BILL ANALYSIS                                                                                                                                                                                                    Ó




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          |SENATE RULES COMMITTEE            |                       SB 1339|
          |Office of Senate Floor Analyses   |                              |
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                                   THIRD READING 


          Bill No:  SB 1339
          Author:   Monning (D) 
          Amended:  5/31/16  
          Vote:     21 

           SENATE HUMAN SERVICES COMMITTEE:  4-0, 3/29/16
           AYES:  McGuire, Hancock, Liu, Nguyen
           NO VOTE RECORDED:  Berryhill

           SENATE HEALTH COMMITTEE:  7-0, 4/20/16
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth
           NO VOTE RECORDED:  Nielsen, Wolk

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 5/27/16
           AYES:  Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

           SUBJECT:   Public social services:  intercounty transfers


          SOURCE:    Coalition of Welfare Rights Organizations 
                               United Way of California 
                               Western Center on Law and Poverty 


          
          DIGEST:   This bill makes a number of changes to the intercounty  
          transfer (ICT) process used when a beneficiary of public  
          assistance programs moves between counties.


          ANALYSIS: 


          Existing law: 









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           1) Establishes in state law the California Work Opportunity and  
             Responsibility to Kids (CalWORKs) program to provide cash  
             assistance and other social services for low-income families  
             through the federal Temporary Assistance for Needy Families  
             (TANF) program. Under CalWORKs, each county provides  
             assistance through a combination of state, county and federal  
             TANF funds. (42 USC § 601 et seq., WIC 10530)


           2) Establishes under federal law the Supplemental Nutrition  
             Assistance Program (SNAP) within the U.S. Department of  
             Agriculture (USDA) to promote the general welfare and to  
             safeguard the health and wellbeing of the nation's population  
             by raising the levels of nutrition among low-income  
             households and in California the CalFresh program. (7 CFR  
             271.1; 7 CFR 273.9, WIC 18900 et seq.)


           3) Establishes the Medi-Cal program, administered by the State  
             Department of Health Care Services, under which qualified  
             low-income persons are provided with health care services.  
             (WIC 14000 et seq.)


           4) Establishes the responsibility of a benefit recipient  
             changing residence from one county to another within the  
             state to promptly notify the county paying aid to the  
             recipient of the move and to apply for a redetermination of  
             eligibility within the new county of residence. The first  
             county shall notify the second county of the recipient's move  
             as soon as the recipient's location in the second county is  
             known. (WIC 11053)


           5) Requires that the county to which the recipient has moved  
             will be responsible for determining the recipient's continued  
             eligibility for payment of aid and, to the extent possible  
             eligibility for the Medi-Cal program, as of the first day of  
             the month following 30 days after the first county has  
             notified the second county of the recipient's relocation. The  
             first county shall provide the second county with copies of  








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             those documents, as specified, necessary to establish current  
             eligibility and grant amount.  (WIC 11053)


           6) Requires the California Department of Social Services (CDSS)  
             to establish and implement a process of ICT of eligibility  
             for CalFresh benefits, and to take various regulatory  
             actions. (WIC 11053.2)


           7) Requires that, for CalFresh recipients who are receiving  
             CalWORKs benefits, the intercounty transfer process utilized  
             for CalWORKs shall be used. Requires that, for CalFresh  
             recipients who are receiving Medi-Cal but are not receiving  
             CalWORKs benefits, the ICT process utilized for the Medi-Cal  
             program shall be used (WIC 11053.2(b))


           8) Requires development of an ICT process, as specified, for  
             CalFresh recipients.  Requires that, to the greatest extent  
             possible, the process shall be simple, client friendly,  
             ensure the client does not need to provide copies of  
             documents that were previously provided to the prior county  
             of residence, build on existing processes for the programs,  
             and minimize workload for county eligibility operations. (WIC  
             11053.2(c))


           9) Requires that, to the extent permitted by federal law, the  
             new county of residence shall not be required to interview  
             persons in the CalFresh household to determine continued  
             eligibility until the next scheduled recertification or other  
             regularly scheduled interview. (WIC 11053.2(d))


          This bill: 


           1) Requires it be the responsibility of a recipient changing  
             residence from one county to another to promptly notify  
             either the county from which he or she moves or the county to  
             which he or she moves of the change of residence. (This  








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             requirement currently exists for Medi-Cal.)


