BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 291| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 SB 291 Page 2 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 SB 291 Page 3 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 SB 291 Page 4 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 SB 291 Page 5 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, SB 291 Page 6 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 SB 291 Page 7 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. SB 291 Page 8 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 **** END ****