Existing law requires each county to provide cash assistance and other social services to needy families through the California Work Opportunity and Responsibility to Kids (CalWORKs) program using federal Temporary Assistance to Needy Families block grant program, state, and county funds. Under existing law, all applicants for or recipients of CalWORKs are required to ensure and provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicants or recipients beliefs.

This bill would, commencing July 1, 2016, instead require the applicant or recipient to ensure that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations. The bill would also authorize the county to review the California Immunization Registry in lieu of initially requesting verification of an immunization before requiring the applicant or recipient to provide documentation that the immunization has been performed.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing the bill.

Existing law requires each county to provide cash assistance and other social services to needy families through the California Work Opportunity and Responsibility to Kids (CalWORKs) program using federal Temporary Assistance to Needy Families block grant program, state, and county funds. Under existing law, all applicants for or recipients of CalWORKs are required to ensure and provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicants or recipients beliefs.

This bill would, commencing July 1, 2016, instead require the applicant or recipient to provide immunization records only if the county first reviews the California Immunization Registry but is unable to verify that the immunizations have been performed. By requiring counties to review the California Immunization Registry, the bill would impose a state-mandated local program. ensure that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations. The bill would also authorize the county to review the California Immunization Registry in lieu of initially requesting verification of an immunization before requiring the applicant or recipient to provide documentation that the immunization has been performed.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing the bill.

Existing law requires each county to provide cash assistance and other social services to needy families through the California Work Opportunity and Responsibility to Kids (CalWORKs) program using federal Temporary Assistance to Needy Families block grant program, state, and county funds. Under existing law, all applicants for or recipients of CalWORKs are required to provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicants or recipients beliefs.

This bill would, commencing July 1, 2016, instead require the applicant or recipient to provide immunization records only if the county obtains a report from first reviews the California Immunization Registry but is unable to verify that the immunizations have been performed. By requiring counties to obtain these reports, review the California Immunization Registry, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing the bill.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Existing law requires each county to provide cash assistance and other social services to needy families through the California Work Opportunity and Responsibility to Kids (CalWORKs) program using federal Temporary Assistance to Needy Families block grant program, state, and county funds. Under existing law, all applicants for or recipients of CalWORKs are required to provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicants or recipients beliefs.

This bill would would, commencing July 1, 2016, instead require the applicant or recipient to provide immunization records only if the county obtains a report from the California Immunization Registry but is unable to verify on behalf of the applicant or recipient that the immunizations have been performed. By requiring counties to obtain these reports, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing the bill.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Existing law requires each county to provide cash assistance and other social services to needy families through the California Work Opportunity and Responsibility to Kids (CalWORKs) program using federal Temporary Assistance to Needy Families block grant program, state, and county funds. Under existing law, all applicants for or recipients of CalWORKs are required to provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age appropriate age-appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicants or recipients beliefs.

This bill would instead require the applicant or recipient to provide immunization records only if the county obtains a report from the California Immunization Registry but is unable to verify on behalf of the applicant or recipient that the immunizations have been performed. By requiring counties to obtain these reports, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing the bill.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Existing law requires each county to provide cash assistance and other social services to needy families through the California Work Opportunity and Responsibility to Kids (CalWORKs) program using federal Temporary Assistance to Needy Families block grant program, state, and county funds. Under existing law, all applicants for or recipients of CalWORKs are required to provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicants or recipients beliefs.

This bill would instead require the applicant or recipient to provide immunization records only if the county obtains a report from the California Immunization Registry but is unable to verify that the immunizations have been performed. By requiring counties to obtain these reports, the bill would impose a state-mandated local program.

Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.

This bill would instead provide that the continuous appropriation would not be made for purposes of implementing the bill.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

GOVERNOR'S VETO

GV Bill Id:AB 376

Author:(Lopez)

As Enrolled Ver:September 10, 2015

2/3 vote

Original Committee Reference: HUM. S.

SUMMARY: Permits counties to access an internet-based computerized information system to verify, when possible, immunization of children under the age of six in California Work Opportunity and Responsibility to Kids (CalWORKs) families. Specifically, this bill:

1. Permits county welfare departments to first search the California Immunization Registry (CAIR) to verify immunization of children not required to be enrolled in school prior to requesting applicants for or recipients of CalWORKs to submit vaccination documentation for those children.

2. Stipulates that no continuous appropriation shall be made from the General Fund to counties in order to implement this act.

The Senate amendments remove the requirement that county welfare departments first search the CAIR for immunization records prior to requesting vaccination documentation from clients, and instead permit counties to use the CAIR in lieu of initially requesting documentation.

EXISTING LAW:

1. Establishes in federal law the Temporary Assistance for Needy Families (TANF) program, which provides block grants to states to develop and implement their own state welfare-to-work programs designed to provide cash assistance and other supports and services to low-income families. (42 United States Code Section 601 et seq.)

2. Establishes the state's TANF program, the CalWORKs program. CalWORKs provides cash assistance and other supports and services to low-income families and is administered by the counties. (Welfare and Institutions Code (WIC) Section 11200 et seq.)

3. Requires CalWORKs applicants and recipients to provide documentation showing that all children in the assistance unit who are not required to be enrolled in school have received all age appropriate immunizations within 30 to 45 days, as specified. Provides exemptions in cases where it has been determined that immunizations are not medically appropriate, or when an affidavit attesting that immunizations are contrary to the applicant's or recipient's beliefs has been filed with the county welfare department. (WIC Section 11265.8)

4. Prohibits an aid payment for any adult in the assistance unit if required documentation of immunization is not provided within the specified time period. (WIC Section 11265.8)

5. Directs the Department of Public Health, in consultation with the Department of Education, to adopt and enforce regulations to carry out the stated legislative intent to fully immunize appropriate age groups against certain childhood diseases, including diphtheria, measles, mumps, and others, as specified. Allows for certain medical and personal-belief exemptions to immunization requirements, provided documentation is supplied, as specified. (Health and Safety Code (HSC) Section 120325 et seq.)

6. Allows local health officers to, either separately or jointly with other jurisdictions and in conjunction with the Department of Public Health's Immunization Branch, operate immunization information systems containing individuals' vaccination information. Further allows the information in these systems to be shared with specified entities, including with county welfare departments for the purpose of assessing the immunization histories of dependents of CalWORKs participants. States that individuals have the right to refuse the sharing of their information in these systems, and requires that individuals be informed of this right. (HSC Section 120440)

FISCAL EFFECT: According to the Senate Appropriations Committee, this bill may result in the following costs:

1. Potentially significant one-time and ongoing non-reimbursable county administrative costs (Local Funds) for training and verification of immunizations of each applicable child in the CAIR for applicants and recipients prior to requesting immunization records. The new workload would be offset in part by replacing the existing workload for cases that provide and require verification of paper documentation, as well as administrative cost savings for those cases found in the CAIR that would no longer require a follow-up request for documentation.

