Date of Hearing: June 19, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

SBPCA Bill Id:SB 301

Author:(Leyva) – As Amended Ver:March 21, 2019

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

SUMMARY:

This bill requires the Department of Health Care Services (DHCS), if there is any reduction in federal financial participation (FFP) to the Family Planning, Access, Care, and Treatment (Family PACT) Program, to submit to the Legislature a plan to ensure the sustainability of the Family PACT Program and specified services provided by the program.

This bill also requires the plan to include, but not be limited to, both of the following:

1. An estimate of the amount of funding that would be required to sustain the level and scope of services provided under the Family PACT Program as those services that existed on January 1, 2019.
2. Identification of non-state or special funds that could be used to sustain program services.

FISCAL EFFECT:

Costs to Department of Health Care Services are expected to be minor and absorbable (GF/federal).

COMMENTS:

1. Purpose. According to the author, over the past two years, congressional proposals have called for shifting all federal Medicaid funding to states to block grant form. If any of those proposals were implemented, the current match for family planning services in California could be threatened. This bill requires a plan for the sustainability of family planning care for low-income and uninsured Californians.
2. Background. Family PACT is a limited-benefits health program administered by DHCS that provides family planning and related services. Family PACT benefits include all federal Food and Drug Administration (FDA)-approved contraceptive methods and supplies, family planning counseling and education, sexually transmitted infection testing and treatment, HIV screening, cervical cancer screening, male and female permanent contraception, and limited infertility services.

Family PACT is available to California residents under 200% of federal poverty level who need and who have no other source of coverage for family planning services. Federal funds make up $338 million of the program’s estimated total cost of $442 million in 2018-19.

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

Date of Hearing: June 11, 2019

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 301

Author:(Leyva) – As Amended Ver:March 21, 2019

SENATE VOTE: 38-0

SUBJECT: Medi-Cal: family planning services.

SUMMARY: Requires the Department of Health Care Services (DHCS), if there are any reductions in federal financial participation (FFP) to the Family Planning, Access, Care, and Treatment (Family PACT) Program, to submit to the Legislature a plan to ensure the sustainability of the Family PACT Program. Specifically, this bill:

1. Requires DHCS, if there are any reductions in FFP to the Family PACT Program to submit to the Legislature a plan to ensure the sustainability of the Family PACT Program, and the expanded services for males of laboratory testing for sexually transmitted infections (STIs) and comprehensive physical examinations within 60 days of the reduction in that federal funding.
   
2. Requires the plan to include, but not be limited to, both of the following:
   
   1. An estimate of the amount of funding that would be required to sustain the level and scope of services provided under the Family PACT Program as those services existed on January 1, 2019; and,
      
   2. Identification of non-state or special funds that could be used to sustain program services.

EXISTING LAW:

1. Establishes in DHCS the State-Only Family Planning Program (Family PACT) to provide comprehensive clinical family planning services to low-income men and women.
   
2. Requires Family PACT family planning services to include, but are not limited to, preconception counseling, maternal and fetal health counseling, general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, medical family planning treatment and procedures, including supplies and follow-up, and informational, counseling, and educational services.
   
3. Requires family planning services for males to include laboratory tests for STIs and comprehensive physical examinations, subject to federal approval and FFP.
   
4. Excludes coverage for, under Family PACT, abortion, pregnancy testing solely for the purposes of referral for abortion or services ancillary to abortions, not including contraceptives, or pregnancy care that is not incident to the diagnosis of pregnancy.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, for many years, California has made a concerted effort to expand and protect family planning services. As changes in our federal policies seem to be occurring at a more rapid and drastic pace, California must do all it can to ensure access to quality family planning services. This bill require a plan for the sustainability of family planning care for low-income and uninsured Californians including contraception, STI testing and treatment and other related services in the event of reductions in federal funding. Specifically, this bill requires DHCS to submit a plan to the Legislature to ensure the sustainably of the expanded Family PACT services, should a reduction in federal financial participation for those services occur.
2. BACKGROUND. DHCS’ Office of Family Planning (OFP) administers Family PACT, which provides comprehensive family planning and reproductive health services at no cost to eligible low-income men and women. Established by the Legislature in and operating since 1996, current eligibility for Family PACT is for persons who meet all of the following criteria:
   1. The person is a resident of California;
      
