Existing federal law provides for allocation of federal funds through the federal Temporary Assistance for Needy Families (TANF) block grant program to eligible states, with Californias version of this program being known as the California Work Opportunity and Responsibility to Kids (CalWORKs) program. Under the CalWORKs program, each county provides cash assistance and other benefits to qualified low-income families and individuals who meet specified eligibility criteria, including limitations on income and assets generally applicable to public assistance programs.

This bill would establish the Baby Wellness and Family Support Home Visiting Program that would require the State Department of Social Services to allocate funds to counties for the purpose of implementing or contracting with specified early home visiting programs to provide voluntary home visiting programs approved by the department and would authorize the funds to be used to coordinate early home visiting services with, among others, child education and development programs and diaper bank services. The bill would require the parent or assisted caretaker to be advised in writing of his or her right to opt in to the home visiting program, and would specify the contents of the opt-in document, including a statement that participation in the program is not a condition of CalWORKs eligibility. The bill would require the department to develop and disseminate an informing notice to ensure that all assistance units, as specified, are aware of the program and their ability to participate. The bill would require the department, in consultation with specified persons and entities, to collect specified data and compile and distribute the data to the appropriate policy and fiscal committees of the Legislature by January 30 of each year. The bill would authorize the department to issue an all-county letter or similar instructions until regulations are adopted and would require the department to adopt regulations to implement the provisions by October 1, 2019. The bill would require counties to identify persons eligible for the program and invite them to participate in the program. The bill would require counties to either implement the program or contract with 3rd parties to administer the program. By imposing additional duties on local officials, 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 the statutory provisions noted above.

Existing federal law provides for allocation of federal funds through the federal Temporary Assistance for Needy Families (TANF) block grant program to eligible states, with Californias version of this program being known as the California Work Opportunity and Responsibility to Kids (CalWORKs) program. Under the CalWORKs program, each county provides cash assistance and other benefits to qualified low-income families and individuals who meet specified eligibility criteria, including limitations on income and assets generally applicable to public assistance programs.

This bill would, as of January 1, 2018, would establish the Baby Wellness and Family Support Home Visiting Program that would require the State Department of Social Services to award allocate funds to counties for the purpose of implementing or contracting with specified early home visiting programs to provide voluntary maternal, infant, and early childhood home visiting programs approved by the department and would authorize the funds to be used to coordinate early home visiting services with, among others, diaper bank services. The bill would require the department to develop and disseminate an informing notice to ensure that all assistance units, as specified, are aware of the program and their ability to participate. The bill would require the department, in consultation with specified persons and entities, to collect specified data and compile and distribute the data to the appropriate policy and fiscal committees of the Legislature, as specified. Legislature by January 30 of each year. The bill would authorize the department to issue an all-county letter or similar instructions but until regulations are adopted and would require the department to adopt regulations to implement the provisions by October 1, 2019. The bill would require counties to identify persons eligible for the program and invite them to participate in the program. The bill would require counties to either implement the program or contract with third 3rd parties to administer the program. By imposing additional duties on local officials, 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 the statutory provisions noted above.

Existing federal law provides for allocation of federal funds through the federal Temporary Assistance for Needy Families (TANF) block grant program to eligible states, with Californias version of this program being known as the California Work Opportunity and Responsibility to Kids (CalWORKs) program. Under the CalWORKs program, each county provides cash assistance and other benefits to qualified low-income families and individuals who meet specified eligibility criteria, including limitations on income and assets generally applicable to public assistance programs.

This bill would, as of January 1, 2018, establish the Baby Wellness and Family Support Home Visiting Program that would require the State Department of Social Services to award funds to counties for the purpose of implementing or contracting with specified early home visiting programs to provide voluntary maternal, infant, and early childhood home visiting programs approved by the department and would authorize the funds to be used to coordinate early home visiting services with, among others, diaper bank services. The bill would require the department to develop and disseminate an informing notice to ensure that all assistance units, as specified, are aware of the program and their ability to participate. The bill would require the department, in consultation with specified persons and entities, to collect specified data and compile and distribute the data to the appropriate policy and fiscal committees of the Legislature, as specified. The bill would authorize the department to issue an all-county letter or similar instructions but would require the department to adopt regulations to implement the provisions by October 1, 2019. The bill would require counties to identify persons eligible for the program and invite them to participate in the program. The bill would require counties to either implement the program or contract with third parties to administer the program. By imposing additional duties on local officials, 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 the statutory provisions noted above.

ASSEMBLY THIRD READING

ATR Bill Id:AB 992

Author:(Arambula)

As Amended Ver:May 26, 2017

Majority vote

SUMMARY: Establishes the California Work Opportunity and Responsibility to Kids (CalWORKs) Baby Wellness and Family Support Home Visiting Program in the Department of Social Services (DSS) to offer a voluntary home visiting program to CalWORKs assistance units with a pregnant recipient or a child up to 24 months of age. Specifically, this bill:

