DATE: March 11, 2003
TO: Board of Supervisors
SUBJECT: Express Lane Eligibility for Children

SUMMARY:
AB 59, Express Lane Eligibility for Children, was signed into law October 14, 2001. The bill provides increased access to healthcare to school-aged children and their families by enabling parents and caretakers to use the
National School Lunch Program (NSLP) application as an application for Medi-Cal.

AB 59 authorizes improved information sharing between the NSLP and Medi-Cal, with the parents consent. The State Departments of Education and Health Services are responsible for developing AB 59 implementation guidelines for counties and school districts. Counties must develop their own procedures for processing Medi-Cal requests for children determined eligible for free lunch. This process must include determining express enrollment eligibility, activating the Medi-Cal record so the child may receive immediate services and evaluating for ongoing eligibility.

RECOMMENDATIONS:
Chairman Greg Cox and Vice Chairwoman Dianne Jacob:

1. Waive Board Policy B-29, Fees, Grants, and Revenue Contracts - Department Responsibility for Cost Recovery, ratify and authorize the Clerk of the Board to execute, upon receipt, the revenue agreement with San Diego Unified School District in the maximum amount of $82,000 to implement Express Lane Eligibility for the period November 1, 2002 through October 31, 2004 and to execute subsequent amendments, extensions, or renewals upon receipt.
2. Direct the Chief Administrative Officer to report back to the Board on the status of AB 59 and the Pilot Project with San Diego Unified School District at regular intervals.

BACKGROUND:
Recent statistics reveal that more than 86,000 children were uninsured in 2002 and that a total of 121,000 children were either uninsured or had been uninsured at some point in the previous 12 months.

Through a variety of efforts, this Board of Supervisors has sought to increase children and families' access to healthcare to ensure healthier communities. Supervisors Dianne Jacob and Ron Roberts, with the establishment of the Improving Access to Healthcare initiative, have worked to improve the quality of life for San Diego residents. Currently, through these efforts and community partnerships, the region has over 222,900
low-income children enrolled in healthcare coverage programs.

A new opportunity now exists for San Diego to reach even more children who are eligible for Medi-Cal but are not currently enrolled in the program. AB 59, Express Lane Eligibility for Children, was signed into law October 14, 2001. The bill provides increased access to healthcare to school-aged children and their families by enabling parents and caretakers to use the National School Lunch Program (NSLP) application as an application for Medi-Cal.

AB 59 authorizes improved information sharing between the NSLP and Medi-Cal, with the parents consent. The State Departments of Education and Health Services are responsible for developing AB 59 implementation guidelines for counties and school districts. Counties must develop their own procedures for processing Medi-Cal requests for children determined eligible for free lunch. This process must include determining express enrollment eligibility, activating the Medi-Cal record so the child may receive immediate services and evaluating for ongoing eligibility.

Due to budget concerns, AB 59 implementation was delayed until July 1, 2003. The current proposal includes implementing AB 59 on a small scale in four pilot counties.

San Diego, along with Los Angeles, Fresno and Santa Clara, have been chosen as pilot counties. The Health and Human Services Agency has been working very closely with San Diego Unified School District (SDUSD) and they have formed a collaborative workgroup in preparation for AB 59 implementation.

San Diego County Health and Human Services Agency (HHSA) and SDUSD have applied for and been awarded funding by the California Endowment to support the pilot project for Express Lane Eligibility using the NSLP application. HHSA will act as a subcontractor for SDUSD and have the responsibility of receiving and processing Express Lane eligible NSLP applications from SDUSD. The grant funds are to be applied to expenses incurred for the period from 11/1/2002 to 10/31/2004.

HHSA, as a subcontractor of SDUSD, will receive a first year award of $41,000 contingent upon receipt of signed Purpose of Grant Award. HHSA will receive a second year award of $41,000 contingent upon State approval for July 2003 implementation of AB 59 and upon timely receipt of interim reports. These grants will cover the following expenses:

• Joint development of a detailed process and workflow timeline for sending, receiving, processing and tracking the NSLP application between pilot schools sites and the County of San Diego.
• Joint development of training curriculum for school and County staff on Express Lane Eligibility implementation. Joint training of key school and County staff on Express Lane Eligibility.
• Participation in the education of 1100 parents/families on the opportunity to enroll in health coverage through the revised NSLP application.
• Development of automation with which to track and monitor the data necessary to determine the success of AB 59.
• Development of automation with which to sustain the Express Lane Eligibility project on a long-term basis, which will be used in the expansion of AB 59 to other schools and school districts as well as in continuing to transmit NSLP application to the County on an on-going basis.

Approval of today's recommendations will allow HHSA and SDUSD to continue their development and implementation of the Express Lane program. By streamlining the application process many more families will enjoy a basic level of health services. We must strengthen our efforts to protect the lives of our future generations.

We urge your support.

Sincerely,

Greg Cox
Chairman

Dianne Jacob
Vice Chairwoman