BILL ANALYSIS Ó
------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 695|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
UNFINISHED BUSINESS
Bill No: SB 695
Author: Hancock (D)
Amended: 9/2/11
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
SENATE FLOOR : 40-0, 6/1/11
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Corbett, Correa, De León, DeSaulnier, Dutton,
Emmerson, Evans, Fuller, Gaines, Hancock, Harman,
Hernandez, Huff, Kehoe, La Malfa, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Runner, Simitian, Steinberg, Strickland, Vargas, Walters,
Wolk, Wright, Wyland, Yee
ASSEMBLY FLOOR : 76-0, 9/7/11 - See last page for vote
SUBJECT : Medi-Cal: county juvenile detention facilities
SOURCE : Alameda County
DIGEST : This bill authorizes, until January 1, 2014,
Medi-Cal benefits to be provided to a Medi-Cal eligible
CONTINUED
SB 695
Page
2
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.
Assembly Amendments clarify that counties will pay the
state's costs for both its share of Medi-Cal benefits and
for administering and implementing the program, delete the
requirement that DHCS adopt regulations to implement this
bill, authorize DHCS to recoup all cost, with interest,
resulting from a federal audit disallowance, and add a
sunset of January 1, 2014.
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,
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, federal
financial participation (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
CONTINUED
SB 695
Page
3
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. 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 FFP is available and the
execution of a declaration by the Director of 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.
CONTINUED
SB 695
Page
4
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.
Comments
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
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.
CONTINUED
SB 695
Page
5
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 Assembly Appropriations Committee:
1. Annual increased Medi-Cal costs, likely in the millions
of dollars (50 percent federal/50 percent 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 percent federal/50 percent
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.
CONTINUED
SB 695
Page
6
SUPPORT : (Verified 8/22/11)
Alameda County (source)
California Council of Community Mental Health Agencies
California Medical Association
California Probation, Parole, and Correctional Association
California State Association of California
California State Sheriffs' Association
California Youth Connection
Chief Probation officers of California
Children's Advocacy Institute
Children's Hospital and Research Center Oakland
City and County of San Francisco
Contra Costa County Board of Supervisors
County Alcohol and Drug Program Administrators Association
of California
County Health Executives Association of California
County of Sacramento
County of Santa Clara
Legal Services for Prisoners with Children
Little Hoover Commission
Mental Health Association in California
National Association of Social Workers
Regional Council of Rural Counties
Urban Counties Caucus
OPPOSITION : (Verified 8/22/11)
Department of Finance
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
help the county to reduce this amount by almost half by
substituting federal funds for county dollars. There would
CONTINUED
SB 695
Page
7
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.
ARGUMENTS IN OPPOSITION : The Department of Finance
opposes this bill for the following reasons:
" The federal government has indicated that these costs
would not be eligible for federal funding.
" The state only receives federal participation for medical
services provided to adults inmates in correctional
facilities if those services are provided in an inpatient
setting and provided off the grounds of the facility.
This bill does not require that the medical services be
provided off the grounds of the facility.
" To the extent that the federal government disallows any
costs related to this population (such as through an
audit), the state would be required to reimburse the
federal government. The General Fund may be at risk if
the state was unable to recover the funds from the
counties.
ASSEMBLY FLOOR : 76-0,09/7/11
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson,
CONTINUED
SB 695
Page
8
Eng, Feuer, Fletcher, Fong, Fuentes, Beth Gaines,
Galgiani, Garrick, Gatto, Gordon, Grove, Hagman,
Halderman, Harkey, Hayashi, Roger Hernández, Hill, Huber,
Hueso, Huffman, Jeffries, Jones, Knight, Lara, Logue,
Bonnie Lowenthal, Ma, Mansoor, Mendoza, Miller, Mitchell,
Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan,
Perea, V. Manuel Pérez, Portantino, Silva, Skinner,
Smyth, Solorio, Swanson, Torres, Valadao, Wagner,
Wieckowski, Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Donnelly, Furutani, Gorell, Hall
CTW:mw 9/8/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED