BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Sheila J. Kuehl, Chair
BILL NO: SB 1369
S
AUTHOR: Cedillo
B
AMENDED: April 10, 2008
HEARING DATE: April 23, 2008
1
FISCAL: No
3
Consultant:
6
Dunstan/cjt
9
SUBJECT
Health care program applications
SUMMARY
Grants school districts the option to avoid the step of
processing a school lunch program application for the
purposes of determining eligibility for Medi-Cal or Healthy
Families, if the district knows that the child already has
an active Medi-Cal or Healthy Families case.
CHANGES TO EXISTING LAW
Existing law:
Existing state law establishes the state's Medicaid
program, known as Medi-Cal, which is administered by the
Department of Health Care Services (DHCS), and provides
comprehensive health benefits to low-income children, their
parents or caretaker relatives, pregnant women, seniors,
persons with disabilities, nursing home residents, and
refugees who meet specified eligibility criteria. Existing
state law establishes the Healthy Families Program to
provide low-cost insurance, including health, dental and
vision coverage to children who do not have insurance, do
Continued---
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not qualify for free Medi-Cal, and are in families at or
below 250 percent of the federal poverty level.
Existing law establishes an express enrollment process to
expedite Medi-Cal enrollment for children receiving free
lunches through the National School Lunch Program.
Existing law grants school districts and county
superintendents of schools the option to include, in the
school lunch program application materials or the
notification of eligibility, a request for parental consent
for the child to participate in the Medi-Cal program, and
have the information on the school lunch application shared
with the entity designated by DHCS, typically the county,
to make an accelerated determination of Medi-Cal
eligibility. Existing law also allows the sharing of
application information for determining Healthy Families
eligibility and any other public health insurance program.
Existing law prohibits a school, if the school is aware
that a child already has an active Medi-Cal or Healthy
Families case, from forwarding the application to the
entity that makes the accelerated determination, but
requires the school to forward that application to the
local agency that determines Medi-Cal eligibility. In that
case, existing law requires the school to notify the parent
of a child's ineligibility for accelerated Medi-Cal and
that the child's application will be forwarded to the
county. The notice must include a statement, with contact
information, advising the parent to contact the Medi-Cal or
Healthy Families programs for further assistance regarding
the child's eligibility.
This bill:
This bill would grant school districts the option of not
processing the school lunch program application for an
accelerated determination and not forwarding it to the
entity designated by DHCS to make an accelerated
determination, when the school has data indicating that the
child already has an active Medi-Cal or Healthy Families
case.
This bill would add to the application for free school
meals, for those school districts or county superintendents
of schools who have chosen to participate in express
enrollment, a notification to parents that, if the school
district possesses data indicating that child already has
STAFF ANALYSIS OF SENATE BILL 1369 (Cedillo) Page
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an active Medi-Cal or Healthy Families case, the
information on the school lunch application will not be
shared. This bill would require that notice sent by a
participating school district contain directions on how to
obtain additional information about the Medi-Cal and
Healthy Families programs so that families can obtain
health care coverage for children.
This bill would require that, if the school district has
verified that the child does not have an active Medi-Cal or
Healthy Families case, it must process the application for
an accelerated Medi-Cal determination and forward it to the
entity designated to make an accelerated determination of
Medi-Cal eligibility.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
According to the author, this bill will streamline
eligibility by allowing school districts the option of not
forwarding Medi-Cal applications for children if the school
district has data showing the child is already enrolled.
The author states that the Los Angeles Unified School
District found that 40 percent of the applications the
district sends to Los Angeles County are for children the
school district already knows are enrolled in Medi-Cal, but
that the district must, by current law, forward these
applications anyway. The author notes that parents or
guardians would be notified and told how to obtain more
information about how to receive coverage under Medi-Cal or
Health Families. The author argues that reducing the
number of applications forwarded to the responsible county
agency for processing will significantly reduce the time
and money spent on processing Medi-Cal applications for
children who are already enrolled.
Background
According to an October 2006 UCLA Center for Health Policy
Research report, out of the three-quarters of a million
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children (763,000) who were uninsured at the time of the
2005 California Health Interview Survey, nearly one-half
million (447,000) were eligible for either Medi-Cal or
Healthy Families under current rules for enrollment, but
were not enrolled. Based on national studies, about
two-thirds of these eligible children are enrolled in other
public programs such as the National School Lunch Program.
