BILL ANALYSIS                                                                                                                                                                                                    Ó




                                                                  AB 2706
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          Date of Hearing:   April 9, 2014

                           ASSEMBLY COMMITTEE ON EDUCATION
                                Joan Buchanan, Chair
                  AB 2706 (Hernández) - As Amended:  March 28, 2014

          [Note: This bill is doubled referred to the Assembly Health  
          Committee and will be heard as it relates to issues under its  
          jurisdiction.]
           
          SUBJECT  :   Schools: health care coverage

           SUMMARY  :   Requires parents and guardians to make a written  
          disclosure stating whether their child, upon enrollment in a  
          public school, is covered by health care coverage and the school  
          to which the disclosure is made, take specified actions, as  
          appropriate.  Specifically,  this bill  :  

             1)   Requires, commencing with the 2015-16 school year, all  
               parents, upon first enrolling their child in a public  
               school's transitional kindergarten, kindergarten or first  
               grade, to make a written disclosure stating whether their  
               child is either of the following:


                  a)        Covered by health care coverage and provide  
                    proof of this coverage.  If the pupil is covered, the  
                    parent or guardian must also indicate whether he/she  
                    believes this coverage constitutes minimum essential  
                    coverage under Section 500A of the federal Internal  
                    Revenue Code.  The parent or guardian may,  
                    alternatively, indicate that he/she is not certain  
                    whether the coverage meets the minimum essential  
                    coverage.


                  b)        Not covered by health care coverage that  
                    constitutes minimum essential coverage under Section  
                    500A of the federal Internal Revenue Code.  If the  
                    pupil is not covered, the parent or guardian shall  
                    also disclose whether he/she believes the pupil is  
                    exempt from the requirement to maintain essential  
                    coverage.











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             2)   Requires a public school to provide written notice to  
               the parent or guardian that when he/she makes this  
               disclosure of health care coverage, that the information  
               the parent or guardian provides will only be used for the  
               purpose of determining whether the parent of guardian  
               should be directed to other resources for the purpose of  
               obtaining health care coverage for the pupil.  


             3)   Requires the school district to make a reasonable effort  
               to direct the parent or guardian that has indicated his or  
               her pupil lacks health coverage that meets the minimum  
               essential coverage, to the resources necessary to obtain  
               affordable health care coverage for the pupil that  
               constitutes minimum essential coverage, as required by law.


             4)   Prohibits a school district from discriminating against  
               a pupil who does not have health care coverage or prevent a  
               pupil from enrolling based on his/her lack of health care  
               coverage or inability to show proof of coverage.


             5)   Permits the California Department of Education (CDE) to  
               develop a standardized template for the written disclosure  
               developed by this section. 


             6)   Specifies that if the CDE does make such a template  
               available, this template must be available on the CDE's Web  
               site, upon request written copies must be made available to  
               a school district, and requires that the template include a  
               statement indicating that the information disclosed shall  
               only be used for the purpose of determining whether a  
               parent or guardian of a pupil should be directed to other  
               resources for the purposes of obtaining health care  
               coverage for the pupil.  


           EXISTING LAW:  
             1)   Requires, effective January 1, 2014, under the federal  
               Patient Protection and Affordable Care Act (ACA), an  
               individual to have the option to apply for state subsidy  
               programs, which include the state Medicaid program, the  
               state's Children's Health Insurance Program (CHIP),  









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               enrollment in a qualified health plan (QHP) through a state  
               exchange, and a Basic Health Plan (BHP), if there is one,  
               either in person, mail, online, telephone, or other  
               commonly available electronic means. 


             2)   Requires, under the ACA, effective in 2014, individuals  
               to maintain health insurance or pay a penalty, with  
               exceptions for financial hardship (if health insurance  
               premiums exceed 8% of a household's adjusted gross income),  
               religion, incarceration, and immigration status.


             3)   Creates the Exchange, known as Covered California, as an  
               independent state entity governed by a five-member board,  
               to be a marketplace for Californians to purchase  
               affordable, quality health care coverage and as a way to  
               meet the personal responsibility requirements of the ACA.  


             4)   Permits school districts or county superintendents of  
               schools to incorporate into the School Lunch Program  
               application packet or notification of eligibility for the  
               School Lunch Program using simple and culturally  
               appropriate language, notification that the child may  
               qualify for free or reduced-cost health coverage under the  
               California Health Benefit Exchange.


           FISCAL EFFECT  :   State-mandated local program.