1. Creates a voluntary CalWORKs early home visiting program intended to provide services to support health outcomes for pregnant women and infants born into poverty that will improve their likelihood to exit poverty, as specified.
2. Requires the state to allocate funds to counties to administer the home visiting program to provide voluntary services to any CalWORKs assistance unit with a pregnant recipient or a child up to 24 months of age.
3. Stipulates that participation in the home visiting program shall not be considered a condition of CalWORKs eligibility or affect a family's application for aid or eligibility for any other CalWORKs benefits, as specified.
4. Authorizes assistance units that are ineligible for, or not required to participate in, the welfare-to-work program, as specified, to receive home visiting services.
5. Prohibits a parent in an assistance unit from being sanctioned in connection with his or her participation or nonparticipation in the home visiting program, and permits a parent whose assistance unit is receiving services through the program to decline the services at any point with no adverse impact to the application or case.
6. Requires a parent or assisted caregiver to be advised in writing of his or her right to opt in to the home visiting program on a document to include a statement, to be initialed by the recipient of the document, that participation in the program is not a condition of CalWORKs eligibility and to also include information regarding terminating services, as specified, and further, requires the parent or assisted caretaker to receive a copy of the signed opt-in document.
7. Requires counties to identify eligible assistance units and invite them to participate in the program.
8. Defines "evidence-based home visiting program" to mean a program that met or would meet the criteria approved by the United States Department of Health and Human Services for evidence-based home visiting program models.
9. Defines "home" to mean a temporary or permanent residence or living space or another location identified by the assistance unit in the event that assistance unit is experiencing homelessness.
10. Requires home visiting services to do all of the following:
    1. Only be those intended to provide high-quality, evidence-based, research-based, culturally competent services that meet the needs of at-risk assistance units in underserved communities, support health outcomes, and improve the likelihood of exiting poverty, as specified; and
    2. Only be provided by a nurse, nurse practitioner, social worker, or another person able to provide culturally appropriate services who is trained and certified according to the criteria of the applicable evidence-based home visiting program.
11. Prohibits home visiting services and visits from being mandatory, random, or unannounced.
12. Prohibits home visits to be conducted by any personnel who do not meet the qualifications consistent with provisions of this bill, as specified.
13. Permits funds allocated to counties for the home visiting program to be used by counties to implement or contract with voluntary home visiting programs, and to be used for coordinating early home visiting services with child education and development programs, health and safety services, lead testing and abatement services, housing assistance, diaper bank services, family financial capability services, and other services meeting the intent of the CalWORKs Baby Wellness and Family Support Home Visiting Program, as specified.
14. Requires DSS to develop and disseminate an informing notice to ensure that all eligible assistance units are aware of the program and their ability to participate.
15. Requires DSS to develop written criteria, in consultation with designated stakeholders, for eligibility and provision of services consistent with the provisions of this bill and to provide these notices and criteria, relevant training, and appropriate outreach to counties, as specified.
16. Requires DSS to collect data from counties related to program outcomes, developed in consultation with specified stakeholders, of participants by designated demographic characteristics and requires these data to be annually compiled and distributed to the appropriate policy and fiscal committees of the Legislature on January 30 of each year.
17. Requires DSS to consult the California maternal, infant, and early childhood home visiting program benchmark data-collection and reporting mandates in the formulation of this data through collaboration with the State Department of Health Care Services and the State Department of Public Health.
18. Authorizes DSS to implement the provisions of this bill by all-county letters or similar instructions and requires DSS to adopt regulations to implement the provisions of this bill by October 1, 2019.
19. Prohibits appropriation, as specified, from being made to implement the provisions of this bill.

EXISTING LAW:

1. Establishes under federal law the Temporary Assistance for Needy Families (TANF) program to provide aid and welfare-to-work services to eligible families and, in California, provides that TANF funds for welfare-to-work services are administered through the CalWORKs program. (42 United States Code (U.S.C.) 601 et seq., Welfare and Institutions Code Section (WIC) 11200 et seq.)
2. Establishes income, asset, and real property limits used to determine eligibility for the CalWORKs program, including net income below the Maximum Aid Payment (MAP), based on family size and county of residence, which is around 40% of the Federal Poverty Level. (WIC 11150 to 11160, 11450 et seq.)
3. Requires all individuals 16 years of age or older, unless they are otherwise exempt, to participate in welfare-to-work activities as a condition of eligibility for CalWORKs. (WIC 11320.3, 11322.6)
4. Provides for family stabilization services for eligible CalWORKs assistance units, as specified. (WIC 11325.24)
5. Establishes the Nurse-Family Partnership program, to be administered by the California Department of Public Health (CDPH), to provide grants to counties for voluntary nurse home visiting programs to be provided to expectant first-time mothers, their children, and their families, as specified. (Health and Safety Code Sections 123491 – 123493)
6. Establishes the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program as part of the Patient Protection and Affordable Care Act of 2010. (42 United States Code Section 711).

FISCAL EFFECT: According to the Assembly Appropriations Committee, Ongoing annual costs of approximately $100 million (General Fund) for participation in early learning and home visitation services. This assumes approximately 12,000 families will participate annually and includes all administrative, supporting services, and program notification costs.

Staff notes that the Assembly Budget Subcommittee on Health and Human Services approved $100 million General Fund on-going to create a CalWORKs Baby Wellness and Family Support Home Visiting Program.

COMMENTS:

Home visiting programs: Today, voluntary home visiting programs are seen as a proven approach to addressing the needs of and improving outcomes for low-income and vulnerable children and their families. These programs typically involve a family receiving regular, planned visits from health, social services, and/or child development professionals and may include the provision of a wide variety of supports and services such as: promoting positive parenting techniques, assisting mothers in learning to breastfeed and care for their infants, working with parents on their educational and career goals, promoting parents' understanding of developmental milestones and behaviors, and the like.