2. Potentially significant decrease in CalWORKs sanctions for failure to provide immunization records, resulting in increased ongoing CalWORKs grant costs of about $1.5 million (General Fund). Department of Social Services data indicates approximately 32% of cases sanctioned for not providing the required documentation were sanctioned for one month (and are assumed to otherwise have the immunizations complete). This estimate assumes 38% of those cases sanctioned for one month would have information available in the CAIR that would potentially result in averted sanctions.

3. Potentially significant one-time costs (General Fund) for reprogramming of the Statewide Automated Welfare System (SAWS).

COMMENTS:

CalWORKs immunization requirements: AB 1542 (Ducheny), Chapter 270, Statutes of 1997, created the CalWORKs program as California's implementation of federal welfare reform. Alongside many other changes, this bill added to the Welfare and Institutions Code Section 11265.8, requiring that all applicants for and recipients of CalWORKs benefits provide documentation that any children in the assistance unit under the age of 6 not required to be enrolled in school have received all age-appropriate immunizations. Applicants and recipients who file an affidavit with the county stating that immunizations are against their beliefs, or who supply documentation stating that it has been medically determined that immunizations are inappropriate, are exempt from this requirement. Applicants and recipients are to be notified of their obligation to provide proof of immunization, and must also receive information on: the relevant childhood immunization schedules, how to obtain immunizations using Medi-Cal or through a county public health clinic or other available sources, as appropriate, and a statement explaining the personal belief exemption.

Parents and caretaker relatives are allowed either 30 or 45 days, depending on their individual situations, to supply documentation of immunization; an additional 30 days may be granted if the county finds that good cause exists for not submitting verification in the timeframe allowed. If documentation is not provided within the required time period, a parent's or caretaker relative's needs will not be considered in determining the grant amount for the assistance unit until the required documentation is supplied. For the past three years, the numbers of adults penalized for not providing timely verification of immunization have been: 99,361 (2014), 83,759 (2013), and 109,238 (2012).

California Immunization Registry: All 50 states have immunization registries. The California Immunization Registry (CAIR) is a secure and confidential statewide computerized information system consisting of nine separate regional registries. These regions, most of which are multi-county, cover 57 of California's 58 counties; Imperial County operates its own registry that is not part of the CAIR system. Seven of the nine CAIR regions currently use the same software, while San Diego County and the greater San Joaquin Valley use different software. The current regional structure of CAIR only enables authorized users to access immunization data within their defined region; however, look-up access to other regional registries is available to state or county governmental agencies upon request. It is expected that CAIR will eventually allow any CAIR user to access immunization data across the state by integrating its regional databases. This effort, the "CAIR 2.0 Project," is currently underway and integration is expected to be completed by the summer of 2017.

Use of CAIR is voluntary. Health care providers are allowed to enter immunization records into a registry, provided the individual or the individual's parent has been notified about the registry and the right to “lock” his or her (or his or her child's) information in CAIR so that no users other than his or her health care provider may access them. Users must sign a confidentiality agreement to access CAIR; a user ID and password are needed to log in to the registry. Authorized users include health care providers and plans, schools, county welfare departments, foster care agencies, family child care homes and child care facilities. Counties were recently polled on their use of CAIR; of the 23 counties that responded, nine currently use it to some extent, but it appears that most seek verification from the client before logging into the system.

Almost 2.9 million children under the age of 6 (96.7% of the total age-group population in the state) have immunization records contained in CAIR, with almost 1.9 million children under the age of 6 (63.5% of the total age-group population) having at least two immunization doses recorded.

Need for the bill: According to the author, "this bill will help streamline and simplify an administrative process, which will help families access the supports they need by using current technology to verify immunization records. Currently, CalWORKs requires an applicant or recipient to immunize their minor children and provide proof of immunization. For our most vulnerable populations, this extra step in the process to receive benefits can add to an already stressful situation. This bill would require that the county first review the California State registry of immunizations, which is maintained by the Department of Public Health before asking the family to provide the records. If the registry indicates that the children have not met the immunization requirements, then the county can request verification of immunization."

GOVERNOR'S VETO MESSAGE:

This bill would allow counties to use the California Immunization Registry to verify that immunization requirements for the California Work Opportunity and Responsibility to Kids program have been met prior to requesting this information from applicants. Counties already have access to this Registry and many already use it. Accordingly, this bill is unnecessary.

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0002529

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 376

Author:(Lopez)

As Amended Ver:August 31, 2015

Majority vote

Original Committee Reference: HUM. S.

SUMMARY: Permits counties to access an internet-based computerized information system to verify, when possible, immunization of children under the age of 6 in CalWORKs families. Specifically, this bill:

1. Permits county welfare departments to first search the California Immunization Registry (CAIR) to verify immunization of children not required to be enrolled in school prior to requesting applicants for or recipients of CalWORKs to submit vaccination documentation for those children.

2. Stipulates that no continuous appropriation shall be made from the General Fund to counties in order to implement this act.

The Senate amendments remove the requirement that county welfare departments first search the CAIR for immunization records prior to requesting vaccination documentation from clients, and instead permit counties to use the CAIR in lieu of initially requesting documentation.

EXISTING LAW:

1. Establishes in federal law the Temporary Assistance for Needy Families (TANF) program, which provides block grants to states to develop and implement their own state welfare-to-work programs designed to provide cash assistance and other supports and services to low-income families. (42 United States Code Section 601 et seq.)

2. Establishes the state's TANF program, the California Work Opportunity and Responsibility to Kids (CalWORKs) program. CalWORKs provides cash assistance and other supports and services to low-income families and is administered by the counties. (Welfare and Institutions Code (WIC) Section 11200 et seq.)

3. Requires CalWORKs applicants and recipients to provide documentation showing that all children in the assistance unit who are not required to be enrolled in school have received all age appropriate immunizations within 30 to 45 days, as specified. Provides exemptions in cases where it has been determined that immunizations are not medically appropriate, or when an affidavit attesting that immunizations are contrary to the applicant's or recipient's beliefs has been filed with the county welfare department. (WIC Section 11265.8)

4. Prohibits an aid payment for any adult in the assistance unit if required documentation of immunization is not provided within the specified time period. (WIC Section 11265.8)

5. Directs the Department of Public Health, in consultation with the Department of Education, to adopt and enforce regulations to carry out the stated legislative intent to fully immunize appropriate age groups against certain childhood diseases, including diphtheria, measles, mumps, and others, as specified. Allows for certain medical and personal-belief exemptions to immunization requirements, provided documentation is supplied, as specified. (Health and Safety Code (HSC) Section 120325 et seq.)

