Existing law requires the State Department of Public Health, in cooperation with the State Department of Education, to establish a Public School Health Center Support Program to perform specified functions relating to the establishment, retention, or expansion of school health centers in California. Existing law, for purposes of those provisions, defines a school health center to mean a center or program located at or near a local educational agency that provides age-appropriate health care services at the program site or through referrals, and may conduct routine physical health, mental health, and oral health assessments. Existing law requires the State Department of Public Health, to the extent funds are appropriated to the department, to establish a grant program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing school health centers, and the development of new school health centers, in accordance with specified procedures. Existing law requires the department to develop a request for proposal (RFP) process for collecting information on applicants, and determining which proposals shall receive grant funding, giving preference for grant funding to schools in areas designated as federally medically underserved areas or in areas with medically underserved populations, or schools with a high percentage of low-income and uninsured children and youth.

This bill would require the department to also give preference to schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal or Covered California. Medi-Cal.

Existing law requires the State Department of Public Health, in cooperation with the State Department of Education, to establish a Public School Health Center Support Program to perform specified functions relating to the establishment, retention, or expansion of school health centers in California. Existing law, for purposes of those provisions, defines a school health center to mean a center or program located at or near a local educational agency that provides age-appropriate health care services at the program site or through referrals, and may conduct routine physical health, mental health, and oral health assessments. Existing law requires the State Department of Public Health, to the extent funds are appropriated to the department, to establish a grant program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing school health centers, and the development of new school health centers, in accordance with specified procedures. Existing law requires the department to develop a request for proposal (RFP) process for collecting information on applicants, and determining which proposals shall receive grant funding, giving preference for grant funding to schools in areas designated as federally medically underserved areas or in areas with medically underserved populations, or schools with a high percentage of low-income and uninsured children and youth.

This bill would require the department to also give preference to schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal or Covered California.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 766 (Ridley-Thomas) - Public School Health Center Support Program

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

Bill Summary:

AB 766 would require the Department of Public Health to give grant funding preference to schools with a high percentage of students enrolled in Medi-Cal, under the Public School Health Center Support Program.

Fiscal Impact:

Unknown cost pressure to provide grant funds to schools with a high percentage of students who are enrolled in Medi-Cal (General Fund or other unknown fund source). Under the existing Public School Health Center Support Program, the Department of Public Health is authorized to provide grant funding for school based health centers. Current law requires preference to be given to schools with a high percentage of low-income and uninsured children. This bill would add schools with a high percentage of students enrolled in Medi-Cal to that grant preference. By expanding the existing preference, the bill may impose cost pressure on the program, to the extent that the new preference results in schools qualifying for grant funds who would not under current law. The bill does not identify a source of funds for these new grants. The current program has been authorized in statute for eight years, but has never been funded.

Background:

Under current law, schools may operate student health centers to provide health services to students.

Under current law, the Department of Public Health is required to establish a Public School Health Center Support Program to support the establishment of school health centers. The Department is also required to establish a grant program to provide funding to school health centers. This program has been in place for the past eight years. To date, no funding has been made available and no program activities have taken place.

Proposed Law:

AB 766 would require the Department of Public Health to give grant funding preference to schools with a high percentage of students enrolled in Medi-Cal, under the Public School Health Center Support Program.

Related Legislation:

• AB 118 (Liu) would authorize a new category of grants within the Public School Health Center Support Program. The bill would also rename the program and change some of the program’s goals and procedures. That bill is pending in the Assembly Appropriations Committee.

• AB 1025 (Thurmond) requires the Department of Education to establish a pilot program to encourage practices that integrate mental health, special education, and other issues. That bill is pending in this committee.

• AB 1133 (Achadjian) would make changes to the statute governing grants to local education agencies to pay for the costs of providing early mental health interventions. That bill was held on the Assembly Appropriations Committee’s Suspense File.

• AB 1055 (Liu, 2014) was substantially similar to SB 118. That bill was held in the Senate Rules Committee.

• AB 174 (Bonta, 2013) would have required the Department of Public Health to establish a pilot program in Alameda County to address trauma and mental health issues in schools. That bill was vetoed by Governor Brown.

Staff Comments:

As noted above, the current program has never been funded. Staff is not aware of any new sources of non-General Fund funding that could be used to fund the existing program or the newly authorized activities in this bill.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 766

SUBJECT: Public School Health Center Support Program.

SUMMARY:

Requires the Department of Public Health to give grant funding preference, as specified, to schools with a high percentage of children and youth who receive free or low-cost insurance through Medi-Cal.

Existing law:

1. Requires the Department of Public Health (DPH) to establish the Public School Health Center Support Program (PSHCSP), in collaboration with the Department of Education (CDE), to perform specified functions relating to the establishment, retention, or expansion of school-based health centers (SBHCs) in California.

2. Establishes a grant program administered by DPH to provide technical assistance and funding to SBHCs, to the extent funds are appropriated for implementation of the PSHCSP. Provides for planning, facilities and startup, sustainability, and technical assistance grants, as specified.

3. Requires grant funding preference to be given to the following schools:

1. Those located in areas designated as federally medically underserved areas or in areas with medically underserved populations;

2. Those with a high percentage of low-income and uninsured children and youth;

3. Those with large numbers of limited English-proficient students;

4. Those in areas with a shortage of health professionals; and,

5. Those that are low-performing with Academic Performance Index rankings in the deciles of three and below of the state.

4. Defines an SBHC, for purposes of the PSHCSP, as a center or program located at or near a local educational agency that provides age-appropriate health care services at the program site or through referrals. Defines a “local educational agency” as a school, school district, charter school, or county office of education, as specified.

5. Establishes the Medi-Cal program, administered by Department of Health Care Services, under which qualified low-income individuals receive health care services.

This bill: Requires DPH to also give grant funding preference to schools with a high percentage of children and youth who receive free or low-cost insurance through Medi-Cal.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill would have negligible state fiscal effect. The PSHCSP grant program is currently not funded.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and using primary care services. Recent expansions in insurance coverage under the Affordable Care Act, Medi-Cal, and Children’s Health Insurance Program have improved access to health care for this population. Yet, even with the expansion of health insurance, children from low-income households are not guaranteed access to health care services. Low-income children who have insurance through a public health program still face problems with gaining access to health care services and finding providers. Low-income children who have private insurance have problems finding providers that accept their insurance, and face unaffordable medical costs. Additionally, some parents feel unwelcome at medical practices, are unable to take time off work for health care appointments, or are unable to travel long distances to seek care for their children. SBHCs provide a health care delivery model that can help to address some of the barriers to health care services that insured children from low-income households face. SBHCs provide improved access to medical care because they are conveniently located and provide a patient-friendly environment.

2. SBHCs. According to the National School-Based Health Alliance (NSBHA), SBHCs provide a broad array of primary care and preventive services, including comprehensive health assessments; prescriptions for medications; treatment for acute illness; asthma treatment; oral health education; dental screenings; and mental health assessments, crisis intervention, brief and long-term therapy, and other services. SBHC staff offer small group and classroom health promotion and outreach, which help increase the number of students exposed to programs and activities that discourage potentially harmful behaviors including alcohol, tobacco, and drug abuse, and violence and bullying. These programs also serve to help promote healthy eating and active living. SBHCs work to ensure that adolescents, a hard-to-reach population, have access to the services they need to stay on a path to success. SBHCs are the primary, and occasionally only, available health care for many children and adolescents who otherwise would have no access. The NSBHA states that Congress recognized the importance of SBHCs as a key link in the nation’s health care safety net by providing $50 million a year for four years in one-time funding for construction, renovation, and equipment for SBHCs in the ACA.
   
   According to the California School-Based Health Alliance (CSBHA), 40% of SBHCs are in high schools, 25% are in elementary schools, 10% are in middle schools, and 25% are "school-linked" or mobile medical vans. CSBHA states that many SBHCs are located on school campuses that serve some of the state's most vulnerable children, with about 70% of students receiving free or reduced-price meals. SBHCs are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. They are financed through various sources, including grants from state, local, and private sources; reimbursements from public programs, such as the Child Health and Disability Prevention Program and Medi-Cal; partnerships with local community clinics and nonprofits; and fundraising efforts by their school districts. According to CSBHA, more than half of SBHCs recover less than 50% of their operating costs from billing sources, as many of them provide health education, case management, parent support, and teacher consultation, much of which is not reimbursable. CSBHA states that research shows investments in SBHCs generate savings through reduced high-cost services, reduced inappropriate emergency room use, and immunization initiatives that prevent disease.