   2. The person has a family income at or below 200% of the federal poverty level (FPL) [at or below $42,660 for a family of three in 2019];
      
   3. The person has no other source of health care coverage unless the use of that health care coverage would create a barrier to access because of confidentiality; and,
      
   4. The person is not otherwise eligible for existing Medi-Cal services without a share of cost.

In 2014-15, Family PACT served 1.3 million income eligible men and women of childbearing age through a network of 7,240 public and private providers (2,539 clinician providers, such as physician groups, solo practitioners, clinics and certified nurse practitioners, 4,607 pharmacies, and 128 laboratories). Family PACT services fall into three main categories: clinician services, pharmacy services, and laboratory services. In 2014-15, 87% of Family PACT clients were women and 17% were men, and nearly 93% of Family PACT clients had incomes at or below 138% of the FPL. Under Family PACT, family planning services and testing for STIs are eligible for 90% FFP, the treatment of STIs and other family planning-related services are eligible for 50% FFP and it is assumed that 13.95% of the Family PACT population are undocumented and are budgeted at 100% General Fund (GF). The DHCS budget for Family PACT is $402 million in 2019-20 ($307.3 million federal funds, $94.8 million GF). This amount includes the time-limited Proposition 56 funded supplemental payments at a rate equal to 150% of the current Family PACT rates for specific family planning services.

1. SUPPORT. This bill is sponsored by Essential Access Health and supported by provider, consumer, and women’s reproductive rights group. Supporters state that, over the past two years, Congressional proposals have called for shifting all federal Medicaid funding to states to block grants. If this proposal – or others similar in nature - were to be implemented, the current match could be threatened. This bill directs the DHCS to create a plan to ensure the sustainability of the Family PACT program, should a significant shift in federal funding occur. Supporters argue that Family PACT has reduced the number of unintended pregnancies in California resulting in substantial financial savings to local, state, and federal governments. California has already enacted several measures to hold the line and protect access to sexual and reproductive health care from hostile actions on the federal level. Supporters conclude that this bill will help ensure the sustainability of Family PACT in the face of shifting political environments.
2. RELATED LEGISLATION. SJR 4 (Leyva) urges the United States Department of Health and Human Services to rescind the new Title X regulations. SJR 4 is pending in the Assembly Health Committee.
3. PREVIOUS LEGISLATION. SB 743 (Hernandez), Chapter 572, Statutes of 2017, prohibits a Medi-Cal managed care plan from restricting the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program, and required a plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.

REGISTERED SUPPORT / OPPOSITION:

Support

Essential Access Health (sponsor)
American Civil Liberties Union of California
American Congress of Obstetricians & Gynecologists - District IX
California Academy of Family Physicians
CaliforniaHealth+ Advocates
Health Officers Association of California
National Association of Social Workers, California Chapter
National Health Law Program
The Los Angeles Trust For Children's Health

Opposition

None on file.

Analysis Prepared by: Scott Bain / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 301

Author: Leyva (D)

Amended: 3/21/19

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 3/20/19

AYES: Pan, Stone, Durazo, Hurtado, Leyva, Mitchell, Monning, Rubio

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT: Medi-Cal: family planning services

SOURCE: Essential Access Health

DIGEST:

This bill requires the Department of Health Care Services, if there are any reductions in federal financial participation for services under the Family PACT program, to submit to the Legislature, as specified, a plan to ensure the sustainability of those services.

