BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 695|
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THIRD READING
Bill No: SB 695
Author: Hancock (D)
Amended: 5/23/11
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/6/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De León, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 9-0, 5/26/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Runner, Steinberg
SUBJECT : Medi-Cal: county juvenile detention facilities
SOURCE : Alameda County
DIGEST : This bill permits counties to pay the
non-federal share of Medi-Cal for eligible youth
temporarily placed in a county juvenile detention facility
until their case is adjudicated in order to access
available federal Medi-Cal funding.
ANALYSIS :
Existing federal law:
1. Defines, in federal Medicaid law, the term "medical
assistance" as payment of the cost of specified care and
services, such as inpatient hospital services,
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outpatient hospital services, and physician services.
The term "medical assistance" generally does not include
care or services for an inmate of a public institution,
except for inpatient psychiatric hospital services for
individuals under age 21.
2. Prohibits, through federal Medicaid regulations, FFP
from being available for services provided to
individuals who are "inmates of public institutions."
3. Exempts from the definition of "inmate of a public
institution" a person who is in a public institution for
a temporary period pending other arrangements
appropriate to his or her needs.
Existing state law:
1. Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), which
provides comprehensive health benefits to low-income
children, their parents or caretaker relatives, pregnant
women, elderly, blind or disabled persons, nursing home
residents, and refugees who meet specified eligibility
criteria. Medi-Cal family income eligibility for
children ages 0 to 1 extends up to 200 percent of the
federal poverty level (FPL), children ages 1 to 5 with
family incomes up to 133 percent of the FPL, and
children ages 6 to 19 with family incomes up to 100
percent of the FPL.
2. Requires benefits provided under the Medi-Cal program to
an individual under 21 years of age who is an inmate of
a public institution to be suspended on the date he or
she becomes an inmate of a public institution. The
suspension ends on the date the individual is no longer
an inmate of a public institution, or one year from the
date he or she becomes an inmate of a public
institution. Health care services under Medi-Cal are
not available to inmates of public institutions whose
Medi-Cal benefits have been suspended.
This bill:
1. Permits Medi-Cal benefits to be provided to an
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individual awaiting adjudication in a county juvenile
detention facility if the following requirements are
met:
A. The individual is eligible to receive Medi-Cal
benefits at the time the individual is admitted to
the juvenile detention facility or the individual is
subsequently determined to be eligible for Medi-Cal
benefits;
B. The county agrees to pay the state's share of
Medi-Cal expenditures and the state's administrative
costs for benefits and related regulations under this
bill; and
C. FFP is available.
2. Requires benefits available under this bill to continue
until the date of the individual's adjudication, after
which benefits would be suspended as provided in
specified existing law, if the individual is an inmate
of a public institution.
3. Prohibits this bill from being construed to require a
county to pay the state's share of Medi-Cal expenditures
or the state's administrative costs for Medi-Cal
benefits that the state is obligated to provide pursuant
to an administrative action (such as a decision by the
federal government) or court order that is final and no
longer subject to appeal.
4. Permits DHCS to implement and administer this bill by
means of all-county letters or similar instructions
without taking regulatory action. Thereafter, DHCS is
required to adopt regulations in accordance with the
Administrative Procedure Act.
5. Implements this bill only if, and to the extent that,
both of the following occur:
A. DHCS receives written confirmation from the
federal Centers for Medicare and Medicaid Services
that FFP is available to implement this bill; and
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B. The DHCS Director executes a declaration that
states that implementation of this bill will not
jeopardize the state's ability to receive FFP or any
increase in federal medical assistance percentage
(FMAP) available on or after October 1, 2008, or
additional federal funds that the director, in
consultation with the Department of Finance (DOF),
has determined would be advantageous to the state.
6. Requires the director of DHCS, if at any time the
director determines that the statement in the
declaration executed above to no longer be accurate, to
give notice to the Joint Legislative Budget Committee
and to DOF. If the director determines, in consultation
with DOF, that it is necessary to cease implementation
of this bill in order to receive FFP, or any increase in
FMAP available on or after October 1, 2008, or
additional federal funds that the director, in
consultation with DOF, has determined would be
advantageous to the state, the director is required to
cease implementation of this bill and to execute a
declaration to that effect.
