BILL ANALYSIS Ó SB 1339 Page 1 Date of Hearing: June 28, 2016 ASSEMBLY COMMITTEE ON HUMAN SERVICES Susan Bonilla, Chair SB 1339 (Monning) - As Amended June 16, 2016 SENATE VOTE: 39-0 SUBJECT: Public social services: intercounty transfers SUMMARY: Clarifies the process counties must follow when a recipient of public assistance benefits, including CalWORKs, CalFresh, and Medi-Cal, moves between counties. Specifically, this bill: 1)Requires a recipient of public assistance benefits who is changing residence from one county to another to notify either the county from which he or she moves, or the county to which he or she is moving, of the change of residence. 2)Grants recipients of CalWORKs, CalFresh, or Medi-Cal benefits the right to report a change of residence in person, in writing, telephonically, or electronically if the technology is available, and requires recipients to be made aware of this right at the time of application or redetermination or recertification. SB 1339 Page 2 3)Requires a county to initiate an intercounty transfer for all benefits as soon as either county is made aware of a recipient's move from one county to another. 4)Requires that benefits for all programs for which the recipient is eligible be transferred within 30 days after any county becomes aware of the recipient's move in order to ensure timely delivery of services. 5)Requires the intercounty transfer process to be as simple and client friendly as possible, to the greatest extent possible, and further requires that the process ensure the applicant or recipient need not provide copies of documents previously provided to the prior county of residence and that there is no interruption in benefits. 6)Requires that case file documents 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, to the extent permitted by federal law and regulation, from interviewing recipients moving to that county from another county to determine continued eligibility for CalWORKs or CalFresh until the next scheduled recertification, as specified, with the exception of an interview conducted regarding welfare-to-work program participation for CalWORKs recipients. 8)Requires the following for beneficiaries required to receive services through a Medi-Cal managed care health plan: SB 1339 Page 3 a) If a beneficiary moves to a new 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, a Medi-Cal Managed Care Ombudsman must, upon request by the beneficiary or either county, disenroll the beneficiary as an expedited disenrollment from his or her managed care health plan; and b) A beneficiary who is disenrolled from the managed care health plan in the county from which he or she transfers shall be entitled to the full scope of benefits for which he or she is entitled in the new county through the fee-for-services delivery system until he or she is enrolled in a managed care health plan in the new county. 9)If a beneficiary moves to a county that provides Medi-Cal services through a county organized health system, the beneficiary shall be enrolled in that county organized health system plan on the first day of the month the new county of residence assumes responsibility for that beneficiary, as specified. 10)Prohibits the failure to report a move to a different county within the state from constituting a basis for an overpayment. 11)Repeals Sections 11053 and 11053.2 of the Welfare and Institutions Code as it pertains to intercounty transfer timelines and existing intercounty transfer process guidelines. 12)Stipulates that once either county, not just the second county as is specified in current law, becomes aware of a recipient's move, responsibility for payment of aid shall SB 1339 Page 4 shift to the second county. Further states that this shift of responsibility must take place as soon as administratively possible and within 30 days of either county becoming aware of the move, instead of, as in current law, as soon as administratively possible but not later than the first day of the month following 30 days after notification. 13)Makes technical changes. EXISTING LAW: 1)Establishes under federal law the Temporary Assistance for Needy Families (TANF) program to provide aid and welfare-to-work services to eligible families and, in California, provides that TANF funds for welfare-to-work services are administered through the CalWORKs program. (42 U.S.C. 601 et seq., WIC 11200 et seq.) 2)Establishes income, asset and real property limits used to determine eligibility for the program, including net income below the Maximum Aid Payment (MAP), based on family size and county of residence. (WIC 11250 et seq.) 3)Requires all individuals over 16 years of age, unless they are otherwise exempt, to participate in welfare-to-work activities as a condition of eligibility for CalWORKs. (WIC 11320.3, 11322.6) 4)Establishes a 48-month lifetime limit of CalWORKs benefits for eligible adults, including 24 months during which a recipient must meet federal work requirements in order to retain eligibility. (WIC 11454, 11322.85) SB 1339 Page 5 5)Establishes the number of weekly hours of welfare-to-work participation necessary to remain eligible for aid, including requirements for an unemployed parent in a two-parent assistance unit, as specified. (WIC 11322.8) 6)Establishes under federal law the Supplemental Nutrition Assistance Program (SNAP) pursuant to the Food Stamp Act of 1964 and establishes, in California statute, the CalFresh program to administer the provision of federal SNAP benefits to families and individuals meeting specified criteria, as specified. (WIC 18900 et seq.) 7)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.) 