BILL ANALYSIS Ó
AB 720
Page 1
Date of Hearing: April 16, 2013
Counsel: Stella Choe
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Tom Ammiano, Chair
AB 720 (Skinner) - As Amended: April 11, 2013
SUMMARY : Requires counties to enroll county jail inmates who
are eligible for federal Medicaid benefits in the Medi-Cal
Program prior to release. Specifically, this bill :
1)Requires each county to designate an individual or agency to
enroll all eligible individuals as specified in the available
Medi-Cal program in that county, consistent with federal
requirements.
2)States that the jail administrator, or his or her designee,
shall coordinate with the individual or agency designated by
the county.
3)Provides that the individual or agency designated by the
county shall enroll an inmate in the Medi-Cal program at any
point before release if all of the following conditions are
met:
a) The inmate has been in detention for at least 72 hours;
and,
b) The inmate will be eligible to be enrolled in the
Medi-Cal program upon release.
4)States that, consistent with federal regulations, individuals
who are currently enrolled in the Medi-Cal program in the
county where they reside and who would become ineligible for
benefits because of detention before or after conviction shall
have their benefits suspended during detention and shall
retain enrollment in the program.
5)Provides that the individual or agency designated by the
county shall supply appropriate information regarding the
California Health Benefit Exchange to those individuals
detained in a county jail who are not eligible for Medi-Cal
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benefits and who do not otherwise have health care coverage.
6)Makes the following legislative declarations and findings:
a) The federal Patient Protection and Affordable Care Act,
also known as health care reform, is designed to ensure
every American has access to affordable quality health
care. To help ensure access, the federal low-income health
insurance program, the Medi-Cal program in California, will
be expanded to previously uncovered populations, including
single men making less than 133% of the federal poverty
level.
b) The cost of the Medi-Cal expansion will be fully paid by
the federal government until 2017, when the federal
government will cover 90% of the cost of the Medi-Cal
expansion.
c) According to research done by the National Health Law
Program, a large portion of individuals currently sentenced
to county jail, and those recently released, are currently
uninsured and may be eligible for Medi-Cal once released.
d) According to a study published in the American Journal
of Public Health, many people coming out of county jail
have significant medical, mental health, and substance
abuse needs that are currently unmet.
e) According to a study funded by the National Criminal
Justice Reference Service, individuals who are enrolled in
Medicaid on the day of release committed fewer repeat
offenses, and the time between offenses was longer.
7)States that it is the intent of the Legislature to enroll
individuals in county jail in the federally funded Medi-Cal
program to provide medical, mental health, and substance abuse
services to individuals when released from county jail, at no
cost to the state until 2017 and at minimal state cost
beginning in 2017.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), to provide
comprehensive health benefits to low-income children, their
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parents or caretaker relatives, pregnant women, elderly, blind
or disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria. [Welfare and
Institutions Code (WIC) Sections 14000 et seq.]
2)States that a person or family may be eligible for Medi-Cal
under one of the following programs (22 Cal. Code Regs.
Section 50201):
a) Aid to Families with Dependent Children;
b) Supplemental Security Income/State Supplemental Program;
c) Other Public Assistance;
d) Medically Needy;
e) Medically Indigent;
f) Miscellaneous Special Programs; and,
g) Medi-Cal Special Treatment Programs.
3)Specifies that the county welfare department in each county
shall be the agency responsible for local administration of
the Medi-Cal program under the direction of DHCS. [22 Cal.
Code Regs. Section 50004(c).]
4)Provides that, notwithstanding any other provision of law, the
California Department of Corrections and Rehabilitation and
DHCS may develop a process to maximize federal financial
participation for the provision of inpatient hospital services
rendered to individuals who, but for their institutional
status as inmates, are otherwise eligible for Medi-Cal or the
Low Income Health Program. [Penal Code Section 5072(a).]
5)Exempts from eligibility of Medi-Cal benefits inmates of a
"public institution" unless they are out on bail or own
recognizance. This includes inmates in prison, county, city
or tribal jail, and inmates in custody awaiting arraignment,
conviction or sentencing. [Medi-Cal Eligibility Procedures
Manual, Article 6, Section 50273 (Revised Apr. 18, 2001).]
