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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