Existing law provides for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) administered by the State Department of Public Health and counties, under which nutrition and other assistance is provided to eligible low-income postpartum and lactating women, infants, and children under 5 years of age.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which health care services, including breastfeeding services, are provided to qualified low-income persons. Existing law requires the State Department of Health Care Services to streamline and simplify existing Medi-Cal program procedures in order to improve access to lactation supports and breast pumps among Medi-Cal recipients.

This bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services and Covered California to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC Program as part of the application process for Medi-Cal and health plans offered through the California Health Benefit Exchange. The bill would require the interface of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) and the Statewide Automated Welfare Systems System (SAWS) to identify individuals who may be eligible for the WIC Program and, by certain dates, provide electronic access to program applications in a certain format, as specified. The specified, if an electronic application is available. The bill would require that these provisions be implemented only to the extent that funding is available, as specified.

This bill would also require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop measures and outcomes for breastfeeding rates, as specified. The bill would require the recommendations from the stakeholder engagement process to be posted on the departments Internet Web sites by January 1, 2018.

Existing law provides for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) administered by the State Department of Public Health and counties, under which nutrition and other assistance is provided to eligible low-income postpartum and lactating women, infants, and children under 5 years of age.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which health care services, including breastfeeding services, are provided to qualified low-income persons. Existing law requires the State Department of Health Care Services to streamline and simplify existing Medi-Cal program procedures in order to improve access to lactation supports and breast pumps among Medi-Cal recipients.

This bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services and Covered California to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC Program as part of the application process for Medi-Cal and health plans offered through the California Health Benefit Exchange. The bill would require the interface of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) and the Statewide Automated Welfare Systems (SAWS) to identify individuals who may be eligible for the WIC Program and, by certain dates, provide electronic access to program applications in a certain format, as specified. The bill would also require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop measures and outcomes for breastfeeding rates, as specified. The bill would require the recommendations from the stakeholder engagement process to be posted on the departments Internet Web sites by January 1, 2018.

Existing law provides for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) administered by the State Department of Public Health and counties, under which nutrition and other assistance is provided to eligible low-income postpartum and lactating women, infants, and children under 5 years of age.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which health care services, including breastfeeding services, are provided to qualified low-income persons. Existing law requires the State Department of Health Care Services to streamline and simplify existing Medi-Cal program procedures in order to improve access to lactation supports and breast pumps among Medi-Cal recipients.

This bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services and Covered California to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC Program as part of the application process for Medi-Cal and health plans offered through the California Health Benefit Exchange. The bill would require the interface of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) to identify individuals who may be eligible for the WIC Program and, by certain dates, provide electronic access to program applications in a certain format, as specified. The bill would also require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop measures and outcomes for breastfeeding rates, as specified. The bill would require the recommendations from the stakeholder engagement process to be posted on the departments Internet Web sites by January 1, 2018.

Existing law provides for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) administered by the State Department of Public Health and counties, under which nutrition and other assistance is provided to eligible low-income postpartum and lactating women, infants, and children under 5 years of age.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which health care services, including breastfeeding services, are provided to qualified low-income persons. Existing law requires the State Department of Health Care Services to streamline and simplify existing Medi-Cal program procedures in order to improve access to lactation supports and breast pumps among Medi-Cal recipients.

This bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC Program, Program as part of the application process for Medi-Cal and health plans offered through the California Health Benefit Exchange. The bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop measures and outcomes for breastfeeding, breastfeeding rates, as specified. No later than January 1, 2018, and every 5 years thereafter, the bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop and update minimum breast pump and accessory equipment standards for the provision of appropriate and effective breast pumps and accessories. The bill would require the recommendations from the stakeholder engagement process to be posted on the departments Internet Web sites by January 1, 2018.

Existing law provides for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) administered by the State Department of Public Health and counties, under which nutrition and other assistance is provided to eligible low-income postpartum and lactating women, infants, and children under 5 years of age.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which health care services, including breastfeeding services, are provided to qualified low-income persons. Existing law requires the State Department of Health Care Services to streamline and simplify existing Medi-Cal program procedures in order to improve access to lactation supports and breast pumps among Medi-Cal recipients.

This bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC Program, as part of the application process for Medi-Cal and health plans offered through the California Health Benefit Exchange. The bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop measures and outcomes for breastfeeding, as specified, and specified. No later than January 1, 2018, and every 5 years thereafter, the bill would require the State Department of Public Health to coordinate with the State Department of Health Care Services, through a stakeholder engagement process, as specified, to develop and update minimum required breast pump and accessory equipment standards for the provision of appropriate and effective breast pumps and accessories in all health plans. accessories.

The Employee Housing Act requires a person operating employee housing to obtain a permit to operate that housing from the agency that enforces the act, which can either be the Department of Housing and Community Development or a city, county, or city and county that assumes responsibility for enforcing the act. The act defines for its purposes several terms, including the term employee community housing.

This bill would make nonsubstantive changes to those provisions.

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 2589 (Gomez) - Public health: lactation services and equipment

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 2589 would require the system currently used to assess eligibility for Medi-Cal and health care coverage through Covered California to assess applicants for eligibility for the WIC program and allow eligible individuals to complete an electronic application for WIC benefits. The bill would also require the Department of Public Health to develop measure and outcomes for breastfeeding rates.

Fiscal Impact:

• One-time costs in the millions to low tens of millions, to make required system changes to CalHEERS, the SAWs, and the new WIC information technology system (General Fund and potentially federal funds). In order to implement the bill’s requirement to allow applicant information to be shared by either CalHEERS or a SAWs with an electronic WIC application, significant information technology upgrades would be required for all related systems. For CalHEERS and the SAWS, system upgrades would be needed to allow systems to screen for potential WIC eligibility, to get the applicant’s consent to share personal information with the WIC system, and to securely share personal information with the new WIC system. For the WIC program, the bill would require the new WIC information technology system to allow for an electronic application and to securely receive applicant information from the other programs’ eligibility systems. Whether those system changes would be allowed by the federal government and whether federal funding will be available to pay for those costs is unknown. (See below).
• One-time costs, likely in the hundreds of thousands per year for one to two years for the Department of Public Health to develop measure and outcomes for breastfeeding rates (General Fund). The costs to implement this requirement of the bill include staff costs to analyze existing information on current breastfeeding rates and the health benefits of breastfeeding, to support the required stakeholder process, and to develop a report or other document that includes the results of the process.

