BILL ANALYSIS Ó AB 50 Page 1 Date of Hearing: April 14, 2015 ASSEMBLY COMMITTEE ON HEALTH Rob Bonta, Chair AB 50 (Mullin) - As Amended April 6, 2015 SUBJECT: Medi-Cal: nurse home visiting programs. SUMMARY: Requires the Department of Health Care Services (DHCS) to develop and implement a plan to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered to Medi-Cal eligible pregnant women. Specifically, this bill: 1)Requires the Department of Health Care Services (DHCS) to develop and implement, by January 1, 2017, a plan to ensure that NFP and other evidence-based nurse home visiting programs are offered to all Medi-Cal eligible pregnant women. 2)Requires DHCS, on or before January 1, 2022, and every five years afterwards, to report to the Legislature on implementation progress and the effectiveness of evidence-based nurse home visiting services. 3)Defines a "nurse home visiting program" as a program that does the following: AB 50 Page 2 a) Contains home visitations by a registered nurse to households with a pregnant woman as a primary service; b) Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to two years old; and, c) Identifies participant outcomes that include improved maternal and child health, improvements in school readiness, reductions in crime or domestic violence, and other outcomes as specified. EXISTING LAW: 1)Establishes the NFP as a voluntary nurse home visiting grant program for expectant first-time mothers, their children, and their families, administered by the Department of Public Health (DPH). 2)Requires DPH to develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of NFP and requires a county, to be eligible to receive an NFP grant, to agree to specific staffing and service-related provisions. 3)Permits DPH to accept voluntary contributions, in cash or in-kind, to pay for the costs in the implementation of the NFP and requires private donations to be deposited into the AB 50 Page 3 California Families and Children Account, which is created and continuously appropriated to DHCS under this bill. 4)Prohibits state funds from being used to implement this bill. 5)Allows DPH to distribute grants if the Director of the Department of Finance (DOF) determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the NFP. Prohibits DPHs' administration costs from exceeding 5% of the moneys in the account. 6)Permits DPH, in consultation with the NFP administrators, to contract with one or more qualified organizations to assist DPH in ensuring that grantees implement the program as established under this bill and to conduct an annual evaluation of the implementation of the grant program on a statewide basis. Requires the first evaluation to be due 12 months after the award of grants. FISCAL EFFECT: This bill has not been analyzed by a fiscal committee. COMMENTS: 1)PURPOSE OF THIS BILL. According to the author, this bill is necessary to increase accessibility for nurse led home visiting and help improve efficiency on this piece of our system of care. This bill helps to address the rising costs AB 50 Page 4 of Medi-Cal and potential burdens of rising Medi-Cal enrollment. With increased Medi-Cal enrollments come the societal savings, care coordination, case management, and healthcare outcomes that NFP and other evidence-based nurse home visiting programs, provide for the consistent solutions resonating among stakeholders. These measures will help improve HEDIS measures, access to services, and reduce costs while further increasing savings. It is the responsibility of the Legislature and in the best interest of all California citizens to prioritize efficiency and effectiveness in the consideration of fiscal expenditures. 2)BACKGROUND. The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using Federal Department of Justice funding. The successful implementation of these initial NFP pilot sites demonstrated to other California communities that it was possible to replicate a scientific-based health strategy while also tailoring the program to meet the needs of each community. NFP seeks to continue to build new partnerships with medical managed care entities, school districts, military bases, clinics and hospitals in order to serve the thousands more eligible families in California that could benefit from NFP's evidenced-based outcomes model. The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500. The California NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school, by the time their infants were 24 months old. 3)MATERNAL, INFANT, EARLY CHILDHOOD HOME VISITING PROGRAM. AB 50 Page 5 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is a federal program that supports pregnant women and families and helps at-risk parents of children from birth to kindergarten entry tap the resources and hone the skills they need to raise children who are physically, socially and emotionally healthy and ready to learn. The Federal Health Resources and Services Administration, in close partnership with the Administration for Children and Families, funds States, territories and tribal entities to develop and implement voluntary, evidence-based home visiting programs using models that are proven to improve child health and to be cost effective. On February 19, 2015, the Department of Health and Human Services announced $386 million in grant awards to states, territories, and nonprofit organizations to support the MEICHV Program. California NFP programs are partially funded by MEICHV funding. 4)SUPPORT. Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now notes that nationally, as well as in California, there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities. Many experts hail home visiting program diversity as essential to providing parents with choices, and ensuring that programs are well matched with local needs and strengths. Children Now concludes that it believes this bill can help promote a broad range of home visiting models, reflective of the diverse needs of families and young children in our state. 5)PREVIOUS LEGISLATION. AB 50 Page 6 a) ACR 155 (Bocanegra), Chapter 144, Statutes of 2014, urges the Governor to identify evidence-based solutions to reduce children's exposure to adverse childhood experiences, address the impacts of those experiences, and invest in preventive health care, mental health and, wellness interventions. b) AB 543 (Ma) of 2010 would have extended, from January 1, 2009 to January 1, 2014, the sunset of the California Children and Families Account (Account). Governor Schwarzenegger vetoed AB 543 stating: "Since the Nurse-Family Partnership program was signed into law in 2006, there have been no private or federal funds received by the state for this program. Since there are no funds to appropriate, there is no need to extend the sunset date for the program's fund account." c) AB 1829 (Ma) of 2008 would have extended, from January 1, 2009, to January 1, 2011, the sunset of the Account. Governor Schwarzenegger vetoed AB 1829, stating: "The historic delay in passing the 2008-2009 State Budget has forced me to prioritize the bills sent to my desk at the end of the year's legislative session. Given the delay, I am only signing bills that are the highest priority for California. This bill does not meet that standard and I cannot sign it at this time." d) SB 1596 (Runner), Chapter 878, Statutes of 2006, establishes the NFP program administered by the Department of Health Services (now DPH). 6)POLICY COMMENTS. The NFP is existing law in the Health and Safety code. This bill establishes new requirements for evidence-based nurse home visiting programs in the Welfare and Institutions code section. This is duplicative and unnecessary in order to meet the intent of expanding access to evidence-based nurse home visiting programs. Instead of adding a new section, the Committee may recommend broadening the provisions that currently govern NFP Programs in Health AB 50 Page 7 and Safety code to include other evidence-based nurse home visiting programs. REGISTERED SUPPORT / OPPOSITION: Support American Nurses Association\California California Right to Life Committee Children Now Parents as Teachers Prevent Child Abuse America Opposition None on file. Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097 AB 50 Page 8