BILL ANALYSIS
SB 82
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Date of Hearing: July 13, 1999
ASSEMBLY COMMITTEE ON HEALTH
Martin Gallegos, Chair
SB 82 (Vasconcellos, Escutia and Solis) - As Amended: April 22,
1999
SENATE VOTE : 23-8
SUBJECT : Medi-Cal eligibility.
SUMMARY : Reauthorizes medically necessary pregnancy services
through the Medi-Cal program to women who would otherwise be
eligible except that they do not meet certain immigration status
requirements. Specifically, this bill :
1)Makes any alien who is otherwise eligible for Medi-Cal
services, but who does not meet specified requirements related
to immigration status, eligible for medically necessary
pregnancy related services.
2)Makes findings and declarations to the effect of the
following:
a) Prenatal care reduces the incidence of low birth weight
infants and of birth complications.
b) For every $1 spent on prenatal care services, $3 is
saved in medical costs associated with pregnancy, birth,
and postnatal care.
c) The cost of prenatal care and a normal delivery is under
$3,000; the cost of a low birth weight baby, including the
first year of care, averages $17,000. Initial
hospitalization charges can reach $1 million.
d) Any infant born in the United States is deemed a
citizen. Adverse outcomes will be covered at state expense
through the Medi-Cal program.
e) Infants with adverse birth outcomes are more likely than
other infants to experience long-term medical, educational,
and social problems, demanding additional long-term costs
borne by the state.
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f) Studies have shown that prenatal care is not a magnet
for illegal immigration.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by the
Department of Health Services (DHS), to provide comprehensive
health care to low-income, aged, blind and disabled
individuals.
2)Provides that certain aliens "permanently residing in the
United States under color of law" (PRUCOL) or who are lawful
temporary or permanent residents are Medi-Cal eligible,
whether federally funded or state-funded, only to the extent
permitted under federal law and regulation.
3)Provides for certain medically necessary pregnancy and
emergency related medical care to aliens who do not meet the
requirements of #2 immediately above.
4)Prohibits, pursuant to federal law, the provision of federal,
state, or local public assistance benefits to specified
aliens, with limited exceptions. Permits states to fund such
benefits if authorizing state legislation is passed after
August 22, 1996.
FISCAL EFFECT : According to the Senate Appropriations Committee
analysis, this bill would cost approximately $64 million
annually from the General Fund (GF) for prenatal care, and there
would be unknown federal and GF savings.
COMMENTS :
1)NEED FOR THIS BILL . This bill would reauthorize policy to
ensure state funding to provide prenatal care to pregnant
women who are not lawful residents of the United States.
According to the author, for at least a decade California has
offered Medi-Cal services for prenatal care for a broader
group of women than those eligible under federal Medicaid law.
The author asserts that the most obvious reason for this is
that for every $1 that is invested in prenatal care, $7 in
cost avoidance is achieved by avoiding high cost premature and
low weight births which would have to be financed in any case
through public programs. The author states that federal
welfare reform (sec. 411 (d) of the Personal Responsibility
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Work Opportunity Act or PRWORA) requires that states who
provide state programs at their own option can explicitly
reenact such programs subsequent to the statutory
reauthorization. This bill provides statutory reenactment of
this state program. According to the author, the Wilson
Administration was sued in two different cases ( Yvette Doe and
Milagro ) over this issue and in both cases the courts have
issued restraining orders pending resolution of this issue.
2)SUPPORT . This bill has many supporters, including counties,
health care providers, and community organizations.
Proponents refer to the demonstrated benefits of prenatal care
and indicate that denying undocumented women access to
prenatal care keeps them out of the public health system that
is intended to reduce the spread of communicable diseases.
Proponents believe that failure to screen these women
contributes to increased disease and increased costs for both
the public and private health care systems.
3)BACKGROUND . On August 22, 1996, President Clinton signed into
law Public law 104-193 (PRWORA), which restricts certain
public benefits for noncitizens. States can authorize
eligibility for certain state-only funded programs. On the
day PRWORA was signed, then Governor Wilson issued Executive
Order W-135-96 calling on all state agencies, departments,
board and commissions to identify public benefit programs in
which noncitizens could be denied access. Over 200 programs
were identified. Governor Wilson attempted to eliminate
prenatal care benefits to noncitizens on more than one
occasion without success due to pending litigation.
4)BUDGET ACTION . The 1999-2000 omnibus health budget trailer
bill also contains provisions to reenact prenatal care
services to undocumented individuals and the Budget contains
$63.2 million to fund these services.
REGISTERED SUPPORT / OPPOSITION :
Support
Alameda County Board of Supervisors
Alameda Health Consortium
American Academy of Pediatrics, California District
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American Civil Liberties Union
American College of Obstetricians and Gynecologists
American Federation of State, County and Municipal Employees
American Jewish Congress
Arroyo Vista Family Health Care
Association of Regional Center Agencies
Bay Harbor Center for Women's Health
California Academy of Family Physicians
California Association of Catholic Hospitals
California Association of Public Hospitals and Health Systems
California Catholic Conference
California Church IMPACT
California District of the American Academy of Pediatrics
California Family Health Council
California Healthcare Association
California Health Executives Association
California Immigrant Welfare Collaborative
California Interfaith Coalition
California National Organization for Women
California Nurses Association
California Primary Care Association
California State Association of Counties
Children's Advocacy Institute/Center for Public Interest Law
City of San Francisco
Community Health Clinic
Council of Community Clinics
County Health Executives Association of California
County of San Francisco
County Welfare Directors Association of California
Frank D. Lanterman Regional Center
Friends Committee on Legislation of California
Huntington East Valley Hospital
JERICHO: A Voice of Justice
KIDS Network of Santa Barbara County
League of Women Voters of California
League of Women Voters of California
Lieutenant Governor, Cruz Bustamante
Los Angeles County Board of Supervisors
March of Dimes
Maternal and Child Health Access
Mission City Community Network, Inc.
Monterey County Health Department
Napa County Medical Society
National Center for Youth Law
National Council of Jewish Women
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National Health Law Program
North Los Angeles County Regional Center Board of Trustees
Northern California Coalition for Immigrant Rights
Northern California Lawyers for Civil Justice
Pediatric & Family Medical Center
Pediatric Management Group
Planned Parenthood Affiliates of California
Project NATEEN
Queen of the Valley Hospital
Sacramento County
San Judas Medical Group
Santa Barbara County
Santa Clara County Board of Supervisors
Solano County Board of Supervisors
South Los Angeles Health Projects
University California Los Angeles Obstetrician-Gynecologist
Clinic
University Children's Medical Group
Urban Counties Caucus
Vista Community Clinic
Western Center on Law and Poverty, Inc.
Opposition
None on file
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097