BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 963
A
AUTHOR: Ammiano
B
VERSION: May 25, 2010
HEARING DATE: June 22, 2010
9
FISCAL: Appropriations
6
3
CONSULTANT:
Park
SUBJECT
Public social services: renewal and recertification of
eligibility
SUMMARY
Requires the 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 workgroup to develop a joint renewal
and recertification form to be used by persons who are
eligible for the Medi-Cal, Food Stamp or CalWORKs programs.
ABSTRACT
Existing federal law:
1.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, which provides food assistance benefits to
qualifying individuals based on specified rules.
Establishes the Temporary Aid to Needy Families program,
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
2
which provides time-limited cash assistance to qualifying
individuals based on specified rules. Each of these
federal programs is administered through state and local
entities.
Existing state law:
1.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.
2.Establishes the Food Stamp program, overseen by DSS and
administered by counties, that enables recipients of aid
and other low-income households to receive federal food
assistance benefits (under SNAP).
3.Establishes the California Work Opportunity and
Responsibility to Kids program, or CalWORKs, overseen by
DSS, under which each county provides time-limited cash
assistance and welfare-to-work services to qualified
low-income families and individuals who meet specified
eligibility criteria. CalWORKs is the state version of
the federal Temporary Assistance for Needy Families
program.
4.Requires DHCS and DSS to develop a statewide eligibility
and enrollment determination process for CalWORKs,
Medi-Cal, and food stamps, as specified. Requires the
departments to convene a stakeholder steering committee
for consultation in the development of the statewide
eligibility and enrollment determination process and
comprehensive plan. Makes implementation of these
provisions contingent upon the availability of federal
financial participation.
This bill:
1.Requires DHCS, in consultation with DSS, counties,
representatives from the Statewide Automated Welfare
System (SAWS) consortia, consumer advocates, and other
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
3
stakeholder groups, to develop a joint renewal and
recertification form to be used by individuals and
families who are recipients of one or more of the
Medi-Cal, Food Stamp or CalWORKs programs, as well as
related policies and procedures.
2.Specifies tasks for the stakeholder group to undertake in
developing the form, policies, and procedures to be
considered for adoption by DHCS, DSS, the counties, and
the SAWS consortia, including the following:
a. Eliminate any duplicative requests for information
or documentation.
b. Develop forms, policies and procedures to be used
for both paper and electronic renewal and
recertification.
c. Maximize use of shared technology and information
to minimize burdens on recipients and county
eligibility staff.
d. Align renewal and recertification dates between the
programs without loss of any benefits.
e. Establish appropriate procedures and safeguards for
data and information sharing.
f. Consider any changes that may be needed under
federal health care reform and other federal laws and
regulations, as specified.
1.Requires DHCS, in consultation with DSS, to obtain
funding from private or public sources to finance the
stakeholder planning workgroup. Prohibits any General
Fund money to be used for that purpose.
2.Requires DHCS and DSS to submit the joint renewal and
recertification form and related policies and procedures
developed by the workgroup to the appropriate policy and
fiscal committees of the Legislature by January 31, 2012.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of a prior version of the bill, the bill would have
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
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
4
eligibility barriers. Recent amendments narrow the scope
of this bill and clarify that no General Fund costs or
pressures will be created.
BACKGROUND AND DISCUSSION
Author's statement
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
and CalWORKs more efficiently. The author states that 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 workgroup
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.
Uninsured children
According to the UCLA Center for Health Policy Research,
among the nearly 700,000 children who are uninsured, more
than half are eligible for two of California's public
health insurance programs; approximately 200,000 for
Medi-Cal and 180,000 for Healthy Families. Uninsured
children 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.
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
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
5
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.
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. Food stamp benefits
are paid monthly through an electronic benefit transfer
system and administered locally by county welfare
departments. The benefits are entirely funded by the
federal government, although federal, state, and county
governments share in the cost of administration.
SNAP requires all recipients, unless exempted by law, to
register for work at the appropriate employment office,
participate in an employment and training program if
assigned by a state or local administering agency, and
accept an offer of suitable employment. Food stamp
recipients are exempted from registering for work and
engaging in employment and training activities if they are
under age 16 or over age 59; physically or mentally unfit
for employment; caring for a child under the age of 6 (or
12, in some cases); employed 30 hours a week; or subject to
and complying with work requirements for other programs,
such as those required by CalWORKs. Additionally, others
are exempted because they are receiving unemployment
insurance compensation, participating in a drug and alcohol
treatment and rehabilitation program, or are students
enrolled at least half time (these students must meet other
work participation requirements).
Families receiving CalWORKs must comply with CalWORKs work
requirements in order to be exempt from meeting the food
stamp work requirements. Non-CalWORKs families (known as
non-assistance food stamps population) must register for
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
6
work, unless exempt, and participate in food stamp
employment and training program activities, if assigned to
such a program. Federal law also requires that able-bodied
adults without dependents (ABAWDs) are generally limited to
three months of food assistance benefits in a 36-month
period unless they fulfill federal work requirements or
receive an exemption. The American Recovery and
Reinvestment Act of 2009 eliminated this time-limit
restriction until September 30, 2010.
CalWORKs
CalWORKs is supervised by DSS and administered by the
counties. CalWORKs has requirements relating to
eligibility, cash grant levels, work participation,
exemptions, time limits, and sanctions. CalWORKs families
receive cash assistance and most receive employment and
supportive services aimed at promoting self-sufficiency.