6. Allows local health officers to, either separately or jointly with other jurisdictions and in conjunction with the Department of Public Health's Immunization Branch, operate immunization information systems containing individuals’ vaccination information. Further allows the information in these systems to be shared with specified entities, including with county welfare departments for the purpose of assessing the immunization histories of dependents of CalWORKs participants. States that individuals have the right to refuse the sharing of their information in these systems, and requires that individuals be informed of this right. (HSC Section 120440)

FISCAL EFFECT: According to the Senate Appropriations Committee, this bill may result in the following costs:

1. Potentially significant one-time and ongoing non-reimbursable county administrative costs (Local Funds) for training and verification of immunizations of each applicable child in the CAIR for applicants and recipients prior to requesting immunization records. The new workload would be offset in part by replacing the existing workload for cases that provide and require verification of paper documentation, as well as administrative cost savings for those cases found in the CAIR that would no longer require a follow-up request for documentation.

2. Potentially significant decrease in CalWORKs sanctions for failure to provide immunization records, resulting in increased ongoing CalWORKs grant costs of about $1.5 million (General Fund). Department of Social Services data indicates approximately 32% of cases sanctioned for not providing the required documentation were sanctioned for one month (and are assumed to otherwise have the immunizations complete). This estimate assumes 38% of those cases sanctioned for one month would have information available in the CAIR that would potentially result in averted sanctions.

3. Potentially significant one-time costs (General Fund) for reprogramming of the Statewide Automated Welfare System (SAWS).

COMMENTS:

CalWORKs immunization requirements: AB 1542 (Ducheny), Chapter 270, Statutes of 1997, created the CalWORKs program as California's implementation of federal welfare reform. Alongside many other changes, this bill added to the Welfare and Institutions Code Section 11265.8, requiring that all applicants for and recipients of CalWORKs benefits provide documentation that any children in the assistance unit under the age of 6 not required to be enrolled in school have received all age-appropriate immunizations. Applicants and recipients who file an affidavit with the county stating that immunizations are against their beliefs, or who supply documentation stating that it has been medically determined that immunizations are inappropriate, are exempt from this requirement. Applicants and recipients are to be notified of their obligation to provide proof of immunization, and must also receive information on: the relevant childhood immunization schedules, how to obtain immunizations using Medi-Cal or through a county public health clinic or other available sources, as appropriate, and a statement explaining the personal belief exemption.

Parents and caretaker relatives are allowed either 30 or 45 days, depending on their individual situations, to supply documentation of immunization; an additional 30 days may be granted if the county finds that good cause exists for not submitting verification in the timeframe allowed. If documentation is not provided within the required time period, a parent's or caretaker relative's needs will not be considered in determining the grant amount for the assistance unit until the required documentation is supplied. For the past three years, the numbers of adults penalized for not providing timely verification of immunization have been: 99,361 (2014), 83,759 (2013), and 109,238 (2012).

California Immunization Registry: All 50 states have immunization registries. The California Immunization Registry (CAIR) is a secure and confidential statewide computerized information system consisting of nine separate regional registries. These regions, most of which are multi-county, cover 57 of California's 58 counties; Imperial County operates its own registry that is not part of the CAIR system. Seven of the nine CAIR regions currently use the same software, while San Diego County and the greater San Joaquin Valley use different software. The current regional structure of CAIR only enables authorized users to access immunization data within their defined region; however, look-up access to other regional registries is available to state or county governmental agencies upon request. It is expected that CAIR will eventually allow any CAIR user to access immunization data across the state by integrating its regional databases. This effort, the "CAIR 2.0 Project," is currently underway and integration is expected to be completed by the summer of 2017.

Use of CAIR is voluntary. Health care providers are allowed to enter immunization records into a registry, provided the individual or the individual's parent has been notified about the registry and the right to “lock” his or her (or his or her child's) information in CAIR so that no users other than his or her health care provider may access them. Users must sign a confidentiality agreement to access CAIR; a user ID and password are needed to log in to the registry. Authorized users include health care providers and plans, schools, county welfare departments, foster care agencies, family child care homes and child care facilities. Counties were recently polled on their use of CAIR; of the 23 counties that responded, nine currently use it to some extent, but it appears that most seek verification from the client before logging into the system.

Almost 2.9 million children under the age of 6 (96.7% of the total age-group population in the state) have immunization records contained in CAIR, with almost 1.9 million children under the age of 6 (63.5% of the total age-group population) having at least two immunization doses recorded.

Need for the bill: According to the author, "this bill will help streamline and simplify an administrative process, which will help families access the supports they need by using current technology to verify immunization records. Currently, CalWORKs requires an applicant or recipient to immunize their minor children and provide proof of immunization. For our most vulnerable populations, this extra step in the process to receive benefits can add to an already stressful situation. This bill would require that the county first review the California State registry of immunizations, which is maintained by the Department of Public Health before asking the family to provide the records. If the registry indicates that the children have not met the immunization requirements, then the county can request verification of immunization."

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0001955

 THIRD READING  

Bill No: AB 376

Author: Lopez (D)

Amended: 8/31/15 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/9/15

AYES: McGuire, Berryhill, Hancock, Liu, Nguyen

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15

ASSEMBLY FLOOR: 77-0, 5/7/15 (Consent) - See last page for vote

SUBJECT: CalWORKs eligibility: immunizations.

SOURCE: Coalition of California Welfare Rights Organizations

DIGEST: This bill allows a county to attempt to verify through the California Immunization Registry that each child under age six in a CalWORKs (California Work Opportunity and Responsibility to Kids) assistance unit has received all age-appropriate immunizations before requiring an applicant or recipient to provide their child’s immunization record, beginning July 1, 2016.

ANALYSIS: Existing federal law establishes the Temporary Assistance for Needy Families (TANF) program, which provides block grants to states to develop and implement their own state welfare-to-work programs to provide cash assistance and other supports and services to low-income families. (42 USC § 601 et seq.)