There are a wide variety of home visiting models, and a number of current models have been rigorously studied and earned a designation as "evidence-based" in contributing to outcomes such as increased child literacy and readiness for school, improved family functioning, reduced rates of child abuse and neglect, and enhanced prenatal health. The United States Department of Health and Human Services (DHHS) established the Home Visiting Evidence of Effectiveness (HomVEE) review to evaluate the body of research on home visiting models and to determine which models meet the DHHS criteria for an evidence-based program model (which involves having a threshold number of impact studies of a certain quality).

Home visiting and TANF: Federal law requires that TANF funds be used to meet at least one of the following goals: "(1) provide assistance to needy families so that children may be cared for in their own homes or in the homes of relatives; (2) end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage; (3) prevent and reduce the incidence of out of wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies; and (4) encourage the formation and maintenance of two parent families." A 2012 report by the Center for Law and Social Policy (CLASP) showed how the outcomes of various home visiting program models aligned with these goals.

In federal fiscal year 2015, 14 states reported that at least some of their total federal TANF and state maintenance-of-effort expenditures went towards home visiting programs, which were defined as "expenditures on programs where nurses, social workers, or other professionals/para-professionals provide services to families in their homes, including evaluating the families' circumstances; providing information and guidance around maternal health and child health and development; and connecting families to necessary resources and services." It is also likely that additional states provided TANF-program-based home visiting services that were reported in other expenditure categories.

Need for this bill: With close to one million low-income California children receiving supports and services through it, CalWORKs is an important state program for addressing child and family poverty. Recent changes to the program have sought to assist families in identifying and addressing barriers to education and employment; these include intensive up-front assessment of family circumstances using the Online CalWORKs Appraisal Tool (OCAT) and provision of family stabilization services. Another important recent change to the program, which went into effect at the beginning of this calendar year, has been the repeal of the "maximum family grant" (MFG) rule, which denied families financial assistance for any child born into the family while a member of the household was receiving CalWORKs aid.

These two sets of changes – to address the needs and barriers facing CalWORKs families and to restore grant amounts for children born into these families – taken together indicate an evolution of CalWORKs, largely in response to Legislative and stakeholder action, to better address child poverty in order to mitigate its many deleterious impacts and to assist parents in getting the supports and developing the tools necessary to meet the needs of their families. These program changes of late would be complemented by this bill's proposal to offer voluntary home visiting services to educate, support, and work with CalWORKs assistance units with pregnant mothers and/or young children in meeting their goals.

According to the author, "Poverty, especially during early childhood can have a devastating impact on child health and well-being and undermines future educational and economic success. [This bill] creates the CalWORKs Baby Wellness and Family Support Home Visiting Program to provide CalWORKs recipients who are pregnant or parenting a child under age 2 with voluntary home visiting services from trained professionals…[This bill] clarifies that home visiting services would only be intended to achieve the goals of improving child health and family wellbeing and would only be provided by a certified nurse, certified nurse practitioner, or a certified social worker. The legislation establishes that the home visits would not be in mandatory, random, unannounced visits and must be completed by a licensed professional social worker or nurse…Research shows high-quality home visiting programs produce significant benefits for both the child and parents including better maternal and child health outcomes, reduced child abuse and neglect, and improved quality of parent-child interactions. In the long term, children are healthier and more successful in school and less likely to have behavior problems or be arrested as they get older. The programs also improve family economic self-sufficiency by increasing parental education attainment, employment and incomes. Ultimately, high-quality voluntary home visiting can produce a substantive return on investment, yielding returns of up to $5.70 for each dollar invested."

PRIOR LEGISLATION:

AB 50 (Mullin) of 2015, would have required DHCS to develop a plan, in consultation with stakeholders, to ensure that evidence-based home visiting programs were offered and provided to Medi-Cal eligible pregnant and parenting women. It was vetoed by the Governor.

ACR 155 (Bocanegra), Chapter 144, Statutes of 2014, urged the Governor to identify evidence-based solutions to reduce children's exposure to adverse childhood experiences, address the impacts of those experiences, and invest in preventive health care and mental health and wellness interventions.

SB 1596 (Runner), Chapter 878, Statutes of 2006, established the Nurse-Family Partnership program to be administered by the Department of Health Services (now CDPH).

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0000900

Date of Hearing: April 26, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 992

Author:(Arambula) – As Amended Ver:March 28, 2017

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

SUMMARY: This bill establishes the California Work Opportunity and Responsibility to Kids (CalWORKs) Baby Wellness and Family Support Home Visiting Program in the Department of Social Services (DSS) to offer a voluntary home visiting program to CalWORKs recipients who are pregnant and/or parenting a child two years old or younger. Specifically, this bill:

1. Creates a voluntary CalWORKs early home visiting program intended to provide services to support health outcomes for pregnant women and infants born into poverty that will improve their likelihood to exit poverty, as specified.
2. Requires the state to provide funds to counties to administer the home visiting program to provide voluntary services to any CalWORKs assistance unit with a recipient who is pregnant or parenting a child up to 24 months of age.
3. Stipulates that participation in the home visiting program must not be considered a condition of CalWORKs eligibility or affect a family’s eligibility for any other CalWORKs benefits.
4. Requires counties to identify eligible assistance units and invite them to participate.
5. Defines “evidence-based home visiting program” to mean a program that met or would meet the criteria approved by the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, as specified.
6. Requires home visiting services to only be provided by a certified nurse, certified nurse practitioner, or certified social worker, and not include mandatory, random, unannounced visits.
7. Requires DSS to collect data from counties related to program outcomes, and requires these data to be annually distributed to the appropriate policy and fiscal committees of the Legislature, as specified.
8. Authorizes DSS to implement the provisions of this bill by all-county letters and requires DSS to adopt regulations to implement the provisions of this bill by October 1, 2019.

