BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: SB 346
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AUTHOR: Beall
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VERSION: April 2, 2013
HEARING DATE: April 9, 2013
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FISCAL: Yes
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CONSULTANT: Sara Rogers
SUBJECT
Public Social Service Programs: Records
SUMMARY
This bill provides, for the purpose of complying with
confidentiality rules governing public social services,
that if a county administers public social services through
more than one county department or agency, each department
or agency administering a public social service shall be
deemed a county welfare department for purposes of
administering that public social service.
ABSTRACT
Existing Law:
1. Requires all applications and records concerning
any individual made or kept in connection with the
administration of any form of public social services
to be confidential, except as specified. (WIC 10850)
2. Provides that the above requirement shall not
prohibit the furnishing of this information to other
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public agencies to the extent required for verifying
eligibility of for other purposes directly connected
with the administration of public social services.
(WIC 10850 (b))
3. Defines "Public social services" to mean activities
and functions of state and local government
administered or supervised by the State Department of
Social Services or the State Department of Health
Services and involved in providing aid or services or
both, including health care services and medical
assistance, to those people of the state who, because
of their economic circumstances or social condition,
are in need thereof and may benefit thereby. (WIC
10051)
4. Establishes the duty of a county or a city and
county to provide health care services to indigent and
dependent poor persons, also known as Medically
Indigent Adults (MIAs), when such persons are not
supported and relieved by their relatives or friends,
by their own means, or by state hospitals or other
state or private institutions. (WIC 17000)
5. Establishes the Low Income Health Program (LIHP) as
a federal Medicaid demonstration project, and requires
the Department of Health Care Services (DHCS) to
authorize local LIHPs to provide specified health care
services to eligible individuals 19 to 64 years of age
who are not otherwise eligible for the Medi-Cal
program or the Children's Health Insurance Program
with family incomes at or below 133 percent of the
federal poverty level. (WIC 15909)
6. Permits a county board of supervisors of any county
with a population of less than 300,000 to elect to
participate in the County Medical Services Program
(CMSP), to provide specified health care services to
medically indigent persons. (WIC 16809)
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7. For larger counties, locally establishes Medically
Indigent Services Programs (MISP) to fulfill county
obligations under WIC 17000. Each county program is
substantially different in scope and eligibility.
8. Provides for the establishment of county General
Assistance programs to fulfill county obligations
under WIC 17000. Each county program is substantially
different in scope and eligibility.
This bill:
1. Provides, for the purpose of complying with
confidentiality rules governing public social
services, that if a county administers public social
services through more than one county department or
agency, each department or agency administering a
public social service shall be deemed a county welfare
department for purposes of administering that public
social service.
2. Clarifies, for the purposes of complying with
confidentiality rules governing public social
services, and except pertaining to Medi-Cal, that
"public social services" includes publicly funded
health care services.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, SB 346 allows county human
services departments to more easily share client
eligibility information with county health departments in
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order to simplify enrollment in public health care coverage
programs such as the Low-Income Health Program or the
county Medically Indigent Services Program.
The bill's sponsor, Santa Clara County, states that its
county Social Services Agency determines eligibility for
Medi-Cal and other social service benefits such as General
Assistance, while the Santa Clara Valley Health and
Hospital System is responsible to administer the county's
Low Income Health Program and its Medically Indigent
Services Program, known locally as the Ability to Pay
Determination Program. The Santa Clara Valley Health and
Hospital System screens approximately 7,000 patients per
month for public health coverage programs, including
Medi-Cal, Healthy Families, and the Low Income Health
Program. The social services agency staff process
approximately 3,000 Medi-Cal applications per month.
According to the county, state confidentiality requirements
for public social services records prevent the two county
departments that administer these public social service
programs from sharing eligibility information to streamline
enrollment. As a result, the county states that these silos
force clients to travel significant distances between
various offices across the county.
Confidentiality of Public Social Services
Existing law under Welfare and Institutions Code Section
10850 provides that all applications and records concerning
applicants of any public social service shall be
confidential, except that such information may be shared
with other public agencies for the purpose of verifying
eligibility or for other purposes directly connected with
the administration of public social services.
Additionally existing law, under WIC 10051, defines "public
social services" to include "health care services and
medical assistance" administered by state and local
government. These confidentiality requirements explicitly
exclude Medi-Cal, since that program is accountable to
various other federal and state privacy protections.
Existing Eligibility Systems
The Statewide Automated Welfare System (SAWS) is a
federally required database that supports eligibility and
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enrollment determinations for a variety of public social
service programs including Medi-Cal, CalFresh, CalWORKS,
Refugee Cash Assistance, General Assistance (GA), Medically
Indigent Adult programs, Low-Income Health Program, Foster
Care, KinGAP and Adoption Assistance.
Currently there are three types of SAWS systems utilized by
the 58 counties. LEADER serves Los Angeles County, CalWIN
serves 18 counties and C-IV serves 39 additional counties -
caseload is divided roughly equally amongst the three
system types. These systems are generally internally
operated by county social service agencies and are the
final eligibility and enrollment system for covered
programs. The state is currently negotiating consolidation
of the LEADER and C-IV system into one LEADER Replacement
System (LRS)<1>. Santa Clara county utilizes the CalWIN
system.
Additionally, many counties utilize the One-e-app system
which screens for eligibility for the majority of public
social service programs including Medi-Cal, GA, Medically
Indigent Programs, CalWORKS, CalFresh, and others. Though
this system does not have the capability to make enrollment
determinations for most programs, some counties have worked
to streamline communication between One-e-app and county
social service eligibility workers. For example, San Mateo
County has established a process whereby all One-e-App
Medi-Cal application submissions are assigned to a single
clerical worker in their Human Services Agency, who assigns
it to a single supervisor to streamline processing.
Alameda County transfers applications from One-e-App
directly to county workers, who clear them and directly
enter the application into the CalWIN system.
Additionally, in Alameda county, the One-e-app system has
the capacity to make direct eligibility determinations for
Medically Indigent Adult Programs.
A recent report from Alameda County indicates that it
currently automatically enrolls all CalWORKS recipients
into Medi-Cal. The report highlights the collaboration
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<1> Legislative Analysis Office. "Consolidating
California's Statewide Automated Welfare Systems".
February 13, 2012.
http://www.lao.ca.gov/reports/2012/ssrv/saws/saws-021312.pdf
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between Alameda County Health Care Services Agency and
Alameda County Social Services Administration that has
resulted in an automated enrollment process for General
Assistance recipients.<2>
Comments
The need for this bill, as stated, is uncertain. The
sponsor states that the purpose of the bill is to enable
collaboration between the social service and health
departments to streamline eligibility for General
Assistance recipients. However, existing law expressly
permits sharing of information with different agencies
for the purpose of administering public social services
and other counties have been successful at streamlining
eligibility in this way.
While increased opportunities exist to improve
streamlined eligibility and enrollment across public
social services, it is not clear that WIC confidentiality
statutes are the primary barrier to these efforts. Should
the bill move forward, the author or sponsor may wish to
seek clarification from the Department of Social Services
to examine barriers to record sharing between county
departments administering public social services.
POSITIONS
Support: Santa Clara County Board of Supervisors
(Sponsor)
California State Association of Counties (As
Amended 4/2/13)
Oppose: None received
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<2> Alameda County Health Care Services Agency. "Alameda
County Eligibility and Enrollment Systems for Low-Income
Health Coverage Programs". February 27, 2013
http://achealthcare.org/wp-content/uploads/2013/03/FINAL-REP
ORT-Alameda-County-Eligibility-and-Enrollment-Systems-.pdf
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