Background:

Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. Medi-Cal provides coverage to childless adults and parents with household incomes up to 138% of the federal poverty level and to children with household incomes up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary.

Under current state and federal law, Covered California functions are the state’s health benefit exchange. Individuals can apply for subsidized health care coverage (and apply for Medi-Cal coverage) through Covered California. The Covered California application process can be performed online, over the phone, or through enrollment counselors. The underlying information technology system that is used to make eligibility determinations for Covered California is known as the California Health Care Eligibility, Enrollment, and Retention System (CalHEERS). CalHEERS makes eligibility determinations for both Covered California coverage and Medi-Cal coverage. Beginning in late 2016, CalHEERS will be able to screen applicants for eligibility for several other income based programs (CalFresh and CalWorks) and will refer likely beneficiaries to those programs. CalHEERS will not actually make eligibility determinations or enroll eligible beneficiaries in those programs.

The Women, Infants, and Children Program (WIC) is a federally funded program that provides nutrition assistance to low-to-moderate income families of pregnant and post-partum women. Women who are enrolled in Medi-Cal are automatically eligible for WIC.

Under current practice, eligibility determinations for the WIC program are made by local WIC agencies (84 agencies with over 600 locations). The federal government requires that WIC eligibility determinations be made as part of an in-person visit that includes height and weight measurements of children and nutritional assessments and counseling for the family. Currently, WIC enrollees are issued paper checks with which they can purchase eligible foods. The Department of Public Health, which manages the WIC program, will soon begin the process of updating the underlying WIC information technology system to switch from paper checks to electronic benefit transfer cards. The federal government must approve the information technology system that the state selects. The federal government has indicated that it will only approve systems that have been implemented in other states. To date, it does not appear that any other state has included an electronic application in their new system and the Department does not anticipate including that function in the new WIC IT system. Some states and local agencies use online screening tools that allow potential applicants to see whether they are likely to qualify for WIC and to allow them to share their contact information with an eligibility worker or schedule an appointment. It does not appear that any of those systems actually perform eligibility determinations.

Proposed Law:

AB 2589 would require the system currently used to assess eligibility for Medi-Cal and health care coverage through Covered California to assess applicants for eligibility for the WIC program and allow eligible individuals to complete an electronic application for WIC benefits. The bill would also require the Department of Public Health to develop measure and outcomes for breastfeeding rates.

Specific provisions of the bill would:

• Require the Department of Public Health to coordinate with the Department of Health Care Services and Covered California to develop a system for information sharing to streamline the enrollment into WIC as part of the process for applying for Medi-Cal or Covered California health care coverage;
• By January 1, 2019, require CalHEERS and the SAWS to identify applicants potentially eligible for WIC, and if the applicant consents and if there is an available WIC electronic application, electronically link the applicant to that WIC application;
• By January 1, 2022, require CalHEERS and the SAWS to identify applicants potentially eligible for WIC, and if the applicant consents and if there is an available WIC electronic application, allow an applicant to complete an electronic WIC application without resubmitting data known to CalHEERS or the SAWS;
• Make implementation of the above requirements subject to funding from the General Fund or federal funds if available;
• Require the Department of Public Health, in consultation with stakeholders, develop measures and outcomes for breast feeding rates.

Staff Comments:

As noted above, the WIC program is fully funded by the federal government and the federal government has to approve changes to the underlying IT system. It is not clear whether the federal government would approve the creation of an online application for WIC, given that the federal government requires in-person interactions with WIC agencies before an applicant is enrolled in the program. If the federal government does not approve the use of federal funding to pay for the costs to make the necessary changes to WIC system, as well as the necessary changes to CalHEERS and the SAWS, those costs would be a General Fund cost. (If the federal government allowed the changes to be made at all.)

It is also important to note that eligibility workers at WIC agencies have access to the information technology system that tracks Medi-Cal participation. Therefore, when a women applies for WIC, the eligibility worker is able to check whether the applicant is enrolled in Medi-Cal. Because Medi-Cal enrollees are considered to be automatically eligible for WIC, a determination by the eligibility worker that a women is already enrolled in Medi-Cal eliminates the need for the applicant to demonstrate that she meets the income requirements of the program.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 2589

SUBJECT: Public health: lactation services and equipment

SUMMARY:

Requires the Department of Public Health (DPH) to coordinate with the Department of Health Care Services (DHCS) and the California Health Benefit Exchange (known as Covered California) to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the Women, Infants, and Children (WIC Program) as part of the application process for Medi-Cal and Covered California. Requires the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS is the on-line application system administered by DHCS and Covered California) and the county Statewide Automated Welfare Systems (SAWS) to identify individuals who are potentially eligible for the WIC Program to electronically link them to a WIC Program application (by January 1, 2017), and (by January 1, 2022) to provide a simple interface for the individual to electronically complete a WIC Program application. Requires DPH to coordinate with DHCS, through a stakeholder engagement process, to develop measures and outcomes for breastfeeding rates.

Existing law:

1. Establishes the California Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program) administered by DPH, under which nutrition and other assistance is provided to eligible low-income postpartum and lactating women, infants, and children under five years of age.
   
2. Establishes the Medi-Cal program, which is administered by the DHCS, under which health care services, including breastfeeding services, are provided to qualified low-income persons. Medi-Cal provides coverage for most adults up to 138% of the Federal Poverty Level (FPL), provides coverage for pregnant women up to 211% of the FPL, and provides coverage to children in families with incomes up to 266% of the federal poverty level (FPL (266% of the FPL is at or below $53,626 for a family of three in 2016).
   
