BILL ANALYSIS Ó
SB 695
Page 1
SENATE THIRD READING
SB 695 (Hancock)
As Amended September 2, 2011
Majority vote
SENATE VOTE :40-0
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hernández, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Hall, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, | |Solorio, Wagner |
| |V. Manuel Pérez, Silva, | | |
| |Smyth, Williams | | |
| | | | |
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SUMMARY : Authorizes, until January 1, 2014, Medi-Cal benefits
to be provided to a Medi-Cal eligible individual awaiting
adjudication in a county juvenile detention facility if the
county agrees to pay the state's share of Medi-Cal expenditures
and administrative costs. Specifically, this bill :
1)Provides that benefits shall be provided until the date of
adjudication and requires benefits to be suspended if the
individual is placed in an institution.
2)Limits eligibility to an individual who is receiving Medi-Cal
benefits at the time of admission or is subsequently
determined to be eligible.
3)Specifies that this bill shall not be construed to require a
county to pay for Medi-Cal benefits that the state is
obligated to provide under administrative action or final
court order.
4)Conditions implementation on receipt of written confirmation
from the federal Centers for Medicare and Medicaid Services
that federal financial participation (FFP) is available and
the execution of a declaration by the director of the
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Department of Health Care Services (DHCS) that implementation
will not jeopardize the state's ability to receive FFP
including any increase in the federal assistance percentage
available as specified.
5)Authorizes DHCS to recoup any amounts resulting from a
disallowance as a result of a federal audit, including any
interest.
6)Authorizes the Director of DHCS to cease operation if a
determination is made that the declaration specified in 5)
above is no longer accurate, authorizes implementation by
all-county-letter or similar instructions and requires notice
to the Joint Legislative Budget Committee, the Department of
Finance and posted on the DHCS Web site.
7)Authorizes initial implementation by all-county letter and
sunsets on January 1, 2014.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
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 : This bill, according to the sponsor, Alameda County,
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is intended to take advantage of federal authority to use
Medicaid funds to reduce the costs of health and mental health
services that the county is already incurring for the first 30
days of a youth's stay in juvenile hall. According to the
sponsor, the average length of stay is 24 days. Medi-Cal
regulations make individuals who are inmates of public
institutions ineligible for Medi-Cal. However, a 2004 letter to
State Medicaid Directors from the federal Centers for Medicare
and Medicaid Services 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 to implement a suspension
of benefits were issued in March 2010.
Federal regulations also appear to allow states to claim FFP for
all Medicaid services provided to a person in a public
institution for a temporary period pending other arrangements as
an exception to unavailability of FFP for services provided to
inmates. This bill is based on information from Pennsylvania
and New Mexico, two states that have taken advantage of this
opportunity.
SB 1091 (Hancock) of 2010 was substantially similar to this bill
and was vetoed. The veto message cited inconsistency with
federal law and potentially significant state costs. This bill,
as drafted, appears to be consistent with federal law and does
not appear to expose the state to significant costs.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0002567