BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 396 (Mitchell)
Hearing Date: 8/25/2011 Amended: 8/15/2011
Consultant: Katie Johnson Policy Vote: Health 9-0 Pub.
Safety 7-0
_________________________________________________________________
____
BILL SUMMARY: AB 396 would require the Department of Health Care
Services (DHCS) to develop a process to allow counties and the
Division of Juvenile Facilities (DJF) within the California
Department of Corrections and Rehabilitation (CDCR) to receive
any available federal financial participation for health care
services provided to juvenile detainees who are admitted as
inpatients in a medical institution and who are eligible for
Medi-Cal.
_________________________________________________________________
____
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
DHCS start-up and ongoing $50 $100 $100
Federal/*
administrative costs County
Increased federal likely significant, in the millions
ofFederal
matching funds for dollars annually, upon federal approval
counties and CDCR and implementation
Cost avoidance for DJF unknown, likely in the hundreds of
General/
and county inpatient thousands to millions of dollars,County
upon federal approval and implementation
*50 percent federal funds, 50 percent county funds.
_________________________________________________________________
____
STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
This bill would require DHCS, in consultation with counties and
DJF, to develop a process to allow counties and CDCR to access
AB 396 (Mitchell)
Page 1
federal financial participation for juvenile inmates who are
eligible for Medi-Cal benefits and who are admitted as
inpatients in a medical institution and to coordinate that
process with the one that exists for adult inmates. Medical
institutions would include acute psychiatric, sub-acute
psychiatric, and general acute care hospitals.
This bill would permit eligible inmates to be exempted from
enrollment into a managed health care plan. DHCS would be
directed to seek any necessary federal approvals. This bill
would provide that these provisions would only be implemented to
the extent that federal approval is obtained and that existing
levels of federal financial participation are not jeopardized.
DHCS would be permitted to recoup payments if the federal
government determined them to not be allowable.
This bill would be implemented only in those counties that would
elect to voluntarily provide the nonfederal share of
expenditures and if DJF voluntarily elects to provide the
nonfederal share of expenditures. This bill would specify that
participating counties and DHCS would annually negotiate the
amount of administrative costs that the county would pay.
DHCS would need staffing resources of approximately $100,000
annually for, first, start -up costs that would include seeking
federal approval and developing any state plan amendments or
waivers, and, second, ongoing program oversight. Administrative
expenditures would be funded with 50 percent federal funds and
50 percent General Fund/county funds. If the amount negotiated
between the counties and DHCS is insufficient to cover the full
administrative costs of the department, there could be General
Fund cost pressure to cover the remaining expenditures.
For participating counties and CDCR, this bill could result in
significant increased federal funds likely in the millions of
dollars annually which would result in an equal amount of county
funds and General Fund offsets. For example, DJF currently pays
approximately $873 per psychiatric hospital day and $1415 per
general acute care hospital day at a cost of $2,477,962 in
calendar year 2010. If DHCS were to be granted approval for this
program, federal funds could offset half of those costs. Actual
federal funding and subsequent offsets would depend on the
number of participating counties and on the number of inmates,
both county and state, for whom this would apply.
AB 396 (Mitchell)
Page 2
There could be local assistance costs incurred by counties that
would determine final Medi-Cal eligibility. These expenditures
would be paid for with 50 percent General Fund and 50 percent
federal funds.
AS PROPOSED TO BE AMENDED. The committee's amendments would
delete the provision that would specify that counties would
negotiate with DHCS the amount of administrative costs that the
county would pay. Instead, these amendments would require
participating counties to cover the non-federal share of DHCS'
administrative expenses, thereby eliminating any General Fund
costs associated with DHCS administration.