CSBHA believes that schools are a natural place to identify health problems and offer solutions, as children spend six to eight hours per day at school, and school-based interventions eliminate transportation barriers faced by other obesity prevention programs. CSBHA cites cases in which SBHCs have implemented strategies, such as reducing television viewing, increasing physical activity, and increasing fruit and vegetable intake. Studies showed that school-based nutrition and fitness programs were generally effective in improving health behaviors, and one study found that 50% fewer children in the intervention schools became overweight compared to the study’s control schools. CSBHA found that one such SBHC’s interventions compared favorably with other public health campaigns, costing less per quality-adjusted life years than programs such as adult hypertension prevention and adult diabetes screening.

3. Integrated Student Supports (ISS). In a white paper issued in February 2014, Child Trends (a national non-profit research center) looked at the benefits of ISS, which are a school-based approach to promoting students’ academic success by developing, securing, and coordinating supports that target academic and non-academic barriers to achievement. To date, ISS programs have served more than 1.5 million students in nearly 3,000 schools across the US, and Child Trends estimates that Hispanic and black students account for more than 75%of the students enrolled in ISS programs. Research cited by Child Trends indicates that the likelihood of academic success, especially for disadvantaged students, is enhanced by a more comprehensive set of supports at the individual, family, and school levels, which implies that providing an array of academic and non-academic supports in a coordinated fashion is a more effective strategy than focusing on one or a small set of supports. Child Trends found that generally the return on investment for ISS programs ranged from $4 to almost $15 for every dollar invested, which suggests that the ISS approach yields a positive return on investment.

4. Related legislation. SB 118 (Liu), renames the PSHCSP the School-Based Health and Education Partnership Program and makes changes to the requirements and funding levels. Creates a new type of grant to fund interventions related to obesity, asthma, alcohol and substance abuse, and mental health. SB 118 is pending in the Assembly Education Committee.

AB 1025 (Thurmond), would require CDE to establish a three-year pilot program to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multitiered framework. AB 1025 is set for hearing in the Senate Education Committee on July 8, 2015.

AB 1133 (Achadjian), would make technical changes to existing law regarding grants to local educational agencies to pay the state share of costs of providing school-based early mental health intervention and prevention services to eligible students. AB 1133 was held under submission in the Assembly Appropriations Committee.

5. Prior legislation. SB 1055 (Liu, 2014), was identical to SB 118. SB 1055 died in the Senate Rules Committee.

SB 596 (Yee, 2014), would have required CDE to establish a three-year pilot program in four schools to provide school-based mental health services that leverage cross-system resources and offer comprehensive multitiered interventions; allocated a total of $600,000 in start-up funding to each school selected to participate in the program; and required CDE to submit a report to the Legislature evaluating the success of the program. SB 596 was held at the Assembly Desk.

AB 1955 (Pan, 2014), would have required the SPI to establish the Healthy Kids, Healthy Minds Demonstration, which would provide grants to local educational agencies for the purpose of employing one full-time school nurse and one full-time mental health professional, and ensured that the schools' libraries were open one hour before and three hours after the regular school day. AB 1955 was held on the Assembly Appropriations Committee’s suspense file.

AB 174 (Bonta, 2013), would have required DPH to establish a pilot grant program in Alameda County, to the extent that funding was made available, to provide resources to eligible applicants for activities and services that directly address the mental health and related needs of students impacted by trauma. AB 174 was vetoed by Governor Brown, who stated in his veto message that, while he supports the efforts of the bill, Alameda County can establish such a program without state intervention and may even be able to use existing funds to do so. In addition, Governor Brown stated that all counties, not just Alameda, should explore all funding options, including Mental Health Services Act funds, to tailor programs that best meet local needs.

AB 1178 (Bocanegra, 2013), would have established the California Promise Neighborhood Initiative to provide funding to schools that have formalized partnerships with local agencies and community organizations to provide a network of services to improve the health, safety, education, and economic development of a defined area. AB 1178 failed in the Assembly Appropriations Committee.

SB 564 (Ridley-Thomas, Chapter 381, Statutes of 2008), specified that an SBHC may conduct routine physical health, mental health, and oral health assessments, and provide for any services not offered onsite or through a referral process. The bill also required DPH, to the extent funds are appropriated for implementation of the PSHCSP, to establish a grant program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing SBHCs, and the development of new SBHCs, in accordance with specified procedures.

