BILL ANALYSIS �
AB 1640
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Date of Hearing: March 28, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1640 (Mitchell) - As Introduced: February 13, 2012
Policy Committee: Human
ServicesVote:4 - 2
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill allows otherwise eligible women, without children, to
receive CalWORKs and full-scope Medi-Cal benefits in their first
and second trimesters of pregnancy. Women in their third
trimester are eligible under current law. Specifically, this
bill:
1)Requires payment of a CalWORKs grant to a pregnant mother in a
family without a needy child upon verification of pregnancy.
2)Allows eligible uninsured women or women, receiving
pregnancy-only fee for service Medi-Cal, to enroll in
full-scope Medi-Cal.
3)Prohibits a pregnant woman from being denied CalFresh benefits
or from being required to participate in a CalFresh employment
and training activity at any time after the verification of
her pregnancy.
4)States legislative findings and declarations, including
asserting that without the supportive services provided by
CalWORKs, CalFresh and full-scope Medi-Cal, poor women are
more likely to have premature and low birth-weight babies,
which may interfere with the parents' ability to reach
economic self-sufficiency.
FISCAL EFFECT
1)Annual CalWORKs grant and administrative costs between $5
million and $20 million (TANF/GF) to the extent that one-third
to one-half of the over 40,000 women who receive
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pregnancy-only Medi-Cal receive three additional months of
CalWORKs benefits under this bill.
While some of these women will remain on CalWORKs the entire
48 months allowed under current law and will simply be
starting those months earlier under this legislation, it is
likely that a portion of the women will be exempt from
participating in an activity and therefore will not have their
48-month time clock activated, thus simply receiving an
additional three months of benefits. In addition, because the
average time on CalWORKs is 24 months, it is likely that a
significant subset of the women will simply extend their stay
on the program by three months because any training and work
activities they may be participating in prior to the birth of
their child will be interrupted to care for an infant. Under
current law, a parent with one child is exempt from
participating in a welfare-to-work activity for up to 2 years.
2)To the extent eligible pregnant women receive three months of
CalFresh benefits that they would not otherwise apply for,
this bill could bring in an additional $13.5 million in
federal food and nutrition benefits. The administrative costs
for those cases would be approximately $4.8 million ($2.4
million GF).
3)One-time Medi-Cal costs in the range of $500,000 or more (50%
GF, 50% federal funds), in both fiscal years 2012-13 and
2013-14. Increased costs would result from pregnant women
making an earlier transition to full-scope Medi-Cal as a
result of automatic eligibility linked to CalWORKs. Precise
costs are difficult to estimate because data on current
sources of health care coverage for women applying to CalWORKs
in the third trimester are not collected.
Medi-Cal costs related to this bill will only be incurred
during calendar year 2013. Under federal law, beginning in
2014, Medicaid programs must provide comprehensive health care
coverage to all adults under 133% of the federal poverty level
poverty (138% with a standard income disregard). Thus,
beginning in 2014, the population affected by this bill will
automatically be eligible for full Medi-Cal benefits based on
income, regardless of the fact or duration of their pregnancy.
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COMMENTS
1)Rationale . The purpose of this bill is to allow poor pregnant
women access CalWORKs, CalFresh and full-scope Medi-Cal upon
verification of their pregnancy, rather than waiting for their
third-trimester as is required under current law. The author
asserts that providing an additional three or four months of
aid will significantly reduce stress and insure continuity of
medical care by allowing access to full-scope Medi-Cal rather
than just pregnancy-related care.
The sponsors of this bill, Western Center on Law and Poverty,
hope that providing cash assistance and other benefits earlier
in a woman's pregnancy will be enough to alleviate her
exposure to stress and thus allow her to carry her fetus to
term rather than having a preterm or low birth-weight infant.
2)Improved Birth Outcomes . Studies suggest that abject poverty
increases the risk of pre-term and low birth-weight infants.
According to a March of Dimes study, the average first-year
medical costs, including both inpatient and outpatient care,
were about 10 times greater for preterm infants ($32,325) than
for full-term infants ($3,325). The author and sponsor argue
that providing an additional three to four months of CalWORKs
benefits and ensuring a continuity of healthcare will improve
the outcomes for these infants, helping to offset the cost of
the additional services.
The overall impact of the specific provisions of this bill on
birth outcomes and maternal self-sufficiency postpartum is
uncertain. For example, it is uncertain whether the provision
of services earlier in pregnancy will result in a substantive
reduction in pre-term births. There are many risk factors that
impact a woman's likelihood of delivering a pre-term baby.
Some of these factors may be affected to some extent by the
services offered, such as late or no prenatal care, or high
levels of maternal stress. However, stress can be caused by
myriad social and economic factors, many of which would not be
substantively affected by expanding eligibility for state
services. All women affected would already be eligible for,
and most would be enrolled in, pregnancy-only Medi-Cal and
have coverage for prenatal care. Many other factors related
to preterm birth are largely unrelated to the provision of
services, including overall maternal health and preexisting
health conditions, obesity, use of cigarettes, alcohol, or
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other drugs, previous premature birth, uterine or cervical
abnormalities, a short time between pregnancies, and twins or
multiple births.
3)Governor's Proposed 2012-13 CalWORKs Budget . The governor's
proposed 2012-13 budget for CalWORKs contains significant
reductions to the program. Among those changes are a complete
restructuring of the overall program into two subprograms
within CalWORKs and a separate program for children continuing
to receive a grant once their parent has been removed from the
aided case due to time limits or other program rules.
