BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 963
A
AUTHOR: Ammiano
B
AMENDED: May 25, 2010
HEARING DATE: June 9, 2010
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REFERRAL: Human Services Committee
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CONSULTANT:
3
Dunstan/jl
SUBJECT
Public social services: renewal and recertification of
eligibility
SUMMARY
Requires the California Department of Health Care Services
(DHCS) to establish, in consultation with counties, the
Department of Social Services (DSS), consumers and
representatives of the Statewide Automated Welfare System
(SAWS) consortia, a stakeholder planning work group to
develop a joint renewal and recertification form to be used
by persons who are eligible for Medi-Cal, Food Stamp or
CalWORKS programs.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Medicaid program to provide comprehensive
health benefits to specified groups of low-income persons.
Establishes the Supplemental Nutrition Assistance Program
(SNAP), formerly known as the Food Stamp program,
administered by the U.S. Department of Agriculture (USDA),
which imposes specified rules on specified program
participants and limits benefits based on those rules.
Continued---
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Establishes the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (Welfare Reform Act)
and the Temporary Aid to Needy Families program, which are
programs designed to help welfare recipients achieve
independence and self-sustenance through employment.
Existing state law:
Establishes the Medi-Cal program, the state's Medicaid
program, administered by DHCS, which provides comprehensive
health benefits to low-income children; their parents or
caretaker relatives; pregnant women; elderly, blind or
disabled persons; nursing home residents and refugees.
Defines the eligibility procedures to be used for
enrollment and redetermination of eligibility.
Establishes the Food Stamp program, administered by state
and local agencies, that enables recipients of aid and
other low-income households to receive federal food
assistance benefits and the CalWORKS program, under which
each county provides cash assistance and other benefits to
qualified low-income families and individuals who meet
specified eligibility criteria. CalWORKs is the state
version of the federal program Temporary Assistance for
Needy Families. Both the Food Stamp program and the
CalWORKs program are administered at the state level by the
Department of Social Services.
This bill:
Requires DHCS, in consultation with DSS, counties,
representatives from the Statewide Automated Welfare System
(SAWS) consortia, consumer advocates, and other stakeholder
groups, to develop a joint renewal and recertification form
to be used by individuals and families who are recipients
of Medi-Cal, Food Stamp or CalWorks programs.
Specifies criteria that the stakeholder group must consider
in developing the plan, including the following:
Eliminate any duplicative requests for information
or documentation.
Develop forms, policies and procedures to be used
for both paper and electronic renewal and
recertification.
Maximize use of shared technology and information
to minimize burdens on recipients and county
eligibility staff.
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Align renewal and recertification dates between the
programs without loss of any benefits.
Establish appropriate procedures and safeguards for
data and information sharing.
Consider any changes that may be needed under
federal health care reform and any other applicable
federal laws and regulations.
Requires DHCS, in consultation with DSS, to obtain funding
from private or public sources to finance the stakeholder
planning work group. Prohibits any General Fund money to
be used for that purpose.
Requires DHCS and DSS to submit the joint renewal and
recertification form and related policies and procedures
developed by the work group to the appropriate policy and
fiscal committees of the Legislature by January 31, 2012.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, the bill would have the following fiscal impacts:
One-time, non-General Fund (e.g., federal or
private) costs of $50,000 to $100,000 to convene the
stakeholder group and conduct analysis to make
recommendations to reduce eligibility barriers. This
bill specifies the stakeholder group will be funded
with non-General Fund support. The author and sponsor
indicate interest has been expressed by philanthropic
stakeholders and that federal Food Stamps funding may
also be available to support these efforts.
Recent amendments narrow the scope of this bill to
delete implementation requirements and to clarify that
no General Fund costs or pressures will be created.
BACKGROUND AND DISCUSSION
According to the author, AB 963 creates a stakeholder work
group tasked with providing strategic direction for
updating program forms and renewal processes to allow
eligible people to stay enrolled in Medi-Cal, Food Stamps
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and CalWORKs more efficiently. According to the author,
each county administers multiple programs to provide basic
necessities to low-income individuals and families,
including Medi-Cal, Food Stamps and CaIWORKS and that many
of the same people are eligible for two or more programs.
The author argues that efforts to modernize and streamline
enrollment in these programs will address the issue of
eligible children and adults who are dropped from coverage
because of complex renewal requirements. The author also
notes that the stakeholder work group recommendations will
identify administrative barriers to the continuity of
coverage, reduce county administrative costs and improve
efficiency in the renewal process for eligible
beneficiaries and counties.
SNAP/Food Stamp program
In California, more than three million people receive
federal food assistance benefits under the SNAP program.
To qualify for SNAP benefits, households must meet certain
income tests, and some households must meet certain
resource tests and work requirements. According to the
USDA, in 2009, California received $4.3 billion in federal
food assistance benefits; yet, only about half of eligible
persons actually receive food stamps. Some advocates argue
that the state could be receiving billions more in food
assistance benefits and the state should take actions to
improve food stamp participation for the benefit of
low-income individuals and the state's economy.
The Food Stamp program is California's most significant
means of reducing hunger and improving nutrition among the
state's poor. It serves a total of nearly two million
people. The benefits, paid monthly through an electronic
benefit transfer system, are entirely funded by the federal
government. The federal, state, and county governments
share the cost of administration. It is administered
locally by county welfare departments.
