Amended in Senate September 3, 2013

Amended in Senate July 9, 2013

Amended in Senate June 24, 2013

Amended in Assembly May 24, 2013

Amended in Assembly April 11, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 720

Introduced by Assembly Member Skinner

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(Coauthor: Senator Beall)

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February 21, 2013

An act to add Section 4011.11 to the Penal Code, begin insert and to amend Section 14011.10 of the Welfare and Institutions Code, end insert relating to inmates.

LEGISLATIVE COUNSEL’S DIGEST

AB 720, as amended, Skinner. Inmates: health care enrollment.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing federal law prohibits federal financial participation for medical care provided to inmates of a public institution, except when the inmate is a patient in a medical institution.

Commencing January 1, 2014, the federal Patient Protection and Affordable Care Act expands eligibility under the Medicaid Program for certain groups and enacts various other health care coverage market reforms that take effect on that date. Existing federal law requires the Secretary of Health and Human Services to develop and provide to each state a single, streamlined form that may be used to apply for all state health subsidy programs, as defined, within the state.

This bill would begin delete require end delete begin insert authorize end insert the board of supervisors in each county begin insert , in consultation with the county sheriff, end insert to designate an entity to assist certain jail inmates to apply for a health insurance affordability program, as defined. The bill would provide that county jail inmates who are currently enrolled in the Medi-Cal program begin insert shall remain eligible for, and end insert shall not be terminated from begin insert , end insert the program due to their detention, unless required by federal law or they become otherwise begin delete ineligible, as specified end delete begin insert ineligible end insert . The bill would require the State Department of Health Care Services to establish, subject to federal law, a process to enable counties to obtain begin insert the maximum available end insert federal financial participation for begin insert the services they provide pursuant to end insert these provisions. begin insert The bill would also authorize an adult who has been involuntarily detained or incarcerated in a county facility to refuse assistance from the designated entity, as specified. The bill would provide that the fact that an applicant is an inmate shall not, in and of itself, preclude a county human services agency from processing an application submitted to it by, or on behalf of, that inmate. end insert

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By imposing additional duties on local governments, this bill would impose a state-mandated local program.

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Existing law also provides for the suspension of Medi-Cal benefits to an inmate of a public institution who is under 21 years of age. Existing law requires county welfare departments to notify the department within 10 days of receiving information that an individual under 21 years of age who is receiving Medi-Cal is or will be an inmate of a public institution.

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This bill would instead make these provisions applicable without regard to the age of the individual, provided that federal financial participation would not be jeopardized. By expanding the duties of county agencies, this bill would impose a state-mandated local program.

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The bill would also include a statement of legislative intent.

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The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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It is the intent of the Legislature in enacting this
act to, among other things, ensure that county human services
agencies recognize that (a) federal law generally does not
authorize federal financial participation for Medi-Cal when a
person is an inmate of a public institution as defined in federal
law, unless the inmate is admitted as an inpatient to a
noncorrectional health care facility, and (b) federal financial
participation is available after an inmate is released from a county
jail.

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begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

Section 4011.11 is added to the Penal Code, to read:

4011.11.  

(a) (1) The board of supervisors in each county begin delete shall end delete begin insert ,
in consultation with the county sheriff, may end insert designate an entity to
assist county jail inmates described in subdivision (c) with
submitting an application for a health insurance affordability
program consistent with federal requirements.

(2) The board of supervisors shall not designate the county
sheriff as the entity to assist with submitting an application for a
health insurance affordability program for county jail inmates
described in subdivision (c) unless the county sheriff agrees to
perform this function.

(3) If the board of supervisors designates a community-based
organization as the entity to assist with submitting an application
for a health insurance affordability program for county jail inmates
described in subdivision (c), the designation shall be subject to
approval by the jail administrator, or his or her designee.

(b) The jail administrator, or his or her designee, begin delete shall end delete begin insert may end insert
coordinate with the entity designated pursuant to subdivision (a).

(c) The entity designated pursuant to subdivision (a) begin delete shall end delete begin insert may end insert
assist begin insert a end insert county jail begin delete inmates end delete begin insert inmate end insert with submitting an application
for a health insurance affordability program if all of the following
conditions are met:

(1) The inmate has been in detention for at least 72 hours
following remand into custody by a court or magistrate.

(2) The inmate appears potentially eligible to be enrolled in the
health insurance affordability program upon release.

(3) The inmate does not currently have health care coverage.

(d) Consistent with federal begin delete regulations, end delete begin insert law, end insert county jail inmates
who are currently enrolled in the Medi-Cal program begin insert shall remain
eligible for, and end insert shall not be terminated begin delete from end delete begin insert from, end insert the program
due to their detention unless required by federal law, or they
become otherwise ineligible.