3. Establishes Covered California in state government, and specifies its duties and authority. Requires Covered California to be governed by a board that includes the Secretary of the California Health and Human Services Agency (Agency) and four members with specified expertise who are appointed by the Governor and the Legislature.
   
4. Requires individuals to have the option to apply for “insurance affordability programs” in person, by mail, online, by telephone, or by other commonly available electronic means. Defines “insurance affordability programs” as Medi-Cal and coverage purchased through Covered California with an federal advanced premium tax credit or cost-sharing reduction.
   
5. Requires a single, accessible, standardized paper, electronic, and telephone application for insurance affordability programs be developed by DHCS in consultation with the Covered California board. Requires the application to be used by all entities authorized to make an eligibility determination for any of the insurance affordability programs and by their agents.
   
6. Requires the Office of Systems Integration to implement a statewide automated welfare system (SAWS) for the following public assistance programs:
7. CalWORKS;
8. CalFresh;
9. Medi-Cal program;
10. The foster care program;
11. The refugee program; and,
12. County medical services programs.

This bill:

1. Requires DPH to coordinate with DHCS and Covered California to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC Program as part of the application process for Medi-Cal and health plans offered through Covered California.
   
2. Requires, on or before January 1, 2019, CalHEERS and the SAWS to identify individuals who are potentially eligible for the WIC Program and, if a potentially eligible individual wishes to apply for the WIC Program, to electronically link them to a WIC Program application.
   
3. Requires, on or before January 1, 2022, CalHEERS and SAWS to identify individuals who are potentially eligible for the WIC Program and, if a potentially eligible individual wishes to apply for the WIC Program and provides consent to share confidential data with the WIC Program, to provide a simple interface for the individual to electronically complete a WIC Program application without resubmitting data already known to the CalHEERS and SAWS systems.
   
4. Requires DPH to coordinate with DHCS, through a stakeholder engagement process, to develop measures and outcomes for breastfeeding rates that do both of the following:
   
5. Include, at a minimum, women’s intention to breastfeed, breastfeeding initiation rates, and exclusivity and duration; and,
6. Identify ethnic disparities and sociodemographic differences.
   
7. Requires the stakeholder process to include, but not be limited to, representatives from health care providers, primary care clinics, and health plans, state and local staff from the WIC Program and the Maternal, Child and Adolescent Health (MCAH) program, and representatives from organizations representing women, infants, and children, beginning prenatally and continuing through the postpartum period and at least until the infant reaches one year of age.
   
8. Requires the stakeholder process to take no longer than six months and the recommendations to be posted on DHCS and DPH Internet Web sites by January 1, 2018.

FISCAL EFFECT:

According to the Assembly Committee on Appropriations:

1. Costs to DPH can be absorbed within their existing MCAH program (federal Title V funds). Costs to DHCS for consultation are also expected to be minor and absorbable (General Fund (GF)/federal).
2. Unknown, significant information technology costs potentially in the millions of dollars (potentially GF/federal/special funds) associated with the provision to develop an electronic interface to share eligibility-related information in order to streamline enrollment in the WIC Program.
3. Unknown, significant administrative costs to ensure federal approval and the availability of federal funding for this work. The WIC Program is fully funded by a federal grant, but it is unknown whether existing federal funds could be used to support this type of expense.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill supports California families through the development of key metrics and improved programmatic coordination that will increase enrollment in the WIC Program and improve breastfeeding rates among women in California. Social determinants of health (conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes) are increasingly being used to understand, measure, and address health equity. Linking families to health care and support systems and providing quality preventative services are basic strategies for ensuring that parents and their children reach their full potential. Health care reform and the Affordable Care Act provide historic opportunities for linking low-income families with health care and healthy food. Breastfeeding has been shown to reduce the incidence of obesity while also contributing to numerous positive health outcomes for mother and child. Much progress has been made in California for breastfeeding with nearly 94% of mothers starting breastfeeding in the hospital and 66% exclusively breastfeeding at discharge. Breastfeeding rates after the hospital stay are important with rates dropping off in the first three months. State breastfeeding metrics would guide policy and practice planning efforts.
2. WIC. The WIC Program provides nutrition services and food assistance to low -to-moderate income families for pregnant, breastfeeding, and non-breastfeeding women, infants, and children up to their fifth birthday. In addition to the categorical eligibility requirement, participants must be at or below 185% of the FPL (equivalent to an annual income of $29,637 for a family size of two in 2016). WIC Program services include nutrition education, breastfeeding support, assistance with finding health care and other community services, and vouchers for specific nutritious foods that are redeemable at retail food outlets throughout the state. The WIC Program is federally funded by the US Department of Agriculture (USDA) under the federal Child Nutrition Act of 1966. Specific uses of the WIC Program funds are required under federal laws and regulations, and CDPH must account for and report funds and expenditures on a monthly basis.
   
   

The WIC Program is administered by DPH, which receives federal funding to administer the WIC Program to Californians based on a discretionary grant appropriated by Congress, plus subsequent reallocations of prior year unspent funds. The WIC Program is not an entitlement program. The number of participants served is limited by the amount of discretionary grant appropriated annually by Congress. For 2016-17, WIC has a budget of approximately $1.3 billion, and the program serves approximately 1.2 million residents each month. In California, 84 WIC agencies provide services at over 600 sites throughout the state. In the 2013-14 fiscal year, 58% percent of WIC participants were children one to five, 20% were infants age zero to one and 9% were pregnant women.