AB 2560 (Ridley-Thomas, Chapter 334, Statutes of 2006), required the Department of Health Services (DHS), in cooperation with CDE, to establish the PSHCSP to perform specified functions relating to the establishment, retention, or expansion of SBHCs; required DHS to establish standardized data collection procedures and collect specified data from SBHCs on an ongoing basis; required CDE, in collaboration with DHS, to coordinate programs within CDE and programs within other specified departments to support SBHCs and to provide technical assistance to facilitate and encourage the establishment, retention, and expansion of SBHCs; and required the program to provide a biennial update to the appropriate policy and fiscal committees of the Legislature containing specified information regarding SBHCs, beginning on or before January 1, 2009.

AB 2105 (Scott, 2000), would have required the Director of Mental Health, in consultation with the Secretary of Child Development and Education and the Superintendent of Public Instruction, to establish a program to award planning grants to counties for the provision of school-based mental health services to children, according to specified criteria, and to the extent funding was made available for that purpose. This bill would have also required the director to provide a preliminary report on the program to the Governor, appropriate policy and fiscal committees of the Legislature, and the Legislative Analyst on or before January 1, 2003, and to provide a final report to these entities on or before January 1, 2007. AB 2105 failed in the Assembly Appropriations Committee.

SB 566 (Escutia, 1999), would have established the SBHC Grant Program, to be administered by DHS, to provide grants to qualifying SBHCs in order to assist the centers in providing health services to students, provided that funds were appropriated in the annual Budget Act. This bill also would have required DHS to convene a study group to explore long-term strategies to support SBHCs and incorporate these centers into a comprehensive and coordinated health care system. SB 566 was moved to the inactive file on the Senate Floor.

6. Support. Supporters of the bill, including health and labor organizations, argue that children from lower socioeconomic backgrounds have poorer health outcomes, particularly those from communities of color who may have issues with accessing care. Supporters further argue that SBHCs provide a health care delivery model that can help address some of the barriers services that insured children from low-income households face, including services like primary health and mental health care, substance abuse counseling, case management, dental health, and nutrition education.

7. Opposition. The California Right to Life Committee, Inc. (CRLC) argues that this bill continues to promote health services that include preventive medical services and reproductive services. Therefore, CRLC opposes any further expansion of abortion services to children and youth when using the public’s tax dollars.

8. Policy comment. The PSHCSP has existed in statute for eight years and has never been implemented due to a lack of funding. This bill does not include provisions to provide for future funding, so it is unclear what the impact would be.

SUPPORT AND OPPOSITION:

Support: California Black Health Network

California Chapter of the National Association of Social Workers

California Federation of Teachers

California Pan-Ethnic Health Network

California School Boards Association

California School Employees Association

California State PTA

Planned Parenthood Affiliates of California

Oppose: California Right to Life Committee, Inc.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 766

Author:(Ridley-Thomas)

As Amended Ver:April 27, 2015

Majority vote

SUMMARY: Requires the Department of Public Health to give preference to schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal or Covered California when developing a request for proposal for grant funding for Public School Health Center Support Programs.

FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill would have negligible state fiscal effect. This grant program is currently not funded.

COMMENTS: According to the author, children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and using primary care services. Recent expansions in insurance coverage under the Patient Protection and Affordable Care Act, Medi-Cal, and the Children's Health Insurance Program have improved access to health care for this population. Yet, even with the expansion of health insurance, children from low-income households are not guaranteed access to health care services.

The author states that children from low-income households who have insurance through a public health program still face problems with gaining access to health care services and finding providers. Children from low-income households who have private insurance also have problems finding providers that accept their insurance and with unaffordable medical costs. Additionally, some parents feel unwelcome at medical practices, unable to take time off work for health care appointments, or unable to travel long distances to seek care for their children.

