BILL ANALYSIS Ó
SB 695
Page 1
Date of Hearing: July 6, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 695 (Hancock) - As Amended: May 23, 2011
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill authorizes counties to access federal Medi-Cal
reimbursement for health services provided to youth awaiting
adjudication in county juvenile detention facilities, subject to
state actions and declarations, as specified. Specifically, this
bill:
1)Requires both of the following conditions to be met in order
to receive federal funding:
a) The youth must be Medi-Cal eligible.
b) The county must agree to pay the non-federal share of
Medi-Cal costs and the state's administrative costs,
including costs associated with development of regulations.
2)Requires the Medi-Cal benefits provided pursuant to this bill
to continue until adjudication.
3)Requires the California Department of Health Care Services
(DHCS) to seek federal approval to allow for federal financial
participation (FFP), and provides that the bill is only
operative if both of the following occur:
a) The DHCS receives written confirmation from the federal
government that FFP is available.
b) The director of DHCS executes a declaration that
implementation of this bill will not jeopardize federal
funding to the state Medi-Cal program.
FISCAL EFFECT
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1)Annual increased Medi-Cal costs, likely in the millions of
dollars (50% federal/50% local) to the extent counties opt
into the funding mechanism established by this bill and
provide Medi-Cal health services to youth awaiting
adjudication.
2)Unknown one-time administrative workload to DHCS to seek
federal approval, not likely to exceed $100,000. Although this
bill requires counties to pay the state share of cost for
state administrative workload, it unclear whether the initial
workload necessary to receive federal approval will be
reimbursed by counties.
3)Unknown ongoing costs (50% federal/50% local) to DHCS to
administer the funding mechanism established by this bill, and
to county welfare departments to verify the Medi-Cal
eligibility status of youth awaiting adjudication and process
new applications. This bill requires counties to pay the
state share of cost for administrative workload. Actual costs
would depend on how many counties opt in to the program and
how many youth are found Medi-Cal eligible.
COMMENTS
1)Rationale . This bill is sponsored by Alameda County to
establish a funding mechanism to provide relief to counties
for providing health services to Medi-Cal beneficiaries at
100% county cost. This bill increases federal funding and
reduces county funding spent providing primary care and mental
health services to youth awaiting adjudication in juvenile
hall. According to the author and sponsor, this bill is based
on a program established in New Mexico in 2000 that allows
receipt of federal funding for health services for juveniles
in temporary custody. Representatives of Alameda County
indicate that the majority of the medical services provided to
youth in the juvenile justice system are provided while they
are awaiting adjudication, because most youth are not actually
incarcerated.
2)Background . Current federal regulations specify that federal
financial participation is not available for services provided
to inmates of public institutions, with limited exceptions.
However, direction from the federal government also encourages
suspending, rather than terminating, Medicaid benefits. SB
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1147 (Calderon), Chapter 546, Statutes of 2008 codified this
directive from the federal government and prohibits DHCS from
terminating the Medi-Cal eligibility of an incarcerated youth.
However, this bill did not address youth awaiting
adjudication.
3)Definition of Inmate . According to federal regulations, an
individual is not considered an inmate if "he/she is in a
public institution for a temporary period pending other
arrangements appropriate to his/her needs." This definition
has reportedly allowed other states to claim federal
reimbursement for youth awaiting adjudication.
4)Related Case Law . A lawsuit brought by San Francisco and Santa
Clara in 2007 challenged California's practice of denying
Medi-Cal coverage of inpatient psychiatric hospital services
provided to youth who are in custody. In April 2010 the San
Francisco Superior Court ruled these denials violate federal
and state law and ordered the state to provide Medi-Cal
coverage of inpatient psychiatric hospital services for
individuals under age 21, regardless of their status as
detainees. The state appealed this ruling, but subsequently
withdrew the appeal in May 2011. This bill includes language
to preserve that ruling.
5)Related Legislation .
a) SB 1091 (Hancock) was substantially similar to this bill
and was vetoed. The veto message cited inconsistency with
federal law and potentially significant state costs. SB
695, as drafted, appears to be consistent with federal law
and does not appear to expose the state to significant
costs.
b) AB 396 (Mitchell) requires DHCS to develop a process to
allow participating counties and the state 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. AB 396 is pending in
the Senate Public Safety committee.
c) AB 1628 (Budget Committee), Chapter 729, Statutes of
2010 (the 2010 corrections trailer bill) authorized state
departments to seek Medi-Cal reimbursement for the
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provision of inpatient hospital services to adult inmates
who would otherwise be eligible for Medi-Cal or similar
county-based low-income health programs (LIHP), but for
their institutional status as inmates.
d) SB 1147 (Calderon), Chapter 546, Statutes of 2008
provides that Medi-Cal eligibility of a minor is suspended,
not terminated, while the minor is incarcerated.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081