           2) Requires that recipients of CalWORKs, CalFresh, or Medi-Cal  
             have the right to report a change of residence in person, in  
             writing, telephonically, or, if the technology is available,  
             electronically online, and to be advised of this right at the  
             time of application and redetermination or recertification. 


           3) Requires counties, if a recipient moves from one county to  
             another county, as soon as either county is aware of the  
             move, that county to initiate an ICT for all benefits that  
             the recipient is receiving. 


           4) Requires benefits for all programs for which the recipient  
             is eligible to be transferred within 30 days after any county  
             becomes aware of the recipient's move in order to effectuate  
             the earliest possible start date.


           5) Requires, to the greatest extent possible, the ICT process  
             to be simple and client friendly and minimize workload for  
             county eligibility operations. Requires the ICT to ensure the  
             applicant or recipient does not need to provide copies of  
             documents that were previously provided to the prior county  
             of residence, and there is no interruption in benefits.


           6) Requires case file documents to be electronically shared  
             between the prior county of residence and the new county of  
             residence, to the extent possible, as specified by the  
             relevant state departments.


           7) Prohibits the new county of residence from interviewing  
             recipients moving to that county from another county to  
             determine continued eligibility for CalWORKs or CalFresh  
             until the next scheduled recertification or redetermination.










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           8) Requires that, if the beneficiary moves to another county  
             and is still enrolled in a managed care health plan in the  
             county from which he or she moved and needs services in the  
             new county, the  Medi-Cal Managed Care Ombudsman shall, upon  
             request by either county, disenroll the beneficiary as an  
             expedited disenrollment from his or her managed care health  
             plan effective the next business day after the request is  
             made.


           9) Requires a beneficiary who is disenrolled from the Medi-Cal  
             managed care health plan in the county from which he or she  
             moved to be entitled to the full scope of benefits for which  
             he or she is entitled to in the new county through the  
             fee-for-services delivery system until he or she is enrolled  
             in a Medi-Cal managed care health plan in the new county.


           10)Requires, if the Medi-Cal beneficiary moves to a county that  
             provides Medi-Cal services through a county organized health  
             system (COHS), the beneficiary to be enrolled in that COHS  
             plan on the first day of the month the new county of  
             residence assumes responsibility for that beneficiary. 


           11)Requires, if a Medi-Cal beneficiary moves to a county  
             without a COHS, the usual health plan choice process to  
             apply.


           12)Prohibits failure to report a move to a different county  
             within the state in itself from constituting a basis for an  
             overpayment.


           13)Requires responsibility for payment of aid to a person  
             qualifying for and receiving aid from a county who moves to  
             another county in this state to make his or her home, to be  
             transferred to the second county as soon as administratively  
             possible and within 30 days after either party becomes aware  
             of the aid recipient's move. 









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           14)Repeals Welfare and Institutions Code Sections 11053 and  
             11053.2 and recasts the provisions into a new code. 


          Background


          The process of transferring cases for eligibility and case  
          management purposes is known as an ICT.  The three major  
          programs (CalFresh, CalWORKs and Medi-Cal) all have ICT  
          procedures. 


          According to the author, there have been a number of instances  
          where the current ICT process does not go smoothly, or  
          beneficiaries have been told that in order to be eligible for  
          benefits in the counties to which they are moving they need to  
          be interviewed again and the eligibility needs to be reassessed.  
           The author also states that there is some confusion among  
          counties with regard to the implementation of ICTs and there are  
          instances in which the sending or receiving county does not  
          fully understand the intercounty transfer process due to current  
          law being vague.  The author says SB 1339 seeks to clarify and  
          update state law for counties to have a better understanding of  
          the ICT process and prevent disruption in benefits. 


