BILL ANALYSIS                                                                                                                                                                                                    Ó



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          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. 








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          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:









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             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  








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            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)









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          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  








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            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  








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            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  








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            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  








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          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  








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          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  








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          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  








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          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. 








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          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