6)States that if an individual under 21 years of age is a
Medi-Cal beneficiary on the date he or she becomes an inmate
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of a public institution, his or her benefits shall be
suspended effective the date he or she becomes an inmate of a
public institution. Provides that the suspension will 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. [WIC
Section 14011.10(c).]
EXISTING FEDERAL LAW : The Patient Protection and Affordable
Care Act (ACA) was signed into law by President Obama in 2010.
In addition to its goals of improving health care quality and
reducing costs, the ACA will also increase access to affordable
health coverage by prohibiting insurance companies from denying
coverage based on pre-existing conditions, allowing young adults
to stay on their parents' insurance longer, providing tax
credits to help people pay for coverage, and allowing states to
cover more people on Medicaid. [Pub.L. No. 111-148 (MAR. 23,
2010) 124 Stat. 133.]
FISCAL EFFECT : Unknown
COMMENTS :
1)Author's Statement : According to the author, "AB 720 would
require counties to enroll eligible inmates into the Medi-Cal
program before being released. This would address one of the
main barriers to re-entry by helping formerly incarcerated
inmates access physical, mental health and substance abuse
services.
"Research shows that formerly incarcerated individuals who have
access to medical services upon release have reduced
recidivism rates, increasing the likelihood they will become
productive citizens. A 2009 California Department of
Corrections and Rehabilitation report showed a 61% recidivism
reduction for female inmates who underwent substance abuse
treatment and a 29% reduction for male inmates who underwent
such treatment." (Footnote omitted.) [California Department
of Corrections and Rehabilitation Adult Programs Annual Report
(June 2009) pages 7 and 8,
.]
2)Background : According to the background materials provided by
the author, "The path to successful re-entry into society for
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formerly incarcerated individuals is riddled with obstacles.
The cards are stacked against them: struggling with higher
rates of poverty, chronic medical conditions, substance abuse
issues and mental illnesses. Data shows that nearly 40% of
jail inmates suffer from a chronic medical condition, and over
half of state prison and jail inmates nationwide have
experienced a mental health problem within the last year.
These issues are compounded by the low rate of health
insurance coverage for jail inmates. One recent study shows
that up to 90% of people in jail do not have health insurance
or financial resources to pay for medical care." (Footnotes
omitted.) [See Rich et al., Medicine and the Epidemic of
Incarceration in the United States (June 2, 2011) New England
Journal of Medicine, pp. 2081-2083;
.]
"There are tremendous medical and public health opportunities
that can be created by addressing the health care needs of
prisoners and former prisoners. Perhaps foremost among these
is that opened up by health care reform: the Affordable Care
Act will permit most former prisoners to receive health
insurance coverage, which will offer them greater access to
much needed medical care. Such access could redirect many
people with serious illnesses away from the revolving door of
the criminal justice system, thereby improving overall public
health in the communities to which prisoners return and
decreasing the costs associated with reincarceration due to
untreated addiction and mental illness." (Rich et al.,
Medicine and the Epidemic of Incarceration in the United
States, supra, at p. 2083.)
3)Medi-Cal and the ACA : Medicaid is a joint federal-state
insurance program that provides health coverage, including
mental and behavioral health benefits, for certain low-income
families and individuals. Medicaid is financed jointly by the
federal government and states, and administered by states
and/or counties within broad federal guidelines. In
California, the Medicaid program is administered by DHCS and
is known as Medi-Cal.
"In choosing to operate a Medicaid program, states receive
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federal funding for a significant share of the program costs.
The percentage of program costs funded with federal funds
varies by state and is known as the federal medical assistance
percentage, (FMAP or 'federal match'). In most cases, the
federal match is determined annually by comparing the state's
per capita income to the national average. The Medi-Cal
Program currently receives a 50 percent federal match for most
services provided to beneficiaries, as well as for state and
county costs to administer the program. In other words, the
program generally receives one dollar of federal funds for
each state dollar spent on Medi-Cal beneficiaries and
administration. The federal government also provides an
enhanced federal match for certain program costs, such as
services for groups with particular medical needs or the
implementation of technology systems.