1. The ACA and enrollment options for state health subsidy programs. The ACA made numerous changes to increase the number of individuals with health coverage. These changes include requiring a single streamlined form for state health subsidy programs, and by allowing individuals to be able to apply in person, by mail, through the internet, or by telephone. DHCS and Covered California jointly administer CalHEERS, which provides an on-line application for state health subsidy programs, including Medi-Cal and coverage through Covered California with advanced premium tax credits (APTCs) and cost-sharing subsidies. In addition, individuals can apply for state health subsidy programs, CalWORKS and CalFRESH through county human services departments in-person, or via fax, phone or on-line. Covered California indicates in September 2016, CalHEERS will implement a referral program that will direct consumers that meet income thresholds for CalFRESH, CalWORKS and non-MAGI Medi-Cal to those separate applications. However, this will only be a referral program, and CalHEERS will still be only able to directly enroll individuals in insurance affordability programs.

The WIC Program income eligibility overlaps with Medi-Cal and eligibility for APTC and cost-sharing subsidies through Covered California. If a person is enrolled in CalFresh or Medi-Cal, they are considered to be automatically eligible for the WIC Program. The WIC Program has an on-line assessment for eligibility, but does not currently have an on-line application. Individuals who complete the on-line assessment are referred to local agencies to discuss potential eligibility with a WIC Program staff person, and a nutrition assessment is required. Federal WIC Program regulations require a nutritional risk assessment to be performed to determine if a person is at nutritional risk through a medical and/or nutritional assessment. In addition, federal regulations require a height or length and weight measurement to be performed and/or documented in the applicant's file at the time of certification.

The current WIC Program computer system is going to be replaced with a new system that will be compatible with the move away from a check-based system to an electronic benefit transfer card. DPH indicates it can use federal WIC Program funds for an interface as proposed by this bill, but it is subject to the approval by the federal Department of Agriculture.

1. Support. This bill is jointly sponsored by the California WIC Association (WIC Association) and the California Primary Care Association (CPCA). The WIC Association states that this bill will require development of measures of breastfeeding data, and a streamlined process for eligibility and application for participants in the WIC Program via the Medi-Cal and Covered California application processes. The WIC Association states there is significant overlap in the Medi-Cal-eligible and WIC-eligible populations, and it makes sense to develop processes and an electronic interface for eligibility-related information sharing to streamline the WIC application as part of the application process for Medi-Cal and Covered California. The WIC Association also notes that breastfeeding has been shown to reduce the incidence of obesity while also contributing to numerous other positive health outcomes for mother and child, and California needs to develop and agree upon measures for breastfeeding in order to evaluate how best to support California women in meeting their infant feeding goals.
   
   CPCA states this bill will empower California moms to breastfeed their babies by streamlining the enrollment process for the WIC Program and create new metrics to track breastfeeding rates and health outcomes. CPCA concludes, with this simple and comprehensive bill, the state can support strategies to improve breastfeeding initiation, duration, and exclusivity.
2. Amendments. This bill requires, on or before January 1, 2019, CalHEERS to identify individuals who are potentially eligible for the WIC Program and, if a potentially eligible individual wishes to apply for the WIC Program, to electronically link them to a WIC Program application. However, the WIC Program application is not currently on-line. Amendments are needed to clarify that this link is required if the WIC Program application is available on-line.
3. Policy issue.
4. CalHEERS funding and system changes to implement this bill. CalHEERS is a jointly funded between Covered California and DHCS. Because federal funding for Exchanges is no longer available, the Covered California portion of the funding will come from assessments levied on Covered California health plans.  The DHCS portion of the funding comes from a combination of Medicaid and Childrens Health Insurance Program federal funds and state General Fund. The CalHEERS budget for 2016-17 is $169.1M ($25.3M General Fund). While easing enrollment and better integration of health and public assistance programs makes it easier for individuals to apply for and receive health and social services for which they are eligible, any changes to CalHEERS under existing law would be funded through assessments on health plans, which are then passed on to individuals purchasing coverage in Covered California.
   

SUPPORT AND OPPOSITION:

Support: California Health+ Advocates (sponsor)

California WIC Association (co-sponsor)

California Primary Care Association (co-sponsor)

Alameda County Board of Supervisors

AltaMed Health Services Corporation

American Federation of State, County and Municipal Employees, AFL-CIO

Ampla Health

Antelope Valley Hospital WIC Program

Association of California Healthcare Districts

Breastfeeding Coalition of Solano County

California Academy of Nutrition and Dietetics

California Advanced Lactation Institute

California Breastfeeding Coalition

California Center for Public Health Advocacy

California Nurse-Midwives Association

Children Now

Clinica Sierra Vista

Community Clinic Association of Los Angeles County

Community Clinic Consortium Contra Costa & Solano Counties

County Health Executives Association of California

Eisner Pediatric & Family Medical Center

Family Health Centers of San Diego

Harmony Health

Health Alliance of Northern California

Health And Life Organization, Inc.

Kheir Center

Marin Community Clinics

Maternal and Child Health Access

Mountain Valleys Health Centers

National Health Law Program

North Coast Clinics Network

North County Health Services

North East Medical Services

Northeast Valley Health Corporation

Northeastern Rural Health Clinics WIC

Omni Family Health

Open Door Community Health Centers

Prevention Institute

Public Health Foundation Enterprises WIC program

Ravenswood Family Health Center

Redwood Community Health Coalition

Sacramento Community Clinics

San Ysidro Health Center

Solano County Public Health WIC Program

South of Market Health Center

Strategic Alliance for Healthy Food and Activity Environments

Tiburcio Vasquez Health Center, Inc.