FISCAL EFFECT:

Ongoing annual costs of approximately $100 million (GF) for participation in early learning and home visitation services. This assumes approximately 12,000 families will participate annually and includes all administrative, supporting services, and program notification costs.

Staff notes: This program is also being proposed in the Budget process as a Legislative augmentation. The Senate Budget Subcommittee on Health and Human Services (Sub 3) considered the proposal on April 20, 2017. The item is pending consideration in the Assembly Budget Subcommittee (Sub 1).

COMMENTS:

1. Purpose. As part of a continuing Legislative effort to address the needs and barriers facing CalWORKs families, this bill proposes voluntary home visiting services to educate, support, and work with CalWORKs pregnant mothers and/or young children.

According to the author, "Poverty, especially during early childhood can have a devastating impact on child health and well-being and undermines future educational and economic success. Voluntary home visiting programs are a proven strategy for promoting child health, strengthening parenting, and building family self-sufficiency. Through regular, planned visits, trained professionals provide pregnant mothers and new parents with a range of supports to meet the family’s needs: promoting preventive health and prenatal practices, coaching parents on how best to care for their babies and support their early learning, and connecting families to available services."

1. Background. The CalWORKs program provides monthly income assistance and employment-related services aimed at moving children out of poverty and helping families meet basic needs. Federal funding for CalWORKs comes from the TANF block grant. The average 2016-17 monthly CalWORKs cash grant is $533.67 per household. The maximum monthly grant amount for a family of three, if the family has no other income and lives in a high-cost county, is currently $714, yielding 8,568 per year. The current federal poverty threshold for a family of three is $20,420 per year.

According to DSS, over 508,000 families rely on CalWORKs, including close to one million children. In federal fiscal year 2016, approximately 23% of the CalWORKs caseload included a child aged two years or younger.

1. Home visiting and TANF. In federal fiscal year 2015, 14 states reported that at least some of their total federal TANF and state maintenance-of-effort expenditures went toward home visiting programs, which were defined as “expenditures on programs where nurses, social workers, or other professionals/para-professionals provide services to families in their homes."

A publication released from the California Home Visiting Program this month entitled “Connecting CalWORKs with Home Visiting” recommended collaboration between home visiting sites and county welfare departments in order to “assure that low-income families are served and that home visitors have the resources needed to facilitate services.”

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

Date of Hearing: March 21, 2017

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Blanca Rubio, Chair

ABPCA Bill Id:AB 992 (

Author:Arambula) – As Introduced Ver:February 16, 2017

SUBJECT: CalWORKs: Baby Wellness and Family Support Home Visiting Program

SUMMARY: Establishes the California Work Opportunity and Responsibility to Kids (CalWORKs) Baby Wellness and Family Support Home Visiting Program in the Department of Social Services (DSS) to offer a voluntary home visiting program to CalWORKs recipients who are pregnant and/or parenting a child 2 years old or younger.

Specifically, this bill:

1. Creates a voluntary CalWORKs early home visiting program intended to provide services to support health outcomes for pregnant women and infants born into poverty that will improve their likelihood to exit poverty, as specified.
2. Requires the state to provide funds to counties to administer the home visiting program to provide voluntary services to any CalWORKs assistance unit with a recipient who is pregnant or parenting a child up to 24 months of age.
3. Stipulates that participation in the home visiting program shall not be considered a condition of CalWORKs eligibility or affect a family’s eligibility for any other CalWORKs benefits, as specified.
4. Authorizes assistance units that are ineligible for, or not required to participate in, the welfare-to-work program, as specified, to receive home visiting services.
5. Prohibits a parent in an assistance unit from being sanctioned in connection with his or her participation or nonparticipation in the home visiting program, and permits a parent whose assistance unit is receiving services through the program to decline the services at any point with no adverse impact to the case.
6. Requires counties to identify eligible assistance units and invite them to participate in the program.
7. Defines “evidence-based home visiting program” to mean a program that met or would meet the criteria approved by the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, as specified.
8. Defines “home” to mean a temporary or permanent residence or living space or another location identified by the assistance unit in the event that assistance unit is experiencing homelessness.
9. Requires home visiting services to do all of the following:
   1. Only be those intended to provide high-quality, evidence-based, research-based, culturally competent services that meet the needs of at-risk assistance units in underserved communities, support health outcomes, and improve the likelihood of exiting poverty, as specified;
   2. Only be provided by a certified nurse, certified nurse practitioner, or certified social worker; and
   3. Not include mandatory, random, unannounced visits or visits by personnel who are not certified nurses, certified nurse practitioners, or certified social workers involved in the provision of home visiting services.
10. Permits funds allocated to counties for the home visiting program to be used by counties to implement or contract with voluntary home visiting programs, and to be used for coordinating early home visiting services with diaper bank services, family financial capability services, and other services meeting the intent of the CalWORKs Baby Wellness and Family Support Home Visiting Program, as specified.
11. Requires DSS to develop and disseminate an informing notice to ensure that all eligible assistance unites are aware of the program and their ability to participate.
12. Requires DSS to develop written criteria, in consultation with designated stakeholders, for eligibility and provision of services consistent with the provisions of this bill and to provide these notices and criteria, relevant training, and appropriate outreach to counties, as specified.
13. Requires DSS to collect data from counties related to program outcomes, developed in consultation with specified stakeholders, of participants by designated demographic characteristics and requires these data to be annually compiled and distributed to the appropriate policy and fiscal committees of the Legislature, as specified.
14. Requires DSS to consult the California maternal, infant, and early childhood home visiting program benchmark data-collection and reporting mandates in the formulation of this data through collaboration with the State Department of Health Care Services and the State Department of Public Health.
15. Authorizes DSS to implement the provisions of this bill by all-county letters or similar instructions and requires DSS to adopt regulations to implement the provisions of this bill by October 1, 2019.
16. Prohibits appropriation, as specified, from being made to implement the provisions of this bill.

