to be updated to allow for this functionality.   
            (General Fund and/or federal funds)


          Background:  Existing law requires a state agency, board, or commission  
          that directly, or by contract, collects demographic data as to  
          the ancestry or ethnic origin of Californians, to use separate  
          collection categories and tabulations for each major Asian group  








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          and each major Pacific Islander group.  This data is required to  
          be made available to the public in accordance with state and  
          federal law, except for personal identifying information, which  
          shall be deemed confidential.


          Proposed Law:  
            AB 959 would enact the Lesbian, Gay, Bisexual, and Transgender  
          Disparities Reduction Act, requiring DHCS, DPH, DSS, and CDA to  
          collect voluntary self-identification information pertaining to  
          sexual orientation and gender identity in the course of  
          collecting demographic data directly or by contract.  These  
          departments must also report the data collected, and the method  
          used to collect the data, and make the data available to the  
          public, excluding any personal identifying information, in  
          accordance with federal law.  The data collected may only be  
          used for demographic analysis, coordination of care, quality  
          improvement of services, conducting approved research,  
          fulfilling reporting requirements, and guiding policy or funding  
          decisions.


          Related  
          Legislation:  SB 280 (Lieu and Lara), which was held on this  
          Committee's Suspense File last year, would have authorized the  
          application form for insurance affordability programs to include  
          questions on sexual orientation and gender identity, and would  
          have required the application to include voluntary questions  
          regarding specified demographic information, including sexual  
          orientation and gender identity or expression, as of January 1,  
          2016.
          AB 1208 (Pan), which was vetoed by Governor Brown in 2013,  
          contained similar provisions to SB 280.  The veto message  
          included the following statement:


               We don't need to mandate these requirements in law. The  
               Department of Health Care Services and Covered California  
               already have the authority to modify these types of  
               questions on the form, and they can work constructively  
               with stakeholders to decide what is necessary to change for  
               2015 and beyond.










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          Staff  
          Comments:  
           Department of Health Care Services  : DHCS indicates that there  
          will be "indeterminate General Fund costs" to implement this  
          bill.  In order to collect and report additional information on  
          sexual orientation and gender identity, DHCS would need to  
          modify the paper and online SSApp as well as various databases  
          and eligibility systems, including the Medi-Cal Eligibility Data  
          System, Medi-Cal Management Information System/Decision Support  
          System and the Statewide Automated Welfare System.  DHCS is  
          currently in discussion with the federal CMS regarding the  
          placement of sexual orientation and gender identity information  
          for the SSApp.  If these efforts are approved by CMS, DHCS will  
          incur costs that would not be attributable to this bill.  These  
          costs would be associated with the bill if CMS does not approve  
          the changes.  In addition, staff estimates that DHCS could incur  
          significant costs to update the various other database and  
          eligibility systems noted above, although DHCS was unable to  
          provide information regarding these other systems.
           Department of Public Health  : The CHSI, within DPH and through  
          the State Registrar, is responsible for registering each live  
          birth, fetal death, death, and marriage that occurs in  
          California, and for providing certified copies of vital records  
          to the public.  Current law requires the State Registrar to  
          permanently preserve vital records in a systematic manner, and  
          to prepare and maintain a comprehensive and continuous index of  
          all registered certificates.  This bill would require DPH to  
          make one-time programming changes to the Birth and Death  
          Registration systems at a cost of about $165,000.  Any ongoing  
          costs to develop new worksheets and forms required for entering  
          information into the database would be minor and absorbable.


          DPH, through the Genetic Disease Screening Program (GDSP),  
          produces the results of the statewide Newborn Screening Program,  
          which provides testing for nearly all babies born in the state,  
          and the Prenatal Screening Program, an optional program which is  
          offered to pregnant women who are in prenatal care before the  
          twentieth week of gestation.  DPH indicates the bill would  
          require programming changes to the Screening Information System  
          at a one-time cost of approximately $160,000.  In addition, DPH  
          notes that it would incur ongoing costs of approximately  








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          $105,000 annually in printing costs related to larger forms  
          required to accommodate additional fields for sexual orientation  
          and gender identity, as well as additional races and  
          ethnicities.  Only some of these ongoing costs would be related  
          to this bill.
           
           Department of Social Services  : The department was unable to  
          provide information for purposes of this analysis.  Staff  
          estimates the bill could result in significant costs to update  
          county welfare department information technology systems (known  
          as SAWS) and to reprint paper applications to provide for the  
          collection of sexual orientation and gender identity  
          information.


           Department of Aging  :  CDA indicates that it collects and reports  
          demographic information from 33 local Area Agencies on Aging  
          (AAA) that use National Aging Programs Information System, and  
          each AAA has its own management information system unique to its  
          service area.  It is unclear whether these systems currently  
          provide functionality for collection of demographic information  
          on sexual orientation and gender identity.  Staff estimates that  
          the bill could result in significant costs to either update  
          those systems to provide necessary functionality, or to create  
          stand-alone methods for collecting this data, to the extent  
          existing systems do not provide for collecting this information.  





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