BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 695 (Hancock)
Hearing Date: 5/26/2011 Amended: 5/23/2011
Consultant: Katie Johnson Policy Vote: Health 9-0
_________________________________________________________________
____
BILL SUMMARY: SB 695 would permit counties to pay the
non-federal share of Medi-Cal for eligible youth temporarily
placed in a county juvenile detention facility for up to 30 days
or until their case is adjudicated, whichever is shorter, in
order to access available federal Medi-Cal funding.
_________________________________________________________________
____
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Federal funds match to likely in the millions County/*
counties for Medi-Cal benefits of dollars annually Federal
DHCS administration likely up to $100 annually
ongoingCounty/*
Federal
*50 percent county funds, 50 percent federal funds
_________________________________________________________________
____
STAFF COMMENTS: SUSPENSE FILE.
Commencing January 1, 2012, or upon federal approval, whichever
is later, this bill would permit all counties to receive federal
funds for Medi-Cal eligible youth temporarily placed in a county
juvenile detention facility prior to adjudication for up to 30
days or until adjudication, whichever time period is less,
provided the county pay the state share of matching funds.
Currently, counties pay for the full cost of health care for
these individuals, including for medical and behavioral health
needs. These youth are residents of the facility temporarily
while awaiting adjudication. To the extent that the Centers for
Medicare and Medicaid Services (CMS) determine that their
temporary residence does not make them inmates of a non-medical
public institution, they could be eligible for Medi-Cal benefits
and the counties could access millions of dollars in new federal
funds.
This bill would be contingent upon federal approval, the
availability of federal financial participation, and on the
county's commitment to pay the state's share of Medi-Cal
expenditures and administrative costs for benefits provided for
SB 695 (Hancock)
Page 3
in these provisions through intergovernmental transfers (IGTs)
of funds. It is unclear whether or not the federal government
would approve such a system of reimbursement.
Increased Federal Fund Expenditures
There would be increased costs in federal funds due to
approximately up to one month of Medi-Cal eligibility for youth
who continue their coverage and who enroll in Medi-Cal while
temporarily placed in the facility, likely in the hundreds of
thousands of dollars. For example, Alameda County states that it
spends about $7 million annually on health care for its juvenile
detention facility. If the county could receive federal matching
funds for even half of its population, this would equate to
$1.75 million in federal funds annually at a sharing ratio of 50
percent county and 50 percent federal funds. Since the federal
financial participation would be part of the Medicaid
entitlement program, there would be no upper limit on the amount
of federal funds that a county could access, provided they
furnished the appropriate county matching funds.
It is unknown how many counties would choose to seek Medi-Cal
reimbursement for services provided to these youth. However,
since counties currently pay all of these costs, there would be
an incentive to seek matching federal funds. Impacts on federal
and county funds would depend upon the number of participating
counties.
DHCS Staff and Regulations
This bill would require the Department of Health Care Services
(DHCS) to adopt regulations implementing this bill by January 1,
2013. The regulation process generally takes 18 months to 2
years to complete. DHCS would need increased staff for 1
calendar year in order to complete the process in a shorter time
at a cost of $200,000 - $300,000. The staff costs would be paid
50 percent General Fund and 50 percent federal funds, since the
bill does not require a participating county to offset the
one-time regulation expenditures.
Additionally, the department would likely need staff to process
and monitor IGTs at an estimated cost of $50,000 - $100,000
annually. DHCS staff costs would be shared 50 percent county and
50 percent federal funds. Since Medi-Cal pays for eligibility
determination performed at the county level, there could be
General Fund and federal cost pressure to the extent there are
SB 695 (Hancock)
Page 4
increased county administrative costs. For example, in order to
access federal funds, a county could choose to determine if a
youth placed temporarily in a facility is Medi-Cal eligible and
refer them to the county for an eligibility determination.
Potential General Fund Cost Pressure
If a county chooses to determine the eligibility of unenrolled
youth, since they are minors, it would be reasonable to assume
that a county welfare department would contact their families
for financial eligibility information and would subsequently
work to enroll any eligible family member as well. The costs of
intake and benefits in Medi-Cal for the family members for one
month of Medi-Cal that they would not have accessed otherwise
would be indeterminate. Associated costs would be shared 50
percent General Fund and 50 percent federal funds.
The author's recent amendments would permit the use of county
funds for the development of regulations in place of the General
Fund as the traditional state match. The recent amendments would
require DHCS to adopt regulations by January 1, 2015, instead of
January 1, 2013. Since this change would give the department
more time to promulgate regulations, the regulations costs would
likely be minor when spread across all available fiscal years.