EXISTING LAW:

1. Establishes under federal law the Temporary Assistance for Needy Families (TANF) program to provide aid and welfare-to-work services to eligible families and, in California, provides that TANF funds for welfare-to-work services are administered through the CalWORKs program. (42 U.S.C. 601 et seq., WIC 11200 et seq.)
2. Establishes income, asset, and real property limits used to determine eligibility for the CalWORKs program, including net income below the Maximum Aid Payment (MAP), based on family size and county of residence, which is around 40% of the Federal Poverty Level. (WIC 11150 to 11160, 11450 et seq.)
3. Establishes a 48-month lifetime limit on CalWORKs benefits for eligible adults, including a period beyond the “24 month clock” during which a recipient must meet federal work requirements in order to retain eligibility. (WIC 11454, 11322.85)
4. Requires all individuals 16 years of age or older, unless they are otherwise exempt, to participate in welfare-to-work activities as a condition of eligibility for CalWORKs. (WIC 11320.3, 11322.6)
5. Establishes the number of weekly hours of welfare-to-work participation necessary to remain eligible for aid, including requirements for an unemployed parent in a two-parent assistance unit, as specified. (WIC 11322.8)
6. Provides for family stabilization services for eligible CalWORKs assistance units, as specified. (WIC 11325.24)
7. Establishes the Nurse-Family Partnership program, to be administered by the California Department of Public Health (CDPH), to provide grants to counties for voluntary nurse home visiting programs to be provided to expectant first-time mothers, their children, and their families, as specified. (HSC 123491 – 123493)
8. Establishes the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program as part of the Patient Protection and Affordable Care Act of 2010. (42 U.S.C. Sec. 711).

FISCAL EFFECT: Unknown.

COMMENTS:

CalWORKs: The CalWORKs program provides monthly income assistance and employment-related services aimed at moving children out of poverty and helping families meet basic needs. Federal funding for CalWORKs comes from the TANF block grant. The average 2016-17 monthly CalWORKs cash grant is $533.67 per household, and the maximum monthly grant amount for a family of three, if the family has no other income and lives in a high-cost county, is currently $714, yielding an amount of $8,568 per year. The current federal poverty threshold for a family of three is $20,420 per year.

According to recent data from the Department of Social Services (DSS), over 508,000 families rely on CalWORKs, including close to one million children; in federal fiscal year 2016, approximately 23% of the CalWORKs caseload included a child aged two years or younger.

CalWORKs time limits: Passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) marked the end of the previous Aid to Families with Dependent Children (AFDC) program and the beginning of the block-granted TANF program, under which CalWORKs was established in California state law. Among the numerous programmatic changes included within the TANF program was a requirement that eligible parents work or participate in work training or other activities that lead to employment. The TANF program provides a great deal of flexibility in how states implement their respective programs, including the ability for states to establish more truncated time limits than the 60-month lifetime limit on aid for adult recipients authorized within it. As of 2011, California has limited aid to adult CalWORKs recipients to a lifetime limit of 48 months.

Welfare-to-Work requirements and the 24-month time clock: Welfare-to-work activities within the CalWORKs program include public or private sector subsidized or unsubsidized employment; on-the-job training; community service; secondary school, adult basic education and vocational education and training when the education is needed for the recipient to become employed; specific mental health, substance abuse, or domestic violence services if they are necessary to obtain or retain employment; and a number of other activities necessary to assist a recipient in obtaining unsubsidized employment.

Unless they are exempt, single parent adults with a child under the age of 6 must participate for 20 hours per week in welfare-to-work activities, single parent adults with no children under 6 years old must participate for at least 30 hours per week in welfare-to-work activities, and the minimum participation requirement for two-parent families is 35 hours per week.

SB 1041 (Senate Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2012, adopted a number of changes to the CalWORKs program, including the establishment of the 24-month time clock. While most adult recipients are expected to participate in welfare-to-work activities during the up to 48 months for which they may receive assistance, those participation requirements can include a broad range of activities for 24 of those 48 months, such as employment, training, education, and mental health, domestic violence, and substance abuse services. After this 24-month time clock “runs out,” recipients must meet the less-flexible federal TANF requirements in order to remain eligible for aid. Failure to meet the welfare-to-work requirements per either set of permissible activities can result in a recipient being sanctioned for noncompliance, and that recipient’s portion of the family’s grant subtracted from the amount provided to the family to meet basic needs.

Home visiting programs: Some scholars date the origin of home visiting programs in the United States back to the 1800s, as part of the public health movement, when philanthropic efforts focused on improving the living conditions of poor immigrant families. The kindergarten movement of the mid-1800s to 1900s highlighted the importance of child development. The early models of home visiting involved preventative care and family education, and relied heavily on the contributions of public health nurses.