Existing state law:

1. Establishes in state law the CalWORKs program to provide cash assistance and other social services for low-income families through the TANF program. Under CalWORKs, each county provides assistance through a combination of state, county and federal TANF funds. (WIC 11200, et seq. WIC 10530)

2. Establishes within the Communicable Disease Prevention and Control Act specific childhood immunization requirements and prohibits admission of a pupil of any private or public elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center, unless, prior to his or her first admission to that institution, he or she has been fully immunized. (HSC 120325)

3. Directs the state Department of Public Health to adopt and enforce regulations to carry out the stated legislative intent to fully immunize appropriate age groups against specified childhood diseases, including measles, mumps, whooping cough, chicken pox and others, as well as any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians. (HSC 120325)

4. Requires CalWORKs applicants and recipients to provide documentation showing that all children in the assistance unit who are not required to be enrolled in school have received all age appropriate immunizations within 30 to 45 days, as specified, unless it has been medically determined that an immunization is not appropriate, or an affidavit attesting that immunizations are contrary to the applicant’s or recipient’s beliefs has been filed with the county welfare department. (WIC 11265.8)

5. Prohibits an aid payment for any adult in the assistance unit if required documentation of immunization is not provided within the specified time period. (WIC 11265.8)

6. Allows local health officers to operate immunization information systems containing individuals’ vaccination information in conjunction with the Department of Public Health’s Immunization Branch. Allows this immunization information to be shared with other states and with specified entities within California, including county welfare departments for the purpose of assessing the immunization histories of dependents of CalWORKs participants. It also states that individuals have the right to refuse the sharing of their information in these systems, and requires that individuals be informed of this right. (HSC 120440)

This bill strikes existing statute requiring immunizations for children in a CalWORKs assistance unit and replaces it with rewritten statutory language mandating the same time frames, sanctions and medical or personal belief exemptions, but requires the following changes:

1. Removes the requirement that documentation be provided to the county that age-appropriate vaccinations are completed, and replaces it with the requirement that all children in the unit receive age-appropriate vaccines.

2. Permits a county to verify each child has received required immunizations by obtaining a report from the California Immunization Registry (CAIR), and requires that if the registry does not contain records, the county must require the applicant or recipient to provide documentation that the immunizations have been performed, as specified, and with defined exceptions.

Background

CalWORKs. California has the highest poverty rate in the nation – just under one-quarter of residents are living at or below the federal poverty level (FPL) according to the national Supplemental Poverty Measure. These families earn no more than $20,090 per year for a family of three. One of California’s most essential anti-poverty strategies is the CalWORKs program, which provided cash assistance to approximately 540,000 families in 2014, including more than one million children. Federal funding for CalWORKs comes from the TANF block grant. A grant to a family of three in a high-cost California county is $704 per month, or income at approximately 42 percent of the FPL.

Immunization requirements and sanctions. Current statute requires that parents or guardians of young children within a CalWORKs assistance unit provide proof of current immunization in order for any adult in the unit to receive assistance. Adults have 30 days from the initial application, and 45 days from a redetermination to submit verification of immunizations, with a 30-day extension available if a county determines there is good cause for not providing the required documentation due to lack of reasonable access to immunization services.

Data compiled by the California Department of Social Services (CDSS), below, indicates that in nearly 100,000 of the 540,000 families receiving assistance in 2014, the household’s adults were sanctioned for failing to provide immunization documentation for children under age six.

California Immunization Registry. All 50 states have immunization registries. California’s registry is a statewide information system that includes nine regional registries encompassing 57 of the state’s 58 counties. Almost 2.9 million children under the age of six, or nearly 97 percent of the state’s total population in that age group, have at least one immunization record recorded in CAIR.

Use of the CAIR is voluntary, and requires parent disclosure before a child’s health care provider can enter a child’s immunization information. Parents have the right to prevent anyone other than their child’s provider from accessing the immunization records. The CAIR is designed to allow access to immunization information for health care providers and plans, schools, county welfare departments, foster care agencies, family child care homes and child care facilities.

According to the County Welfare Directors Association (CWDA), about half of the state’s counties currently access the CAIR to verify that required CalWORKs household immunizations have been completed. At least some counties may seek independent verification of immunizations from the client before logging into the system. CWDA notes that not all children’s immunizations would be able to be verified through the CAIR because of a parent’s refusal to share information, or because of misspelled children’s names.

Other hurdles to full use of the CAIR include technology: Imperial County operates its own registry that is not part of the CAIR system. Seven of the nine CAIR regions are using the same software, but San Diego County and the greater San Joaquin Valley use different software. Additionally, users can only access immunization data in CAIR within their defined regions; to verify whether a child has had an immunization in another region of the state requires a separate request to the registry. Efforts are underway to modernize the CAIR, including allowing statewide access to data, and are expected to be completed by the summer of 2017.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee, this bill will result in potentially significant one-time and ongoing non-reimbursable county administrative costs (Local Funds) for training and verification of immunizations of each applicable child in the CAIR for applicants and recipients prior to requesting immunization records. The new workload would be offset in part by replacing the existing workload for cases that provide and require verification of paper documentation, as well as administrative cost savings for those cases found in the CAIR that would no longer require a follow-up request for documentation.

The analysis also identified a potentially significant decrease in CalWORKs sanctions for failure to provide immunization records, resulting in increased ongoing CalWORKs grant costs of about $1.5 million (General Fund). According to CDSS data approximately 32 percent of cases sanctioned for not providing the required documentation were sanctioned for one month (and are assumed to otherwise have the immunizations complete). This estimate assumes 38 percent of those cases sanctioned for one month would have information available in the CAIR that would potentially result in averted sanctions. Additionally, the Appropriations Committee identified potentially significant one-time costs (General Fund) for reprogramming of the Statewide Automated Welfare System.

SUPPORT: (Verified 8/28/15)

Coalition of California Welfare Rights Organizations (source)

California Immigrant Policy Center

County Welfare Directors Association of California

Western Center on Law and Poverty

OPPOSITION: (Verified 8/28/15)

None received

ARGUMENTS IN SUPPORT: According to the author, this bill will help streamline and simplify an administrative process, which will help families access the supports they need by using current technology to verify immunization records. Currently, CalWORKs requires an applicant or recipient to immunize their minor children and provide proof of immunization. For our most vulnerable populations this extra step in the process to receive benefits can add to an already stressful situation, according to the author. This bill permits the county to first review the California State registry of immunizations, before asking the family to provide the records, the author states. If the registry indicates that the children have not met the immunization requirements, then the county must request verification of immunization within 30 days.

This bill’s sponsor, the Coalition of California Welfare Rights Organizations, writes that this bill will “allow the county to use current technology to simplify the CalWORKs administrative process, saving taxpayer administrative dollars and simplifying the process for the beneficiaries of the CalWORKs program.”

