BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2589
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|AUTHOR: |Gomez |
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|VERSION: |June 13, 2016 |
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|HEARING DATE: |June 22, 2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Public health: lactation services and equipment
SUMMARY : Requires the Department of Public Health (DPH) to coordinate
with the Department of Health Care Services (DHCS) and the
California Health Benefit Exchange (known as Covered California)
to develop processes, procedures, and an electronic interface
for eligibility-related information sharing to streamline
enrollment into the Women, Infants, and Children (WIC Program)
as part of the application process for Medi-Cal and Covered
California. Requires the California Healthcare Eligibility,
Enrollment, and Retention System (CalHEERS is the on-line
application system administered by DHCS and Covered California)
and the county Statewide Automated Welfare Systems (SAWS) to
identify individuals who are potentially eligible for the WIC
Program to electronically link them to a WIC Program application
(by January 1, 2017), and (by January 1, 2022) to provide a
simple interface for the individual to electronically complete a
WIC Program application. Requires DPH to coordinate with DHCS,
through a stakeholder engagement process, to develop measures
and outcomes for breastfeeding rates.
Existing law:
1)Establishes the California Special Supplemental Nutrition
Program for Women, Infants and Children (WIC Program)
administered by DPH, under which nutrition and other
assistance is provided to eligible low-income postpartum and
lactating women, infants, and children under five years of
age.
2)Establishes the Medi-Cal program, which is administered by the
DHCS, under which health care services, including
breastfeeding services, are provided to qualified low-income
persons. Medi-Cal provides coverage for most adults up to 138%
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of the Federal Poverty Level (FPL), provides coverage for
pregnant women up to 211% of the FPL, and provides coverage to
children in families with incomes up to 266% of the federal
poverty level (FPL (266% of the FPL is at or below $53,626 for
a family of three in 2016).
3)Establishes Covered California in state government, and
specifies its duties and authority. Requires Covered
California to be governed by a board that includes the
Secretary of the California Health and Human Services Agency
(Agency) and four members with specified expertise who are
appointed by the Governor and the Legislature.
4)Requires individuals to have the option to apply for
"insurance affordability programs" in person, by mail, online,
by telephone, or by other commonly available electronic means.
Defines "insurance affordability programs" as Medi-Cal and
coverage purchased through Covered California with an federal
advanced premium tax credit or cost-sharing reduction.
5)Requires a single, accessible, standardized paper, electronic,
and telephone application for insurance affordability programs
be developed by DHCS in consultation with the Covered
California board. Requires the application to be used by all
entities authorized to make an eligibility determination for
any of the insurance affordability programs and by their
agents.
6)Requires the Office of Systems Integration to implement a
statewide automated welfare system (SAWS) for the following
public assistance programs:
a) CalWORKS;
b) CalFresh;
c) Medi-Cal program;
d) The foster care program;
e) The refugee program; and,
f) County medical services programs.
This bill:
1)Requires DPH to coordinate with DHCS and Covered California to
develop processes, procedures, and an electronic interface for
eligibility-related information sharing to streamline
enrollment into the WIC Program as part of the application
process for Medi-Cal and health plans offered through Covered
AB 2589 (Gomez) Page 3 of ?
California.
2)Requires, on or before January 1, 2019, CalHEERS and the SAWS
to identify individuals who are potentially eligible for the
WIC Program and, if a potentially eligible individual wishes
to apply for the WIC Program, to electronically link them to a
WIC Program application.
3)Requires, on or before January 1, 2022, CalHEERS and SAWS to
identify individuals who are potentially eligible for the WIC
Program and, if a potentially eligible individual wishes to
apply for the WIC Program and provides consent to share
confidential data with the WIC Program, to provide a simple
interface for the individual to electronically complete a WIC
Program application without resubmitting data already known to
the CalHEERS and SAWS systems.
4)Requires DPH to coordinate with DHCS, through a stakeholder
engagement process, to develop measures and outcomes for
breastfeeding rates that do both of the following:
a) Include, at a minimum, women's intention to
breastfeed, breastfeeding initiation rates, and
exclusivity and duration; and,
b) Identify ethnic disparities and
sociodemographic differences.
1)Requires the stakeholder process to include, but not be
limited to, representatives from health care providers,
primary care clinics, and health plans, state and local staff
from the WIC Program and the Maternal, Child and Adolescent
Health (MCAH) program, and representatives from organizations
representing women, infants, and children, beginning
prenatally and continuing through the postpartum period and at
least until the infant reaches one year of age.