"The ACA gives states the option to significantly expand their
Medicaid programs, with the federal government paying for a
large majority of the additional costs. Beginning January 1,
2014, federal law gives state Medicaid programs the option to
cover most individuals under age 65-including childless
adults-with incomes at or below 133 percent of the [federal
poverty level]. . . . [T]he federal matching rate for
coverage of this expansion population will be 100 percent for
the first three years, but will decline between 2017 and 2020,
with states eventually bearing 10 percent of the additional
cost of health care services for the expansion population."
[Legislative Analyst's Office, The 2013-14 Budget: Obtaining
Federal Funds for Inmate Medical Care-A Status Report, (Feb.
5, 2013) pp. 2-4.]
4)Arguments in Support :
a) The California State Association of Counties (CSAC)
states, "Assembly Bill [720] will give counties an
important tool to reduce repeat crime and recidivism by
allowing newly released inmates to access critical health
care and substance abuse disorder services through
Medi-Cal, or if they qualify, through a qualified health
plan in the state's health benefits exchange. By
pre-enrolling incarcerated individuals, counties can get a
jump on providing wrap-around services to the most
high-risk inmates to ensure adequate supervision and
successful and sustainable reentry in our communities.
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"CSAC supports efforts to increase local flexibility and
innovation in serving the AB 109 and county jail population
because the benefits of successful reintegration of
incarcerated individuals accrue to a variety of
stakeholders, including counties, the state, our local
communities and families."
b) The California Primary Care Association writes, "The
national Patient Protection and Affordable Care Act (ACA)
increases the income threshold for Medicaid eligibility
from 100% to 138% of the federal poverty level and extends
eligibility to childless adults, who formerly were not
eligible. A significant proportion of county inmates and
detainees are men who fit into these extended categories.
National studies show many have medical, mental health and
substance abuse needs. Our member clinics and health
centers currently provide primary care services at no cost
to them following their release even though they are
largely uninsured.
"Additional national studies show that when these individuals
are enrolled in Medicaid programs on the day of their
release are less likely to re-offend, and, if they do, the
period between offenses is greater. This bill not only
would provide them with access to health care services they
need and reduce recidivism, it also would provide health
centers with additional resources to help accommodate the
expanded Medi-Cal population under the ACA."
5)Prior Legislation :
a) AB 396 (Mitchell), Chapter 394, Statutes of 2011,
requires DHCS to develop processes to allow counties and
the Division of Juvenile Facilities within CDCR to receive
any available federal financial participation for acute
inpatient hospital services and inpatient psychiatric
services provided to juvenile inmates, as defined and as
applicable, who are admitted as inpatients in a medical
institution.
b) SB 695 (Hancock), Chapter 647, Statutes of 2011,
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
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expenditures and administrative costs.
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
provision of inpatient hospital services to adult inmates
who would otherwise be eligible for Medi-Cal or similar
county-based low-income health programs, 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.
e) SB 1469 (Cedillo), Chapter 657, Statutes of 2006,
requires county juvenile detention facilities to notify
county welfare departments about the release of a ward so
that eligibility for Medi-Cal can be determined prior to
the release of the inmate.
f) AB 1945 (Coto), of the 2005-06 Legislative Session,
among other provisions, would have required a juvenile
detention facility, when a minor is released from custody,
to determine if the minor will have health insurance after
release, and if the minor will not, to evaluate the
eligibility of the minor for enrollment in appropriate
need-based programs. AB 1945 was never heard by the
Assembly Health Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Californians for Safety and Justice (Sponsor)
American Civil Liberties Union
California Attorneys for Criminal Justice
California Pan-Ethnic Health Network
California Public Defenders Association
California State Association of Counties
California State Conference of the National Association for the
Advancement of Colored People
Drug Policy Alliance
Ella Baker Center for Human Rights
Greenlining Institute
Legal Services for Prisoners with Children
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Local Health Plans of California
Los Angeles Regional Reentry Partnership
National Association of Social Workers - California Chapter
San Francisco Sheriff's Department
Taxpayers for Improving Public Safety
Women's Foundation of California
Opposition
None
Analysis Prepared by : Stella Choe / PUB. S. / (916) 319-3744