ANALYSIS:

Existing law:

1. Establishes the Family PACT program, which is administered by the Department of Health Care Services (DHCS), to provide comprehensive clinical family planning services, including, but not limited to, preconception counseling, maternal and fetal health counseling, general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, medical family planning treatment and procedures, including supplies and follow-up, and informational, counseling, and educational services, to qualified, low income individuals. [WIC §14132 (aa)]
2. Requires family planning services for males under the state-only Family PACT program to include laboratory tests for sexually transmitted infections (STIs) and comprehensive physical examinations.  Requires the implementation of these services to be dependent upon federal approval and receipt of federal financial participation (FFP).  [WIC § 24001 (a)(2)]
3. Requires DHCS to seek a Medi-Cal waiver or state plan amendment, as specified, for purposes of the Family PACT program. Requires Family PACT, to the extent that FFP is available, to continue to conduct education, outreach, enrollment, service delivery, and evaluation services as specified under such a waiver. Requires the services to be provided under the program only if the waiver or state plan amendment are approved by the federal Centers for Medicare and Medicaid Services and only to the extent that FFP is available for the services. [WIC §14132 (aa)(2)]

This bill requires DHCS, if there are any reductions in FFP for family planning services under the Family PACT program, to submit to the Legislature, as specified, a plan to ensure the sustainability of those services.

Comments

1. Author’s statement. According to the author, for many years, California has made a concerted effort to expand and protect family planning services. As changes in our federal policies seem to be occurring at a more rapid and drastic pace, California must do all it can to ensure access to quality family planning services. This bill provides a plan for the sustainability of family planning care for low-income and uninsured Californians including contraception, STI testing and treatment and other related services in the event of reductions in federal funding. Specifically, this bill updates current statute to mirror the current status of the Family PACT program and requires DHCS to submit a plan to the legislature to ensure the sustainably of the expanded Family PACT services, should a reduction in FFP for those services occur.
2. Family planning services. According to the Guttmacher Institute, federal and state governments have worked for decades to expand access to family planning services for young and low-income women and men, channeling public funds through multiple programs. The Medicaid program provides the large majority of public funding for clinical care through coverage of these services. Title X national family planning program provides additional funding for family planning centers, sets standards of care, and fills gaps in services and coverage. A September 2016 Guttmacher Institute Fact Sheet states that the contraceptive services provided help individuals avoid unintended and unwanted pregnancies, unplanned births, and abortions that might follow. Publicly supported family planning visits also include screenings for STIs such as chlamydia, gonorrhea and HIV; cervical cancer prevention services, including Pap tests and testing and vaccination for human papillomavirus; and other key preventive care services, all of which have their own health benefits. Collectively, these family planning services yield substantial government savings—$13.6 billion nationally in 2010, or $7.09 for every public dollar spent.
3. Family PACT. Family PACT was created in 1996, is administered by DHCS’ Office of Family Planning, and is funded through 90% federal funds and 10% state funds. The program serves 1.1 million income eligible men and women of childbearing age through a network of 2,200 public and private providers. Family PACT provides comprehensive family planning services to women and men including all FDA-approved forms of contraception, emergency contraception, pregnancy testing with counseling, preconception counseling, male and female sterilization, limited infertility services, STI testing and treatment, cancer screening, and HIV screening. Licensed Medi-Cal providers in good standing are eligible to serve clients once they have attended a mandatory Provider Orientation and have an accepted Application and Enrollment Agreement. Reimbursement is generally consistent with California’s Medi-Cal fee-for-service rates. Family PACT clients are female and male residents of California with a family income at or below 200% of the federal poverty level with no other source of family planning coverage. Individuals with a medical necessity for family planning services who do not have Medi-Cal and do not have access to health insurance are eligible for Family PACT. Medi-Cal clients with an unmet share of cost may also be eligible. Eligibility determination and enrollment are conducted at the provider’s office. Family PACT clinician providers include private physicians in individual or group settings, nonprofit community-based clinics, OB/GYNs and physicians representing general practice, family practice, internal medicine and pediatrics. Medi-Cal licensed pharmacies and laboratories also participate by referrals from enrolled Family PACT clinicians.