School Based Health Centers (SBHCs) provide a broad array of primary care and preventive services, including comprehensive health assessments; prescriptions for medications; treatment for acute illness; asthma treatment; oral health education; and dental screenings. SBHCs have mental health providers on staff to offer mental health assessments, crisis intervention, brief and long-term therapy, and other services. SBHCs are the primary, and occasionally only, available health care for many children and adolescents who otherwise would have no access. There are approximately 200 SBHCs in California. Half of SBHC's are in high schools, a third are in elementary schools and the remainder are in middle schools or in mobile medical vans. Many SBHCs are located in schools serving some of the state's most vulnerable children and on campuses with SBHCs, about 70% of students receive free or reduced price meals. According to the California School-Based Health Alliance (CSBHA), 13,500 children have gained access to health care in their school since 2012, through the expansion of SBHCs. SBHCs are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. They are financed through grants from state, local, and private sources as well as reimbursements from public programs, such as the Child Health and Disability Prevention Program and Medi-Cal. According to CSBHA, more than half of SHCs recover less than 50% of their operating costs from billing sources.

The California Pan-Ethnic Health Network (CPEHN), states in support of this bill that children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and using primary care services. Recent expansions in insurance coverage under the Affordable Care Act, Medi-Cal, and the Children's Health Insureance Program have improved access to health care for this population. CPEHN notes that even with the expansion of health insurance, children from low-income households are not guaranteed access to health care services. According to CPEHN, this bill ensures that grant funding considers schools that have a high percentage of youth who may come from low-income households and face more challenges accessing health care services.

The California Black Health Network (CBHN) states in support of this bill that boys and young men of color are disproportionately affected by violence and trauma, which can lead to disparities in health outcomes. For instance, boys and young men of color are more likely than white to characterize their health as "poor" or "fair". CBHN believes that SBHCs can specifically help boys and young men of color through the range of services offered that are locally designed to meet the specific needs of the student population. SBHCs increase access to care and this bill would ensure that boys and young men of color from low-income households, who may have issues with accessing care, are able to utilize SBHCs in their communities. By broadening the requirement of the Public School Health Center Support Program grant funding to include schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal, this bill will provide health care to California's most vulnerable students.

The California Right to Life Committee (CRLC) states in opposition that CRLC must continue to oppose any publicly funded program which advocates and promotes abortions and related services.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0000887

Date of Hearing: May 27, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 766

Author:(Ridley-Thomas) – As Amended Ver:April 27, 2015

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

SUMMARY:

This bill requires the Department of Public Health (DPH) to give preference to schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal or Covered California when developing a request for proposal (RFP) for grant funding for Public School Health Center Support Programs

FISCAL EFFECT:

Negligible state fiscal effect. This grant program is currently not funded.

COMMENTS:

1. Purpose. According to the author, children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and using primary care services. Recent expansions in insurance coverage have improved access to health care for this population. Yet, even with the expansion of health insurance, children from low-income households are not guaranteed access to health care services. The author concludes that SBHCs provide a health care delivery model that can help to address some of the barriers to health care services that insured children from low-income households face.

2. Related Legislation. SB 118 (Liu) renames the Public School Health Center Support Program the School-Based Health and Education Partnership Program and makes changes to the requirements and funding levels. Creates a new type of grant to fund interventions related to obesity, asthma, alcohol and substance abuse, and mental health. SB 118 is pending a hearing in the Senate Appropriations Committee.

3. Support. Health advocacy groups, including the California Pan Ethnic Health Network and the California Black Health Network, support this bill, stating it will provide health care to California's most vulnerable students.

4. Opposition. The California Right to Life Committee (CRLC) states in opposition that CRLC must continue to oppose any publicly funded program which advocates and promotes abortions and related services.

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

Date of Hearing: April 21, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

ABPCA Bill Id:AB 766

Author:(Ridley-Thomas) – As Introduced Ver:February 25, 2015

SUBJECT: Public School Health Center Support Program.

SUMMARY: Requires the Department of Public Health (DPH) to give preference to schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal or Covered California when developing a request for proposal (RFP) for grant funding for Public School Health Center Support Programs (PSHCSP).

EXISTING LAW:

1. Requires DPH to establish the PSHCSP, in collaboration with the Department of Education (CDE), to perform specified functions relating to the establishment, retention, or expansion of school-based health centers (SBHCs) in California.

2. Establishes a grant program administered by DPH to provide technical assistance and funding to SBHCs, to the extent funds are appropriated for implementation of the PSHCSP. Provides for planning, facilities and startup, and sustainability grants, as specified.

