BILL ANALYSIS �
AB 720
Page 1
Date of Hearing: May 1, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 720 (Skinner) - As Amended: April 11, 2013
Policy Committee: Public
SafetyVote: 7-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill requires each county to designate an individual or
agency to determine Medi-Cal eligibility and process Medi-Cal
applications for county jail inmates prior to their release from
custody. (This provision applies only to inmates in detention
for more than 72 hours.) This designated individual or agency is
also required to provide information regarding the California
Health Benefit Exchange to jail inmates who are ineligible for
Medi-Cal benefits.
This bill also specifies that persons currently enrolled in
Medi-Cal in the county where they reside, who would become
ineligible for benefits because of detention, shall have their
benefits suspended during detention and retain program
enrollment.
FISCAL EFFECT
1)Significant state-reimbursable local administrative costs,
likely in excess of $4 million, assuming a 50/50 state/federal
share of costs. County jails statewide average about 86,000
per month (1,032,000 per year). This figure includes bookings
that do not result in more than 72 hours of detention, as well
as multiple releases for the same person. If half of these
releases require a Medi-Cal eligibility determination and an
application, assuming about 30 minutes per inmate, at a cost
of about $30 per hour, the annual cost would be in the range
of $8 million.
To the extent counties are able to access private funding,
such as a recent announcement that the California Endowment
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will be awarding close to $20 million to groups assisting in
the implementation of the Affordable Care Act, state costs
could be considerably reduced.
2)To the extent this bill results in providing Medi-Cal services
to individuals who might otherwise not avail themselves of the
program, the cost in most cases will be fully paid by the
federal government for several years, assuming California
adopts Medi-Cal expansion to include childless adults at 138%
of the poverty level, until the reimbursement ratio settles at
90:10, federal:state.
COMMENTS
1)Rationale . The author's intent is to require counties to
enroll eligible jail inmates into the Medi-Cal program before
inmates are released in order to address one of the main
barriers to successful community re-entry.
The author references an article in the June 2, 2011 issue of
the New England Journal of Medicine, which states, "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. To achieve these
gains, we will need to ensure linkages to medical homes that
provide substance-use and mental health treatment for
reentering populations. Partnerships between correctional
facilities and community health care providers - especially
community health centers and academic medical centers - can
capitalize on health gains made during incarceration and
improve the continuity of care for former inmates during the
critical post-release period. The success of this effort will
determine not only the health of released prisoners, but that
of our society as a whole."
2)Support . The California State Association of Counties (CSAC)
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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."
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."
3)There is no registered opposition to this measure.
Analysis Prepared by : Geoff Long / APPR. / (916) 319-2081