Tulare Regional Medical Center

United States Lactation Consultant Association

Valley Community Healthcare

Watts Healthcare WIC Program

Westside Family Health Center

White Memorial Community Health Center

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2589

Author:(Gomez)

As Amended Ver:May 27, 2016

Majority vote

SUMMARY: Requires the California Department of Public Health (DPH) to coordinate with the Department of Health Care Services (DHCS) and Covered California to streamline enrollment into the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) through the Covered California; and, requires DPH and DHCS to coordinate on a stakeholder process to develop measures and outcomes for breastfeeding. Specifically, this bill:

1. Requires DPH, DHCS, and Covered California to coordinate to develop processes, procedures and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC program as part of the application process for Medi-Cal and health plans offered through Covered California.
2. Requires the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), on or before January 1, 2019, to identify individuals who are potentially eligible for the WIC Program and, if a potentially eligible individual wishes to apply for the WIC Program, electronically link them to a WIC Program application.
3. Requires CalHEERS, on or before January 1, 2022, to identify individuals who are potentially eligible for the WIC Program and, if a potentially eligible individual wishes to apply for the WIC Program and provides consent to share confidential data with the WIC Program, provide a simple interface for the individual to electronically complete the WIC Program application without resubmitting data already known to the CalHEERS system.
4. Requires DPH and DHCS to coordinate through a stakeholder process that includes, but is not limited to representatives from health care providers, primary care clinics, health plans, state and local staff from the WIC program and the Maternal, Child and Adolescent Health (MCAH) program, and representatives from organizations representing women, infants and children to, beginning prenatally and continuing through the postpartum period and at least until the infant reaches one year of age, develop measures and outcomes for breastfeeding rates that do both of the following:
   1. Include, at a minimum, women's intention to breastfeed, breastfeeding initiation rates, and exclusivity and duration; and,
   2. Identify ethnic disparities and sociodemographic differences
5. Specifies that the stakeholder process take no longer than six months and the recommendations be posted on the departments' Internet Web sites by January 1, 2018.

FISCAL EFFECT: According to the Assembly Committee on Appropriations:

1. Costs to CDPH can be absorbed within their existing MCAH program (federal Title V funds). Costs to DHCS for consultation are also expected to be minor and absorbable (General Fund (GF)/federal).
2. Unknown, significant information technology costs potentially in the millions of dollars (potentially GF/federal/special funds) associated with the provision to develop an electronic interface to share eligibility-related information in order to streamline enrollment in WIC.
3. Unknown, significant administrative costs to ensure federal approval and the availability of federal funding for this work. WIC is fully funded by a federal grant, but it is unknown whether existing federal funds could be used to support this type of expense.

COMMENTS: According to the author, evidence indicates that early infant feeding practices can affect later growth and development in children, while significantly reducing their risk for infections and chronic diseases such as diabetes, asthma and obesity. The author notes that the United States Surgeon General, and all the major health organizations, including the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for most babies, unless specifically contraindicated, for the first six months and continued breastfeeding with the addition of appropriate foods up to at least one year of age. The author contends that California has supported breastfeeding policies that increase rates among low-income women and must continue efforts, and study and collect data relating to breastfeeding exclusivity, initiation, and duration not only in a hospital setting, but at home. The author also states that California has recognized that low-income and minority women have lower rates when it comes to breastfeeding duration, initiation, and exclusivity. The author concludes, in order to help to achieve health equity for new mothers and their children, we must expand data collection outside our hospital settings.

Breastfeeding rates and recommendations. California in-hospital infant feeding practices are monitored using data collected by the Newborn Screening (NBS) Program within DPH. All non-military hospitals providing maternity services are required to complete the Newborn Screening Test Form. In addition to tracking genetic diseases and metabolic disorders, the NBS Program gathers data on all infant feedings for about 24 to 48 hours since birth. The MCAH Program staff analyze this data and publish breastfeeding rates by hospital, county and the State. In addition to the Newborn Screening data, all hospitals with 300 or more births are required to report on the Perinatal Core Measure Set, which includes a measure on exclusive breast milk feeding.

According to the federal Centers for Disease Control and Prevention, breastfeeding rates continue to rise in the United States. In 2011, 79% of newborn infants started to breastfeed. Yet breastfeeding does not continue for as long as recommended. Of infants born in 2011, 49% were breastfeeding at 6 months and 27% at 12 months.

Current nutrition program linkages. When a family or individual is applying for Medi-Cal or Covered California, the application includes information that identifies the person as eligible for CalFresh. The system is not completely automated, because the CalFresh application is not auto-populated, but an on-line application is made available and the applicant can fill that out and the county is notified of the potential CalFresh participant.

Currently there is no electronic linkage for WIC eligibility in Medi-Cal or Covered California enrollment. The applications provide a statewide toll-free number for mothers to call, where they would receive another number or numbers for a local WIC agency. The mother would then call that number to find out if they are eligible.

According to the proponents of this bill, CalFresh is working to streamline related data sharing, integration and bridging between programs, including Medi-Cal. WIC and CalFresh are working on data sharing and analysis, particularly related to the participation of children.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003261

Date of Hearing: May 4, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2589

Author:(Gomez) – As Amended Ver:April 26, 2016

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill contains two separate provisions related to maternal and child nutrition. Specifically, this bill:

1. Requires the California Department of Public Health (CDPH) to coordinate with the Department of Health Care Services (DHCS) to develop processes, procedures, and an electronic interface for eligibility-related information sharing to streamline enrollment into the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), as part of the application process for Medi-Cal and health plans offered through the Covered California (CoveredCA) enrollment portal.
2. Requires CDPH to coordinate with the DHCS, through a stakeholder engagement process, to develop specified measures and outcomes related to breastfeeding during the first year of infancy. It also requires recommendations to be posted on the departments’ Internet Web sites by January 1, 2018.

FISCAL EFFECT:

1. Costs to CDPH can be absorbed within their existing Maternal, Child, and Adolescent Health program (federal Title V funds). Costs to DHCS for consultation are also expected to be minor and absorbable (GF/federal).
2. Unknown, significant costs (potentially GF/federal/special funds) associated with the provision to develop an electronic interface to share eligibility-related information in order to streamline enrollment in WIC. A variety of approaches, varying in complexity and cost, could be responsive to this requirement. For comparison's sake, a data-sharing project proposed in the Governor's 2016-17 Budget requests $513,000 for CDPH and $758,000 for DSS to increase enrollment of children in WIC and CalFresh, respectively, through data matching, geographic hotspot analysis, and outreach. This would be a relatively simple data-sharing project to streamline enrollment if expanded to include greater linkages between Medi-Cal and WIC, for example.

