BILL ANALYSIS Ó
AB 396
Page 1
Date of Hearing: May 3, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 396 (Mitchell) - As Amended: April 25, 2011
SUBJECT : Medi-Cal: juvenile detention facilities.
SUMMARY : Requires the Department of Health Care Services (DHCS)
to develop a process to allow counties to obtain matching
federal funds for health care services provided to juvenile
detainees who are admitted to a medical institution.
Specifically, this bill :
1)Prohibits a juvenile detainee who is an inpatient in a medical
institution from being denied Medi-Cal eligibility on the
basis of the institutional status as a detainee of a public
institution.
2)Requires DHCS to consult with counties in the development of a
process to allow counties to obtain matching federal funds for
health care services provided to juvenile detainees in a
medical institution and to seek any federal approvals
necessary.
3)Conditions implementation on the obtaining of necessary
federal approval and only to the extent that existing levels
of federal financial participation (FFP) are not jeopardized.
4)Authorizes DHCS to exempt the juvenile detainees from
mandatory enrollment in a managed care plan.
5)Provides for implementation only for those counties that elect
to voluntarily provide the nonfederal share of expenditures
for juvenile detainees and who, but for inpatient status,
would be otherwise ineligible for Medi-Cal as a detainee of a
public institution.
6)Requires the FFP obtained through this process to be paid to
the participating county.
7)Authorizes implementation without any further regulatory
action by means of all-county letter or similar instruction.
8)Prohibits this bill from being construed to alter or abrogate
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any obligation of the state pursuant to administrative action
or court order as specified to fund and reimburse counties for
medical services provided to juvenile detainees.
9)Makes legislative findings with regard to potential
availability of FFP for counties that provide health care
services to juvenile detainees while the juveniles are
admitted as patients in a medical institution, that an
individual under 21 years of age who is an inmate of a public
institution has his or her Medi-Cal services suspended for up
to one year, that current procedures do not allow counties to
obtain FFP, that DHCS is authorized to develop a process to
maximize FFP for inpatient hospital services to adult inmates
residing in a state prison facility and that to reduce the
fiscal strain on counties, it is imperative that DHCS work
with counties to develop and implement a similar process to
allow counties to obtain FFP based on county expenditures for
inpatient hospital services provided to juveniles in their
custody.
EXISTING LAW :
1)Establishes the Medi-Cal Program, administered by DHCS, to
provide comprehensive health care services and long-term care
to pregnant women, children, and people who are aged, blind,
and disabled.
2)Establishes a schedule of benefits under the Medi-Cal Program
but excludes from the definition of "health care services,"
care or services for any individual who is an inmate of an
institution (except as a patient in a medical institution),
except to the extent permitted by federal law.
3)Allows, under federal law, continued Medicaid (Medi-Cal in
California) eligibility even when an inmate of a public
institution is prohibited from receiving benefits, and states
that an individual is not considered to be living in a public
institution if the individual is in a public institution for a
temporary period pending other arrangements.
4)Requires that Medi-Cal benefits of a juvenile who is an inmate
of a public institution to be suspended, as specified.
5)Establishes a Low-Income Health Program (LIHP) that includes
inpatient hospital services for state prison inmates,
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parolees, and county jail inmates and authorizes DHCS to
obtain FFP through the Medi-Cal Program or the LIHP.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, currently,
when counties detain minors in a juvenile detention facility
or probation camp, their Medi-Cal benefits are suspended. The
author asserts that there is a federal option that would
permit Medi-Cal benefits if a minor is admitted to a hospital
for treatment and is away from the detention facility for more
than 24 hours. The author states that counties are unable to
use this option unless set in statute and therefore counties
are now paying the full cost of minors detained in juvenile
detention facilities or camps when they are treated outside of
the facility. According to the author, this bill would allow
counties to seek reimbursement from the federal government.
2)BACKGROUND . Medi-Cal regulations make individuals who are
inmates of public institutions ineligible for Medi-Cal.
However, the federal Social Security Act governing Medicaid
and a 1997 letter from the federal Department of Health and
Human Services indicates FFP is available through Medicaid
when an inmate becomes a patient in a medical institution on
an inpatient basis. Additionally, a 2004 letter to State
Medicaid directors from the federal Centers for Medicare and
Medicaid Services (CMS) encourages states to "suspend" and not
"terminate" benefits while a person is in a public institution
or Institute for Mental Disease, noting the payment exclusion
(known as the "inmate exception") under Medicaid does not
affect the eligibility of an individual for the Medicaid
program. This policy was codified with regard to juveniles in
SB 1147 (Calderon and Yee), Chapter 546, Statutes of 2008.
DHCS indicated that the necessary protocols were issued in
March 2010.