2)Requires the stakeholder process to take no longer than six
months and the recommendations to be posted on DHCS and DPH
Internet Web sites by January 1, 2018.
FISCAL
EFFECT : According to the Assembly Committee on Appropriations:
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1)Costs to DPH can be absorbed within their existing MCAH
program (federal Title V funds). Costs to DHCS for
consultation are also expected to be minor and absorbable
(General Fund (GF)/federal).
2)Unknown, significant information technology costs potentially
in the millions of dollars (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 the WIC Program.
3)Unknown, significant administrative costs to ensure federal
approval and the availability of federal funding for this
work. The WIC Program is fully funded by a federal grant, but
it is unknown whether existing federal funds could be used to
support this type of expense.
PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |16 - 0 |
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COMMENTS :
1)Author's statement. According to the author, this bill
supports California families through the development of key
metrics and improved programmatic coordination that will
increase enrollment in the WIC Program and improve
breastfeeding rates among women in California. Social
determinants of health (conditions in the places where people
live, learn, work, and play that affect a wide range of health
risks and outcomes) are increasingly being used to understand,
measure, and address health equity. Linking families to
health care and support systems and providing quality
preventative services are basic strategies for ensuring that
AB 2589 (Gomez) Page 5 of ?
parents and their children reach their full potential. Health
care reform and the Affordable Care Act provide historic
opportunities for linking low-income families with health care
and healthy food. Breastfeeding has been shown to reduce the
incidence of obesity while also contributing to numerous
positive health outcomes for mother and child. Much progress
has been made in California for breastfeeding with nearly 94%
of mothers starting breastfeeding in the hospital and 66%
exclusively breastfeeding at discharge. Breastfeeding rates
after the hospital stay are important with rates dropping off
in the first three months. State breastfeeding metrics would
guide policy and practice planning efforts.
2)WIC. The WIC Program provides nutrition services and food
assistance to low -to-moderate income families for pregnant,
breastfeeding, and non-breastfeeding women, infants, and
children up to their fifth birthday. In addition to the
categorical eligibility requirement, participants must be at
or below 185% of the FPL (equivalent to an annual income of
$29,637 for a family size of two in 2016). WIC Program
services include nutrition education, breastfeeding support,
assistance with finding health care and other community
services, and vouchers for specific nutritious foods that are
redeemable at retail food outlets throughout the state. The
WIC Program is federally funded by the US Department of
Agriculture (USDA) under the federal Child Nutrition Act of
1966. Specific uses of the WIC Program funds are required
under federal laws and regulations, and CDPH must account for
and report funds and expenditures on a monthly basis.
The WIC Program is administered by DPH, which receives federal
funding to administer the WIC Program to Californians based on
a discretionary grant appropriated by Congress, plus
subsequent reallocations of prior year unspent funds. The WIC
Program is not an entitlement program. The number of
participants served is limited by the amount of discretionary
grant appropriated annually by Congress. For 2016-17, WIC has
a budget of approximately $1.3 billion, and the program serves
approximately 1.2 million residents each month. In California,
84 WIC agencies provide services at over 600 sites throughout
the state. In the 2013-14 fiscal year, 58% percent of WIC
participants were children one to five, 20% were infants age
zero to one and 9% were pregnant women.
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3)The ACA and enrollment options for state health subsidy
programs. The ACA made numerous changes to increase the number
of individuals with health coverage. These changes include
requiring a single streamlined form for state health subsidy
programs, and by allowing individuals to be able to apply in
person, by mail, through the internet, or by telephone. DHCS
and Covered California jointly administer CalHEERS, which
provides an on-line application for state health subsidy
programs, including Medi-Cal and coverage through Covered
California with advanced premium tax credits (APTCs) and
cost-sharing subsidies. In addition, individuals can apply for
state health subsidy programs, CalWORKS and CalFRESH through
county human services departments in-person, or via fax, phone
or on-line. Covered California indicates in September 2016,
CalHEERS will implement a referral program that will direct
consumers that meet income thresholds for CalFRESH, CalWORKS
and non-MAGI Medi-Cal to those separate applications. However,
this will only be a referral program, and CalHEERS will still
be only able to directly enroll individuals in insurance
affordability programs.
The WIC Program income eligibility overlaps with Medi-Cal and
eligibility for APTC and cost-sharing subsidies through
Covered California. If a person is enrolled in CalFresh or
Medi-Cal, they are considered to be automatically eligible for
the WIC Program. The WIC Program has an on-line assessment for
eligibility, but does not currently have an on-line
application. Individuals who complete the on-line assessment
are referred to local agencies to discuss potential
eligibility with a WIC Program staff person, and a nutrition
assessment is required. Federal WIC Program regulations
require a nutritional risk assessment to be performed to
determine if a person is at nutritional risk through a medical
and/or nutritional assessment. In addition, federal
regulations require a height or length and weight measurement
to be performed and/or documented in the applicant's file at
the time of certification.