Today, voluntary home visiting programs are seen as a proven approach to addressing the needs of and improving outcomes for low-income and vulnerable children and their families. These programs typically involve a family receiving regular, planned visits from health, social services, and/or child development professionals and may include the provision of a wide variety of supports and services such as: promoting positive parenting techniques, assisting mothers in learning to breastfeed and care for their infants, working with parents on their educational and career goals, promoting parents’ understanding of developmental milestones and behaviors, and the like.

There are a wide variety of home visiting models, and a number of current models have been rigorously studied and earned a designation as “evidence-based” in contributing to outcomes such as increased child literacy and readiness for school, improved family functioning, reduced rates of child abuse and neglect, and enhanced prenatal health. The United States Department of Health and Human Services (DHHS) established the Home Visiting Evidence of Effectiveness (HomVEE) review to evaluate the body of research on home visiting models and to determine which models meet the DHHS criteria for an evidence-based program model (which involves having a threshold number of impact studies of a certain quality).

Examples of home visiting program models that meet DHHS’s criteria include:

1. Early Head Start – Home Visiting, which targets pregnant women and families with children birth through 3 years old, the majority of which live at or below the poverty level. Home-based services include weekly 90-minute visits, as well as two group socializations events per month for parents and children. Home visitors are required to be trained in certain topics, including early child development and child health, safety, and nutrition. This model has been linked to favorable results in, among other things: maternal health, child development and school readiness, reductions in child maltreatment, and family economic self-sufficiency.
2. Healthy Families America, which targets infants through children who are between 3 and 5 years old; visits begin either while the mother is pregnant or within the first three months after a child is born. Goals of this model include promoting school readiness, reducing maltreatment, and improving parent-child interactions. Staff should have experience in providing services for children and/or families and receive specific training. This model has been linked to favorable results in a number of outcomes, including: child health; family economic self-sufficiency, and reductions in juvenile delinquency, family violence, and crime.
3. Nurse Family Partnership, which is designed for first-time, low-income women and their children under the age of 2. This model involves one-on-one home visits between a family and a trained public health registered nurse. Visits begin early in a woman’s pregnancy (no later than the 28^th week of gestation). This model has been linked to favorable results in areas such as: child and maternal health, child development and school readiness, and reductions in juvenile delinquency, family violence, and crime.

Home visiting in California: Various home visiting models and programs, administered at the state and local levels, currently operate in California. For example, the Nurse-Family Partnership had implementing agencies launched in 1996 in Los Angeles, Fresno, and Oakland as the result of federal Department of Justice Office of Juvenile Justice and Delinquency Prevention funding. SB 1596 (Runner), Chapter 878, Statutes of 2006, established the Nurse-Family Partnership program to be administered by the Department of Health Services (today, the California Department of Public Health [CDPH]) to provide grants for voluntary nurse home visiting programs expectant first-time mothers, their children, and their families; in order to be eligible to receive a grant, counties had to satisfy certain criteria. As of December 2015, Nurse-Family Partnerships were implemented in 21 counties, and 23,249 families had been served since 1996; funding was derived from a variety of sources which include Medicaid, Prop 10 (First 5), Prop 63 (Mental Health Services Act), the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV, described below) program administered by the California Department of Public Health, Public Health Realignment funds, county general funds, and a number of other funding sources.

The MIECHV funding was new as a result of federal health care reform. According to a 2014 report by Next Generation, “The [Patient Protection and Affordable Care Act of 2010] marked an unprecedented federal investment in home visiting programs. The legislation authorized $1.5 billion in new federal funding over five years (from FY 2010 to FY 2014) for states to provide voluntary, evidence-based home visiting programs to support at-risk young children and their families. As a result, the federal Maternal, Infant, and Early Childhood (MIECHV) program was created to provide funding, technical assistance, and evaluation efforts to states.” The California Home Visiting Program (CHVP) was created using MIECHV funds; it is housed in CDPH and administers home visiting programs in various counties using the Nurse-Family Partnership and Healthy Families America models. MIECHV funds have allowed the state an opportunity to supplement other funding for home visiting programs (as with the Nurse-Family Partnership programs described above). The federal budget appropriated $400 million for MIECHV for federal fiscal year 2017, which is the same amount appropriated for the three previous years.

In many jurisdictions across the state, local First 5 Commissions and Early Head Start programs also offer home visiting services to families with pregnant mothers and/or young children. In 2014, Next Generation reported that, “MIECHV funding, along with First 5 Commissions and other federal programs, combine to make a range of home visiting programs available for California families. Many counties also operate federally-funded Early Head Start home visiting programs, and across the state approximately 1,800 children ages 0 to 3 are served by those programs. …In a 2014 survey, First 5 reported investing $55.9 million in home visiting programs in 22 counties, reaching over 27,000 families. …First 5 programs offer a mixture of nationally recognized evidence-based models and locally developed models.”

Home visiting and TANF: Federal law requires that TANF funds be used to meet at least one of the following goals: “(1) provide assistance to needy families so that children may be cared for in their own homes or in the homes of relatives; (2) end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage; (3) prevent and reduce the incidence of out of wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies; and (4) encourage the formation and maintenance of two parent families.” A 2012 report by the Center for Law and Social Policy (CLASP) showed how the outcomes of various home visiting program models aligned with these goals.

In federal fiscal year 2015, 14 states reported that at least some of their total federal TANF and state maintenance-of-effort expenditures went towards home visiting programs, which were defined as “expenditures on programs where nurses, social workers, or other professionals/para-professionals provide services to families in their homes, including evaluating the families’ circumstances; providing information and guidance around maternal health and child health and development; and connecting families to necessary resources and services.” It is also likely that additional states provided TANF-program-based home visiting services that were reported in other expenditure categories.