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

SUPPORT: (Verified 4/10/19)

Essential Access Health (source)

American Civil Liberties Union of California

American College of Obstetricians and Gynecologists, District IX California

CaliforniaHealth+ Advocates

National Health Law Program

OPPOSITION: (Verified 4/10/19)

None received

ARGUMENTS IN SUPPORT: According to Essential Access Health (EAH), the sponsor of this bill, Family PACT program evaluations conducted by the University of California, San Francisco’s Bixby Center for Global Reproductive Health showed that for every dollar spent on the program, the public sector saves $9.25 in public health and social welfare expenses. Over the past three decades, Family PACT and Title X have partnered to reduce unintended pregnancy rates in California to historic lows. The Family PACT program is currently funded by a 90/10 federal match, however over the past two years, Congressional proposals have called for shifting all federal Medicaid funding to states to block grants. If this proposal – or others similar in nature - were to be implemented, the current match could be threatened. California has already enacted several measures to hold the line and protect access to sexual and reproductive health care in the face of hostile actions on the federal level. EAH states that this bill will help ensure Family PACT’s sustainability in the face of shifting political environments. The American College of Obstetricians and Gynecologists, District IX California, writes that vital services provided by this program include contraception, STD testing, treatment and other related services, and that those services should not be subject to reductions in federal funding.

Prepared by: Melanie Moreno / HEALTH / (916) 651-4111

4/10/19 16:15:34

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: SB 301

SUBJECT: Family planning services

SUMMARY:

Requires the Department of Health Care Services, if there are any reductions in federal financial participation for services to males under the State-only Family PACT program, to submit to the Legislature, as specified, a plan to ensure the sustainability of those services.

Existing law:

1. Establishes the Family PACT program, which is administered by the Department of Health Care Services (DHCS), to provide comprehensive clinical family planning services, including, but not limited to, preconception counseling, maternal and fetal health counseling, general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, medical family planning treatment and procedures, including supplies and follow-up, and informational, counseling, and educational services, to qualified, low income individuals. [WIC §14132 (aa)]
2. Requires family planning services for males under the State-only Family PACT program to include laboratory tests for sexually transmitted infections (STIs) and comprehensive physical examinations.  Requires the implementation of these services to be dependent upon federal approval and receipt of federal financial participation (FFP).  [WIC § 24001 (a)(2)]
3. Requires DHCS to seek a Medi-Cal waiver or state plan amendment, as specified, for purposes of the Family PACT program. Requires Family PACT, to the extent that FFP is available, to continue to conduct education, outreach, enrollment, service delivery, and evaluation services as specified under such a waiver. Requires the services to be provided under the program only if the waiver or state plan amendment are approved by the federal Centers for Medicare and Medicaid Services (CMS) and only to the extent that FFP is available for the services. [WIC §14132 (aa)(2)]

