BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 1382 (Hernandez)
Hearing Date: 8/15/2011 Amended: 7/7/2011
Consultant: Katie Johnson Policy Vote: Health 8-0
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BILL SUMMARY: AB 1382 would permit HIV counselors to perform
skin puncture tests for Hepatitis C virus or combination
HIV/hepatitis C tests.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Increased treatment of unknown, potentially significant
General/*
individuals with HIV Federal/
and Hepatitis C Local
*See Staff Comments.
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would permit HIV counselors to perform skin puncture
tests for Hepatitis C virus or combination HIV/Hepatitis C
tests. HIV counselors are currently allowed to perform rapid HIV
tests, but may only provide home testing kits for Hepatitis C.
An individual using a home test kit would take the test at home
and then send the results to a laboratory. He/she would then
return to the site of the procurement of the test two weeks
later for the test results.
According to the California Department of Public Health's Office
of AIDS (CDPH/OA), 50 to 80 percent of injection drug users
(IDUs) who are infected with HIV are also infected with
Hepatitis C. Symptoms associated with Hepatitis C infection,
such as fatigue, abdominal bloating, flu-like symptoms, and
jaundice, are present in only 20 to 30 percent of cases;
therefore, most infections go undiagnosed until liver disease
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develops often 20 to 30 years later. Liver disease is one of the
leading causes of death of individuals with Hepatitis C. In a
fact sheet, CDPH/OA cites a 2003 pilot project in which it was
concluded that HIV test disclosure return rates increased by 21
percent among IDUs when individuals were able to receive both
their Hepatitis C and HIV test results and that HIV testing
rates among IDUs nearly doubled when HIV counseling and testing
was offered in conjunction with Hepatitis C counseling and
treatment. In January of 2008, CDPH/OA integrated Hepatitis C
testing into its HIV counseling and treatment program.
Currently, CDPH/OA provides federal HIV testing funds to 17 high
incidence counties.
To the extent that testing increases and more individuals are
identified to be infected with Hepatitis C or HIV as a result of
this bill, there could be unknown, potentially significant,
treatment costs to state health programs such as Medi-Cal, the
Low-Income Health Program (LIHP), Pre-Existing Condition
Insurance Plan (PCIP), Managed Risk Medical Insurance Program
(MRMIP), and the AIDS Drug Assistance Program (ADAP). However,
to the extent that this bill were to aid in reducing long-term
health care costs of individuals infected with HIV and Hepatitis
C and in preventing future cases of HIV and/or Hepatitis C,
there could be future cost avoidance to publicly funded health
care programs.
Medi-Cal is generally funded 50 percent General Fund and 50
percent federal funds. However, commencing January 1, 2014,
newly eligible individuals would be paid for with 100 percent
federal funds for calendar quarters 2014 - 2016, 95 percent for
calendar quarters in 2017, 94 percent for calendar quarters in
2018, 93 percent for calendar quarters in 2019, and 90 percent
for calendar quarters in 2020 and thereafter. The remainder
would be covered by General Fund.
The LIHP is funded 50 percent federal funds and 50 percent local
funds and sunsets December 31, 2013. ADAP is funded with General
Fund, federal funds, and prescription drug rebate revenues. The
percentages vary by an enrollee's insurance status and carrier.
PCIP is funded by federal and private funds and MRMIP is funded
by state tobacco tax funds and private funds. Impacts to these
programs could decrease after January 1, 2014, when the federal
Affordable Care Act would require health plans and insurers to
offer insurance to individuals regardless of pre-existing
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medical conditions.