           COMMENTS  : 
          According to the author, the expansion of health care coverage  
          options under the ACA generated approximately seven million  
          newly eligible Californians as of January 1, 2014. Of those 7  
          million, nearly one million children under the age 18 are  
          uninsured and 67% of these qualify for Medi-Cal<1>. There is  
          great opportunity in 2014 to enroll these eligible children;  
          however notable barriers exist for eligible populations to  
          enroll in Medi-Cal including lack of awareness about the  
          programs, difficult application or re-enrollment processes, and  
          ---------------------------
          <1>"California Health Care Almanac Quick Reference Guide,  
          California's Uninsured: A supplement to California HealthCare  
          Foundation's California's Uninsured: By the Numbers," California  
          HealthCare Foundation. May 2013.








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          stigmas associated with enrolling in low-income health insurance  
          and other public programs<2>. While the ACA will dramatically  
          reduce the number of uninsured Californians, a significant  
          number of eligible children will be left behind in the absence  
          of proactive and practical solutions. 

           Disclosure of Health Care Coverage  
          Every parent or guardian will be required to indicate whether  
          their child, upon enrollment in transitional kindergarten,  
          kindergarten, or grade 1, has the minimum essential coverage as  
          required by the ACA.  The committee may wish to consider whether  
          the requirement that schools collect this information will have  
          unintended consequences.  For example, parents may be  
          discouraged from enrolling their child in non-compulsory  
          programs such as transitional kindergarten or kindergarten if he  
          or she fears being uninsured or underinsured will adversely  
          affect their ability to enroll their child. Specifically, a  
          parent may be concerned that the form requires disclosure of  
          his/her or the child's immigration status.  Therefore, committee  
          staff recommends an amendment to delete the requirement that a  
          parent or guardian indicate that their child is exempt from the  
          minimum essential coverage requirement.  Committee staff also  
          recommends an amendment that will allow a parent or guardian to  
          decline to disclose any of the information required by this  
          disclosure form. 

          The committee may also wish to consider whether this bill places  
          unreasonable and unsustainable expectations on parents or  
          guardians and school employees.   This bill  requires a parent or  
          guardian to determine whether the pupil's health care coverage  
          meets the statutory requirements of the ACA and similarly  
          requires schools to provide guidance to those parents or  
          guardians who may need assistance in completing this disclosure.  
           While the intent of the bill is simply to use schools as a  
          place to identify and access uninsured or underinsured children,  
          there may be more effective means by which to achieve this goal.  
           For example, the committee may wish to consider whether schools  
          should instead be required to distribute resources from existing  
          community organizations designed to assist families with  
          ---------------------------
          <2> Laurel Lucia, Ken Jacobs, M. Miranda Dietz, Dave  
          Graham-Squire, Nadereh Pourat, and Dylan H. Roby. "After  
          Millions of    Californians Gain Health Coverage under the  
          Affordable Care Act, Who Will Remain Uninsured?" UCLA Center for  
          Health Policy Research, UC Berkeley Labor Center, CalSIM,  
          September 2012








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          enrollment options or partner with local community health  
          centers where other health services required by statute (such as  
          oral health examination and vaccines) are performed to  
          distribute this information.  

           Arguments in Support 
          According to the author,  this bill  seeks to reduce the number of  
          eligible, but uninsured children by requiring parents or legal  
          guardians to show proof of health coverage for children being  
          enrolled into transitional kindergarten, kindergarten, and grade  
          1. Parents/guardians of children without health insurance at the  
          time of school enrollment will be directly referred to qualified  
          community enrollment entities and counselors who can provide  
          them with free enrollment assistance into an affordable health  
          plan. In so doing, California can ensure more of California's  
          young students will obtain coverage and the potential for  
          greater educational achievement that comes with it.  

           Previous Legislation  
          AB 422 (Nazarian), Chapter 444, Statutes of 2013, adds  
          information regarding health care coverage available through the  
          California Health Benefit Exchange, known as Covered California,  
          to notifications that may be included at the option of the  
          school district or county superintendent on applications for the  
          School Lunch Program, effective January 1, 2014.  
           
           
           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California Coverage & and Health Initiatives
          Children Now
          Children's Defense Fund-California 
          El Monte Union High School District
          El Rancho Unified School District
          Lynwood Unified School District

           Opposition 
           
          None on file
           
          Analysis Prepared by  :    Jill Rice / ED. / (916) 319-2087 











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