To be eligible, families must meet income and asset
requirements and must include a child who is "deprived" of
parental support or care, as defined. The cash grant is
based, in part, on the number of people in the family, the
number eligible to receive aid, the region the family lives
in, and whether anyone in the household is exempt from work
participation.
All CalWORKs recipients are required to participate in
welfare-to-work activities as a condition of aid, unless
the recipient is exempt. State law requires counties to
sanction individuals for noncompliance with specific
welfare-to-work program requirements. When a family,
without good cause, does not comply with program
requirements, the family's grant is reduced to remove
support for the noncompliant adult (or adults), leaving a
"child-only" grant.
In general, CalWORKs has a 60-month limit. However, some
months may not be counted towards the 60-month time limit,
and some eligible adults may have their aid or services
extended beyond the 60-month limit. (Under new state time
limits enacted in one of last year's budget trailer bills,
adult CalWORKs recipients may receive aid for up to 48
cumulative months. At that point, the adult portion of the
grant is eliminated and a child-only grant is given for 12
months. If at that point, after the 12 months, the adult
continues to be eligible, the adult is added back into the
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
7
family grant for the remaining 12 months of his or her
60-month limit.)
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
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. Additionally, counties redetermine recipient
eligibility and grant amounts for food stamps and CalWORKs
on a quarterly basis. 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.
Centralized statewide eligibility and enrollment
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 generally 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 workgroup to assess the
viability of a broader effort to develop a single statewide
eligibility system for enrollment in health and social
service programs. Though the Health and Human Services
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
8
Agency has convened a few meetings to date, several issues
concerning the direction of the stakeholder process and
work product remain. It is also unclear how federal health
reform and pending guidance impact the direction of the
stakeholder process and work product.
Arguments in support
The sponsors of AB 963, Western Center on Law & Poverty
(WCLP), the Children's Partnership, and United Way of the
Bay Area believe 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 likewise state that eligible
recipients of these benefits are often have lapses in
coverage or drop coverage due to the complex renewal
requirements.
Related/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 (Lieber) 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 programs.
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
9
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.
PRIOR VOTES
Senate Health Committee 5 - 0
Assembly Floor 45 - 26
Assembly Appropriations Committee 12 - 5
Assembly Health Committee 18 - 0
COMMENTS
1.Author's amendments. The author proposes the following
clarifying amendments in response to questions raised by
committee staff.
14012.6. (a) The department, in consultation with
counties, the State Department of Social Services,
representatives of the Statewide Automated Welfare System
(SAWS) consortia, consumers, and other affected
stakeholder groups, shall conduct a stakeholder planning
workgroup to develop a joint single renewal and
recertification form to be used by individuals and
families who are recipients of one or more of the
Medi-Cal, Food Stamp, or CalWORKs benefits programs. The
workgroup shall include consumer advocates with expertise
in each of the Medi-Cal, Food Stamp, and CalWORKs
programs.
(b) The stakeholder planning workgroup shall develop the
joint single renewal and recertification form, and any
related policies and procedures, to be considered for
adoption by the department, the counties, the State
Department of Social Services, and the SAWS consortia. In
developing the form, policies, and procedures the
stakeholder planning workgroup shall do all of the
following:
(1) Determine which questions and documentation
requests on existing renewal and recertification forms
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
10
are necessary and eliminate any requests for
information or documentation that are duplicative.
(2) Develop the joint single renewal and
recertification form to allow recipients to skip
sections on the form if they are not enrolled in, or
do not want to be evaluated for, one or more of the
benefit programs.
?
(9) Consider any additional modifications that could
be made to the renewal and recertification procedures
to minimize burdens on the recipients and encourage
retention of Medi-Cal, Food Stamp, and CalWORKs
benefits. Additional modifications to be considered
shall include, but not be limited to, those permitted
under federal law, including those permitted through a
waiver, such as electronic and telephonic renewal
methods, prepopulated forms, elimination of interview
requirements, and electronic positive verification s of
information required for determination of eligibility.
(10) Consider implications of any changes that may be
needed under federal health reform implementation, any
guidance provided by the United States Department of
Agriculture, and identify any waivers to other changes
that may be needed in federal law or policy
regulations or policies needed to that would ensure a
smooth transition successful implementation to the use
of the joint single renewal and recertification form,
policies, and procedures.
?
(d) The department and the State Department of Social
Services shall submit the joint single renewal and
recertification form and related policies and procedures
developed by the workgroup to the appropriate policy and
fiscal committees of the Legislature by January October
31, 2012 2011.
POSITIONS
Support: Children's Partnership (co-sponsor)
United Way of the Bay Area (co-sponsor)
STAFF ANALYSIS OF ASSEMBLY BILL 963 (Ammiano) Page
11
Western Center on Law & Poverty (co-sponsor)
AIDS Project Los Angeles
Alameda County Food Bank
Aspiranet
California Association of Food Banks
California Children's Hospital Association
California Medical Association
California School Employees Association
County Welfare Directors Association of California
LifeLong Medical Care
Los Angeles County Board of Supervisors
National Association of Social Workers - California
Chapter
San Diego Hunger Coalition
Ventura County Board of Supervisors
Oppose: None received
-- END --