Policy At A Glance: December 2019 INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

AB 577 Health Care Coverage: Maternal Mental Health

AB 942

New California Public Health Laws

New 2020 California Public Health Legislation

AB 577. Health Care Coverage: Maternal Mental Health Prenatal and postpartum depression and anxiety are a common medical complication of childbirth in the United States, affecting one in seven women.1 Maternal depression also affects one in ten children in any given year, placing these children at a greater risk for delayed cognitive and language development, mental health problems, and behavioral problems.2 Further, less than 15 percent of maternal mental health disorders are treated.3 Researchers estimate the national cost of untreated maternal mental health to be $14.2 billion in 2017.1

Bringing wholeness to individuals and communities, the Institute for Health Policy and Leadership (IHPL) strives to integrate health policy research and education with

leadership development. Our goal is to improve the health of our communities by building on our strong heritage of health promotion and disease prevention.

To learn more, visit us at www.IHPL.llu.edu

In October, Governor Newsom signed 870 out of 1,042 bills passed by California’s legislature during its regular session. In this issue of ‘Policy At A Glance,’ we will provide a

roundup of five notable public health bills going into effect in 2020.

In his first year in office, Governor Gavin Newsom considered over 1,000 bills ranging from incorporating cultural competency into emergency plans to vaping in state parks and beaches to limiting rent inflation.

He also signed a number of bills related to public health. Below is a summary of these new laws, listed in numerical order by Assembly Bill (AB) or Senate Bill (SB). The effective date is January 1, 2020, unless otherwise noted.

HIV: Preexposure and Postexposure Prophylaxis

CalFresh: Restaurant Meals Program

SB 159

SB 265

SB 276 Immunizations: Medical Exemptions

Pupil Meals: Child Hunger: Child Hunger Prevention and Fair Treatment Act of 2017

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP December 2019

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AB 577 allows women to complete treatment for maternal mental health condition with their treating health care provider (for up to 12 months from the diagnosis or from the end of pregnancy) even when the provider has been terminated or is no longer participating in her current health plan. AB 577 defines a maternal mental health condition as “a mental health condition that can impact a woman during pregnancy, peri or postpartum, or that arises during pregnancy, in the peri or postpartum period, up to one year after delivery.” This definition essentially extends the required duration that private plans have to provide continuity of care for pregnant women.4

The extension of covered services under AB 577 is contingent upon the woman presenting a written documentation of diagnosis as well as her provider agreeing to accept the reimbursement rate. To learn more about AB 577, please refer to the October issue of Policy At A Glance.

AB 942. CalFresh: Restaurant Meals Program

CalFresh is California’s Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. This program is the largest nutrition assistance program in California and is fully funded by the federal government.5 Eligible families receive a monthly allowance in the form of an Electronic Benefit Transfer (EBT) card that can only be spent on non-prepared food items.

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The average monthly CalFresh benefit is $126 per person, with a maximum benefit amount of $192 per person.5

Traditionally Covered Under CalFresh

Traditionally Not Covered Under

CalFresh Breads, Cereals, Meats,

Fruits, Vegetables, Seeds or Plants that can

grow food

Non-food Items such as Pet Food, Soap, Hot Foods or Foods Eaten

in the Store

The Restaurant Meals Program (RMP) allows CalFresh recipients who are unable to cook foods on their own (older than 60 years, disabled, or homeless) to purchase low cost, prepared meals at participating restaurants.6 As this is an optional county program, only ten counties currently participate in RMP: Alameda, Los Angeles, Orange, Riverside, Sacramento, San Diego, San Francisco, San Luis Obispo, Santa Clara, and Santa Cruz.6

AB 942, the Access to Safe Food Choices and Food Security Act of 2019, establishes a statewide RMP by September 1, 2020. RMP restaurants must welcome all RMP-eligible individuals, may not charge sales tax, meal tax, or gratuities, and agree to post an “EBT Accepted Here” sign.5

SB 159. HIV: Preexposure and Postexposure Prophylaxis

While Human Immunodeficiency Virus (HIV) can be controlled, there is no effective cure for HIV. In California, almost 5,000 new HIV cases have been identified every year since 2012, with 88 percent occurring in males.7

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP December 2019

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Preexposure Prophylaxis (PrEP) and Postexposure Prophylaxis (PEP) are antiretroviral drug treatments that can prevent new HIV infections. When taken daily by individuals engaging in high-risk behaviors, PrEP can reduce the risk of an HIV infection through sex and needle sharing by 99 percent and 74 percent, respectively.8 PEP is taken once or twice a day for 28 days to prevent a potential infection within 72 hours after exposure. PEP is not recommended as a routine therapy for high-risk individuals.9 SB 159 increases the accessibility of PrEP and PEP by allowing pharmacists to dispense them without a prescription. SB 159 also expands Medi-Cal (California’s version of Medicaid) benefits to include PrEP and PEP as pharmacist services. Under SB 159, pharmacists have to finish a training program in order to furnish a 30 or 60-day supply of PrEP and a full course of PEP.