The first program would be called "CalWORKs Basic" and would
provide services to families similar to the style of the
current CalWORKs program, including job search, barrier
removal, employment training, and child care services, but for
a reduced period of 24-months, versus the current 48-month
time limit. Failure to meet welfare to work requirements will
result in a sanction equal to the adult portion of the grant.
Clients unable to meet federal work participation requirements
after 24 months, or cases in sanction status for more than
three months will be disenrolled from CalWORKs and moved to a
separate child-only program.
The second program would be called "CalWORKs Plus" and would
serve recipients working sufficient hours to meet federal work
participation requirements (WPR) in unsubsidized employment,
generally 30 hours per week (20 hours per week for families
with children under the age of six). These clients will retain
access to supportive services and child care that they have
now. These benefits continue for up to 48 months if clients
maintain unsubsidized employment. After 48 months, the adult
will no longer be aided.
This program essentially houses those cases currently meeting
federal WPR through unsubsidized employment (25,445 cases).
Recipients in this program are discontinued after their
48-month lifetime time limit and moved to the child-only
program.
The third subprogram would be called "Child Maintenance" and
would, at the outset of 2012-13, include 300,999 cases in the
CalWORKs caseload that do not meet the eligibility
requirements for either CalWORKs Basic or Plus. This includes:
Safety Net cases (where the case no longer includes the
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adult portion of the grant), including those not meeting
WPR through unsubsidized employment;
Recipients of Social Security Income;
Non-Needy Caretaker Relatives;
Citizen Children of Undocumented Parents;
Drug/Fleeing Felon Parents; and,
Cases sanctioned for more than three months.
The average monthly cash aid grant for these child-only cases
currently is $463. Under the new proposal, the grant would be
reduced to $375 per month for a family with two children in
Child Maintenance.
In total, the changes proposed by the governor would reduce
the CalWORKs program by a net $946 million in 2012-13, growing
to $1.1 billion in 2013-14. These proposed reductions are in
addition to $1.6 billion in combined reductions adopted over
the last few years.
1)CalWORKs Cost Consideration . The committee may wish to
consider whether it is prudent to expand eligibility for a
program that has been significantly reduced in recent years
and potentially faces an additional $1 billion in cuts in the
coming year.
2)Automatic Eligibility for Full-Scope Medi-Cal . California
state law maintains an automatic link between Medi-Cal and
CalWORKs; any family receiving CalWORKs benefits is also
automatically eligible for full-scope Medi-Cal without a share
of cost. Thus, an expansion in CalWORKs eligibility also
results in an expansion in Medi-Cal eligibility. This bill
would result in some women transitioning earlier from being
uninsured, or from less generous Medi-Cal eligibility
categories, to full-scope Medi-Cal benefits without a share of
cost. These less generous Medi-Cal categories include
pregnancy-only coverage for women under 200% FPL, which is
delivered through the Medi-Cal fee-for-service (FFS) system,
and "share-of-cost" (SOC) Medi-Cal. In pregnancy-only
coverage, Medi-Cal will not provide coverage for certain
services deemed unrelated to a woman's pregnancy. Women who
happen to be uninsured when gaining eligibility from Medi-Cal
through linkage to CalWORKs would generally be eligible for,
but not enrolled in, pregnancy-only Medi-Cal under current
law. If an individual has SOC Medi-Cal, services are only
covered once an individual has exceeded his share of cost for
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the month-for example, an individual with a SOC of $700 needs
to spend $700 on health services within a given month before
Medi-Cal will begin paying for services.
3)Continuity of Pregnancy-related Care . The author states that
this bill would prevent disruptions in health care for
pregnant women. Disruptions in care may result when pregnant
women who are enrolled in pregnancy-only coverage on a FFS
basis gain access to full-scope Medi-Cal and are enrolled into
a managed care plan. If a woman's regular care provider is
not in the managed care plan network, a woman may be forced to
switch providers, jeopardizing her continuity of care during
the last months of a pregnancy.
An All-County Welfare Director's Letter from the Department of
Health Care Services dated November 9, 2011 indicates the
department is aware of this continuity of care issue and has
taken some administrative steps to address it. The letter
directs counties to clearly communicate to women transitioning
from pregnancy-only to full-scope Medi-Cal that they have the
right to remain with their current providers. Although
enrollment into a managed care plan is generally mandatory for
families enrolled in Medi-Cal through automatic linkage to
CalWORKs, the letter indicates that the managed care
enrollment system currently has a medical exemption process in
place to allow pregnant women to remain with their care
providers when they switch eligibility categories. The
department states that women have the option to continue their
prenatal care in the FFS system until 60 days post-partum.
Pregnant women must contact the Medi-Cal program to request a
delay in joining the managed care delivery system.
Given that there is already a viable means for women to
request exemption from managed care enrollment if they wish to
remain with their provider, it is unclear whether providing
earlier access to full-scope Medi-Cal-as this bill does-is an
efficient way to further promote the policy goal of ensuring
continuity of pregnancy-related care. In addition, this
change to earlier Medi-Cal eligibility would only be in effect
for calendar year 2013. As noted above, the population
affected by this bill will be eligible for full Medi-Cal
benefits based purely on income level beginning in 2014.
Analysis Prepared by : Julie Salley-Gray and Lisa Murawski /
APPR. / (916) 319-2081
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