7. Requires DHCS to adopt regulations by January 1, 2015,
instead of January 1, 2013. Since this change would
give DHCS more time to promulgate regulations, the
regulations costs could likely be minor when spread
across all available fiscal years.
Comment
If a county elected the option in this bill, this bill will
enable federal Medicaid matching funds to be drawn down to
treat youth who are pending adjudication in a county
juvenile detention facility. "Pending adjudication" is the
period of time from when a youth is admitted to a juvenile
detention facility (such as a juvenile hall) and to when
the youth appears before a judge or commissioner to have
his/her case heard. The average daily population in
juvenile halls and camps and other county facilities was
12,274, according to data from the last quarter of 2009
from the California Corrections Standards Authority.
Background
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Exemption from counties providing the state match to draw
federal funds
Medi-Cal is funded, with some exceptions, with state
General Fund dollars and federal matching funds. This bill
requires counties electing to provide Medi-Cal benefits to
an individual awaiting adjudication to pay the state's
share of Medi-Cal expenditures and the state's
administrative costs for benefits. This bill contains a
new provision that was not in last year's legislation that
creates an exception from this county-funding requirement
by prohibiting a county from being required to pay the
state's share of Medi-Cal expenditures, or the state's
administrative costs, for Medi-Cal benefits that the state
is obligated to provide pursuant to an administrative
action or court order that is final and no longer subject
to appeal.
This provision is included in this bill at the request of
the City Attorney of the City and County of San Francisco
in response to litigation filed by the Office of the City
Attorney of San Francisco and the County of Santa Clara
against DHCS over the obligation of the state to provide
inpatient psychiatric hospital services for individuals
under age 21. In that case, the Superior Court issued an
order stating that DHCS' policy of denying Medi-Cal
coverage of inpatient psychiatric hospital services to
youth who are in custody violates federal and state law.
That case is currently on appeal. The language in this
bill that creates an exception to the county funding
requirement is not specific to inpatient psychiatric
hospital services and would apply to other court orders
that are final and no longer subject to appeal.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Federal funds match to likely in the millions of
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dollars annually County/
counties for Medi-Cal
*Federal
benefits
DHCS administration likely up to $100 annually
ongoing County/
*Federal
DHCS regulations $100-$150 $100-$150
$0General/
**Federal
SUPPORT : (Verified 5/26/11)
Alameda County (source)
California Alliance of Child and Family Services
California Council of Community Mental Health Agencies
California Probation, Parole, and Correctional Association
California State Association of Counties
California State Sheriffs' Association
Chief Probation Officers of California
County Alcohol and Drug Program Administrators Association
of California
County Health Executives Association of California
County of Santa Clara Board of Supervisors
Legal Services for Prisoners with Children
Mental Health Association in California
Regional Council of Rural Counties
Urban Counties Caucus
ARGUMENTS IN SUPPORT : This bill is sponsored by Alameda
County, which writes in support that every county has an
obligation to tend to the health care needs of the persons
detained in its institutions. Alameda County writes that it
takes that responsibility very seriously and has developed
a state of the art medical clinic within its new Juvenile
Justice Center where every youth who is admitted to this
facility is given a thorough physical examination of their
health, dental, and mental health needs. Alameda County
states this care comes at a significant cost to the county
- approximately $7 million annually - and this bill would
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help the county to reduce this amount by almost half by
substituting federal funds for county dollars. There would
be no cost to the state General Fund because the county
would cover not only the state's share of cost, but also
the state's reasonable expenses for administering the
pass-through of the federal funds.
Alameda County argues this approach is consistent with
federal regulations, which allow Medicaid funds to be used
for a person who is detained in an institution "for a
temporary period of time pending other arrangements
appropriate to his needs." This bill limits the
availability of Medi-Cal services to the period of time
beginning at detention until adjudication. Finally,
Alameda County argues the approach in this bill is not
novel, as New Mexico, Pennsylvania, and Vermont have been
using Medicaid funds to provide health and mental health
services for youths in their juvenile detention facilities
for several years.
CTW:mw 5/27/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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