8)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. (WIC 11053) 9)Requires the first county to notify the second county of a recipient's move as soon as the recipient's location in the second county is known. (WIC 11053) 10)Requires that the county to which the recipient has moved will be responsible for determining 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 those documents, as SB 1339 Page 6 specified, necessary to establish eligibility and grant amount. (WIC 11053) 11)Requires DSS to establish and implement a process of intercounty transfer (ICT) of eligibility for CalFresh benefits, and to take various regulatory actions. (WIC 11053.20) 12)Requires that, for CalFresh recipients who are receiving CalWORKs benefits, the ICT 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)) 13)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 process for the programs, and minimize workload for county eligibility operations. (WIC 11053.2(c)) FISCAL EFFECT: According to the Senate Appropriations Committee on May 27, 2016, this bill may result in the following costs: 1)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). 2)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 SB 1339 Page 7 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. 3)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. 4)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 SB 1339 Page 8 extent of those costs is unknown. COMMENTS: CalWORKs: The California Work Opportunity and Responsibility to Kids (CalWORKs) program provides monthly income assistance and employment-related services aimed at moving children out of poverty and helping families meet basic needs. Federal funding for CalWORKs comes from the Temporary Assistance for Needy Families (TANF) block grant. The average 2016-17 monthly cash grant for a family of three on CalWORKs (one parent and two children) is $497.35, and the maximum monthly grant amount for a family of three, if the family has no other income and lives in a high-cost county, is $704. According to recent data from the California Department of Social Services, over 497,000 families rely on CalWORKs, including over one million children. Nearly 60% of cases include children under 6 years old. Maximum grant amounts in high-cost counties of $704 per month for a family of three with no other income means $23.46 per day, per family, or $7.82 per family member, per day to meet basic needs, including rent, clothing, utility bills, food, and anything else a family needs to ensure children can be cared for at home and safely remain with their families. This grant amount puts the annual household income at $8,448 per year, or 42% of poverty. Federal Poverty Guidelines for 2016 show that 100% of poverty for a family of three is $20,160 per year. CalFresh: CalFresh benefits are funded entirely by the federal government through the Supplemental Nutrition Assistance Program (SNAP), and the United States Department of Agriculture (USDA) sets specific eligibility requirements for SNAP programs across the United States, including a gross and net income test, work requirements, and other documentation requirements. The maximum allowable gross income is typically 200% of the Federal Poverty SB 1339 Page 9 Level (FPL). Households with elderly or disabled members are not subject to gross income criteria but must have a net monthly income at or below 100% of the FPL. Other households must meet both gross and net monthly income tests. CalFresh is administered locally by county human services agencies, and the federal, state, and county governments share in the cost of administration of the program. Benefits are made available on a monthly basis for food purchase through an ATM-like electronic benefits transfer (EBT) card. However, unlike other types of benefits that may be accessed through an EBT card, CalFresh benefits cannot be withdrawn in cash at point-of-sale terminals or at ATM machines. CalFresh benefits can only be used to purchase food items to be prepared and consumed at home, as well as seeds and plants that can be grown at home and produce food. The average monthly benefit for a CalFresh recipient is $144.35 per month, or $4.81 per person per day. Medi-Cal: Medi-Cal is California's Medicaid program which serves low-income individuals including families, seniors, persons with disabilities, and children in foster care, among others. Administered by DHCS, Medi-Cal services are often implemented at the local level through California's 58 counties. According to DHCS, in January 2016 approximately 13,480,000 Californians were deemed eligible and received benefits through the Medi-Cal program. Women and those adults between the ages of 21 and 64 constituted a majority of Medi-Cal benefit recipients. In the Governor's 2016 Budget, DHCS received just over $26 billion for administration and implementation of services, including Medi-Cal. Inter-County Transfers: In the event that a recipient of public assistance benefits