BILL ANALYSIS                                                                                                                                                                                                    Ó



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

          SB 1139 (Lara) - Health professionals:  medical residency  
          programs:  undocumented immigrants:  scholarships, loans, and  
          loan repayment
          
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          |Version: April 19, 2016         |Policy Vote: HEALTH 7 - 2       |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: May 9, 2016       |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.

          Bill  
          Summary:  SB 1139 would make undocumented immigrants eligible  
          for admission to medical schools, medical residency programs,  
          and specified state programs that provide financial support to  
          health professionals.


          Fiscal  
          Impact:  
           Unknown fiscal impact on University of California medical  
            residency programs (General Fund, federal funds, and UC  
            enterprise funds). Under current practice, undocumented  
            immigrants who are authorized to work in the United States and  
            have a social security number can enter a UC residency  
            program. However, the bill would make undocumented immigrants  
            who are not authorized to work in the United States eligible  
            for UC medical residency programs. Medical residents are  
            employees of UC medical centers, rather than students. UC  
            indicates that if medical residency programs were to admit  
            undocumented immigrants without authorization to work, UC  







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            could be in violation of federal law. In addition, because  
            medical residency placements are mostly funded by the federal  
            government, funding would not be available for undocumented  
            medical residents

            In theory, the University could create residency "look-alike"  
            positions that were classified as students, not employees, and  
            were funded without using federal funds. The number of  
            undocumented students who would apply for and be admitted to  
            such a program is unknown. Nationwide, the average Medicare  
            subsidy to hospitals per residency slot is about $110,000 per  
            year. The University would have to cover all the costs of  
            offering such residency slots. Historically, the state General  
            Fund has not been used to support medical residency training.  
            To the extent that UC would allow medical residency training  
            in some form without federal financial support, there would be  
            pressure on the state to provide General Fund support for such  
            programs.

           Unknown cost pressure on various programs that provide  
            financial support for medical professionals (various special  
            funds). The Office of Statewide Health Planning and  
            Development operates several programs that provide financial  
            support for health professionals who agree to provide service  
            in areas that are medically underserved. Under current law and  
            practice, the Office does not allow undocumented individuals  
            to access those programs. By expanding eligibility for those  
            programs, the bill will impose cost pressures on those funds,  
            due to a larger population who would be eligible for existing  
            funds. The size of the impact is not known, because there is  
            limited information available about the number of undocumented  
            individuals who would be eligible for funding under the bill.  
            Based on the current undocumented population in the state and  
            available information about college attendance rates in the  
            undocumented population and the number of college students  
            going into medicine, staff estimates fewer than 50  
            undocumented immigrants are likely to apply for funding per  
            year. (This estimate also assumes a much higher percentage of  
            undocumented would be willing to provide services in medically  
            underserved areas and therefore would be eligible for these  
            programs than is the case for the larger population of health  
            care workers.)










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          Background:  The University of California operates six medical schools (and  
          one small physician training program at UC Berkeley). The  
          University employs about 2,500 medical residents at hospitals  
          and health facilities. Medical residents are employed by their  
          sponsoring university or hospital. As such, they must be legally  
          authorized to work in the United States and have a social  
          security number (under federal law). Medical residency  
          placements are mostly funded by the federal Medicaid program,  
          which does not allow federal funding to go to undocumented  
          immigrants.
          Under current law, the Office of Statewide Health Planning and  
          Development operates several programs to provide financial  
          support to health professionals. These programs provide  
          scholarships, loan repayments, and financial support for medical  
          residency programs. Generally, these programs are designed to  
          provide financial support to individuals who agree to provide  
          care in medically underserved areas of the state. Funding for  
          these programs comes from additional assessments on health  
          professional license fees, fine and penalty revenues assessed on  
          health plans, the Mental Health Services Act, and other sources.  
          Under current law, undocumented immigrants are not allowed to  
          access these programs. In 2014-15, the Office provided funding  
          to about 2,000 individuals. However, roughly 1,300 of those  
          individuals were funded with Mental Health Services Act funding  
          that was one-time in nature.




          Proposed Law:  
            SB 1139 would make undocumented immigrants eligible for  
          admission to medical schools, medical residency programs, and  
          specified state programs that provide financial support to  
          health professionals.
          Specific provisions of the bill would:
                 Authorize individuals who do not have lawful immigration  
               status and/or who are exempt from nonresident tuition to  
               participate in medical school programs and medical  
               residency training programs;
                 Encourage the University of California to develop a  
               process for awarding financial aid in lieu of employment  
               for individuals covered by the bill;
                 Prohibit the Office of Statewide Health Planning and  
               Development from denying an application for one of several  








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               specified financial support programs based on citizenship  
               or immigration status;
                 Authorize an applicant for a financial support program  
               administered by the Office to provide an individual tax  
               identification number rather than a social security number  
               when applying.


          Staff  
          Comments:  Under current state law, undocumented individuals can  
          access public university programs. Based on an individual's  
          state residency, graduation from a California high school, and  
          other criteria, undocumented residents of the state can qualify  
          for in-state tuition at California public universities.
          Undocumented immigrants are generally prohibited from receiving  
          federal benefits or working legally in the United States. This  
          prohibition limits access to certain state program (such as  
          Medi-Cal in most cases or federal financial aid for students).  
          Prohibitions on employing undocumented immigrants generally  
          prevent medical residency programs from employing undocumented  
          immigrants and most residency placements are funded by the  
          federal Medicare program.


          Under an executive action of President Obama, certain  
          undocumented immigrants who came to the United States as  
          children have been granted deferred action. Those individuals  
          are shielded from deportation, are authorized to work legally in  
          the United States, and can receive a social security number.  
          About 300,000 Californians are subject to this executive order  
          (referred to as "DACA"). In addition, President Obama issued a  
          second executive order in 2014 that would have shielded  
          additional young immigrants and parents of lawful US residents  
          from deportation. The second executive action has been stayed by  
          the courts while undergoing judicial review.




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