(e) Notwithstanding any other provision of law, and only to the
extent that federal law allows, the State Department of Health Care
Services shall establish a process to enable counties to obtain the
maximum available federal financial participation for
begin delete administrative activities end delete begin insert services they provide end insert related to this
section.

(f) Notwithstanding any other begin insert state end insert law, begin insert and only to the extent
federal law allows and, for purposes of the Medi-Cal program,
federal financial participation is available, end insert the entity designated
pursuant to subdivision (a) is authorized to act on behalf of a county
jail inmate begin insert who meets all of the conditions described in paragraphs
(1) to (3), inclusive of subdivision (c) end insert , for begin delete purposes end delete begin insert the limited
purpose end insert of applying for or a determination of eligibility for a health
insurance affordability program begin insert , including, but not limited to, the
Medi-Cal program. The entity shall not determine Medi-Cal
eligibility or redetermine Medi-Cal eligibility, unless the entity is
the county human services agency. The fact that an applicant is
an inmate shall not, in and of itself, preclude a county human
services agency from processing an application submitted to it by,
or on behalf of, that inmate end insert .

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(g) An adult who has been involuntarily detained or incarcerated
in a county facility may refuse in writing to authorize the entity
designated pursuant to subdivision (a) to act on his or her behalf
for purposes of applying for or determining eligibility for a health
insurance affordability program, in which case the entity shall not
act on that person’s behalf. That person shall be informed of, and
given the opportunity to exercise, this right before the entity
submits an application on his or her behalf.

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(g)

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begin insert (h) end insert  For purposes of this section, “health insurance affordability
program” means a program that is one of the following:

(1) The state’s Medi-Cal program under Title XIX of the federal
Social Security Act.

(2) The state’s children’s health insurance program (CHIP)
under title XXI of the federal Social Security Act.

(3) A program that makes coverage in a qualified health plan
through the California Health Benefit Exchange established
pursuant to Section 100500 of the Government Code with advance
payment of the premium tax credit established under Section 36B
of the Internal Revenue Code available to qualified individuals.

(4) A program that makes available coverage in a qualified
health plan through the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code
with cost-sharing reductions established under Section 1402 of the
federal Patient Protection and Affordable Care Act (Public Law
111-148) and any subsequent amendments to that act.

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(h)

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begin insert (i) end insert  Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement this section by means of all-county
letters or similar instructions, without taking regulatory action.

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begin insert SEC. 3. end insert   

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begin insert Section 14011.10 of the end insert begin insert Welfare and Institutions Code end insert
begin insert is amended to read: end insert

14011.10.  

(a) Except as provided in Section 14011.11, benefits
provided under this chapter to an individual begin delete under 21 years of age end delete
who is an inmate of a public institution shall be suspended in
accordance with Section begin delete 1396d(a)(28)(A) end delete begin insert 1396d(a)(29)(A) end insert of Title
42 of the United States Code as provided in subdivision (c).

(b) County welfare departments shall notify the department
within 10 days of receiving information that an individual begin delete under
21 years of age end delete on Medi-Cal in the county is or will be an inmate
of a public institution.

(c) If an individual begin delete under 21 years of age end delete is a Medi-Cal
beneficiary on the date he or she becomes an inmate of a public
institution, his or her benefits under this chapter and under Chapter
8 (commencing with Section 14200) shall be suspended effective
the date he or she becomes an inmate of a public institution. The
suspension shall end on the date he or she 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, whichever is sooner.

(d) Nothing in this section shall create a state-funded benefit or
program. Health care services under this chapter and Chapter 8
(commencing with Section 14200) shall not be available to inmates
of public institutions whose Medi-Cal benefits have been suspended
under this section.

(e) This section shall be implemented only if and to the extent
allowed by federal law. This section shall be implemented only to
the extent that any necessary federal approval of state plan
amendments or other federal approvals are obtained.

(f) If any part of this section is in conflict with or does not
comply with federal law, this entire section shall be begin delete inoperable end delete
begin insert inoperative end insert .

(g) This section shall be implemented on January 1, 2010, or
the date when all necessary federal approvals are obtained,
whichever is later.

(h) By January 1, 2010, or the date when all necessary federal
approvals are obtained, whichever is later, the department, in
consultation with the Chief Probation Officers of California and
the County Welfare Directors Association, shall establish the
protocols and procedures necessary to implement this section,
including any needed changes to the protocols and procedures
previously established to implement Section 14029.5.

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(i) The department shall determine whether federal financial
participation will be jeopardized by implementing the amendments
to this section made by the act adding this subdivision and shall
implement those provisions only if and to the extent that federal
financial participation is not jeopardized.

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(i)

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begin insert (j) end insert  Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department shall implement this section by means of all-county
letters or similar instructions without taking regulatory action.
Thereafter, the department shall adopt regulations in accordance
with the requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.

begin delete SEC. 2. end delete
begin insert SEC. 4. end insert   

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.