Amended in Senate September 6, 2013

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

(Coauthor: Senator Beall)

February 21, 2013

An act to add Section 4011.11 to the Penal Code, and to amend Section 14011.10 of the Welfare and Institutions Code, 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 authorize the board of supervisors in each county, in consultation with the county sheriff, to designate an entity begin insert or entities end insert to assist begin delete certain end delete begin insert county end insert jail inmates to apply for a health insurance affordability program, as defined. begin insert The bill would authorize the entity, to the extent authorized by federal law and federal financial participation is available, to act on behalf of a county jail inmate for the purpose of applying for, or determinations of, Medi-Cal eligibility for acute inpatient hospital services, as specified. end insert The bill would provide that county jail inmates who are currently enrolled in the Medi-Cal program shall remain eligible for, and shall not be terminated from, the program due to their detention, unless required by federal law begin delete or end delete begin insert , end insert they become otherwise ineligible begin insert , or the suspension of their benefits has ended end insert . begin delete The bill would require the State Department of Health Care Services to establish, subject to federal law, a process to enable counties to obtain the maximum available federal financial participation for the services they provide pursuant to these provisions. 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. end delete 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 begin insert for the Medi-Cal program end insert submitted to it by, or on behalf of, that inmate.

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.

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.

The bill would also include a statement of legislative intent.

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:

SECTION 1.  

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 begin insert , end insert as defined in federal law, unless the
inmate is admitted as an inpatient to a noncorrectional health care
facility, begin delete and end delete (b) federal financial participation is available after an
inmate is released from a county jail begin insert , and (c) the fact that an
applicant is currently an inmate does not, in and of itself, preclude
the county human services agency from processing the application
submitted to it by, or on behalf of, that inmate end insert .

SEC. 2.  

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

4011.11.  

(a) (1) The board of supervisors in each county, in
consultation with the county sheriff, may designate an entity begin insert or
entities end insert to assist county jail inmates begin delete described in subdivision (c) end delete
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 begin delete the end delete begin insert an end insert entity to assist with submitting an application for
a health insurance affordability program for county jail inmates begin delete described in subdivision (c) end delete unless the county sheriff agrees to
perform this function.

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

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

begin delete

(c) The entity designated pursuant to subdivision (a) may assist
a county jail inmate 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.

end delete begin delete

(d)

end delete

begin insert (c) end insert  Consistent with federal law, begin insert a end insert county jail begin delete inmates end delete begin insert inmate end insert
who begin delete are end delete begin insert is end insert currently enrolled in the Medi-Cal program shall remain
eligible for, and shall not be terminated from, the program due to
begin delete their end delete begin insert his or her end insert detention unless required by federal law, begin delete or they
become end delete begin insert he or she becomes end insert otherwise ineligible begin insert , or the inmate’s
suspension of benefits has ended pursuant to Section 14011.10 of
the Welfare and Institutions Code end insert .

begin delete

(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 services they
provide related to this section.

end delete begin delete

(f)

end delete

begin insert (d) end insert  Notwithstanding any other state law, and only to the extent
federal law allows begin delete and, for purposes of the Medi-Cal program, end delete
begin insert and end insert federal financial participation is available, begin delete the end delete begin insert an end insert entity
designated pursuant to subdivision (a) is authorized to act on behalf
of a county jail inmate begin delete who meets all of the conditions described
in paragraphs (1) to (3), inclusive of subdivision (c), end delete for the begin delete limited end delete
purpose of applying begin delete for or a determination of end delete begin insert for, or determinations
of, Medi-Cal end insert eligibility for begin delete a health insurance affordability program,
including, but not limited to, the Medi-Cal program end delete begin insert acute inpatient
hospital services authorized by Section 14053.7 of the Welfare
and Institutions Code end insert . begin delete The end delete begin insert An end insert entity begin insert designated pursuant to
subdivision (a) end insert shall not determine Medi-Cal eligibility or
redetermine Medi-Cal eligibility, unless the entity is the county
human services agency. begin delete The end delete

begin insert (e) end insert begin insert   end insert begin insert The end insert fact that an applicant is an inmate shall not, in and of
itself, preclude a county human services agency from processing
an application begin insert for the Medi-Cal program end insert submitted to it by, or on
behalf of, that inmate.

begin delete

(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.

end delete begin delete

(h)

end delete

begin insert (f) 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 begin delete title end delete begin insert Title end insert 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.

begin delete

(i)

end delete

begin insert (g) 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.

SEC. 3.  

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

14011.10.  

(a) Except as provided in begin delete Section end delete begin insert Sections end insert 14011.11,
begin insert 14053.7, and 14053.8, end insert benefits provided under this chapter to an
individual who is an inmate of a public institution shall be
suspended in accordance with Section 1396d(a)(29)(A) 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 on
Medi-Cal in the county is or will be an inmate of a public
institution.

(c) If an individual 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 inoperative.

(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.

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

(j) 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.

SEC. 4.  

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.