A publication released from the California Home Visiting Program this month entitled “Connecting CalWORKs with Home Visiting” recommended collaboration between home visiting sites and county welfare departments in order to “assure that low-income families are served and that home visitors have the resources needed to facilitate services.”

Need for this bill: With close to one million low-income California children receiving supports and services through it, CalWORKs is an important state program for addressing child and family poverty. Recent changes to the program have sought to assist families in identifying and addressing barriers to education and employment; these include intensive up-front assessment of family circumstances using the Online CalWORKs Appraisal Tool (OCAT) and provision of family stabilization services. Another important recent change to the program, which went into effect at the beginning of this calendar year, has been the repeal of the “maximum family grant” (MFG) rule, which denied families financial assistance for any child born into the family while a member of the household was receiving CalWORKs aid.

These two sets of changes – to address the needs and barriers facing CalWORKs families and to restore grant amounts for children born into these families – taken together indicate an evolution of CalWORKs, largely in response to Legislative and stakeholder action, to better address child poverty in order to mitigate its many deleterious impacts and to assist parents in getting the supports and developing the tools necessary to meet the needs of their families. These program changes of late would be complemented by this bill’s proposal to offer voluntary home visiting services to educate, support, and work with CalWORKs assistance units with pregnant mothers and/or young children in meeting their goals.

According to the author:

“Poverty, especially during early childhood can have a devastating impact on child health and well-being and undermines future educational and economic success.

[This bill] creates the CalWORKs Baby Wellness and Family Support Home Visiting Program to provide CalWORKs recipients who are pregnant or parenting a child under age 2 with voluntary home visiting services from trained professionals.

Voluntary home visiting programs are a proven strategy for promoting child health, strengthening parenting, and building family self-sufficiency. Through regular, planned visits, trained professionals provide pregnant mothers and new parents with a range of supports to meet the family’s needs: promoting preventive health and prenatal practices, coaching parents on how best to care for their babies and support their early learning, and connecting families to available services.

[This bill] clarifies that home visiting services would only be intended to achieve the goals of improving child health and family wellbeing and would only be provided by a certified nurse, certified nurse practitioner, or a certified social worker. The legislation establishes that the home visits would not be in mandatory, random, unannounced visits and must be completed by a licensed professional social worker or nurse.

The home visiting services would be evidence-based under the criteria of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which has been established nationally with bi-partisan support. Counties would have the flexibility to meet local needs by implementing the program or partnering with approved home visiting programs that are working in local communities. Participation in the program would be entirely voluntary for eligible families.

Research shows high-quality home visiting programs produce significant benefits for both the child and parents including better maternal and child health outcomes, reduced child abuse and neglect, and improved quality of parent-child interactions. In the long term, children are healthier and more successful in school and less likely to have behavior problems or be arrested as they get older. The programs also improve family economic self-sufficiency by increasing parental education attainment, employment and incomes. Ultimately, high-quality voluntary home visiting can produce a substantive return on investment, yielding returns of up to $5.70 for each dollar invested.”

Staff comments: Child-only cases comprise close to one-third of all CalWORKs cases. The purpose of home visiting programs is to support low-income children and their families through the provision of a variety of services by trained professionals; pregnant mothers and young children in assistance units with unaided adults could arguably stand to benefit from home visiting services as much as, if not more than, those mothers and children in other types of assistance units.

Recommended amendments: In order to ensure that the CalWORKs Baby Wellness and Family Support Home Visiting Program proposed by this bill is made available to Child Only CalWORKs assistance units, alongside other assistance units, and in order to make a number of other technical changes aimed at clear and consistent use of terminology and references, committee staff recommends the following amendments beginning on line 8 of page 2 of the bill:

11337.   (a) Effective January 1, 2018, the The Legislature hereby

9

establishes the CalWORKs Baby Wellness and Family Support

10

Home Visiting Program in the State Department of Social Services.

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This is as a voluntary CalWORKs early home visiting program to

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serve recipients of aid under this chapter for the purpose of

2

supporting health outcomes for pregnant women and infants born

3

into poverty, expanding their future educational, economic, and

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financial capability opportunities, and improving the likelihood

5

that they will exit poverty. The program is intended to provide

6

high-quality, evidence-based, research-based, culturally competent

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services that meet the needs of at-risk assistance units, including those in

8

underserved communities, including rural, tribal, and impoverished, and other

9

communities.

10

(b) The state shall subvene allocate funds to counties for the purpose of

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administering the CalWORKs Baby Wellness and Family Support

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Home Visiting Program, to provide voluntary maternal, infant,

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and early childhood home visiting services to any CalWORKs

14

assistance units with a recipient who is pregnant or parenting a

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child 24 months of age or younger. Participation in this program

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shall not be considered a condition of CalWORKs eligibility.

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Assistance units receiving home visiting services need not be

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eligible for or required to participate in the welfare-to-work

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program established pursuant to Article 3.2 (commencing with

20

Section 11320). Participation in a home visiting program shall not

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affect a family’s eligibility for any other CalWORKs benefits,

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supports, or services, including, but not limited to, welfare-to-work

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exemptions pursuant to subdivision (b) of Section 11320.3, good

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cause for not participating pursuant to subdivision (f) of Section

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11320.3, participating in housing support services pursuant to

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Article 3.3 (commencing with Section 11330), or participating in

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family stabilization pursuant to Section 11325.24.