CalWORKS
CalWORKs is a program based on a partnership concept
between government and the participant, under which the
government promises to provide a monthly cash grant and
offer supportive services to the participant. Together,
the cash and services are intended to defray living
expenses and help the participant overcome barriers, such
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as substance abuse or domestic violence, or to give them
the basic tools, such as a bus pass or proper work
clothing, that make obtaining and maintaining a job
possible. While counties administer the cash aid and
arrange for or provide supportive services for a
participant, the state and federal governments provide most
of the funding for this program.
Statewide Automated Welfare System (SAWS)
Each of California's fifty-eight counties uses one of four
automated systems to administer California's human services
programs, including Medi-Cal, CalWORKs, and Food Stamps.
Taken together, these four automated systems comprise the
Statewide Automated Welfare System (SAWS). These systems
facilitate initial and ongoing eligibility determinations,
case management, sending of notices, processing of mid-year
and quarterly reports, and annual eligibility
redeterminations.
The systems also interface directly with the state's
Medi-Cal Eligibility Data System (MEDS), the statewide
Medi-Cal database. SAWS allows counties to determine
initial eligibility for Food Stamps, CalWORKS, and Medi-Cal
all at the same time. However, currently, the annual
redeterminations for these three programs are done via two
separate processes, one for Medi-Cal and another for Food
Stamps and CalWORKs, which creates additional work for both
county workers and recipients and acts as a barrier to
reenrollment. A specific barrier to continued enrollment
in Medi-Cal is that annual redetermination forms sent to
recipients do not contain prior information reported by the
recipient to the county, such as household composition and
income.
ABX4 7 (Budget Committee), Chapter 7, Statutes of 2009,
authorized DHCS and DSS to develop a comprehensive
implementation plan regarding a centralized statewide
eligibility and enrollment process for the Medi-Cal,
CalWORKs, and Food Stamp programs. Current eligibility
processes are administered by county welfare departments
and rely on a face-to-face and mail-in application process
that is burdensome for both recipients and administrators.
Several foundations have funded an ABX4 7 centralized
eligibility work group to assess the viability of a broader
effort to develop a single statewide eligibility system for
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enrollment in health and social service programs.
Uninsured children
There are approximately 700,000 children in California who
are not covered by health insurance, according to
researchers. Many of these uninsured children come from
low-income working families. As a result of the lack of
insurance, they are less likely to visit a doctor, less
likely to receive preventive services, and may delay
seeking necessary care. Often when they seek care, they
have more serious conditions and require more extensive and
costly treatment.
According to the UCLA Center for Health Policy Research,
among the nearly 700,000 children who are uninsured, over
half are eligible for two of California's public health
insurance programs; approximately 200,000 for Medi-Cal and
180,000 for Healthy Families.
Studies have reported 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 less than
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. Of the uninsured children who are
eligible for Healthy Families, parents of nearly 25 percent
did not know of the program's existence and 20 percent knew
of the program but thought that their children were not
eligible.
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Prior legislation
ABX4 7 (Committee on Budget), Ch. 7, Statutes of 2008)
requires a task force to convene to assess current and
future efforts for enrollment across health and social
services programs including Medi-Cal, CalWORKs and Food
Stamps.
AB 2875 (Liebert) of 2008 would have required that a
Medi-Cal beneficiary who completes a periodic report or
annual renewal form, under the CalWORKS program or Food
Stamps program, be deemed to have met the requirement for
periodic redetermination for the Medi-Cal program and would
have made other changes in Medi-Cal enrollment. This bill
was held on the Senate Appropriations Committee suspense
file.
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.
SB 87 (Escutia), Chapter 1088, Statutes of 2000, requires
counties to follow specified steps and procedures
determining Medi-Cal eligibility for those beneficiaries
who have lost their CalWORKS eligibility.
Arguments in support
The sponsors of AB 963, Western Center on Law & Poverty
(WCLP) and the Children's Partnership argue that this bill
will help to streamline the Medi-Cal eligibility process
and eliminate duplicate, burdensome paperwork. The
sponsors state that this bill proposes a simple solution to
ensuring that eligible children and families stay enrolled
in Medi-Cal, Food Stamps and CalWORKS. Supporters note
that, while these programs have very similar eligibility
and renewal requirements and are administered by the same
county departments, many low-income families lose their
benefits because they are required to complete separate
renewal paperwork for each program, which is both
frustrating and time consuming. Supporters also argue that
under current law, eligible recipients of these benefits
are often subject to drops or lapses in coverage due to the
complex renewal requirements.
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PRIOR ACTIONS
Assembly Health Committee 18- 0
Assembly Appropriations Committee 12- 5
Assembly Floor 45-26
COMMENTS
1. Double referral. This bill has been double referred to
the Human Services Committee.
POSITIONS
Support: Children's Partnership (co-sponsor)
Western Center on Law & Poverty (co-sponsor)
AIDS Project Los Angeles (APLA)
Alameda County Food Bank
Aspiranet
California Association of Food Banks
California Primary Care Association (CPCA)
California School Employees Association
County Welfare Directors Association of California
(CWDA)
Los Angeles County Board of Supervisors
National Association of Social Workers - California
Chapter (NASW-CA)
Ventura County Board of Supervisors
Oppose: None received
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