BILL ANALYSIS                                                                                                                                                                                                    Ó




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          |SENATE RULES COMMITTEE            |                       SB 1339|
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                                UNFINISHED BUSINESS 


          Bill No:  SB 1339
          Author:   Monning (D) 
          Amended:  8/19/16  
          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

           SENATE FLOOR:  39-0, 6/1/16
           AYES:  Allen, Anderson, Bates, Beall, Berryhill, Block,  
            Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,  
            Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,  
            Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,  
            Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone,  
            Vidak, Wieckowski, Wolk
           NO VOTE RECORDED:  Runner

           ASSEMBLY FLOOR:  77-1, 8/22/16 - See last page for vote

           SUBJECT:   Public social services:  intercounty transfers


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

          








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          DIGEST:  This bill clarifies the process counties must follow  
          when a recipient of public assistance benefits, including  
          CalWORKs, CalFresh, and Medi-Cal, moves between counties. 


          Assembly Amendments refine the ICT process, including, but not  
          limited to, requiring a county to initiate the ICT within seven  
          business days of notice of a new residence; providing that  
          benefits shall be transferred within specified timelines;  
          permitting the new county of residence to interview CalWORKs  
          recipients regarding welfare-to-work program participation;  
          providing procedures for disenrollment of Med-Cal benefits; and  
          stating that beneficiaries moving from one county to another  
          shall have continued access to emergency services, as specified,  
          until the ICT process is complete.  The amendments provide  
          technical and clarifying changes to codify existing practice and  
          to comply with federal/state requirements for these programs.   
          They also delay implementation of the bill until June 1, 2017.


          ANALYSIS:   


          Existing law: 


           1) Establishes in state law the 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 the federal 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,  








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


           6) Requires the California Department of Social Services (DSS)  
             to establish and implement a process of Inter-county  
             Transfers (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 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))








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           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 a recipient of public assistance benefits who is  
             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 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. 


           3) Requires the notified county to initiate an ICT for all  
             benefits that the recipient is receiving within seven days of  
             notice of a new residence, and requires benefits be  
             transferred no later than the first day of the next available  
             benefit month following 30 days after a county was notified.








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           4) Requires, to the greatest extent possible, that the ICT  
             process to be as simple and client friendly as possible, to  
             the greatest extent possible, and that it minimize workload  
             for county eligibility operations.  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. 


           5) 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.


           6) 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.


           7) Requires the following for beneficiaries required to receive  
             services through a Medi-Cal managed care health plan:


              a)    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, the beneficiary shall have  
                continued access to emergency services and any other  
                coverage the managed care health plan authorizes  
                out-of-network until the time that the ICT process is  
                complete and the beneficiary is disenrolled from the  
                managed care health plan.


              b)    If the beneficiary moves to another county and is  
                still enrolled in a managed care health plan in the county  








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                from which he or she moved and needs nonemergent care that  
                same month in the new county, the Medi-Cal Managed Care  
                Ombudsman shall, upon request by the beneficiary or either  
                county, disenroll the beneficiary as an expedited  
                disenrollment from his or her managed care health plan, as  
                specified. 


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


              d)    If the 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  
                following month once the new county of residence is  
                reflected in the Medi-Cal Eligibility Data System. If a  
                beneficiary moves to a county without a county organized  
                health system, the usual health plan choice process shall  
                apply.


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


           9) Requires the Department of Health Care Services (DHCS) and  
             DSS to implement, interpret, or make specific the provisions  
             of this bill, as specified, and report to the Legislature on  
             a semiannual basis until regulations have been adopted.


           10)Requires DHCS and DSS to adopt regulations, as specified, by  
             July 1, 2021.










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           11)Makes specified provisions of the bill contingent upon the  
             availability of federal financial participation and the  
             acquisition of any necessary federal approvals.