ASSEMBLY FLOOR: 77-0, 5/7/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau, Chávez, 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, 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, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

NO VOTE RECORDED: Campos, Roger Hernández, Steinorth

Prepared by: Mareva Brown / HUMAN S. / (916) 651-1524

8/31/15 8:54:53

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 376 (Lopez) - CalWORKs eligibility: immunizations

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 27, 2015

Bill Summary:

AB 376 would, commencing July 1, 2016, allow county human services agencies to first review the California Immunization Registry (CAIR) to verify that specified children in the CalWORKs assistance unit have received all age-appropriate immunizations prior to requiring CalWORKs applicants and recipients to provide immunization records, as specified.

Fiscal Impact:

• Potentially significant one-time and ongoing non-reimbursable county administrative costs (Local Funds) for training and verification of immunizations of each applicable child in the CAIR for applicants and recipients prior to requesting immunization records. The new workload would be offset in part by replacing the existing workload for cases that provide and require verification of paper documentation, as well as administrative cost savings for those cases found in the CAIR that would no longer require a follow-up request for documentation.

• Potentially significant decrease in CalWORKs sanctions for failure to provide immunization records, resulting in increased ongoing CalWORKs grant costs of about $1.5 million (General Fund). DSS data indicates approximately 32 percent of cases sanctioned for not providing the required documentation were sanctioned for one month (and are assumed to otherwise have the immunizations complete). This estimate assumes 38 percent of those cases sanctioned for one month would have information available in the CAIR that would potentially result in averted sanctions.

• Potentially significant one-time costs (General Fund) for reprogramming of the Statewide Automated Welfare System (SAWS).

Author Amendments:

Remove the mandate on county human services agencies to first review the CAIR to verify documentation and instead make the activity permissive.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 376 (Lopez) - CalWORKs eligibility: immunizations

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

Bill Summary:

AB 376 would, commencing July 1, 2016, require county human services agencies to first review the California Immunization Registry (CAIR) to verify that specified children in the CalWORKs assistance unit have received all age-appropriate immunizations prior to requiring CalWORKs applicants and recipients to provide immunization records, as specified.

Fiscal Impact:

• Potentially significant one-time and ongoing state-reimbursable county administrative costs (General Fund) for training and verification of immunizations of each applicable child in the CAIR for applicants and recipients prior to requesting immunization records. The new workload would be offset in part by replacing the existing workload for cases that provide and require verification of paper documentation, as well as administrative cost savings for those cases found in the CAIR that would no longer require a follow-up request for documentation. The net increase in ongoing administrative costs is estimated at $360,000 to $1 million (General Fund).

• Potentially significant decrease in CalWORKs sanctions for failure to provide immunization records, resulting in increased ongoing CalWORKs grant costs of about $1.5 million (General Fund). DSS data indicates approximately 32 percent of cases sanctioned for not providing the required documentation were sanctioned for one month (and are assumed to otherwise have the immunizations complete). This estimate assumes 38 percent of those cases sanctioned for one month would have information available in the CAIR that would potentially result in averted sanctions.

• Potentially significant one-time costs (General Fund) for reprogramming of the Statewide Automated Welfare System (SAWS).

Background:

Existing law provides that all applicants for or recipients of CalWORKs are required to provide documentation within 30 or 45 days of determination of aid, as specified, that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations, unless it has been medically determined that an immunization for the child is not appropriate or the applicant or recipient has filed with the county welfare department an affidavit that the immunizations are contrary to the applicant’s or recipient’s beliefs. If the county determines that good cause exists for not providing the required documentation due to lack of reasonable access to immunization services, the period is extended for an additional 30 days. (Welfare and Institutions Code § 11265.8.)

Under existing law, if the documentation is not provided within the required time period, the needs of all parents or caretaker relatives in the assistance unit are not to be considered in determining the grant to the assistance unit until the required documentation is provided.

Existing law provides that local health officers may operate immunization information systems in conjunction with the Immunization Branch of the State Department of Public Health (DPH). (Health and Safety Code § 120440). For those counties that do operate the CAIR, it is optional on the part of medical providers in that county to submit the immunization information for all patients. According to the DPH, the annual cost to operate the statewide system is $2.9 million utilizing funds from the federal Centers for Disease Control (CDC) Immunization grants.

Proposed Law:

This bill would, commencing July 1, 2016, require that in lieu of initially requesting verification of age-appropriate immunizations, the county shall first verify whether each child has received all age-appropriate immunizations by reviewing the California Immunization Registry. If the registry does not contain records of these immunizations, the county shall require the applicant or recipient to provide documentation that the immunizations have been performed, unless the applicant or recipient has filed an affidavit that the immunizations are contrary to his or her beliefs or has supplied documentation that it has been medically determined that an immunization is not appropriate. 

Staff Comments:

By placing new duties on county human services agencies, this bill creates a state-mandated local program. While it has been indicated that approximately one third to one half of counties currently utilize the CAIR, by statutorily requiring county agencies to use CAIR to verify immunization for all children not required to be enrolled in school for all applicants and recipients, this bill could result in a reimbursable state mandate for costs associated with statewide usage of the CAIR, which could include one-time costs for training and ongoing costs for the administrative time required to check the system for verification of each applicable child. The new workload would replace in part the existing process of verifying paper immunization records for those cases that currently provide documentation and are not sanctioned.

The net increase in ongoing administrative costs are estimated at $360,000 to $1 million (General Fund) assuming new county administrative workload of three to five minutes per child to query the CAIR for those cases that are sanctioned. No additional net costs for counties to verify immunization in the CAIR for the population that currently provides documented proof of immunization is estimated, as the county administrative time would be replaced from verifying physical documentation to verifying web-based documentation.

The DSS has indicated over 2,400 cases per month are sanctioned for one month for not providing the required documentation. To the extent utilization of the CAIR results in fewer CalWORKs sanctions for failure to provide immunization records, the provisions of this measure could result in increased ongoing CalWORKs grant costs of about $1.5 million (General Fund). This cost estimate assumes 38 percent of those cases would have information available in the CAIR that would potentially result in averted sanctions.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator McGuire, Chair

2015 - 2016 Regular

Bill No: AB 376

Subject: CalWORKs eligibility: immunizations.

SUMMARY

This bill requires a county to attempt to verify through the California Immunization Registry that each child under age 6 in a CalWORKs assistance unit has received all age-appropriate immunizations before requiring an applicant or recipient to provide their child’s immunization record, beginning July 1, 2016.