On the other hand, if the Medi-Cal/CoveredCA enrollment information system, called CalHEERS, was changed in order to identify women and children who were likely WIC-eligible and provide direct enrollment into WIC, this would be far more complex and information technology costs would be significant, potentially in the millions of dollars. There would likely be significant administrative work to ensure federal approval and the availability of federal funding for this work. WIC is fully funded by a federal grant, but it is unknown whether existing federal funds could be used to support this type of expense.

COMMENTS:

1. Purpose. The author states existing state and national data collection on breastfeeding is incomplete because data collection is only robust in a hospital setting. Data collection does not occur once a nursing woman is in the community, despite the public health importance of supporting higher breastfeeding exclusivity, initiation, and duration rates among California's diverse population throughout the first year of infancy. This bill would take the first step toward more robust data collection– namely, it would require definition of measures, which currently are not standardized for an outpatient setting, as well as provide desired target outcomes for improvement. Furthermore, the author explains WIC is a resource that can support breastfeeding and nutrition for women and children, but is not tightly integrated with other health and human services programs. This bill would improve coordination between WIC and public health care programs.
2. Breastfeeding rates and recommendations. According to the federal Centers for Disease Control and Prevention, breastfeeding rates continue to rise in the United States. In 2011, 79% of newborn infants started to breastfeed. Yet breastfeeding does not continue for as long as recommended. Of infants born in 2011, 49% were breastfeeding at 6 months and 27% at 12 months. In the policy statement, "Breastfeeding and the Use of Human Milk," published in the March 2012 issue of Pediatrics, the AAP reaffirms its recommendation of exclusive breastfeeding for about the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.
3. WIC. WIC provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.
4. Related state efforts.
   1. Breastfeeding. CDPH oversees the Maternal and Infant Health Assessment (MIHA) Survey that tracks certain breastfeeding measures and outcomes. CDPH collects in-hospital exclusive breastfeeding initiation and percent of breastfed infants receiving formula supplementation while in the hospital. Neither include data collection on an outpatient basis, which this bill addresses. CDPH's “Healthy People 2020” initiative and “California Wellness Plan” promote the increase of California breast feeding rates. DPH’s Office of Health Equity’s “Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity” report cites the benefits of breastfeeding and positive health outcomes. DPH’s “Let’s Get Healthy California” initiative includes priorities for healthy beginnings and well-being starting with infancy.
   2. Program linkages. When a family or individual is applying for Medi-Cal or Covered California, the application includes information that identifies the person as eligible for CalFresh. The system is not completely automated, because the CalFresh application is not auto-populated, but an on-line application is made available and the applicant can fill that out and the county is notified of the potential CalFresh participant. Currently there is no similar electronic linkage for WIC eligibility in Medi-Cal or Covered California enrollment. The applications provide a statewide toll-free number for mothers to call, where they would receive another number or numbers for a local WIC agency. The mother would then call that number to find out if they are eligible.

When Medi-Cal expanded to cover childless adults in 2014, over 600,000 were targeted for enrollment through an "express lane" eligibility process by using data matching between CalFresh and Medi-Cal.

1. Support. This bill is co-sponsored by the California WIC Association, who states California needs to develop and agree upon measures for breastfeeding in order to evaluate how best to support California women in meeting their infant feeding goals. The California Primary Care Association (CPCA) is a co-sponsor and states this bill will empower California moms to breastfeed their babies by streamlining the enrollment process for the WIC Program, create new metrics to track breastfeeding rates and health outcomes. This bill is supported by a bevy of other community clinics, local WIC programs, breastfeeding advocacy, nutrition and public health groups, and children's' advocacy groups.
2. Prior legislation.
   1. SB 402 (De Leon), Chapter 666, Statutes of 2013, requires all general acute care hospitals and special hospitals, that have a perinatal unit by January 1, 2025, to adopt the “Ten Steps to Successful Breastfeeding,” as adopted by Baby-Friendly USA, per the Baby-Friendly Hospital Initiative (BFHI), or an alternate process adopted by a health care service plan that includes evidenced-based policies and practices and targeted outcomes, or the Model Hospital Policy Recommendations, as defined.
   2. SB 502 (De Leon and Pavley), Chapter 511, Statutes of 2011, establishes the Hospital Infant Feeding Act, which requires all general acute care and special hospitals that have a perinatal unit to have an infant-feeding policy, as specified, to clearly post the policy and routinely communicate the policy to perinatal unit staff.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 19, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2589

Author:(Gomez) – As Amended Ver:April 5, 2016

SUBJECT: Lactation services and equipment.

SUMMARY: Requires the California Department of Public Health (DPH) to coordinate with the Department of Health Care Services (DHCS) to streamline enrollment into the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) through the California Health Benefit Exchange (the Exchange); and, requires DPH and DHCS to coordinate on two stakeholder processes, first, to develop measures and outcomes for breastfeeding, and second, to develop and update minimum breast pump and accessory equipment standards. Specifically, this bill:

1. Requires DPH and DHCS to coordinate to develop processes, procedures and an electronic interface for eligibility-related information sharing to streamline enrollment into the WIC program as part of the application process for Medi-Cal and health plans offered through the Exchange.
2. Requires DPH and DHCS to coordinate through a stakeholder process that includes, but is not limited to representatives from health care providers, primary care clinics, health plans, state and local staff from the WIC program and the Maternal, Child and Adolescent Health (MCHA) program, and representatives from organizations representing women, infants and children to do both of the following:
   1. With respect to prenatal care, develop measures and outcomes for breastfeeding that shall include, at a minimum, women's intention to breastfeed, including ethnic diversity; and,
   2. After birth and following discharge from the hospital or other birthing location, develop measures and outcomes for breastfeeding that include, at a minimum, initiation, duration, exclusivity, and ethnic disparities.
3. Requires DPH and DHCS, no later than January 1, 2018, and every five years thereafter, to coordinate through a stakeholder process to develop and update minimum breast pump and accessory equipment standards for the provision of appropriate and effective breast pumps and accessories.
4. Requires the stakeholder process described in 3) above, to include, but not be limited to representatives from health care providers, health plans, primary care clinics, lactation consultants and specialists, state and local staff from the WIC program, and representatives of manufacturers and distributors of breast pumps and accessories.

