BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session AB 959 (Chiu) - Lesbian, Gay, Bisexual, and Transgender Disparities Reduction Act ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: July 7, 2015 |Policy Vote: G.O. 12 - 1 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 17, 2015 |Consultant: Mark McKenzie | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: AB 959 would require the Department of Health Care Services (DHCS), the Department of Public Health (DPH), the Department of Social Services (DSS), and the Department of Aging (CDA) to collect voluntary self-identification information on sexual orientation and gender identity, beginning no later than January 1, 2017, when collecting demographic data. Fiscal Impact: DHCS: This department indicates costs to implement the bill would be "indeterminate." DHCS is currently engaged in dialogue with the federal Centers for Medicare and Medicaid Services (CMS) regarding the placement of sexual orientation and gender identity information on the paper and online single streamline application (SSApp). If CMS approves these efforts, costs to update the SSApp would not be attributable to this bill, but these costs would be accelerated as a result AB 959 (Chiu) Page 1 of ? of the bill. In addition, staff estimates that DHCS could incur significant costs to modify various other databases and eligibility systems to provide for the collection of this information. (General Fund, federal funds, and/or special funds). DPH: DPH administers two programs that would be impacted by the bill. o Under its Center for Health Statistics and Information (CHSI), DPH estimates one-time costs of approximately $165,000 (General Fund) to make programming changes to Birth and Death Registration systems. Ongoing costs for CHSI-related activities would be minor and absorbable. o Under its Genetic Disease Screening Program (GDSP), DPH estimates one-time programming costs of approximately $160,000 (General Fund) to update the Screening Information System. There would also be ongoing costs of approximately $105,000 (General Fund) related to printing an enlarged form, but only some of these ongoing costs can be attributed to this bill. (see staff comments) DSS: Unknown costs to DSS. The department was unable to provide information for purposes of this analysis. Staff estimates that there could be significant one-time costs to the extent that county welfare department information technology systems would need programming changes to provide for the collection of sexual orientation and gender identity information. (General Fund) CDA: The CDA indicates minor and absorbable costs to implement the bill, but was unable to provide information about whether specified information technology systems related to federal aging programs have current functionality for collecting demographic information on sexual orientation and gender identity. There could be significant costs if these systems would need to be updated to allow for this functionality. (General Fund and/or federal funds) Background: Existing law requires a state agency, board, or commission that directly, or by contract, collects demographic data as to the ancestry or ethnic origin of Californians, to use separate collection categories and tabulations for each major Asian group AB 959 (Chiu) Page 2 of ? and each major Pacific Islander group. This data is required to be made available to the public in accordance with state and federal law, except for personal identifying information, which shall be deemed confidential. Proposed Law: AB 959 would enact the Lesbian, Gay, Bisexual, and Transgender Disparities Reduction Act, requiring DHCS, DPH, DSS, and CDA to collect voluntary self-identification information pertaining to sexual orientation and gender identity in the course of collecting demographic data directly or by contract. These departments must also report the data collected, and the method used to collect the data, and make the data available to the public, excluding any personal identifying information, in accordance with federal law. The data collected may only be used for demographic analysis, coordination of care, quality improvement of services, conducting approved research, fulfilling reporting requirements, and guiding policy or funding decisions. Related Legislation: SB 280 (Lieu and Lara), which was held on this Committee's Suspense File last year, would have authorized the application form for insurance affordability programs to include questions on sexual orientation and gender identity, and would have required the application to include voluntary questions regarding specified demographic information, including sexual orientation and gender identity or expression, as of January 1, 2016. AB 1208 (Pan), which was vetoed by Governor Brown in 2013, contained similar provisions to SB 280. The veto message included the following statement: We don't need to mandate these requirements in law. The Department of Health Care Services and Covered California already have the authority to modify these types of questions on the form, and they can work constructively with stakeholders to decide what is necessary to change for 2015 and beyond. AB 959 (Chiu) Page 3 of ? Staff Comments: Department of Health Care Services : DHCS indicates that there will be "indeterminate General Fund costs" to implement this bill. In order to collect and report additional information on sexual orientation and gender identity, DHCS would need to modify the paper and online SSApp as well as various databases and eligibility systems, including the Medi-Cal Eligibility Data System, Medi-Cal Management Information System/Decision Support System and the Statewide Automated Welfare System. DHCS is currently in discussion with the federal CMS regarding the placement of sexual orientation and gender identity information for the SSApp. If these efforts are approved by CMS, DHCS will incur costs that would not be attributable to this bill. These costs would be associated with the bill if CMS does not approve the changes. In addition, staff estimates that DHCS could incur significant costs to update the various other database and eligibility systems noted above, although DHCS was unable to provide information regarding these other systems. Department of Public Health : The CHSI, within DPH and through the State Registrar, is responsible for registering each live birth, fetal death, death, and marriage that occurs in California, and for providing certified copies of vital records to the public. Current law requires the State Registrar to permanently preserve vital records in a systematic manner, and to prepare and maintain a comprehensive and continuous index of all registered certificates. This bill would require DPH to make one-time programming changes to the Birth and Death Registration systems at a cost of about $165,000. Any ongoing costs to develop new worksheets and forms required for entering information into the database would be minor and absorbable. DPH, through the Genetic Disease Screening Program (GDSP), produces the results of the statewide Newborn Screening Program, which provides testing for nearly all babies born in the state, and the Prenatal Screening Program, an optional program which is offered to pregnant women who are in prenatal care before the twentieth week of gestation. DPH indicates the bill would require programming changes to the Screening Information System at a one-time cost of approximately $160,000. In addition, DPH notes that it would incur ongoing costs of approximately AB 959 (Chiu) Page 4 of ? $105,000 annually in printing costs related to larger forms required to accommodate additional fields for sexual orientation and gender identity, as well as additional races and ethnicities. Only some of these ongoing costs would be related to this bill. Department of Social Services : The department was unable to provide information for purposes of this analysis. Staff estimates the bill could result in significant costs to update county welfare department information technology systems (known as SAWS) and to reprint paper applications to provide for the collection of sexual orientation and gender identity information. Department of Aging : CDA indicates that it collects and reports demographic information from 33 local Area Agencies on Aging (AAA) that use National Aging Programs Information System, and each AAA has its own management information system unique to its service area. It is unclear whether these systems currently provide functionality for collection of demographic information on sexual orientation and gender identity. Staff estimates that the bill could result in significant costs to either update those systems to provide necessary functionality, or to create stand-alone methods for collecting this data, to the extent existing systems do not provide for collecting this information. -- END --