BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 291|
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VETO
Bill No: SB 291
Author: Lara (D), et al.
Amended: 9/4/15
Vote: 21
SENATE HEALTH COMMITTEE: 7-0, 4/22/15
AYES: Hernandez, Nguyen, Mitchell, Monning, Pan, Roth, Wolk
NO VOTE RECORDED: Hall, Nielsen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 36-1, 6/1/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Gaines, Galgiani, Glazer, Hall, Hancock,
Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno,
Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell,
Nguyen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk
NOES: Moorlach
NO VOTE RECORDED: Fuller, Nielsen, Runner
SENATE FLOOR: 37-1, 9/10/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Huff, Jackson, Lara,
Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Morrell, Nguyen, Pan, Pavley, Roth, Runner, Stone, Vidak,
Wieckowski, Wolk
NOES: Moorlach
NO VOTE RECORDED: Hueso, Nielsen
ASSEMBLY FLOOR: 80-0, 9/9/15 - See last page for vote
SUBJECT: Public health: vulnerable communities
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SOURCE: Cambodian Advocacy Collaborative
DIGEST: This bill expands the definition of vulnerable
communities, as specified, and requires the Department of Health
Care Services (DHCS) to include stakeholders in vulnerable
communities, as specified, in its meaningful decision making
process for purposes of providing technical assistance to
specified entities.
ANALYSIS:
Existing law:
1)Establishes the Office of Health Equity (OHE) within the
Department of Public Health (DPH) to align state resources,
decision making, and programs to establish various goals
relating to health. Requires OHE to perform various duties
relating to vulnerable communities.
2)Defines "vulnerable communities" as, but not limited to:
a) Women;
b) racial or ethnic groups;
c) low-income individuals and families;
d) individuals who are and have been incarcerated;
e) individuals with disabilities;
f) individuals with mental health conditions;
g) children, youth and young adults, and seniors,
h) immigrants and refugees;
i) individuals who are limited-English proficient;
j) lesbian, gay, bisexual, transgender, queer, and
questioning (LGBTQQ) communities; or,
aa) combinations of these populations.
3)Requires DHCS to provide, to the extent resources are
available, technical assistance to county mental health
programs and other local mental health agencies, through DHCS
staff or by contract, in the areas of program operations,
research, evaluation, demonstration, or quality assurance
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projects. Requires DHCS to utilize a meaningful decision
making process that includes local mental health directors and
representatives of local mental health boards, as well as
other stakeholders as determined by DHCS.
This bill:
1)Expands the definition of "vulnerable communities" to include
individuals who have experienced trauma related to genocide.
2)Requires DHCS to include stakeholders in vulnerable
communities in its meaningful decision making process, for
purpose of providing technical assistance, including:
a) diverse racial, ethnic, cultural, and LGBTQQ
communities;
b) communities that experience trauma related to genocide;
c) women's health advocates;
d) mental health advocates;
e) health and mental health providers;
f) community-based organizations and advocates;
g) academic institutions;
h) local public health departments;
i) local government entities; and,
j) low-income and vulnerable consumers.
Comments
1)Author's statement. According to the author, the Office of
Statewide Health Planning and Development, OHE, DHCS, and
other state and local entities have been charged with carrying
out various mental health initiatives, yet barriers remain. In
particular the Cambodian-American population, which has the
largest population in California, still suffers from the
effects of the Cambodian Genocide that occurred between 1975
and 1979. Their mental health challenges are
multigenerational, extending past the elders who were refugees
to the youth who are born in the U.S. Unfortunately, the
Cambodian community is lumped together, if recognized at all,
under the Asian Pacific-Islander category by departments. The
current system, where groups are collapsed together in a broad
category, disenfranchises people who suffer from trauma
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related to genocide. These individuals have unique challenges
that cannot be generalized by any other category and,
therefore, should be separately assessed. In the absence of
laws that highlight this group as a vulnerable population,
smaller community and non-profit organizations that serve
these individuals are often unable to access funding under the
current system. In the interest of continuing the state's goal
towards advancing mental health care access, SB 291 will
improve institutional access for Californians who have
experienced trauma related to genocide by improving
stakeholder engagement, service delivery, and ultimately
access to mental health services.
2)Health care disparities. According to the Health Services
Research Community of the National Institutes of Health,
health care disparities refer to differences in access to or
availability of facilities and services. Health status
disparities refer to the variation in rates of disease
occurrence and disabilities between socioeconomic and/or
geographically defined population groups. Health disparities
have been measured between those of a different race,
ethnicity, gender, sexual orientation, age, ability, religion,
socioeconomic status, language proficiency, and geographic
location. Many racial and ethnic minorities, people with
disabilities, and LGBTQQ communities face unique health
challenges, have reduced access to health care and insurance,
and often have poorer health throughout their lives. For
example, research suggests LGBTQQ people and families may face
significant challenges associated with health disparities in
insurance coverage and access to health care services.
