BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 720 (Skinner) - Inmates: health care enrollment.
Amended: July 9, 2013 Policy Vote: Health 7-2, Public
Safety 7-0
Urgency: No Mandate: Yes
Hearing Date: August 19, 2013
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 720 would require each county to designate an
entity to assist county jail inmates with submitting an
application for health care coverage.
Fiscal Impact:
Likely ongoing county costs in the tens of millions per
year to assist inmates with applications for health care
coverage (General Fund). For example, based on the current
average county jail population and average residence time
and assuming that 50% of the jail population meets the
bill's criteria, staff estimates that about 660,000 inmates
will be eligible for assistance under the bill. If it takes
on average about 30 minutes to assist in the application
total annual costs would be about $17 million per year.
Because the bill mandates that counties undertake these
activities, the state would be obligated to reimburse
counties for the costs incurred under the bill.
The bill requires the Department of Health Care Services to
establish a process for counties to receive federal matching
funds for their expenditures. However, the Department has
indicated that recent agreements with the federal government
will not allow local governments to receive federal matching
funds for administrative activities associated with inmates.
If that is the case, the state would be required to
reimburse all county costs under the bill.
Unknown increase in Medi-Cal expenditures for former
inmates, potentially in the low hundreds of millions per
year (General Fund and federal funds). By assisting inmates
with the application process, the bill is likely to increase
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enrollment in Medi-Cal, at least in the short term. Because
of the individual mandate to have health care coverage in
the Affordable Care Act and the general increase in public
awareness of new health care coverage options after 2014, it
is likely that many current jail inmates will apply for
coverage at some point after leaving jail. Under the bill,
this process will be accelerated and therefore the Medi-Cal
program is likely to incur costs to provide coverage sooner
for eligible former inmates.
For example, assuming that 25% of inmates who are eligible
for assistance under the bill are eligible for Medi-Cal and
that applying for coverage before release accelerates the
average inmate's enrollment in Medi-Cal by six months, total
additional Medi-Cal costs would be about $150 million per
year.
Some inmates would be eligible for the current Medi-Cal
program upon release, provided they are a caretaker to a
child and are eligible based on family income. Other inmates
may be eligible for expanded Medi-Cal (which provides
coverage for childless adults). Individuals eligible for
traditional Medi-Cal would be funded 50% from the General
Fund and 50% from federal funds. For individuals who are
eligible for the Medi-Cal expansion, the federal government
would pay 100% of the costs initially, dropping to 90% of
costs by 2020.
Background: Under state and federal law, the Department of
Health Care Services operates the Medi-Cal program, which
provides health care coverage to pregnant women, children and
their parents with incomes below 100 percent of the federal
poverty level, as well as blind, disabled, and certain other
populations. Generally, the federal government provides a 50
percent federal match for state Medi-Cal expenditures.
The federal Affordable Care Act allows states to expand Medicaid
(Medi-Cal in California) eligibility to persons under 65 years
of age, who are not pregnant, not entitled to Medicare Part A or
enrolled in Medicare Part B, and whose income does not exceed
133 percent of the federal poverty level (effectively 138
percent of the federal poverty level as calculated under the
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Affordable Care Act). As enacted, the Affordable Care Act
required states to expand their Medicaid programs to 138 percent
of the federal poverty level. In June of 2012, the United States
Supreme Court ruled that mandating the Medicaid expansion is
unconstitutional. Subsequently, the federal Health and Human
Services Agency released guidance indicating that states may
only reject the Medicaid Expansion or fully enact the Medicaid
Expansion. California has opted to expand eligibility for
Medi-Cal up to 138 percent of the federal poverty level.
The Affordable Care Act provides a significantly enhanced
federal match for the Medicaid expansion. Under the law, the
federal government will pay for 100 percent of the cost of the
Medicaid expansion in 2013-14 declining to a 90 percent federal
match in the 2020 federal fiscal year and thereafter.
Proposed Law: AB 720 would require each county to designate an
entity to assist county jail inmates with submitting an
application for health care coverage.
Specific provisions of the bill would:
Require each county to designate an entity to assist
inmates with the process of applying for health insurance
affordability programs;
Prohibit counties from designating the county sheriff as
the entity, without the sheriff's permission;
Require the entity to assist inmates that have been in
detention for at least 72 hours, may be eligible for
specified health insurance affordability programs, and do
not have health care coverage;
Prohibit the Department of Health Care Services from
terminating inmates in county jails from the Medi-Cal
program, unless they become ineligible;
Require the department to develop a process for counties to
receive available federal funding for administrative
activities under the bill;
Define health insurance affordability programs to include
Medi-Cal, Healthy Families, and subsidized health care
coverage provided through the California Health Benefit
Exchange.
Staff Comments: There is evidence that incarcerated individuals
have higher rates of mental health problems and substance abuse
problems than the general population. Under the Affordable Care
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Act, expanded Medi-Cal coverage and subsidized health care
coverage purchased through the California Health Benefit
Exchange will cover mental health and substance abuse treatment
services. To the extent that this bill results in greater
numbers of former inmates being enrolled in comprehensive health
care coverage, access to such services is likely to reduce
recidivism rates for this population in the long-run.