The current WIC Program computer system is going to be
replaced with a new system that will be compatible with the
move away from a check-based system to an electronic benefit
transfer card. DPH indicates it can use federal WIC Program
funds for an interface as proposed by this bill, but it is
subject to the approval by the federal Department of
Agriculture.
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4)Support. This bill is jointly sponsored by the California WIC
Association (WIC Association) and the California Primary Care
Association (CPCA). The WIC Association states that this bill
will require development of measures of breastfeeding data,
and a streamlined process for eligibility and application for
participants in the WIC Program via the Medi-Cal and Covered
California application processes. The WIC Association states
there is significant overlap in the Medi-Cal-eligible and
WIC-eligible populations, and it makes sense to develop
processes and an electronic interface for eligibility-related
information sharing to streamline the WIC application as part
of the application process for Medi-Cal and Covered
California. The WIC Association also notes that breastfeeding
has been shown to reduce the incidence of obesity while also
contributing to numerous other positive health outcomes for
mother and child, and 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.
CPCA states this bill will empower California moms to breastfeed
their babies by streamlining the enrollment process for the
WIC Program and create new metrics to track breastfeeding
rates and health outcomes. CPCA concludes, with this simple
and comprehensive bill, the state can support strategies to
improve breastfeeding initiation, duration, and exclusivity.
5)Amendments. This bill requires, on or before January 1, 2019,
CalHEERS to identify individuals who are potentially eligible
for the WIC Program and, if a potentially eligible individual
wishes to apply for the WIC Program, to electronically link
them to a WIC Program application. However, the WIC Program
application is not currently on-line. Amendments are needed to
clarify that this link is required if the WIC Program
application is available on-line.
6)Policy issue.
a) CalHEERS funding and system changes to implement
this bill. CalHEERS is a jointly funded between Covered
California and DHCS. Because federal funding for
Exchanges is no longer available, the Covered California
portion of the funding will come from assessments levied
on Covered California health plans. The DHCS portion of
the funding comes from a combination of Medicaid and
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Childrens Health Insurance Program federal funds and
state General Fund. The CalHEERS budget for 2016-17 is
$169.1M ($25.3M General Fund). While easing enrollment
and better integration of health and public assistance
programs makes it easier for individuals to apply for and
receive health and social services for which they are
eligible, any changes to CalHEERS under existing law
would be funded through assessments on health plans,
which are then passed on to individuals purchasing
coverage in Covered California.
SUPPORT AND OPPOSITION :
Support: California Health+ Advocates (sponsor)
California WIC Association (co-sponsor)
California Primary Care Association (co-sponsor)
Alameda County Board of Supervisors
AltaMed Health Services Corporation
American Federation of State, County and Municipal
Employees, AFL-CIO
Ampla Health
Antelope Valley Hospital WIC Program
Association of California Healthcare Districts
Breastfeeding Coalition of Solano County
California Academy of Nutrition and Dietetics
California Advanced Lactation Institute
California Breastfeeding Coalition
California Center for Public Health Advocacy
California Nurse-Midwives Association
Children Now
Clinica Sierra Vista
Community Clinic Association of Los Angeles County
Community Clinic Consortium Contra Costa & Solano
Counties
County Health Executives Association of California
Eisner Pediatric & Family Medical Center
Family Health Centers of San Diego
Harmony Health
Health Alliance of Northern California
Health And Life Organization, Inc.
Kheir Center
Marin Community Clinics
Maternal and Child Health Access
Mountain Valleys Health Centers
National Health Law Program
North Coast Clinics Network
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North County Health Services
North East Medical Services
Northeast Valley Health Corporation
Northeastern Rural Health Clinics WIC
Omni Family Health
Open Door Community Health Centers
Prevention Institute
Public Health Foundation Enterprises WIC program
Ravenswood Family Health Center
Redwood Community Health Coalition
Sacramento Community Clinics
San Ysidro Health Center
Solano County Public Health WIC Program
South of Market Health Center
Strategic Alliance for Healthy Food and Activity
Environments
Tiburcio Vasquez Health Center, Inc.
Tulare Regional Medical Center
United States Lactation Consultant Association
Valley Community Healthcare
Watts Healthcare WIC Program
Westside Family Health Center
White Memorial Community Health Center
Oppose: None received
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