3. Requires DPH to develop an RFP process to determine which proposals shall receive grant funding and requires the RFP process to prioritize the following:

1. Schools in areas designated as federally medically underserved areas or in areas with medically underserved populations;

2. Schools with a high percentage of low-income and uninsured children and youth;

3. Schools with large numbers of limited English proficient students;

4. Schools in areas with a shortage of health professionals; and,

5. Low-performing schools as measured by the Academic Performance Index.

4. Defines an SBHC as a center or program located at or near a local educational agency (LEA) that provides age-appropriate health care services at the program site or through referrals.

5. Defines a LEA as a school, school district, charter school, or county office of education, as specified.

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and using primary care services. Recent expansions in insurance coverage under the Patient Protection and Affordable Care Act (ACA), Medi-Cal, and the Children’s Health Insurance Program (CHIP) have improved access to health care for this population. Yet, even with the expansion of health insurance, children from low-income households are not guaranteed access to health care services.

The author states that children from low-income households who have insurance through a public health program still face problems with gaining access to health care services and finding providers. Children from low-income households who have private insurance also have problems finding providers that accept their insurance and with unaffordable medical costs. Additionally, some parents feel unwelcome at medical practices, unable to take time off work for health care appointments, or unable to travel long distances to seek care for their children.

The author concludes that SBHCs provide a health care delivery model that can help to address some of the barriers to health care services that insured children from low-income households face. SBHCs provide improved access to medical care because they are conveniently located and provide a patient-friendly environment.

2. BACKGROUND. SBHCs provide a broad array of primary care and preventive services, including comprehensive health assessments; prescriptions for medications; treatment for acute illness; asthma treatment; oral health education; and dental screenings. SBHCs have mental health providers on staff to offer mental health assessments, crisis intervention, brief and long-term therapy, and other services. SBHCs are the primary, and occasionally only, available health care for many children and adolescents who otherwise would have no access. The National School-Based Health Alliance states that Congress recognized the importance of SBHCs as a key link in the nation’s health care safety net by providing $50 million a year for four years in one-time funding for construction, renovation, and equipment for SBHCs in the ACA and more than 350 applicants from around the nation are seeking funding through the first round of competitive grants created under the law.
   
   There are approximately 200 SBHCs in California. Half of SBHC's are in high schools, a third are in elementary schools and the remainder are in middle schools or in mobile medical vans. Many SBHCs are located in schools serving some of the state's most vulnerable children and on campuses with SBHCs, about 70% of students receive free or reduced price meals. According to the California School-Based Health Alliance (CSBHA), 13,500 children have gained access to health care in their school since 2012, through the expansion of SBHCs. SBHCs are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. They are financed through grants from state, local, and private sources as well as reimbursements from public programs, such as the Child Health and Disability Prevention Program and Medi-Cal. According to CSBHA, more than half of SHCs recover less than 50% of their operating costs from billing sources.

3. SUPPORT. The California Pan-Ethnic Health Network (CPEHN), states in support of the bill that children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and using primary care services. Recent expansions in insurance coverage under the ACA, Medi-Cal, and CHIP have improved access to health care for this population. CPEHN notes that even with the expansion of health insurance, children from low-income households are not guaranteed access to health care services. According to CPEHN, this bill ensures that grant funding considers schools that have a high percentage of youth who may come from low-income households and face more challenges accessing health care services.

The California Black Health Network (CBHN) states in support of the bill that boys and young men of color are disproportionately affected by violence and trauma, which can lead to disparities in health outcomes. For instance, boys and young men of color are more likely than white to characterize their health as "poor" or "fair". CBHN believes that SBHCs can specifically help boys and young men of color through the range of services offered that are locally designed to meet the specific needs of the student population. SBHCs increase access to care and this bill would ensure that boys and young men of color from low-income households, who may have issues with accessing care, are able to utilize SBHCs in their communities. By broadening the requirement of the PSHCSP grant funding to include schools with a high percentage of children and youth who receive free or low-cost health coverage through Medi-Cal, this bill will provide health care to California's most vulnerable students.

4. OPPOSITION. The California Right to Life Committee (CRLC) states in opposition that CRLC must continue to oppose any publicly funded program which advocates and promotes abortions and related services.