3)ADULT INMATES AND PAROLEES . In November 2010, CMS approved a
five-year Medi-Cal Section 1115(a) Demonstration/Pilot Project
Waiver, entitled "A Bridge to Reform." This Demonstration is
intended as a bridge to implementation of the Patient
Protection and Affordable Care Act which requires states to
include childless adults, under age 65, who are not otherwise
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eligible for Medi-Cal or Medicare with incomes up to 133% of
the federal poverty level (FPL) in its Medicaid program. The
2010 waiver and AB 342 (John A. Pérez), Chapter 723, Statutes
of 2010, implementing these provisions, establishes the LIHP
for this population and provides for it to be statewide at
county option. A county that chooses to participate will use
Certified Public Expenditures as the matching funds. Counties
are authorized to provide LIHP coverage to persons with income
up to 200% FPL as well, but in a fashion that minimizes the
need to impose a limit on the population that is 0-133% FPL.
AB 1628 (Committee on Budget), Chapter 729, Statutes of 2010,
allows counties to use enroll inmates, prisoners and parolees
in the LIHP program to obtain FFP for inpatient hospital
services provided to state prison inmates and for mental
health services provided to parolees and provides for
reimbursement to the counties from the California Department
of Corrections and Rehabilitation (CDCR) for those inmates for
whom it is responsible. Additionally, AB 1628 allows
participating counties to seek FFP for Medi-Cal eligible jail
inmates that were paid for from county funds.
4)SUPPORT . The Los Angeles County Board of Supervisors, sponsor
of this bill, writes that this bill would allow counties to
draw down federal matching funds to reimburse them for the
medical treatment of minors who are hospitalized and outside
of the County's detention facility for more than 24 hours.
According to the supporters, the Los Angeles County Probation
Department operates three juvenile detention facilities and 18
juvenile camps. The supporters state that most of the minors
taken into custody are from low-income families which make
them eligible for Medi-Cal. The supporters also state that
many minors detained in local detention facilities often
require medical care which is outside the scope of medical
services available at the facility. According to the
supporters, medical conditions requiring hospitalization
include complications from asthma, diabetes, epilepsy, or
heart problems. The supporters also argue that in cases where
minors require hospitalization for a contagious or
communicable disease, care at a medical facility is vital not
only for their health and wellbeing, but for the other
detainees and probation staff before the minor returns to the
detention facility.
The Los Angeles County Probation Officers' Union (LACPOU),
AFSCME, Local 685, also in support, states that to the extent
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that FFP is not jeopardized and federal approval obtained, the
CDCR and DHCS are authorized to develop a process for the
provision of inpatient hospital services to inmates who would
otherwise be eligible for Medi-Cal, but for their
institutional status as inmates. According to LACPOU, this
bill will additionally require DHCS to maximize FFP for the
health care services provided by counties to juveniles in
their custody who would otherwise be eligible for Medi-Cal.
5)RELATED LEGISLATION . SB 695 (Hancock) of 2011 allows counties
to seek reimbursement for Medi-Cal benefits for an individual
awaiting adjudication in a county juvenile detention facility
or camp, if that individual is eligible to receive benefits at
the time of their admittance. SB 695 is a reintroduction of
SB 1091 (Hancock) of 2010.
6)PRIOR LEGISLATION :
a) SB 1091 (Hancock) of 2010, was vetoed by Governor
Schwarzenegger. The veto message was as follows: "This
bill, while well-intentioned, is inconsistent with federal
law and exposes the state to potentially significant costs.
If the author wishes to craft workable legislation that
allows for additional federal funds but also adheres to
federal Medicaid law and regulations, the Department of
Health Care Services would be willing to assist in that
effort next year."
b) SB 1147 (Calderon and Yee), Chapter 546, Statutes of
2008, requires DHCS to develop procedures to ensure that
the Medi-Cal eligibility of minors is not terminated when
they are incarcerated.
c) SB 648 (Calderon) of 2007 would have required DHCS to
suspend rather than terminate the Medi-Cal benefits of an
incarcerated minor. SB 648 was referred to Senate Health
Committee but was not heard.
d) SB 1469 (Cedillo), Chapter 657, Statutes of 2007,
requires county juvenile detention facilities, following
the issuance of an order of the juvenile court committing a
county ward to a juvenile hall, camp, or ranch for 30 days
or longer, to provide the county welfare department with
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the ward's name, his or her scheduled or actual release
date, any known information regarding the ward's Medi-Cal
status prior to disposition, and sufficient information,
when available, for the county welfare department to begin
the process of determining the ward's Medi-Cal eligibility.
7)DOUBLE REFERRAL . This bill is double referred. It was heard
in the Assembly Public Safety Committee on April 5, 2011 and
passed out on a vote of 7-6.
REGISTERED SUPPORT / OPPOSITION :
Support
The Los Angeles County Board of Supervisors, (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Medical Association
Los Angeles County Probation Officers' Union, AFSCME, Local 685
Riverside Sheriffs' Association
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097