ABSTRACT

Existing law:

1. Establishes in federal law the Temporary Assistance for Needy Families (TANF) program, which provides block grants to states to develop and implement their own state welfare-to-work programs to provide cash assistance and other supports and services to low- income families. (42 USC § 601 et seq.)

2. Establishes in state law the California Work Opportunity and Responsibility to Kids (CalWORKs) program to provide cash assistance and other social services for low-income families through the TANF program. Under CalWORKs, each county provides assistance through a combination of state, county and federal TANF funds. (WIC 11200, et seq. WIC 10530)

3. Establishes within the Communicable Disease Prevention and Control Act specific childhood immunization requirements and prohibits admission of a pupil of any private or public elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center, unless, prior to his or her first admission to that institution, he or she has been fully immunized. (HSC 120325)

4. Directs the state Department of Public Health to adopt and enforce regulations to carry out the stated legislative intent to fully immunize appropriate age groups against specified childhood diseases, including measles, mumps, whooping cough, chicken pox and others, as well as any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians. (HSC 120325)

5. Requires CalWORKs applicants and recipients to provide documentation showing that all children in the assistance unit who are not required to be enrolled in school have received all age appropriate immunizations within 30 to 45 days, as specified, unless it has been medically determined that an immunization is not appropriate, or an affidavit attesting that immunizations are contrary to the applicant’s or recipient’s beliefs has been filed with the county welfare department. (WIC 11265.8)

6. Prohibits an aid payment for any adult in the assistance unit if required documentation of immunization is not provided within the specified time period. (WIC 11265.8)

7. Allows local health officers to operate immunization information systems containing individuals’ vaccination information in conjunction with the Department of Public Health’s Immunization Branch. Allows this immunization information to be shared with other states and with specified entities within California, including county welfare departments for the purpose of assessing the immunization histories of dependents of CalWORKs participants. States that individuals have the right to refuse the sharing of their information in these systems, and requires that individuals be informed of this right. (HSC 120440)

This bill:

1. Strikes existing statute requiring immunizations for children in a CalWORKs assistance unit and replaces it with rewritten statutory language mandating the same time frames, sanctions and medical or personal belief exemptions, but requires the following changes:

1. Removes the requirement that documentation be provided to the county that age-appropriate vaccinations are completed, and replaces it with the requirement that all children in the unit receive age-appropriate vaccines.

2. Requires that a county verify each child has received required immunizations by obtaining a report from the California Immunization Registry (CAIR), and requires that if the registry does not contain records the county must require the applicant or recipient to provide documentation that the immunizations have been performed, as specified.

FISCAL IMPACT

According to an Assembly Appropriations Committee analysis, about one-third of counties already use CAIR for this purpose and the costs to train additional staff to use CAIR are minor and likely absorbable within existing county training budgets.

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, this bill will help streamline and simplify an administrative process, which will help families access the supports they need by using current technology to verify immunization records. Currently, CalWORKS requires an applicant or recipient to immunize their minor children and provide proof of immunization. For our most vulnerable populations this extra step in the process to receive benefits can add to an already stressful situation, according to the author. This bill requires that the county first review the California State registry of immunizations, before asking the family to provide the records, the author states. If the registry indicates that the children have not met the immunization requirements, then the county can request verification of immunization within 30 days.

California Work Opportunity and Responsibility to Kids program (CalWORKs)

California has the highest poverty rate in the nation – just under one-quarter of residents are living at or below the federal poverty level (FPL) according to the national Supplemental Poverty Measure. These families earn no more than $20,090 per year for a family of three. One of California’s most essential anti-poverty strategies is the CalWORKs program, which provided cash assistance to approximately 540,000 families in 2014, including more than 1 million children. Federal funding for CalWORKs comes from the TANF block grant. A grant to a family of three in a high-cost California county is $704 per month, or income at approximately 42 percent of the federal poverty level (FPL).

Immunization requirements and sanctions

Current statute requires that parents or guardians of young children within a CalWORKs assistance unit provide proof of current immunization in order for any adult in the unit to receive assistance. Adults have 30 days from the initial application, and 45 days from a redetermination to submit verification of immunizations, with a 30-day extension available if a county determines there is good cause for not providing the required documentation due to lack of reasonable access to immunization services.

Data compiled by the California Department of Social Services, below, indicates that in nearly 100,000 of the 540,000 families receiving assistance in 2014, the household’s adults were sanctioned for failing to provide immunization documentation for children under age 6.

Total Adults Penalized for Failure to Provide Immunization Documentation
Calendar Year 2014	Calendar Year 2013	Calendar Year 2012
99,361	83,759	109,238

California Immunization Registry

All 50 states have immunization registries. California’s registry is a statewide information system that includes nine regional registries encompassing 57 of the state’s 58 counties. Almost 2.9 million children under the age of 6, or nearly 97 percent of the state’s total population in that age group, have at least one immunization record recorded in CAIR.

Use of the CAIR is voluntary, and requires parent disclosure before a child’s health care provider can enter a child’s immunization information. Parents have the right to prevent anyone other than their child’s provider from accessing the immunization records. The CAIR is designed to allow access to immunization information for health care providers and plans, schools, county welfare departments, foster care agencies, family child care homes and child care facilities.

According to the County Welfare Directors Association (CWDA), about half of the state’s counties currently access the CAIR to verify that required CalWORKs household immunizations have been completed. At least some counties may seek independent verification of immunizations from the client before logging into the system. CWDA notes that not all children’s immunizations would be able to be verified through the CAIR because of either parent refusal to share names, or misspelled children’s names.

Other hurdles to full use of the CAIR include technology: Imperial County operates its own registry that is not part of the CAIR system. Seven of the nine CAIR regions are using the same software, but San Diego County and the greater San Joaquin Valley use different software. Additionally, users can only access immunization data in CAIR within their defined regions; to verify whether a child has had an immunization in another region of the state requires a separate request to the registry. Efforts are underway to modernize the CAIR, including allowing statewide access to data, and are expected to be completed by the summer of 2017.

Related legislation:

AB 1542 (Ducheny), Chapter 270, Statutes of 1997, created the CalWORKs program as California’s implementation of federal welfare reform and included the requirement that children in an assistance unit under the age of 6 not required to be enrolled in school have received all age-appropriate immunizations.

