BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | SB 1469| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ THIRD READING Bill No: SB 1469 Author: Cedillo (D) Amended: 5/26/06 Vote: 21 SENATE HEALTH COMMITTEE : 9-0, 4/19/06 AYES: Ortiz, Runner, Aanestad, Alquist, Chesbro, Cox, Figueroa, Kuehl, Maldonado SENATE PUBLIC SAFETY COMMITTEE : 5-0, 5/2/06 AYES: Migden, Cedillo, Margett, Perata, Romero NO VOTE RECORDED: Poochigian SENATE APPROPRIATIONS COMMITTEE : 8-4, 5/25/06 AYES: Murray, Alarcon, Alquist, Escutia, Florez, Ortiz, Romero, Torlakson NOES: Aanestad, Ashburn, Battin, Dutton NO VOTE RECORDED: Poochigian SUBJECT : Medi-Cal: eligibility: juvenile offenders SOURCE : Author DIGEST : This bill requires, beginning May 1, 2007, county juvenile detention facilities to notify county welfare departments about the release of a ward so that eligibility for Medi-Cal can be determined. ANALYSIS : CONTINUED SB 1469 Page 2 Existing federal law: 1.Establishes the Medicaid program to provide comprehensive health benefits to low-income persons. 2.Provides that Medicaid benefits generally cannot be paid for incarcerated individuals. 3.Allows incarcerated individuals to retain their Medicaid eligibility. Existing state law: 1.Establishes the Medi-Cal program, administered by the Department of Health Services (DHS) to provide health care benefits to qualified low-income individuals. 2.Defines health care benefits eligible under the Medi-cal programs. 3.Excludes from the definition of health care benefits, care or services for any individual who is an inmate of an institution (except as a patient in a medical institution). This bill: 1.Commencing May 1, 2007, directs the county juvenile detention facilities (county) to provide the appropriate county welfare department with the ward's name, release date and sufficient information for the county welfare department to begin the process of determining the ward's eligibility for Medi-Cal, including, if the ward is a minor, contact information for the ward's parent or guardian, if available. 2.Mandates county juvenile detention facilities to notify the ward's parents or guardian so that they may have the option of opting out of the Medi-Cal eligibility determination. 3.Requires the county welfare director to expedite the review of the enrollment application. SB 1469 Page 3 4.Directs the county welfare director to forward the application to the appropriate entity for Healthy Families eligibility or other appropriate health coverage program, if the ward does not meet the requirements for Medi-Cal. 5.Requires the county welfare department to issue appropriate documentation to obtain necessary medical care for a released ward who meets eligibility requirements for Medi-Cal. 6.Requires DHS in consultation with the County Welfare Directors Association, Chief Probation Officers of California to establish protocols and procedures to implement this bill. 7.Allows DHS to implement this bill though all-county letters or similar methods without adopting regulations. 8.Requires DHS to seek any federal waivers necessary for the implementation of this bill. 9.Establishes a method for paying any mandates that this bill creates. Background Medi-Cal eligibility: Under Medicaid law, states do not receive federal matching funds for services provided to individuals in jail. However, federal law does not require states to terminate inmates' eligibility. Inmates may remain enrolled in Medicaid even though services received while in jail are not covered. Accordingly, someone who had a Medicaid card when jailed may be able to use it to obtain needed services and medication immediately after release. Under federal rules, Medicaid eligibility should be reinstated upon release unless the person is no longer eligible. Before ending eligibility, states must determine the potential for qualifying under all the state's eligibility categories. Regrettably, this re-determination SB 1469 Page 4 often does not occur. Even inmates who keep their Medicaid eligibility may lose Medicaid coverage unnecessarily because of procedures in correctional facilities. Many individuals will be incarcerated for so long that they will lose their Medicaid benefits after the state's customary re-determination of eligibility is conducted (annually for California). Something as simple as the loss of a Medicaid card following arrest can make it impossible to obtain mental health services from Medicaid providers upon release. Cards are often lost because jails take possession of all personal property when booking a person. In many jurisdictions, this property is destroyed if it is not claimed within a certain time. Inmates cannot claim the property themselves and if they have no one to do it for them, their Medicaid card is destroyed. Federal view: As part of a federal effort to reduce homelessness, the Centers for Medicare and Medicaid Services has sent a letter encouraging states to suspend and not terminate Medicaid benefits while a person is in a public institution. The letter points out the difference between the prohibitions on receiving benefits versus maintaining eligibility while an eligible individual is in an institution. The letter also encourages state Medicaid agencies to work with corrections officials. Related legislation SB 1616 (Kuehl) - requires the division to work with the Social Security Administration and DHS to ensure that disabled wards are enrolled in Medi-Cal and that their disability benefits are available to them when they are released from a state institution. AB 1945 (Coto) - requires that a juvenile detention facility determine if an eligible minor being released is enrolled in need-based health insurance programs. AB 2004 (Yee) - prohibits the use of inmate status to terminate the eligibility of a minor under the Medi-Cal SB 1469 Page 5 program, require DHS to suspend rather than terminate eligibility and ensure that eligibility was reinstated upon release. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes According to the Senate Appropriations Committee: Fiscal Impact (in thousands) Major Provisions 2006-07 2007-08 2008-09 Fund State mandated local Program unknown, significant costs General Medi-Cal benefits unknown, significant costs General Implementation protocol $80 General SUPPORT : (Verified 5/26/06) Adolescent Health Working Group Books Not Bars California Coalition for Youth California Commission on the Status of Women California Medical Association California Public Defenders Association City of Los Angeles City of Santa Monica County Alcohol and Drug Program Administrators Association of California Girl Scout Councils of California Juvenile Court Judges of California Juvenile Justice Commission, County of Santa Clara National Association of Social Workers, California Chapter Stanford University Medical Center Stanford University School of Medicine, Department of Pediatrics ARGUMENTS IN SUPPORT : The County Alcohol and Drug Program Administrators Association of California strongly support the bill. They believe that this bill will provide SB 1469 Page 6 Medi-Cal and other health benefits for eligible adolescents immediately upon their release from juvenile detention facilities. They believe that this bill will be a valuable effort to help trouble youth who are trying to put their lives together after incarceration. The National Association of Social Workers supports the bill because it will help provide youth access to adequate health care, member health treatment and substance abuse treatment so that they have the opportunity to stay out of the juvenile detention system. CTW:nl 5/30/06 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END ****