EXISTING LAW:

1. Establishes DPH to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention and requires DPH to include in its public service campaign the promotion the benefits of mothers breast-feeding their infants.
2. Requires DPH, to the extent that non-United States Department of Agriculture (USDA) federal funds and private grants or donations are made available, to, no later than July 1, 2008 begin expansion of the breast-feeding peer counseling program at local WIC sites.
3. Requires all general acute care hospitals, and special hospitals providing maternity care to make available a breast feeding consultant, or provide information to the mother on where to receive breast feeding information.
4. Requires all general acute care hospitals and special hospitals that have a perinatal unit to have an infant-feeding policy that promotes breastfeeding according to the World Health Organization's (WHO) Baby-Friendly Hospital Initiative or the DPH Model Hospital Policy Recommendations.
5. Establishes the Exchange (also referred to as Covered California) within state government, as an independent public entity not affiliated with an agency or department, and requires the Exchange to compare and make available through selective contracting health insurance for individual and small business purchasers as authorized under the Patient Protection and Affordable Care Act (ACA). Specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans though the Exchange by qualified individuals and small employers.
6. Requires the board to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs.
7. Establishes the Medi-Cal program, which is administered by DHCS, under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions. Authorizes DHCS to extend continuous Medi-Cal eligibility to children 19 years of age and younger.

EXISTING FEDERAL LAW under the ACA requires health plans and health insurers to provide coverage for breast pumps at no cost-sharing, as a preventative service.

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, evidence indicates that early infant feeding practices can affect later growth and development in children, while significantly reducing their risk for infections and chronic diseases such as diabetes, asthma and obesity. The author notes that the United States Surgeon General, and all the major health organizations, including the American Academy of Pediatrics (AAP) and WHO recommend exclusive breastfeeding for most babies, unless specifically contraindicated, for the first six months and continued breastfeeding with the addition of appropriate foods up to at least one year of age. The author contends that California has supported breastfeeding policies that increase rates among low-income women and must continue efforts, and study and collect data relating to breastfeeding exclusivity, initiation, and duration not only in a hospital setting, but at home. The author also states that California has recognized that low-income and minority women have lower rates when it comes to breastfeeding duration, initiation, and exclusivity. The author concludes, in order to help to achieve health equity for new mothers and their children, we must expand data collection outside our hospital settings.
   
2. BACKGROUND.
   1. Breastfeeding rates and recommendations. California in-hospital infant feeding practices are monitored using data collected by the Newborn Screening (NBS) Program within DPH. All non-military hospitals providing maternity services are required to complete the Newborn Screening Test Form. In addition to tracking genetic diseases and metabolic disorders, the NBS Program gathers data on all infant feedings for about 24 to 48 hours since birth. The MCAH Program staff analyze this data and publish breastfeeding rates by hospital, county and the State. In addition to the Newborn Screening data, all hospitals with 300 or more births are required to report on the Perinatal Core Measure Set, which includes a measure on exclusive breast milk feeding.
      
      According to the federal Centers for Disease Control and Prevention, breastfeeding rates continue to rise in the United States. In 2011, 79% of newborn infants started to breastfeed. Yet breastfeeding does not continue for as long as recommended. Of infants born in 2011, 49% were breastfeeding at 6 months and 27% at 12 months.
      
      In the policy statement, "Breastfeeding and the Use of Human Milk," published in the March 2012 issue of Pediatrics, the AAP reaffirms its recommendation of exclusive breastfeeding for about the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby. According to the National Institute of Health, breastfeeding carries many health benefits for infants and mothers, as well as potential economic and environmental benefits for communities. Among the known health benefits are nutritionally balanced meals, some protection against common childhood infections, and better survival during the first year of life, including a lower risk of Sudden Infant Death Syndrome. Other studies suggest that breastfeeding may reduce the risk for certain allergic diseases, asthma, obesity, and type 2 diabetes. It also may help improve an infant’s cognitive development.
      
   2. WIC. WIC provides Federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC requires breast pumps provided to participants to meet equipment specifications to effectively support breastfeeding.
      
   3. State breastfeeding support and programs. DPH’s MCAH Division and the Genetic Disease Screening Program (GDSP) support DPH efforts to promote breastfeeding. MCAH programs (Black Infant Health Program, Adolescent Family Life Program, California Home Visiting Program, and Local MCAH) discuss the benefits of breastfeeding; the importance of partner and family support; and connect women to peer support groups and professional lactation consultants as needed. The Comprehensive Perinatal Services Program provides technical assistance on breastfeeding to health care providers and their staff. The Regional Perinatal Programs of California assist hospital with quality improvement efforts to advance the Model Hospital Policies or Baby Friendly Hospital standards. Some Local MCAH Programs provide professional breastfeeding support directly or through community resources, and promote development of additional lactation professionals in the community. MCAH oversees the Maternal and Infant Health Assessment (MIHA) Survey that tracks breastfeeding measures and outcomes. GDSP collects in-hospital exclusive breastfeeding initiation and percent of breastfed infants receiving formula supplementation while in the hospital.

DPH reports “Healthy People 2020” and “California Wellness Plan” promote the increase of California breast feeding rates. DPH’s Office of Health Equity’s “Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity” cites the benefits of breastfeeding and positive health outcomes. DPH’s “Let’s Get Healthy California” includes priorities for healthy beginnings and well-being starting with infancy.

DPH offers three types of breast pumps to participants: multi-user electric, personal-use electric, and manual. Under the ACA, private insurers must cover the cost of breast pumps; however, it is up to the plan to decide whether the pump is manual or electric.