5. RELATED LEGISLATION.

   1. SB 118 (Liu) renames the Public School Health Center Support Program the School-Based Health and Education Partnership Program and makes changes to the requirements and funding levels. Creates a new type of grant to fund interventions related to obesity, asthma, alcohol and substance abuse, and mental health. SB 118 is pending a hearing in the Senate Appropriations Committee.

   2. AB 1025 (Thurmond) requires CDE to establish a three-year pilot program to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multitiered framework. AB 1025 is pending in the Assembly Education Committee.

   3. AB 1133 (Achadjian) makes technical changes to existing law regarding grants to LEAs to pay the state share of costs of providing school-based early mental health intervention and prevention services to eligible students. AB 1133 is pending in the Assembly Health Committee.

6. PREVIOUS LEGISLATION.

   1. SB 596 (Yee) of 2014 would have required CDE to establish a three-year pilot program in four schools to provide school-based mental health services that leverage cross-system resources and offer comprehensive multitiered interventions; allocated a total of $600,000 in start-up funding to each school selected to participate in the program; and required CDE to submit a report to the Legislature evaluating the success of the program. SB 596 was held at the Assembly Desk.

   2. AB 1955 (Pan) of 2014 would have required the SPI to establish the Healthy Kids, Healthy Minds Demonstration, which would provide grants to LEAs for the purpose of employing one full-time school nurse and one full-time mental health professional, and ensured that the schools' libraries were open one hour before and three hours after the regular school day. AB 1955 was held on the Assembly Appropriations Committee’s suspense file.

   3. AB 174 (Bonta) of 2013 would have required DPH to establish a pilot grant program in Alameda County, to the extent that funding was made available, to provide resources to eligible applicants for activities and services that directly address the mental health and related needs of students impacted by trauma. AB 174 was vetoed by Governor Brown, who stated in his veto message that, while he supports the efforts of the bill, Alameda County can establish such a program without state intervention and may even be able to use existing funds to do so. In addition, Governor Brown stated that all counties, not just Alameda, should explore all funding options, including Mental Health Services Act funds, to tailor programs that best meet local needs.

   4. AB 1178 (Bocanegra) of 2013 would have established the California Promise Neighborhood Initiative to provide funding to schools that have formalized partnerships with local agencies and community organizations to provide a network of services to improve the health, safety, education, and economic development of a defined area. AB 1178 was help on the Assembly Appropriations Committee Suspense File.

   5. SB 564 (Ridley-Thomas), Chapter 381, Statutes of 2008, specified that an SBHC may conduct routine physical health, mental health, and oral health assessments, and provide for any services not offered onsite or through a referral process. SB 564 also required DPH, to the extent funds are appropriated for implementation of the PSHCSP, to establish a grant program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing SBHCs, and the development of new SBHCs, in accordance with specified procedures.

   6. AB 2560 (Ridley-Thomas), Chapter 334, Statutes of 2006, required the Department of Health Services (DHS now DPH), in cooperation with CDE, to establish the PSHCSP to perform specified functions relating to the establishment, retention, or expansion of SBHCs; required DHS to establish standardized data collection procedures and collect specified data from SBHCs on an ongoing basis; required CDE, in collaboration with DHS, to coordinate programs within CDE and programs within other specified departments to support SBHCs and to provide technical assistance to facilitate and encourage the establishment, retention, and expansion of SBHCs; and required the program to provide a biennial update to the appropriate policy and fiscal committees of the Legislature containing specified information regarding SBHCs, beginning on or before January 1, 2009.

7. COMMITTEE AMENDMENTS. The PSHCSP grant was established to provide financial assistance to SBHCs. State program requirements, and the intent behind the program, specify that the funding must be prioritized towards low-income and underserved students. This bill broadens the requirements to include prioritization based on Medi-Cal and Covered California eligibility. Currently, families must be at 138% of the federal poverty level or below to qualify for Medi-Cal. In order to qualify for Covered California, families can earn up to 400% of the federal poverty level. Given the already limited scope of this program due to funding restrictions, it would not be prudent to expand the criteria by which programs are identified for funding to include Covered California eligibility. The committee recommends the following amendment to the bill:

On page 6, line (15), strike "or Covered California."

REGISTERED SUPPORT / OPPOSITION:

Support

California Black Health Network
California Pan-Ethnic Health Network
National Association of Social Workers – California Chapter

Opposition

California Right to Life Committee, Inc.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097