BILL ANALYSIS
AB 1640
Page 1
ASSEMBLY THIRD READING
AB 1640 (Evans and Nava)
As Amended May 28, 2010
Majority vote
HEALTH 15-0 APPROPRIATIONS 12-5
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|Ayes:|Monning, Adams, Ammiano, |Ayes:|Fuentes, Ammiano, |
| |Carter, Conway, De La | |Bradford, |
| |Torre, De Leon, Eng, | |Charles Calderon, Coto, |
| |Hayashi, Hernandez, | |Davis, |
| |Jones, | |Monning, Ruskin, Skinner, |
| |Bonnie Lowenthal, Nava, | |Solorio, |
| |V. Manuel Perez, Salas | |Torlakson, Torrico |
|-----+--------------------------+-----+--------------------------|
| | |Nays:|Conway, Harkey, Miller, |
| | | |Nielsen, Norby |
| | | | |
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SUMMARY : Reverses new administrative policy changes regarding
eligibility and enrollment requirements for breast cancer
screenings covered under "Every Woman Counts" (EWC), a state
program designed for low-income women who are uninsured or
underinsured. Specifically, this bill :
1)States legislative intent that screening services provided
under EWC meet the demand based on eligibility requirements in
place prior to January 1, 2010.
2)Requires the Department of Public Health (DPH) to provide
notification to the Joint Legislative Budget Committee at
least 90 days prior to changing eligibility requirements for
EWC services or reducing access to EWC screening services.
3)Specifies that funding for the EWC program is contingent on an
appropriation in the annual Budget Act or other measure.
EXISTING FEDERAL LAW :
1)Establishes the Breast and Cervical Cancer Mortality
Prevention Act of 1990 which creates the National Breast and
Cervical Cancer Early Detection Program (NBCCEDP) and
authorizes the Centers for Disease Control and Prevention
AB 1640
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(CDC) to administer grants to states for screening services
for underserved eligible women, 40 years of age and older.
2)Establishes the Breast and Cervical Cancer Prevention and
Treatment Act of 2000 which provides states the option to
provide medical assistance through Medicaid to eligible women
who are screened for and found to have breast or cervical
cancer, including precancerous condition, through the NBCCEDP.
EXISTING STATE LAW :
1)Establishes the California Breast Cancer Act of 1993 within
the California Department of Health Services (now DPH) which
mandates 50% of the revenues collected from a $0.02 tax on
tobacco products towards breast cancer control.
2)Requires DPH to provide for breast and cervical cancer
screening services under the NBCCEDP grant, at the level of
funding budgeted from state and other resources during the
fiscal year in which the Legislature has appropriated funds
for this purpose. These screenings are provided under the EWC
program and are not deemed an entitlement.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill will result in the following fiscal impact:
1)An annual unknown appropriation in the range of $55 million
(90% special fund/10% federal fund) to provide breast cancer
screening services to approximately 240,000 women in
California. These figures reflect the range of actual
spending and screening caseloads over the past eight years.
Historically, the EWC program is funded with state special
fund revenues generated by tobacco taxes. The remaining
support is provided by a grant from the CDC.
2)This bill contains language to make it contingent on the
annual Budget Act.
3)The recent May Revision includes several cost containment
proposals related to EWC, including changes to case management
and frequency of screening.
COMMENTS : According to the authors, in December of 2009, in
response to an evolving budget crisis within the EWC program,
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DPH announced two significant policy changes effective January
1, 2010 that restrict access to the EWC program: 1) a permanent
increase in the minimum age eligibility for breast cancer
screening services from age 40 to 50; and, 2) a temporary
six-month enrollment freeze for all women seeking breast cancer
screening services from January 1 through June 30, 2010.
According to the authors, these two changes will deny or delay
services to approximately 100,000 women, putting an estimated
1,000 lives at risk by delaying breast cancer diagnosis. The
authors maintain that DPH made these very significant changes to
the program without seeking the customary input from the
Legislature or the breast cancer advocacy community.
The EWC program provides free breast and cervical cancer
screening services to low-income, uninsured, and underinsured
women. Administered by The Cancer Detection Section at DPH, the
EWC serves approximately 350,000 women per year of the
approximately 1.2 million that are eligible for breast cancer
screening services through the program in California. Prior to
January 1, 2010 the eligibility requirements for EWC were as
follows: a) must have been 40 years of age or older (25 years or
older for cervical cancer); b) lived in California; c) had no
health insurance or had a co-payment or a deductible that was
not affordable; and, d) had a family income below 200% of the
federal poverty level. According to the CDC, of those women who
received mammography screening in California through the EWC
program from July 2003 to June 2008, 45.1% were between the ages
of 40-49.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0004638