           12)Makes inoperative as of June 1, 2017, and repeal as of  
             January 1, 2018, exemptions for caretaker relatives as they  
             pertain to personal interviews for public assistance, as  
             specified.


           13)Delays implementation of the provisions of this bill until  
             June 1, 2017 and makes technical changes.


          Background


          CalFresh provides monthly benefits to assist low-income  
          households in purchasing food or food product intended for human  
          consumption.  CalFresh benefits are 100% federally funded and  
          national eligibility standards and benefit levels are  
          established by the federal government.  To participate in  
          CalFresh, households must meet certain income-eligibility  
          standards.  The average monthly benefit for a CalFresh recipient  
          in federal fiscal year 2015 was $126.83 per month, or $4.23 per  
          day, according to the USDA. Households who receive or are  
          eligible to receive cash assistance under CalWORKs or General  
          Assistance/General Relief programs are categorically eligible  
          for CalFresh.  CalFresh currently serves approximately 4.4  
          million people, according to USDA data. 


          The 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 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 DSS, around 497,000 families  








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          rely on CalWORKs, including over one million children.  Nearly  
          60% of cases include children under 6 years old.


          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.


          ICT Procedures


          DSS and 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.  


          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. 










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          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 during the transfer  
          process, nor may counties require a beneficiary to complete a  
          new application for benefits.


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


          According to the Assembly Appropriations Committee:


          1)Unknown, potentially reimbursable, state mandated costs for  
            increased county administrative costs (General Fund).  By  
            expediting the transfer of responsibility for providing  
            CalWORKs benefits between counties, this bill will result in  
            the shifting of administrative costs from one county to  
            another.  The net effect is unlikely to be an overall increase  
            in expenditures for CalWORKs benefits.  Therefore, it is  
            unlikely that counties would be successful in seeking state  
            reimbursement for the increased costs due to the expedited  








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            deadlines for processing transfers.

          2)Unknown potential increased costs for benefits (General  
            Fund/local funds), likely minor, from the potential increase  
            in eligibility due to the prohibition on redetermining  
            eligibility upon a transfer.

          3)Minor and absorbable costs to revise existing regulations  
            governing the ICT process by the DHCS and DSS. 


          SUPPORT:   (Verified  8/22/16)


          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 Association of Public Authorities
           California Catholic Conference, INC
           California Chapter of the American College of Emergency  
            Physicians
           California Food Policy Advocates
           Central California Legal Services
           Children Now
           Children's Defense Fund- California
           Community Health Councils
           County Welfare Directors Association of California
           Courage Campaign
           Disability Rights Legal Center
           Food Bank of Contra Costa and Solano
           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








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           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
          Three individuals


          OPPOSITION:  (Verified  8/22/16)


          California Department of Finance


          ARGUMENTS IN SUPPORT:      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. 


          ARGUMENTS IN OPPOSITION:      The Department of Finance opposes  
          the August 1, 2016 version of this bill because it does the  
          following: 

           Results in costs not included in the current fiscal plan and  
            creates a state-reimbursable mandate. 
           Requirements are inconsistent with existing policy for  








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            Medi-Cal. 
           Is not consistent with DHCS's current practice of  
            incorporating changes to the transfer process through the All  
            County Welfare Director's letter. 
           Shortens the time allowed for the transfer of benefits, a  
            timeline that may not be achievable for counties.

           ASSEMBLY FLOOR:  77-1, 8/22/16
           AYES: Achadjian, Alejo, Arambula, Atkins, Baker, Bigelow,  
            Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos,  
            Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh,  
            Dahle, Daly, Dodd, Eggman, Frazier, Gallagher, Cristina  
            Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,  
            Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,  
            Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,  
            Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,  
            Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson,  
            Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth,  
            Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk,  
            Williams, Wood, Rendon
           NOES: Travis Allen
           NO VOTE RECORDED: Beth Gaines, Melendez



          Prepared by:Taryn Smith / HUMAN S. / (916) 651-1524
          8/22/16 22:49:41


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