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(c) Home visiting participation is a voluntary program to provide

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needed services and constructive interventions for at-risk CalWORKs families

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with a child 24 months of age or younger. A parent in the assistance

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unit shall not be sanctioned in connection with his or her

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participation or nonparticipation in this program. A parent whose

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assistance unit is receiving services through the program may

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decline or terminate home visiting the services offered pursuant to this section at any point time with no adverse impact to their CalWORKs

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case.

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(d) (1) (A) Counties shall identify eligible assistance units

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pursuant to this section and shall invite them to participate in the

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program. For those who decide to participate, the program shall

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provide evidence-based home visiting program services.

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(B) “Evidence-based home visiting program” means a program

2

that met or would meet the criteria approved by the United States

3

Department of Health and Human Services criteria for evidence-based home visiting program models. Maternal, Infant, and

4

Early Childhood Home Visiting (MIECHV) Program adopted

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April 1, 2015, as described in Section 511(d)(3)(A)(i)(I) of Title

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V of the federal Social Security Act (42 U.S.C. Sec. 711).

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(2) (A) Home visiting services shall only be those intended to

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achieve the goals established in subdivision (a) and that are

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provided in the home of an assistance unit. Home visiting services

10

shall only be provided by a certified nurse, certified nurse

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practitioner, or a certified social worker.

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(B) A “home“ is defined in this section as a temporary or

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permanent residence or living space, or another location identified

14

by the assistance unit in the case that the assistance unit is

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homeless.

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(3) Home visiting services shall not include mandatory, random,

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unannounced visits or visits by any personnel that do not meet the

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qualifications consistent with paragraph (2).

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(e) Funds allocated to counties for this home visiting program

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may be used by counties to implement or to contract with voluntary

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maternal, infant, and early childhood home visiting programs

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approved by the department pursuant to subparagraph (B) of paragraph (1) of subdivision (d). , including, but not limited to, the

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California Home Visiting Program, a home visiting program funded

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in whole or in part by the state or a local First 5 Commission, or

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another voluntary home visiting program for low-income

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Californians that is approved by the United States Department of

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Health and Human Services. These funds may also be used to

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coordinate early home visiting services with diaper bank services,

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family financial capability services, and other services that would

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meet the intent of the CalWORKs Baby Wellness and Family

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Support Home Visiting Program, as established in subdivision (a).

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(f) The department State Department of Social Services shall develop and

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disseminate an informing notice, to ensure that all assistance units

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who are which contain a woman who is pregnant, parenting, adopting, or fostering or a child 24

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months of age or younger are aware of the program and their ability

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to participate. The department shall develop written criteria for

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eligibility and provision of services consistent with this section.

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These notices and written criteria shall be developed in consultation

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with stakeholders, including appropriate legislative staff, the

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Western Center on Law and Poverty, and the County Welfare

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Directors Association, and shall be disseminated to counties, with

2

training on the identification of potentially eligible assistance units

3

and appropriate outreach provided to county staff prior to the

4

effective date of program implementation.

5

(g) The department shall collect data from counties related to

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the outcomes of participants and children by race, ethnicity,

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national origin, primary and secondary language, and county. This These

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data shall include program outcomes for the parents and children

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served in the program and these data components shall be

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developed in consultation with stakeholders, including appropriate

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legislative staff, the State Department of Health Care Services and the State Department of Public Health home visiting program administrators, the Western Center on Law and Poverty, and the

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County Welfare Directors Association. This These data shall be compiled

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and distributed to the appropriate policy and fiscal committees of

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the Legislature each year January 30^th. on a date that is arrived at with these

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same stakeholders in the first year of implementation. The State

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Department of Social Services shall consult the California maternal,

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infant, and early childhood home visiting program benchmark

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data-collection and reporting mandates in the formulation of this

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data through collaboration with the State Department of Health

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Care Services and the State Department of Public Health.

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(h) Notwithstanding the rulemaking provisions of the

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Administrative Procedure Act (Chapter 3.5 (commencing with

23

Section 11340) of Part 1 of Division 3 of Title 2 of the Government

24

Code), the department may implement this section by all-county

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letters or similar instructions until regulations are adopted. Thereafter, the The department shall

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adopt regulations to implement this section by October 1, 2019.

PRIOR LEGISLATION:

AB 50 (Mullin), 2015, would have required DHCS to develop a plan, in consultation with stakeholders, to ensure that evidence-based home visiting programs were offered and provided to Medi-Cal eligible pregnant and parenting women. It was vetoed by the Governor.

ACR 155 (Bocanegra), Chapter 144, Statutes of 2014, urged the Governor to identify evidence-based solutions to reduce children’s exposure to adverse childhood experiences, address the impacts of those experiences, and invest in preventive health care and mental health and wellness interventions.

SB 1596 (Runner), Chapter 878, 2006, established the Nurse-Family Partnership program to be administered by the Department of Health Services (now CDPH).

REGISTERED SUPPORT / OPPOSITION:

Support

Advokids

American Academy of Pediatrics, CA

Black Women for Wellness (Sponsor)

California Alternative Payment Program Association (CAPPA)

Children’s Defense Fund – CA (Sponsor)

County Welfare Directors Association

Courage Campaign

Nurse Family Partnership

United Ways of California (UWCA)

Western Center on Law and Poverty (Sponsor)

Women’s Foundation of CA

Opposition

None on file.

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