BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 50|
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THIRD READING
Bill No: AB 50
Author: Mullin (D)
Amended: 9/1/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 7/8/15
AYES: Hernandez, Nguyen, Hall, Monning, Nielsen, Pan, Roth,
Wolk
NO VOTE RECORDED: Mitchell
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/2/15 - See last page for vote
SUBJECT: Medi-Cal: evidence-based home visiting programs
SOURCE: Author
DIGEST: This bill requires the Department of Health Care
Services to develop a plan on or before January 1, 2017, to
determine the feasibility of offering evidence-based home
visiting programs, as defined, to Medi-Cal eligible pregnant and
parenting women.
ANALYSIS:
Existing law:
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1)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
Children up to age 19 are eligible for Medi-Cal in families
with incomes up to 266% of the federal poverty level (FPL)
(266% of the FPL is at or below $52,641 annually for a family
of three in 2015) and pregnant women are eligible with family
incomes up to 322% of the FPL.
2)Establishes the Nurse-Family Partnership (NFP) program, which
is administered by the Department of Public Health (DPH), to
provide grants for voluntary nurse home visiting programs for
expectant first-time mothers, their children, and their
families. Requires a county to satisfy specified requirements
in order to be eligible to receive a grant. The provisions of
the NFP program are subject to the normal Budget Act process
and are operative to the extent funds are appropriated.
This bill:
1)Requires DHCS to develop a plan on or before January 1, 2017,
to determine the feasibility of offering evidence-based home
visiting programs to Medi-Cal eligible pregnant and parenting
women. Requires DHCS to develop the plan in consultation with
stakeholders, including, but not limited to, representatives
from Medi-Cal managed care plans, public and private
hospitals, evidence-based home visiting programs, and local
governments, from diverse geographical regions of the state.
2)Requires DHCS to consider all of the following in developing
the plan:
a) Establishing Medi-Cal coverage for evidence-based home
visiting program services;
b) Incentives for Medi-Cal providers to offer
evidence-based home visiting program services;
c) Other mechanisms to fund evidence-based home visiting
program services for Medi-Cal eligible pregnant and
parenting women; and,
d) Identifying among evidence-based home visiting programs
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those with established evidence to improve health outcomes,
the experience of care, and cost savings to the health care
system.
1)Requires DHCS, in developing the plan, to prioritize the
identification of funding sources, other than General Fund
moneys, to fund evidence-based home visiting program services,
including local, federal, or private funds, or any other funds
made available for these program services.
2)Defines an "evidence-based program" as a program that is based
on scientific evidence demonstrating that the program model is
effective, that is reviewed on site and compared to program
model standards by the model developer or the developer's
designee at least every five years to ensure that the program
continues to maintain fidelity with the program model, and
that has had demonstrated and replicated significant and
sustained positive outcomes that have been in one or more
well-designed and rigorous randomized controlled research
designs, and where the evaluation results have been published
in a peer-reviewed journal.
3)Defines an "evidence-based home visiting program" as a program
or initiative that does all of the following:
a) Meets, on or before April 1, 2015, the U.S. Department
of Health and Human Services Maternal, Infant, and Early
Childhood Home Visiting criteria, as specified;
b) Contains home visiting as a primary service delivery
strategy by providers satisfying home visiting program
requirements to provide services to families with a
pregnant or parenting woman who is eligible for medical
assistance;
c) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children
from prenatal to five years of age; and,
d) Targets participant outcomes that include all of the
following:
i) Improved maternal and child health.
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ii) Prevention of child injuries, child abuse or
maltreatment, and reduction of emergency department
visits.
iii) Improvements in school readiness and achievement.
iv) Reduction in crime or domestic violence.
v) Improvements in family economic self-sufficiency.
vi) Improvements in coordination of, and referrals to,
other community resources and support.
vii) Improvements in parenting skills related to child
development.
Comments
1)Author's statement. According to the author, with rising
health care costs and an increasing Medi-Cal eligible
population across California, there is a need to strengthen
the capacity of our current healthcare system to address the
health needs of our most vulnerable populations at lower
costs. Evidence-based home visiting programs are proven
health-based interventions that can improve the health of
low-income families in the state, while helping reduce overall
costs to our system and improving system outcomes for the
state. Voluntary evidence-based home visiting programs - such
as NFP, Healthy Families America, Early Head Start (Home Based
Option), Parents as Teachers, and Home Instruction for Parents
of Preschool Youngsters - strengthen the critical parent-child
relationship and connect families with information and
resources during the pivotal time from pregnancy to age five.
With more than 37 years of evidence from randomized,
controlled trials and longitudinal follow-up studies, evidence
based home visiting programs have demonstrated sizeable,
sustained improvements in maternal health, child health and
development, economic stability of families, and helping break
intergenerational poverty. By establishing mechanisms for
Medi-Cal to increase the reach of home visiting programs, this
bill substantially expands the scale of evidence-based home
visiting programs in California.
2)Background. The first California NFP implementing agencies
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were launched in 1996 in Fresno, Los Angeles, and Alameda
Counties using federal Department of Justice funding. NFP
provides first-time, low-income mothers with home visitation
services by public health nurses. Typically beginning 18 to 28
weeks into their pregnancy, nurses work intensively with
mothers to improve prenatal, maternal, and early childhood
health and well-being, focusing on therapeutic relationships
with the family designed to improve family functioning in
health, home and neighborhood environment, family and friend
support, parental roles, and major life events. 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.
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. A 1997 RAND study examined the benefits for
children and their families enrolled in early childhood
intervention programs. The study found that the NFP generated
increased tax revenues from increased employment and earnings,
decreased enrollment in public assistance programs, reduced
expenditures for education, health, and other services,
including special education, emergency room visits, and stays
in homeless shelters, and lowered criminal justice system
costs.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, one-time
costs, likely from $250,000 to $500,000 per year for one to two
years, to consult with stakeholders, review existing programs
and program evaluations, and develop a plan for the provision of
home visitation services in Medi-Cal by DHCS (General Fund and
federal funds).
SUPPORT: (Verified8/31/15)
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California Black Health Network
California Nurses Association
Children Now
First 5 Alameda County
First 5 Association of California
First 5 California
First 5 Monterey County
First 5 Solano Children and Families Commission
First 5 Sonoma County Commission
First 5 Tehama
March of Dimes California Chapter
Monterey County Board of Supervisors
Parents as Teachers
Prevent Child Abuse America
San Mateo County Board of Supervisors
Santa Clara County Board of Supervisors
Solano County Board of Supervisors
OPPOSITION: (Verified8/31/15)
California Right to Life Committee
Department of Finance
ARGUMENTS IN 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 states 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
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diverse needs of families and young children in our state.
ARGUMENTS IN OPPOSITION: The California Right to Life
Committee, Inc. (CRLC) writes in opposition that the language in
this bill presumes to know better than families how to beget and
raise children. CRLC writes the mingling of public and private
funds does not represent a republican form of government
guaranteed by the U.S. Constitution. CRLC continues that this
program is very invasive of family life, and it sees the
home-visitation program as one of supposed helpful programs
which is foisted on the more vulnerable and less educated family
members.
The Department of Finance (DOF) argues this bill places
significant pressure on the Medi-Cal program to fund a new
benefit, and including this benefit is likely unnecessary as the
Department of Public Health administers the California Home
Visiting Program which provides home visiting services to
at-risk pregnant women and parents with young children. DOF
states that, because this program already is in operation, this
bill is unnecessary.
ASSEMBLY FLOOR: 79-0, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by:Scott Bain / HEALTH /
9/1/15 21:30:46
**** END ****
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