BILL ANALYSIS Ó
AB 2589
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Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2589 (Gomez) - As Amended April 26, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill contains two separate provisions related to maternal
and child nutrition. Specifically, this bill:
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1)Requires the California Department of Public Health (CDPH) to
coordinate with the Department of Health Care Services (DHCS)
to develop processes, procedures, and an electronic interface
for eligibility-related information sharing to streamline
enrollment into the California Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC Program), as
part of the application process for Medi-Cal and health plans
offered through the Covered California (CoveredCA) enrollment
portal.
2)Requires CDPH to coordinate with the DHCS, through a
stakeholder engagement process, to develop specified measures
and outcomes related to breastfeeding during the first year of
infancy. It also requires recommendations to be posted on the
departments' Internet Web sites by January 1, 2018.
FISCAL EFFECT:
1)Costs to CDPH can be absorbed within their existing Maternal,
Child, and Adolescent Health program (federal Title V funds).
Costs to DHCS for consultation are also expected to be minor
and absorbable (GF/federal).
2)Unknown, significant costs (potentially GF/federal/special
funds) associated with the provision to develop an electronic
interface to share eligibility-related information in order to
streamline enrollment in WIC. A variety of approaches,
varying in complexity and cost, could be responsive to this
requirement. For comparison's sake, a data-sharing project
proposed in the Governor's 2016-17 Budget requests $513,000
for CDPH and $758,000 for DSS to increase enrollment of
children in WIC and CalFresh, respectively, through data
matching, geographic hotspot analysis, and outreach. This
would be a relatively simple data-sharing project to
streamline enrollment if expanded to include greater linkages
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between Medi-Cal and WIC, for example.
On the other hand, if the Medi-Cal/CoveredCA enrollment
information system, called CalHEERS, was changed in order to
identify women and children who were likely WIC-eligible and
provide direct enrollment into WIC, this would be far more
complex and information technology costs would be significant,
potentially in the millions of dollars. There would likely be
significant administrative work to ensure federal approval and
the availability of federal funding for this work. WIC is
fully funded by a federal grant, but it is unknown whether
existing federal funds could be used to support this type of
expense.
COMMENTS:
1)Purpose. The author states existing state and national data
collection on breastfeeding is incomplete because data
collection is only robust in a hospital setting. Data
collection does not occur once a nursing woman is in the
community, despite the public health importance of supporting
higher breastfeeding exclusivity, initiation, and duration
rates among California's diverse population throughout the
first year of infancy. This bill would take the first step
toward more robust data collection- namely, it would require
definition of measures, which currently are not standardized
for an outpatient setting, as well as provide desired target
outcomes for improvement. Furthermore, the author explains
WIC is a resource that can support breastfeeding and nutrition
for women and children, but is not tightly integrated with
other health and human services programs. This bill would
improve coordination between WIC and public health care
programs.
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2)Breastfeeding rates and recommendations. According to the
federal Centers for Disease Control and Prevention,
breastfeeding rates continue to rise in the United States. In
2011, 79% of newborn infants started to breastfeed. Yet
breastfeeding does not continue for as long as recommended.
Of infants born in 2011, 49% were breastfeeding at 6 months
and 27% at 12 months. In the policy statement, "Breastfeeding
and the Use of Human Milk," published in the March 2012 issue
of Pediatrics, the AAP reaffirms its recommendation of
exclusive breastfeeding for about the first six months of a
baby's life, followed by breastfeeding in combination with the
introduction of complementary foods until at least 12 months
of age, and continuation of breastfeeding for as long as
mutually desired by mother and baby.
3)WIC. WIC provides federal grants to states for supplemental
foods, health care referrals, and nutrition education for
low-income pregnant, breastfeeding, and non-breastfeeding
postpartum women, and to infants and children up to age five
who are found to be at nutritional risk.
4)Related state efforts.
a) Breastfeeding. CDPH oversees the Maternal and Infant
Health Assessment (MIHA) Survey that tracks certain
breastfeeding measures and outcomes. CDPH collects
in-hospital exclusive breastfeeding initiation and percent
of breastfed infants receiving formula supplementation
while in the hospital. Neither include data collection on
an outpatient basis, which this bill addresses. CDPH's
"Healthy People 2020" initiative and "California Wellness
Plan" promote the increase of California breast feeding
rates. DPH's Office of Health Equity's "Portrait of
Promise: The California Statewide Plan to Promote Health
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and Mental Health Equity" report cites the benefits of
breastfeeding and positive health outcomes. DPH's "Let's
Get Healthy California" initiative includes priorities for
healthy beginnings and well-being starting with infancy.
b) Program linkages. When a family or individual is
applying for Medi-Cal or Covered California, the
application includes information that identifies the person
as eligible for CalFresh. The system is not completely
automated, because the CalFresh application is not
auto-populated, but an on-line application is made
available and the applicant can fill that out and the
county is notified of the potential CalFresh participant.
Currently there is no similar electronic linkage for WIC
eligibility in Medi-Cal or Covered California enrollment.
The applications provide a statewide toll-free number for
mothers to call, where they would receive another number or
numbers for a local WIC agency. The mother would then call
that number to find out if they are eligible.
When Medi-Cal expanded to cover childless adults in 2014,
over 600,000 were targeted for enrollment through an
"express lane" eligibility process by using data matching
between CalFresh and Medi-Cal.
5)Support. This bill is co-sponsored by the California WIC
Association, who states California needs to develop and agree
upon measures for breastfeeding in order to evaluate how best
to support California women in meeting their infant feeding
goals. The California Primary Care Association (CPCA) is a
co-sponsor and states this bill will empower California moms
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to breastfeed their babies by streamlining the enrollment
process for the WIC Program, create new metrics to track
breastfeeding rates and health outcomes. This bill is
supported by a bevy of other community clinics, local WIC
programs, breastfeeding advocacy, nutrition and public health
groups, and children's' advocacy groups.
6)Prior legislation.
a) SB 402 (De Leon), Chapter 666, Statutes of 2013,
requires all general acute care hospitals and special
hospitals, that have a perinatal unit by January 1, 2025,
to adopt the "Ten Steps to Successful Breastfeeding," as
adopted by Baby-Friendly USA, per the Baby-Friendly
Hospital Initiative (BFHI), or an alternate process adopted
by a health care service plan that includes evidenced-based
policies and practices and targeted outcomes, or the Model
Hospital Policy Recommendations, as defined.
b) SB 502 (De Leon and Pavley), Chapter 511, Statutes of
2011, establishes the Hospital Infant Feeding Act, which
requires all general acute care and special hospitals that
have a perinatal unit to have an infant-feeding policy, as
specified, to clearly post the policy and routinely
communicate the policy to perinatal unit staff.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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