          Streamlining the codes. ICTs of health and human services  
          benefits are outlined in two separate code sections. Both CDSS  
          and the Department of Health Care Services (DHCS) have issued  
          All County Letters and regulations providing instructions for  
          the counties on the ICT process.  CalWORKs, CalFresh and  
          Medi-Cal each have their own ICT protocols.  Additionally, there  
          are protocols for transferring recipients participating in more  
          than one program.  


          SB 1339 repeals the two sections of current law and creates one  
          new overarching section that applies to all three health and  
          human services programs.  









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          Simplifying the ICT process. Existing law requires the recipient  
          of CalWORKs benefits to apply for redetermination of eligibility  
          within the new county of residence. While not mandated by law or  
          regulation, some counties require interviews as part of the  
          redetermination process, which may delay completion of the  
          transfer.  On the other hand, CalFresh ICTs do not require  
          submission of a new application and the counties are not  
          permitted to require interviews for redetermination of  
          eligibility.  


          SB 1339 brings conformity to the transfer process by deleting  
          the current requirement for CalWORKs recipients to apply for  
          redetermination.  It would also prohibit the new county of  
          residence from interviewing recipients to determine continued  
          eligibility for CalWORKs or CalFresh until the next scheduled  
          recertification or redetermination.


          Currently, the receiving county's responsibility starts at the  
          end of the month following the 30-day transfer period.  By  
          mutual agreement of the counties, the transfer may occur at an  
          earlier date.  SB 1339 shortens the transfer period by requiring  
          that the transfer be completed within 30 days after the  
          receiving county becomes aware of the recipient's move. 


          DHCS guidance instructs counties to ensure all Medi-Cal cases  
          remain active throughout the ICT period with no interruption in  
          benefits. Counties are instructed not to terminate benefits when  
          a Medi-Cal beneficiary moves to another county until an  
          effective date of benefits for the beneficiary in the new county  
          is confirmed. In addition, counties are prohibited from  
          requiring a beneficiary to reapply for Medi-Cal benefits or  
          apply for a redetermination of eligibility in the new county  
          solely due to the change in county residence.


          Change to expedited disenrollment. Under existing regulation,  
          expedited disenrollment from Medi-Cal managed care is subject to  
          specified criteria. One of the criteria is that the beneficiary  








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          has not used services for which the Medi-Cal managed plan is  
          contractually obligation to pay during the month for which  
          disenrollment is requested. Under current regulation, expedited  
          disenrollment requests are be effective on the first day of the  
          month in which the request is processed. 



          This bill no longer limits the expedited disenrollment of  
          Medi-Cal managed care beneficiaries to individuals who have not  
          received services in a month in their original county Medi-Cal  
          managed care plan. Instead, this bill requires that an expedited  
          disenrollment be effective the next business day after the  
          request is made. In addition, the beneficiary would be entitled  
          to the full scope of services for which he or she is entitled in  
          the new county for FFS Medi-Cal. 


          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes

          According to the Senate Appropriations Committee: 

           Potential one-time costs up to $300,000 to revise existing  
            regulations governing the ICT process by the DHCS and CDSS  
            (General Fund and federal funds). 


           Unknown state reimbursable mandate costs, to the extent that  
            this bill results in significantly higher administrative costs  
            to the counties (General Fund). There are some elements of  
            this bill that may increase county costs. For example this  
            bill requires counties to transfer responsibility for benefits  
            within 30 days of either county becoming aware of a  
            recipient's move, whereas current law requires the transfer of  
            responsibility to occur on the first day of the month  
            following 30 days of notification to the receiving county.  
            Whether shortening the timeline for transferring  
            responsibility will have a significant administrative cost to  
            the counties is unknown.