To enroll in these public programs, families complete an
application and submit necessary documentation, providing
much of the same information that is required for Medicaid
and SCHIP enrollment.
Researchers have surveyed the reasons that parents may not
enroll eligible children. They report that, when parents
of uninsured children who are potentially eligible for
Medi-Cal were asked why their children were not enrolled,
close to eight percent reported being unsure about their
children's eligibility as the reason for not applying, and
almost one percent did not know the program existed.
Parents of about one in eight uninsured eligible children
objected to some characteristics of the program,
particularly the onerous paperwork.
According to the aforementioned UCLA study, uninsured
children reported lower health status than those enrolled
in Medi-Cal or Healthy Families. Over three-fourths of
insured children or their parents reported their health as
"excellent" or "very good," while less than half of
uninsured children reported the same. Uninsured children
were also more than three times as likely to report their
health status as "fair" or "poor" than those with job-based
coverage. Nearly half of the uninsured reported no usual
source of care and were only half as likely as those with
Medi-Cal to list a doctor's office or health maintenance
organization as their usual source of care and only
one-third as likely as those with job-based coverage or
individually purchased private insurance.
Express enrollment process
Under express enrollment, families in a participating
school district can apply for Medi-Cal by authorizing the
use of their child's school lunch application information
for a Medi-Cal eligibility determination. School districts
review the applications of children eligible for free
school meals and provide a certification for express
STAFF ANALYSIS OF SENATE BILL 1369 (Cedillo) Page
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enrollment into Medi-Cal, on the basis of the information
in the school lunch application, within five days.
Families do not need to complete a full Medi-Cal
application or document their income since eligibility for
the school lunch program meets these requirements.
Children certified as eligible for express enrollment
immediately receive temporary health care coverage and are
sent a beneficiary card while the county collects
additional information to make a final eligibility
determination. If a child is found ineligible based on
the information, the county conducts a complete review for
Medi-Cal eligibility and also may send the information to
the Healthy Families program.
School districts have the option to participate in express
enrollment. Counties, typically through the county welfare
office, are required to implement the Medi-Cal eligibility
determination aspects of the program if a school district
decides to participate. School districts cannot implement
the process without first contacting their county Medi-Cal
office and establishing a memorandum of understanding with
the county.
Related legislation
AB 2875 (Lieber) would require DHCS to conduct a study to
determine how to implement a pilot program allowing parents
applying for eligibility for Food Stamps for their children
to allow eligibility information to be forwarded to county
health agencies for determining presumptive eligibility for
Medi-Cal or Healthy Families. Pending in Assembly
Appropriations Committee.
Prior legislation
SB 1196 (Cedillo), Chapter 729, Statutes of 2004,
authorizes the sharing of the school lunch program
application for purposes of the Healthy Families Program
and any other county or local sponsored health insurance
program when the child does not meet eligibility
requirements for Medi-Cal.
SB 493 (Sher), Chapter 897, Statutes of 2001, implements a
simplified eligibility process as part of the Food Stamp
Program to expedite the enrollment of individuals and
families in the Medi-Cal and Healthy Families Program.
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AB 59 (Cedillo), Chapter 894, Statutes of 2001, establishes
a statewide pilot project to expedite Medi-Cal enrollment
for children receiving free lunches through the National
School Lunch Program.
Arguments in support
The Los Angeles Unified School District (LAUSD), SB 1369's
sponsor, states that this bill will allow school districts
the option of not processing applications for express
eligibility determinations when they know of a child's
active Medi-Cal case. LAUSD argues that this will allow
them to focus on those children for whom an application is
truly needed and will expedite the enrollment of eligible
children into Medi-Cal or Healthy Families. The County
Welfare Directors Association (CWDA) argues that this bill
will eliminate duplicative work on the part of schools and
counties who are processing applications for children who
are already receiving Medi-Cal. CWDA points out that this
bill would notify parents of the decision, so they could
seek assistance from the county if they were not aware of
their existing eligibility for Medi-Cal or do not have the
beneficiary card.
POSITIONS
Support: The Los Angeles Unified School District (sponsor)
100% Campaign
California Teachers Association
County Welfare Directors Association of California
Western Center on Law & Poverty
Oppose: None received
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