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 ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 19, 2016 |Policy Vote: HEALTH 7 - 2 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 9, 2016 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- 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 SB 1139 (Lara) Page 1 of ? 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.) SB 1139 (Lara) Page 2 of ? 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 SB 1139 (Lara) Page 3 of ? 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. -- END -- SB 1139 (Lara) Page 4 of ?