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           Unknown additional expenditures for CalFresh and CalWorks  
            benefits due to additional beneficiaries retaining eligibility  
            after a move between counties (General Fund and local funds).  
            Under current law, the receiving county is required to  
            determine a beneficiary's continuing eligibility for aid. This  
            bill prohibits the receiving county from interviewing  
            recipients to determine continuing eligibility. By removing  
            this requirement, it is likely that this bill will result in  
            some beneficiaries retaining benefits until the next  
            redetermination period who would have lost benefits after a  
            move. The extent of this impact is unknown.


           Unknown additional costs for Medi-Cal benefits (General Fund  
            and federal funds). Most Medi-Cal beneficiaries are enrolled  
            in managed care. Medi-Cal does not allow an enrollee to be  
            covered by more than one managed care plan in any given month.  
            Under current practice, when a Medi-Cal enrollee moves between  
            counties, the enrollee would normally only be eligible for  
            emergency services in the new county until his or her  
            disenrollment from the original managed care plan was  
            processed. Under this bill, a beneficiary would be able to  
            request an expedited disenrollment that would be effective the  
            next business day. The beneficiary would then be entitled to  
            full-scope fee-for-service benefits for the remainder of the  
            month. Making this change will allow some number of  
            beneficiaries to access additional, non-emergency health care  
            services for the remainder of the month of the move. The  
            extent of those costs is unknown.


          SUPPORT:   (Verified  5/31/16)

          Coalition of Welfare Rights Organizations (co-source)
          United Way of California (co-source)
          Western Center on Law and Poverty (co-source)
          Asian Law Alliance
          Bay Area Legal Aid
          California Association of Food Banks
          California Catholic Conference, INC
          California Food Policy Advocates
          Central California Legal Services








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          Children Now
          Community Health Councils
          County Welfare Directors Association of California
          Courage Campaign
          Disability Rights Legal Center
          Health Access California
          Hunger Action Los Angeles
          Inland Empire United Way
          Law Foundation of Silicon Valley
          Legal Aid Society of Orange County
          LIUNA Locals 777 & 792
          Maternal and Child Health Access
          National Association of Social Workers
          National Health Law Program
          North Coast Opportunities, Inc.
          Nurse-Family Partnership
          Orange County United Way
          Project Inform
          San Francisco AIDS Foundation
          The Children's Partnership
          United Way Monterey County
           United Way of Fresno and Madera Counties and The United way of  
            Stanislaus County 
          United Way of Santa Cruz County
          United Way of the Bay Area
          3 Individuals


          OPPOSITION:   (Verified5/31/16)


          None received


          ARGUMENTS IN SUPPORT:      This bill is jointly sponsored by the  
          Coalition of California Welfare Rights, United Ways of  
          California and Western Center on Law and Poverty (WCLP). WCLP  
          writes this bill modernizes the process for transferring records  
          for people who are receiving CalWORKs, CalFresh or Medi-Cal when  
          they move from one county to another within California to ensure  
          no break in benefits. 









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          According to WCLP, retaining safety net benefits when moving to  
          a new county is not only critical to the health and stability of  
          the family in their new community, but also a right to which  
          recipients are entitled. WCLP states it has heard from community  
          partners assisting consumers who have had trouble transferring  
          their benefits to a new county. In these cases, people haven't  
          been able to access medical care or CalWORKs supportive services  
          including cash aid, transportation and child care services. WCLP  
          states delays in processing ICTs results in individuals and  
          families who are already struggling to get by on very limited  
          means being unable to participate in job training or see the  
          doctor, because their benefits have not been moved to their new  
          county. Current ICT rules require people to report the move to  
          the county human services agency in the county from which they  
          moved, which has proven not to work well sometimes, and the  
          process itself is outdated in a number of other respects. This  
          bill streamlines and modernizes the ICT process. 


           

          Prepared by:Taryn Smith / HUMAN S. / (916) 651-1524
          5/31/16 20:58:30


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