SB 265. Pupil Meals: Child Hunger: Child Hunger Prevention and Fair Treatment Act of 2017.

Some California school districts serve students with school meal debts half a cheese sandwich and four ounces of juice.10 In schools across the country, it is common practice to serve non-menu items such as cheese or peanut butter and jelly sandwiches to students with outstanding meal debts.11 An elementary school in Alabama even stamped, “I need lunch money,” on a child’s arm.12 These practices are known as “lunch shaming.”

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The Child Hunger Prevention and Fair Treatment Act of 2017 prohibits public and nonprofit private schools providing student meals with federal funding from shaming, treating differently, or serving an alternative meal to children with unpaid school meal fees. That is, schools cannot require children with unpaid fees to go through a separate serving line, use a separate entrance, eat at a different time, or use special tokens or tickets to receive their meals.10 However, a provision in the 2017 law allows some school districts to continue the practice if they have an existing meal charge policy that prescribes it.

SB 265 is an urgency statute and immediately removes this provision from the Child Hunger Prevention and Fair Treatment Act until July 1, 2026. Accordingly, SB 265 ensures that all students with unpaid meal fees have a meal of the student’s choice and that the student is not shamed or treated differently from other students.

SB 276. Immunizations: Medical Exemptions

Vaccine exemptions vary from state to state. With the passage of SB 277 in 2015, California became one of five states, along with Maine, New York, Mississippi, and West Virginia, that only allows medical reasons to bypass childhood vaccines.13 Since 2015, however, medical exemption rates in California more than quadrupled.14 This trend is more salient in some schools, especially public charter schools, where 30 to 50 percent of children had medical exemptions in 2018.15

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP December 2019

SB 276 requires the California Department of Public Health (CDPH) to monitor school immunization rates and the number of medical exemptions written by each physician. SB 276 also allows the state Public Health Officer to revoke or deny medical exemptions under certain circumstances. Under SB 276, CDPH will develop an electronic medical exemption certification and may only accept it as documentation of medical exemption beginning January 1, 2021. The Governor also approved SB 714, whose provisions are contingent upon the enactment of SB 276. If a child was issued a medical exemption before January 1, 2020, SB 714 allows that child to continue with school. After July 1, 2021, SB 714 requires the same child to be immunized or file a medical exemption through the new statewide process. To learn more about SB 276, please refer to the August issue of Policy At A Glance. References

1. https://www.mathematica.org/news/new-study-uncovers-the-heavy-financial-toll-of-untreated-maternal-mental-health-conditions

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253390/ 3. https://www.disabilityrightsca.org/system/files/file-

attachments/AB577EggmanHealthCareCoverageMaternalMentalHealthRequestForSignatureSeptember102019.pdf

4. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201920200AB577

5. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201920200AB942

6. https://www.cdss.ca.gov/benefits-services/food-nutrition-services/restaurant-meals-program

7. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201920200SB159

8. https://www.cdc.gov/hiv/risk/prep/index.html 9. https://www.cdc.gov/hiv/basics/pep.html 10. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201920200S

B265 11. https://apnews.com/21d02ce0aff444508ca427508ac1580b 12. https://www.eater.com/2019/5/22/18634237/lunch-shaming-students-meal-debt-

american-schools 13. http://www.ncsl.org/research/health/school-immunization-exemption-state-

laws.aspx 14. https://sd06.senate.ca.gov/news/2019-06-05-new-data-released-today-shows-

percentage-medical-exemptions-have-more-quadrupled 15. https://californiahealthline.org/news/exemptions-surge-as-parents-and-doctors-do-

hail-mary-around-vaccine-laws/ 16. https://www.latimes.com/politics/la-pol-ca-vaccine-medical-exemptions-sb276-bill-

20190517-story.html

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Questions? Please contact Helen Jung, DrPH, MPH. Senior Health Policy Analyst at the Institute for Health Policy & Leadership (helenjung@llu.edu)

Did you know? According to public health

officials, SB 276 would deny over 43 percent of medical exemptions

for childhood vaccination.16