• 1. Current nutrition program linkages. When a family or individual is applying for Medi-Cal or Covered California, the application includes information that identifies the person as eligible for CalFresh. The system is not completely automated, because the CalFresh application is not auto-populated, but an on-line application is made available and the applicant can fill that out and the county is notified of the potential CalFresh participant.

Currently there is no electronic linkage for WIC eligibility in Medi-Cal or Covered California enrollment. The applications provide a statewide toll-free number for mothers to call, where they would receive another number or numbers for a local WIC agency. The mother would then call that number to find out if they are eligible.

According to the proponents of this bill, CalFresh is working to streamline related data sharing, integration and bridging between programs, including Medi-Cal. WIC and CalFresh are working on data sharing and analysis, particularly related to the participation of children.

1. SUPPORT. The California WIC Association (WIC Association) is a cosponsor of this bill and states that this bill will help to ensure that California families and young children are utilizing the programs that will provide them the most help, and support their own health and nutrition goals as well as the public health and nutrition goals of California. The WIC Association also notes that Breastfeeding has been shown to reduce the incidence of obesity while also contributing to numerous other positive health outcomes for mother and child, and California needs to develop and agree upon measures for breastfeeding in order to evaluate how best to support California women in meeting their infant feeding goals.
   
   The California Primary Care Association (CPCA) is a co-sponsor and states this bill will empower California moms to breastfeed their babies by streamlining the enrollment process for the WIC Program, crate new metrics to track breastfeeding rates and health outcomes, and require the state to regularly review breast pump equipment standards and reimbursement rates. CPCA concludes, with this simple and comprehensive bill we can support strategies to improve breastfeeding initiation, duration, and exclusivity.
2. PREVIOUS LEGISLATION.
   1. SB 402 (De Leon), Chapter 666, Statutes of 2013, requires all general acute care hospitals and special hospitals, that have a perinatal unit by January 1, 2025, to adopt the “Ten Steps to Successful Breastfeeding,” as adopted by Baby-Friendly USA, per the Baby-Friendly Hospital Initiative (BFHI), or an alternate process adopted by a health care service plan that includes evidenced-based policies and practices and targeted outcomes, or the Model Hospital Policy Recommendations, as defined.
   2. SB 502 (De Leon and Pavley), Chapter 511, Statutes of 2011, establishes the Hospital Infant Feeding Act requires all general acute care and special hospitals that have a perinatal unit to have an infant-feeding policy, as specified, to clearly post the policy and routinely communicate the policy to perinatal unit staff.
3. SUGGESTED AMENDMENTS. As currently drafted this bill requires DPH and DHCS to establish a stakeholder process to update breast pump standards. However, the ACA has existing minimum requirements for durable medical equipment, which include breast pumps that must be covered by health insurance. The Committee may wish to remove this requirement, since it appears unnecessary and instead amend the bill as follows:
   

123363. (a) The State Department of Public Health shall coordinate with the State Department of Health Care Services, through a stakeholder engagement process that shall include, but not be limited to, representatives from health care providers, primary care clinics, and health plans, state and local staff from the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) and the Maternal, Child and Adolescent Health program, and representatives from organizations representing women, infants, and children, to do both of the following:

(1)Beginning prenatally and continuing through the postpartum period and at least until the infant reaches one year of age, develop measures and outcomes for breastfeeding rates that include, at a minimum, women's intention to breastfeed, breastfeeding initiation rates, exclusivity and duration, and that identify ethnic disparities and sociodemographic differences. The stakeholder process shall take no longer than six months, and the recommendations shall be posted on the departments' Websites by January 1, 2018.

(1) With respect to prenatal care, develop measures and outcomes for breastfeeding that shall include, at a minimum, women’s intention to breastfeed, including ethnic diversity.

(2) After birth and following discharge from the hospital or other birthing location, develop measures and outcomes for breastfeeding that shall include, at a minimum, initiation, duration, exclusivity, and ethnic disparities.

(b) No later than January 1, 2018, and every five years thereafter, the State Department of Public Health shall coordinate with the State Department of Health Care Services, through a stakeholder engagement process that shall include, but not be limited to, representatives from health care providers, health plans, and primary care clinics, lactation consultants and specialists, state and local staff from the WIC Program, and representatives of manufacturers and distributors of breast pumps and accessories, to develop and update minimum breast pump and accessory equipment standards for the provision of appropriate and effective breast pumps and accessories, taking into account the current reimbursement rates for durable medical equipment related to breastfeeding, including any potential need to modify the reimbursement rates.

REGISTERED SUPPORT / OPPOSITION:

Support

California WIC Association (co-sponsor)
California Primary Care Association (co-sponsor)

AltaMed Health Services Corporation

Ampla Health

Association of California Healthcare Districts

BreastfeedLA

California Academy of Nutrition and Dietetics

California Advance Lactation Institute

California Breastfeeding Coalition

California Food Policy Advocates

California Nurse-Midwives Association

Children Now

Clinica Sierra Vista

Community Clinic Association of Los Angeles County

Community Clinic Consortium

County Health Executives Association of California

Family Health Centers of San Diego

Fresno EOC WIC Program

Harmony Health

Health Alliance of Northern California

Health and Life Organization, Inc.

Henry Mayo Newhall Hospital

Kheir Center

L.A. Trust for Children's Health

Marin Community Clinics

Maternal and Child Health Access

Mountain Valleys Health Centers

National Health Law Program

North Coast Clinics Network

North County Health Services

North East Medical Services

Northeast Valley Health Corporation

Omni Family Health

Open Door Community Health Centers

Prevention Institute

Ravenswood Family Health Center

Redwood Community Health Coalition

San Ysidro Health Center

Solano Public Health WIC Program

South of Market Health Center

Strategic Alliance for Healthy Food and Activity Environments

The Santa Cruz County Breastfeeding Coalition

Tiburcio Vasquez Health Center, Inc.

Tulare Reginal Medical Center

United States Lactation Consultant Association

Valley Community Healthcare

Watts Healthcare WIC Program

Westside Family Health Center

White Memorial Community Health Center

One Individual

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097