BILL ANALYSIS                                                                                                                                                                                                    



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

          AB 2424 (Gomez) - Community-based Health Improvement and  
          Innovation Fund
          
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          |Version: August 2, 2016         |Policy Vote: HEALTH 7 - 0       |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 8, 2016    |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.

          Bill  
          Summary:  AB 2424 would create the Community-based Health  
          Improvement Fund, to support programs to improve public health.


          Fiscal  
          Impact:  
           Unknown costs to support the programs authorized in the bill,  
            likely in the tens of millions per year (General Fund). The  
            intention of the bill is to provide funding for a wide array  
            of programs designed to improve public health and reduce  
            health disparities. The total amount of funding that would be  
            available for the Fund would depend on future appropriations.  
            To have a significant impact on statewide public health,  
            funding for the program would likely be in the tens of  
            millions per year. The bill would require local health  
            jurisdictions to be awarded $250,000 each, which would make up  
            about one-half of the available funding. This indicates an  
            overall program size of at least $30 million per year.

           One-time startup costs in the millions to develop program  







          AB 2424 (Gomez)                                        Page 1 of  
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            guidelines, develop an information technology system to allow  
            for grant making and oversight, and undertake other  
            administrative tasks by the Department of Public Health  
            (General Fund). Given the broad range of potential projects  
            that could be funded under the bill and the requirements for  
            monitoring and evaluation of projects, the Department will  
            incur substantial upfront costs to set up the processes and  
            systems for implementing the bill, regardless of the future  
            funding amounts.

           Likely ongoing administrative costs in the millions to conduct  
            public education campaigns, solicit grant proposals, review  
            applications, oversee grant funding, and perform program  
            evaluations (General Fund). The amount of ongoing  
            administrative costs incurred by the Department would depend  
            on the overall amount of funding made available for the  
            program.

           Unknown potential long-run cost savings to state health care  
            programs (various funds). There is published research that  
            indicates a strong cost-benefit ratio for some community-based  
            public health programs. To the extent that funding authorized  
            in the future to implement the bill is used to fund  
            evidence-based public health programs, there are likely to be  
            improvements in overall public health The Medi-Cal program  
            provides health care coverage to over 12 million Californians.  
            Therefore, any overall reduction in health care costs due to  
            successful public health interventions would likely result in  
            some unknown level of cost savings to the state and federal  
            government.


          Background:  The public health system in the state is a partnership between  
          the Department of Public Health and local health jurisdictions  
          (mostly county health departments and a few city health  
          departments). Historically, the state has provided substantial  
          funding for public health activities. However, during the  
          2008-09 and 2009-10 budget years, most state General Fund  
          funding for public health activities was eliminated. Currently,  
          public health programs in the state are supported largely by  
          local funds and federal funds.


          Proposed Law:  








          AB 2424 (Gomez)                                        Page 2 of  
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            AB 2424 would create the Community-based Health Improvement  
          Fund, to support programs to improve public health.
          Specific provisions of the bill would:
           Create the Community-based Health Improvement and Innovation  
            Fund;
           Require a target level of annual statewide investment to be  
            set, on a per capita basis (presumably by the Department of  
            Public Health or the advisory committee created in the bill);
           Specify the allowable uses of monies in the fund, including  
            reducing health inequality and disparities, preventing the  
            onset of chronic conditions, evaluating the effectiveness of  
            prevention strategies, and other uses;
           Require the Fund to be used to address the social,  
            environmental, and behavioral determinants of chronic disease;
           Require the Department of Public Health to allocate up to 20%  
            of available funding for statewide media campaigns, evaluation  
            of program activities, program implementation and oversight;
           Of the remaining 80% of funding, require at least 47% to be  
            allocated to local health jurisdictions (including a base  
            award of $250,000) and 33% to be allocated through competitive  
            grants;
           Establish an advisory committee, with specified membership;
           Make implementation of the bill contingent on an appropriation  
            of funding.


          Staff  
          Comments:  The recently enacted 2016 Budget Act includes about  
          $40 million in new General Fund spending on a variety of public  
          health programs. None of that funding would be available to fund  
          the program established in this bill.


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