moves between counties, a seamless benefit transfer process is available through an Inter-County Transfer of their case. Currently, CalFresh, CalWORKs and Medi-Cal have SB 1339 Page 10 ICT processes in place. CalFresh : In September 2013, DSS issued an All County Letter (ACL) outlining the ICT process for individuals receiving CalFresh assistance. In acknowledging that ensuring households are not subject to a break in benefits is of high priority, the ACL cites the importance of intercounty communication when determining in which county it is most beneficial for recertification to be completed. The ACL also cites that it is the responsibility of the sending county to confirm that the receiving county is provided with all information necessary to complete the transfer, and that a household may not be terminated for being a resident of the receiving county until the receiving county has assumed responsibility for the case. CalWORKs : According to the DSS Manual of Policies and Procedures, the ICT process for CalWORKs recipients requires the sending county to notify the receiving county of the initiation of a case transfer and inform the recipient in writing of his or her responsibility to immediately apply for a redetermination of eligibility in the receiving county to avoid a break in benefits. The sending county is also responsible for ensuring all necessary documents are sent to the receiving county within seven working days from the date that the sending county notified the receiving county of a case transfer. Medi-Cal : In ACL 03-12 distributed by DHCS in February 2003, the ICT process for Medi-Cal cases is cited and states that counties may not terminate Medi-Cal benefits when a beneficiary moves from one county to another until an effective date of benefits for the beneficiary in the new county is confirmed. Counties also may not ask or require a beneficiary to reapply for Med-Cal benefits or apply for a redetermination of eligibility in the new county of residence solely due to the change in county residence. The ICT process for Medi-Cal recipients does not allow for the redetermination of eligibility SB 1339 Page 11 during the transfer process, nor may counties require a beneficiary to complete a new application for benefits. Need for this bill: According to the author's office, "Low-income individuals and families move more frequently and need to be able to keep their safety-net programs when they do. [This bill] modernizes and simplifies the inter-county transfer process in state statute to make sure that benefits are not interrupted when a beneficiary of the CalWORKs, CalFresh, or Medi-Cal program relocates. There is some confusion among counties with regard to the implementation of Inter-County Transfers and there are instances in which the sending or receiving county does not fully understand the process due to current law being vague. By making the inter-county transfer process easy to eligible beneficiaries and understanding for counties to implement we will be able to prevent unnecessary disruptions in benefits that ensure that people are able to work and stay healthy." Suggested amendments: Because this bill seeks to clarify the responsibilities of sending and receiving counties throughout the ICT process, it is important to note which counties are involved in the process; therefore, in order to clarify that services must be transferred within 30 days of the sending county or receiving county (and not an uninvolved third county) becoming aware of recipient's move, committee staff recommends the following amendments: 1) On page 4, line 7 of the bill strike the word "any" and replace with the word "either". PRIOR LEGISLATION AB 1970 (Skinner), 2012: This bill would have made technical SB 1339 Page 12 changes to existing code sections pertaining to sending and receiving information related to CalFresh and CalWORKs benefits and eligibility. This bill was held on the Senate Appropriations suspense file. REGISTERED SUPPORT / OPPOSITION: Support Coalition of California Welfare Rights Organizations, Inc. - sponsor Asian Law Alliance Bay Area Legal Aid California Catholic Conference California Chapter of the American College of Emergency Physicians (California ACEP) California Food Policy Advocates Central California Legal Services, Inc. (CCLS) Children's Defense Fund Children Now Community Health Councils (CHC) County Welfare Directors Association of CA (CWDA) Courage Campaign Disability Rights Legal Center Health Access California Hunger Action LA Inland Empire United Way Law Foundation of Silicon Valley Legal Aid Society of Orange County LIUNA Locals 777 & 792 Maternal and Child Health Access (MCHA) National Association of Social Workers, CA Chapter (NASW-CA) National Health Law Program North Coast Opportunities, Inc. SB 1339 Page 13 Nurse-Family Partnership (NFP) Orange County United Way Project Inform San Francisco AIDS foundation The Children's Partnership (TCP) The Food Bank of Contra Costa and Solano United Way Fresno and Madera Counties United Way Monterey County United Way of Santa Clara County United Way of Santa Cruz County United Way of the Bay Area United Ways of California - cosponsor Western Center on Law & Poverty - cosponsor Opposition None on file. Analysis Prepared by:Kelsy Castillo / HUM. S. / (916) 319-2089