This bill: Requires DHCS, if there are any reductions in FFP for family planning services for males under the State-only Family PACT program, to submit to the Legislature, as specified, a plan to ensure the sustainability of those services.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, for many years, California has made a concerted effort to expand and protect family planning services. As changes in our federal policies seem to be occurring at a more rapid and drastic pace, California must do all it can to ensure access to quality family planning services. This bill provides a plan for the sustainability of family planning care for low-income and uninsured Californians including contraception, STI testing and treatment and other related services in the event of reductions in federal funding. Specifically, this bill updates current statute to mirror the current status of the Family PACT program and requires DHCS to submit a plan to the legislature to ensure the sustainably of the expanded Family PACT services, should a reduction in FFP for those services occur.
2. Family planning services. According to the Guttmacher Institute, federal and state governments have worked for decades to expand access to family planning services for young and low-income women and men, channeling public funds through multiple programs. The Medicaid program provides the large majority of public funding for clinical care through coverage of these services. Title X national family planning program provides additional funding for family planning centers, sets standards of care, and fills gaps in services and coverage. A September 2016 Guttmacher Institute Fact Sheet states that the contraceptive services provided help individuals avoid unintended and unwanted pregnancies, unplanned births, and abortions that might follow. Publicly supported family planning visits also include screenings for STIs such as chlamydia, gonorrhea and HIV; cervical cancer prevention services, including Pap tests and testing and vaccination for human papillomavirus (HPV); and other key preventive care services, all of which have their own health benefits. Collectively, these family planning services yield substantial government savings—$13.6 billion nationally in 2010, or $7.09 for every public dollar spent.
3. Family PACT. Family PACT was created in 1996, is administered by DHCS’ Office of Family Planning, and is funded through 90% federal funds and 10% state funds. The program serves 1.1 million income eligible men and women of childbearing age through a network of 2,200 public and private providers. Family PACT provides comprehensive family planning services to women and men including all FDA- approved forms of contraception, emergency contraception, pregnancy testing with counseling, preconception counseling, male and female sterilization, limited infertility services, STI testing and treatment, cancer screening, and HIV screening. Licensed Medi-Cal providers in good standing are eligible to serve clients once they have attended a mandatory Provider Orientation and have an accepted Application and Enrollment Agreement. Reimbursement is generally consistent with California’s Medi-Cal fee-for-service rates. Family PACT clients are female and male residents of California with a family income at or below 200% of the federal poverty level with no other source of family planning coverage. Individuals with a medical necessity for family planning services who do not have Medi-Cal and do not have access to health insurance are eligible for Family PACT. Medi-Cal clients with an unmet share of cost may also be eligible. Eligibility determination and enrollment are conducted at the provider’s office. Family PACT clinician providers include private physicians in individual or group settings, nonprofit community-based clinics, OB/GYNs and physicians representing general practice, family practice, internal medicine and pediatrics. Medi-Cal licensed pharmacies and laboratories also participate by referrals from enrolled Family PACT clinicians.
4. Support. According to Essential Access Health (EAH), the sponsor of this bill, Family PACT program evaluations conducted by the University of California, San Francisco’s Bixby Center for Global Reproductive Health showed that for every dollar spent on the program, the public sector saves $9.25 in public health and social welfare expenses. Over the past three decades, Family PACT and Title X have partnered to reduce unintended pregnancy rates in California to historic lows. The Family PACT program is currently funded by a 90/10 federal match, however over the past two years, Congressional proposals have called for shifting all federal Medicaid funding to states to block grants. If this proposal – or others similar in nature - were to be implemented, the current match could be threatened. California has already enacted several measures to hold the line and protect access to sexual and reproductive health care in the face of hostile actions on the federal level. EHA states that this bill will help ensure Family PACT’s sustainability in the face of shifting political environments. The American College of Obstetricians and Gynecologists, District IX California, writes that vital services provided by this program include contraception, STD testing, treatment and other related services, and that those services should not be subject to reductions in federal funding.
5. Amendments. In line with the author and sponsor’s intent, this bill should be amended to move its language to the Family PACT authorizing statute, therefore applying the report to the sustainability of the entire program, and to clarify that the sustainability plan be submitted to the Legislature within 60 days of a reduction in FFP, as follows:

Add WIC 14132.04

If there are any reductions in federal financial participation, the department shall, within 60 days of the reduction in that federal funding, submit to the Legislature, in compliance with Section 9795 of the Government Code, a plan to ensure the sustainability of the Family PACT Program, and the expanded services described in paragraph (2) of subdivision (a) of Section 24001. The plan shall include, but not be limited to, both of the following:

(i) An estimate of the amount of funding that would be required to sustain the level and scope of services provided under the Family PACT Program as those services existed on January 1, 2019.

(ii) Identification of nonstate or special funds that could be used to sustain program services.

SUPPORT AND OPPOSITION:

Support: Essential Access Health (sponsor)

American Civil Liberties Union of California

American College of Obstetricians and Gynecologists, District IX California

CaliforniaHealth+ Advocates

National Health Law Program

Oppose: None received

-- END --