3)Behavioral health evidence-based/best practice service
provision lacking in the state? The Technical Assistance
Collaborative/Human Services Research Institute's final report
in February 2012, California Mental Health and Substance Use
System Needs Assessment, notes that the percent of individuals
reported to be receiving an evidence-based practice service
was low: only one percent in 2010, down from two percent in
2009. It also notes that there is a variability among counties
in the use and training of staff in state-of-the-art and
evidence-based and recovery-oriented treatment; there is a
need to address better preparation of physical health
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providers to engage and treat people with behavioral health
needs; and there is still disproportionate access to
behavioral health services on the part of certain ethnic
populations-compounded by the relative lack of cultural and
linguistic capacity among providers and practitioners in the
state.
4)Let's Get Healthy Task Force. In May 2012, Governor Jerry
Brown established the Let's Get Healthy California Task Force
(Task Force) to develop a 10-year plan for improving the
health of Californians, controlling health care costs,
promoting personal responsibility for individual health, and
advancing health equity. The Executive Order directed the Task
Force to issue a report with recommendations for how the state
can make progress toward becoming the healthiest state in the
nation over the next decade. In the report, issued in December
2012, the Task Force developed an overarching framework,
identifying six goals, organized under two strategic
directions: Health Across the Lifespan and Pathways to Health.
The report states that the framework makes clear that health
equity should be fully integrated across the entire effort.
5)DHCS. DHCS recently indicated that, beginning in Fiscal Year
2015-2016, it will stratify quality measures by demographic
factors. Their goal is to focus quality improvement efforts to
eliminate heath disparities and improve quality overall. DHCS
is in the process of identifying initial measures to conduct
this analysis. Another demographic analysis currently
conducted by DHCS is the use of managed care plan grievances
and appeals data. DHCS is able to determine if an
over-prevalence of grievances and/or appeals exists among a
specific demographic group. DHCS has previously collected race
and/or ethnicity data when conducting the Consumer Assessment
of Healthcare Providers and Systems (CAHPS) survey. This
survey is a measure of Medi-Cal beneficiary satisfaction. DHCS
reports they will continue to conduct this analysis by race
and/or ethnicity and use the CAHPS survey to collect
additional demographic factors.
6)Covered California. Covered California has stated that one of
its missions is to reduce health disparities, and that it
recognizes the diverse cultural, language, economic,
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educational, and health status needs of those they serve.
Their ongoing outreach initiatives include efforts to enroll
underserved beneficiaries. Covered California runs the
Community Outreach Network, which partners with local
organizations across the state to provide information,
resources, and training. Community Outreach Network partners
include organizations devoted to serving at-risk (vulnerable)
populations, including immigrants, African Americans, Asians
and Asian sub-populations, LGBTQQ, Mexican Americans, Native
Americans, and HIV and AIDS patients. Partners distribute
materials, provide outreach and enrollment assistance, and are
compensated by Covered California for each application that
leads to a purchase. Covered California has also awarded $43
million in grants to organizations that have trusted
relationships with culturally and linguistically diverse
uninsured markets.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to Assembly Appropriations Committee, negligible state
fiscal impact.
SUPPORT: (Verified11/13/15)
Cambodian Advocacy Collaborative (source)
African Communities Public Health Coalition
Asian Americans Advancing Justice - Los Angeles
Asian American Pacific Islander Health Research Group
Asian Pacific Environmental Network
Building Health Communities: Long Beach
Cambodian Americans for Rural Education Foundation
Cambodian Association of America
Center for the Pacific Asian Family
Children's Defense Fund California
Families in Good Health
Institute for Multicultural Counseling and Education Services
Los Angeles Lesbian, Gay, Bisexual, Transgender Center
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Khmer Parent Association
Khmer Girls in Action
Kingdom Causes Long Beach
Mental Health America's Homeless Innovations Project
Santa Clara County Board of Supervisors
Southeast Asia Resource Action Center
U.S. Representative Alan Lowenthal
Vietnamese Youth Development Center
OPPOSITION: (Verified11/13/15)
None received
ARGUMENTS IN SUPPORT: Supporters of this bill argue that there
continues to be barriers to accessing mental health services,
especially for the Cambodian community, which still suffers from
effects of genocide that occurred between the years of 1975 and
1979. They further argue that because many Asian subpopulations
get lumped together as Asian Pacific-Islander, groups that have
experienced trauma related to genocide are disenfranchised,
particularly because of unique challenges. Supporters cite
mounting research that shows trauma/stress affects brain
development, as well as physical and mental health.
GOVERNOR'S VETO MESSAGE:
I am returning Senate Bill 291 without my signature.
This bill would amend the definition of "vulnerable
communities" for the Office of Health Equity in the
California Department of Public Health to include
individuals who have experienced trauma related to
genocide. The bill would also require the Department of
Public Health as well as the Department of Health Care
Services to involve these communities in their stakeholder
work.
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The definition of "vulnerable communities" already includes
people with mental health conditions, immigrants and
refugees. No additional authority is necessary to ensure
that both of these departments continue to consider the
needs of all those who have suffered trauma related to
genocide.
ASSEMBLY FLOOR: 80-0, 9/9/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
Prepared by:Reyes Diaz / HEALTH /
11/13/15 16:03:38
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