COMMENTS

Providing up-to-date immunization records can be a barrier to aid for families who already are challenged by a lack of resources. Using an available registry to verify immunization records for children can save clients time and may streamline the application process for counties. CWDA reports that the counties that use CAIR find the database to be useful. While the CAIR is not 100 percent functional yet, with limitations around accessing children’s information in the database and use of technology across the state’s regions, the author argues that it remains a valuable tool to help the poorest parents in this state access the CalWORKs program.

PRIOR VOTES

POSITIONS

Support:

Coalition of California Welfare Rights Organizations (Sponsor)

California Immigrant Policy Center

County Welfare Directors Association of California

Western Center on Law and Poverty

Oppose:

None received.

-- END --

Date of Hearing: April 29, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 376

Author:(Lopez) – As Amended Ver:April 21, 2015

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

SUMMARY:

This bill requires county welfare departments, beginning July 1, 2016, to first search the California Immunization Registry (CAIR), and find no record of immunization, prior to requesting CalWORKs applicants or recipients to submit vaccination documentation for children under age six who are not required to be enrolled in school.

FISCAL EFFECT:

About one-third of counties already use CAIR for this purpose. The costs to train additional staff to use CAIR are minor and likely absorbable within existing county training budgets.

COMMENTS:

1. Purpose. By using CAIR to verify children’s immunization histories before requiring families to provide documentation, this bill seeks to assist families in the navigation of the CalWORKs eligibility and redetermination process and, ultimately, reduce the number of families facing reduced grant amounts resulting from tardy submission of verification.

According to the author, “this bill will help streamline and simplify an administrative process, which will help families access the support they need by using current technology to verify immunization records. Currently, CalWORKs requires an applicant or recipient to immunize their minor children and provide proof of immunization. For our most vulnerable populations, this extra step in the process to receive benefits can add to an already stressful situation. This bill would require the county first review the California State registry of immunizations, which is maintained by the Department of Public Healt, before asking the family to provide the records. If the registry indicates that the children have not met the immunization requirements, then the county can request verification of immunization.”

2. CalWORKs immunization requirements: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 was the federal law creating the federal TANF program which offers block grants to states to design their own welfare programs. One of the many provisions contained in PRWORA permits states to create “individual responsibility plans” for participants that may, among other things, require individuals to immunize their children.

In 1997, the Legislature created the CalWORKs program as California’s implementation of federal welfare reform. Among its many provisions is the requirement that all applicants for and recipients of CalWORKs benefits provide documentation that any children in the assistance unit under the age of 6 have received all age-appropriate immunizations. If documentation is not provided within the required 30 or 45 day time period, a parent’s or caretaker relative’s needs are not considered in determining the grant amount for the assistance unit. Since 2012, on average, 97,000 adults per year have been penalized for not providing timely verification of immunization.

3. California Immunization Registry (CAIR). Maintained by the Department of Public Health, CAIR is a secure and confidential statewide computerized information system consisting of nine separate regional immunization registries. CAIR covers 57 of California’s 58 counties; Imperial County operates its own registry that is not part of the CAIR system. CAIR enables authorized users to access immunization data within their defined region, however, look-up access to other regional registries is available to state or county governmental agencies upon request. It is expected that CAIR will eventually allow authorized users to access immunization data across the state by integrating its regional databases. This effort, the “CAIR 2.0 Project,” is currently underway and integration is expected to be completed by the summer of 2017.

Nearly 2.9 million children under the age of 6 (96.7% of the total age-group population in the state) have immunization records contained in CAIR. Authorized users of CAIR include health care providers and plans, schools, county welfare departments, foster care agencies, family child care homes and child care facilities. Users must sign a confidentiality agreement to access CAIR, and need a user ID and password to log in to the registry.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 14, 2015

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Kansen Chu, Chair

ABPCA Bill Id:AB 376

Author:(Lopez) – As Amended Ver:April 6, 2015

SUBJECT: CalWORKs eligibility: immunizations

SUMMARY: Requires counties to access an internet-based computerized information system to verify, when possible, immunization of children under the age of 6 in CalWORKs families.

Specifically, this bill:

1. Requires county welfare departments to first search the California Immunization Registry and find no records of immunization prior to requesting applicants for or recipients of CalWORKs to submit vaccination documentation for children not required to be enrolled in school.

2. Stipulates that no continuous appropriation shall be made from the General Fund to counties in order to implement this act.

EXISTING LAW:

1. Establishes in federal law the Temporary Assistance for Needy Families (TANF) program, which provides block grants to states to develop and implement their own state welfare-to-work programs designed to provide cash assistance and other supports and services to low-income families. (42 USC § 601 et seq.)

2. Establishes the state’s TANF program, the California Work Opportunity and Responsibility to Kids (CalWORKs) program. CalWORKs provides cash assistance and other supports and services to low-income families and is administered by the counties. (WIC 11200 et seq.)

3. Requires CalWORKs applicants and recipients to provide documentation showing that all children in the assistance unit who are not required to be enrolled in school have received all age appropriate immunizations within 30 to 45 days, as specified. Provides exemptions in cases where it has been determined that immunizations are not medically appropriate, or when an affidavit attesting that immunizations are contrary to the applicant’s or recipient’s beliefs has been filed with the county welfare department. (WIC 11265.8)

4. Prohibits an aid payment for any adult in the assistance unit if required documentation of immunization is not provided within the specified time period. (WIC 11265.8)

5. Directs the Department of Public Health, in consultation with the Department of Education, to adopt and enforce regulations to carry out the stated legislative intent to fully immunize appropriate age groups against certain childhood diseases, including diphtheria, measles, mumps, and others, as specified. Allows for certain medical and personal-belief exemptions to immunization requirements, provided documentation is supplied, as specified. (HSC 120325 et seq.)

6. Allows local health officers to, either separately or jointly with other jurisdictions and in conjunction with the Department of Public Health’s Immunization Branch, operate immunization information systems containing individuals’ vaccination information. Further allows the information in these systems to be shared with specified entities, including with county welfare departments for the purpose of assessing the immunization histories of dependents of CalWORKs participants. States that individuals have the right to refuse the sharing of their information in these systems, and requires that individuals be informed of this right. (HSC 120440)

FISCAL EFFECT: Unknown

COMMENTS:

CalWORKs immunization requirements: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (P.L. 104-193) was the federal law adopting the “welfare reform” of the late 1990s. It created the federal TANF program, which offers block grants to states to design their own welfare programs, provided they meet certain requirements, including establishing work requirements and placing a lifetime limit of five years on receipt of benefits. One of the many provisions contained in PRWORA permits states to create “individual responsibility plans” for participants that may, among other things, require individuals to immunize their children.

Twenty-four states including California require TANF participants to submit documentation of immunization for young children (data as of July 2013). AB 1542 (Ducheny), Chapter 270, Statutes of 1997, created the CalWORKs program as California’s implementation of federal welfare reform. Alongside many other changes, this bill added Section 11265.8 to the Welfare and Institutions Code, requiring that all applicants for and recipients of CalWORKs benefits provide documentation that any children in the assistance unit under the age of 6 not required to be enrolled in school have received all age-appropriate immunizations. Applicants and recipients who file an affidavit with the county stating that immunizations are against their beliefs, or who supply documentation stating that it has been medically determined that immunizations are inappropriate, are exempt from this requirement. Applicants and recipients are to be notified of their obligation to provide proof of immunization, and must also receive information on: the relevant childhood immunization schedules, how to obtain immunizations using Medi-Cal or through a county public health clinic or other available sources, as appropriate, and a statement explaining the personal belief exemption.

Parents and caretaker relatives are allowed either 30 or 45 days, depending on their individual situations, to supply documentation of immunization; an additional 30 days may be granted if the county finds that good cause exists for not submitting verification in the timeframe allowed. If documentation is not provided within the required time period, a parent’s or caretaker relative’s needs will not be considered in determining the grant amount for the assistance unit until the required documentation is supplied. For the past three years, the numbers of adults penalized for not providing timely verification of immunization have been: 99,361 (2014), 83,759 (2013), and 109,238 (2012).

California Immunization Registry: All 50 states have immunization registries. The California Immunization Registry (CAIR) is a secure and confidential statewide computerized information system consisting of nine separate regional registries. These regions, most of which are multi-county, cover 57 of California’s 58 counties; Imperial County operates its own registry that is not part of the CAIR system. Seven of the nine CAIR regions currently use the same software, while San Diego County and the greater San Joaquin Valley use different software. The current regional structure of CAIR only enables authorized users to access immunization data within their defined region; however, look-up access to other regional registries is available to state or county governmental agencies upon request. It is expected that CAIR will eventually allow any CAIR user to access immunization data across the state by integrating its regional databases. This effort, the “CAIR 2.0 Project,” is currently underway and integration is expected to be completed by the summer of 2017.

Use of CAIR is voluntary. Health care providers are allowed to enter immunization records into a registry, provided the individual or the individual’s parent has been notified about the registry and the right to “lock” his or her (or his or her child’s) information in CAIR so that no users other than his or her health care provider may access them. Users must sign a confidentiality agreement to access CAIR; a user ID and password are needed to log in to the registry. Authorized users include health care providers and plans, schools, county welfare departments, foster care agencies, family child care homes and child care facilities. Counties were recently polled on their use of CAIR; of the 23 counties that responded, nine currently use it to some extent, but it appears that most seek verification from the client before logging into the system.

Almost 2.9 million children under the age of 6 (96.7% of the total age-group population in the state) have immunization records contained in CAIR, with almost 1.9 million children under the age of 6 (63.5% of the total age-group population) having at least two immunization doses recorded.

Need for the bill: According to the author, “this bill will help streamline and simplify an administrative process, which will help families access the supports they need by using current technology to verify immunization records. Currently, CalWORKs requires an applicant or recipient to immunize their minor children and provide proof of immunization. For our most vulnerable populations, this extra step in the process to receive benefits can add to an already stressful situation. This bill would require that the county first review the California State registry of immunizations, which is maintained by the Department of Public Health before asking the family to provide the records. If the registry indicates that the children have not met the immunization requirements, then the county can request verification of immunization.”

Staff comments: Locating or obtaining immunization documentation, and providing this information to the county, can create an additional set of barriers for families who already face numerous obstacles to securing services and supports as they work to move out of poverty. Using CAIR to verify children’s immunization histories before requiring families to locate or obtain related documentation will assist in the navigation of the CalWORKs eligibility and redetermination process and, ultimately, reduce the number of families facing reduced grant amounts resulting from tardy submission of verification.

However, beyond facilitating access to documentation, more could be done to facilitate access to the immunizations themselves. Poverty can be correlated with limited access to a regular source of affordable health care, contributing to reduced access to age-appropriate vaccinations. National data for 2013 from Centers for Disease Control indicate that, for children 19 to 35 months old, 71% living in families with incomes below the poverty level had received specified vaccinations, compared to 80% of those living in families with incomes above the poverty line. Options exist for counties to help families access immunization services, such as requiring counties to provide information on local free vaccination clinics prior to penalizing the family by reducing their grant amount. One example of facilitated access exists in Virginia: there, sanctions may not be imposed on families until the reason for failing to comply with the immunization requirement has been identified and any barriers to accessing immunizations have been removed (45 Code of Virginia 63.2-603). Should this bill move forward, the author may wish to include provisions that further assist CalWORKs applicants and recipients in obtaining necessary vaccinations for their children.

Recommended amendments:

1. In order to make clear that parents and caretaker relatives are able to secure a personal-belief exemption at any point prior to immunization documentation being due, committee staff recommends the following amendments to paragraph (a)(2), beginning on page 2 of the bill:

11 (2) If an applicant or recipient has not filed an affidavit has not

12 been filed with the county welfare department, the The county shall

13 verify on behalf of any applicant or recipient required to provide

14 documentation that the immunizations have been performed each

15 child in the assistance unit not required to be enrolled in school

16 has received all age-appropriate immunizations by obtaining a

17 report from the California Immunization Registry established

18 pursuant to Section 120440 of the Health and Safety Code. If the

19 registry does not contain records of these immunizations, the

20 county shall require the applicant or recipient to provide

21 documentation that the immunizations have been performed, or

22 are not medically appropriate,, unless the applicant or recipient has filed an affidavit that the immunizations are contrary to his or her beliefs or supplied documentation that it has been medicially medically

23 determined that an immunization is not appropriate within 30 days

24 of the determination of eligibility for Medi-Cal benefits under

1 Chapter 7 (commencing with Section 14000), or 45 days for

2 applicants already eligible for benefits under Chapter 7

3 (commencing with Section 14000), or within 45 days of a full or

4 financial redetermination of eligibility for aid under this chapter.

2. Additionally, in order to ensure that DSS and the counties have ample time for proper implementation, committee staff further recommends that the bill become effective on July 1, 2016.

REGISTERED SUPPORT / OPPOSITION:

Support

Coalition of California Welfare Rights Organizations, Inc. - sponsor

California Alternative Payment Program Association (CAPPA)

California Immigrant Policy Center

San Diego Hunger Coalition

Western Center on Law and Poverty

Opposition

None on file.

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089