BILL ANALYSIS �
AB 720
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CONCURRENCE IN SENATE AMENDMENTS
AB 720 (Skinner)
As Amended September 6, 2013
Majority vote
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|ASSEMBLY: |56-19|(May 29, 2013) |SENATE: |35-0 |(September 11, |
| | | | | |2013) |
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Original Committee Reference: PUB. S.
SUMMARY : Authorizes the board of supervisors in each county in
consultation with the county sheriff, to designate an entity or
entities to assist county jail inmates with submitting an
application for a health insurance affordability program, as
consistent with federal requirements.
The Senate amendments :
1)Specify that the board of supervisor shall not designate the
county sheriff as an entity unless the county sheriff agrees
to perform this function.
2)State if the board of supervisors designates a community-based
organization as an entity, the designation shall by subject to
approval by the jail administrator, or his or her designee.
3)State, notwithstanding any other state law, and only to the
extent federal law allows, and federal financial participation
is available, the designated entity or entities, is authorized
to act on behalf of a county jail inmate for specified
purposes related to Medi-Cal.
4)Provide that an entity designated by the board of supervisors
shall not determine Medi-Cal eligibility or redetermine
Medi-Cal eligibility, unless the entity is the county human
services agency.
5)Specify 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 for the Medi-
Cal program submitted to it by, or on behalf of, that inmate.
6)Remove the requirement in the applicable Welfare and
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Institutions Code that the individual must be under 21 years
of age.
7)Require the State Department of Health Care Services to
determine whether federal financial participation will be
jeopardized by implementing the provisions of this bill and to
implement those provisions only if and to the extent that
federal financial participation is not jeopardized.
8)Add legislative intent.
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
parents or caretaker relatives, pregnant women, elderly, blind
or disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
2)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.
3)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.
4)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)
5)States that if an individual under 21 years of age is a
Medi-Cal beneficiary on the date he or she becomes an inmate
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
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institution or one year from the date he or she becomes an
inmate of a public institution, whichever is sooner.
AS PASSED BY THE ASSEMBLY , this bill:
1)Required each county to designate an individual or agency to
complete and submit an application for a health insurance
affordability program application for specified inmates in a
county jail at any time before release.
2)Stated that the jail administrator, or his or her designee,
shall coordinate with the individual or agency designated by
the county.
3)Specified that the designated individual or agency shall
complete and submit an application for a health insurance
affordability program on behalf of an inmate in a county jail
at any time before release if the inmate has been in detention
for at least 72 hours and the inmate appears potentially
eligible to be enrolled in the health insurance affordability
program upon release.
4)Provided that, consistent with federal regulations,
individuals who are currently enrolled in the Medi-Cal program
shall not be terminated from the program due to their
detention, unless required by federal law, or they become
otherwise ineligible.
5)Stated, notwithstanding any other provision of law, and only
to the extent that federal law allows, the state shall
establish a process to enable counties to obtain the maximum
available federal financial participation for administrative
activities related to this bill.
6)Stated, notwithstanding any other provision of law, the
individual or agency designated by the county is authorized to
act on behalf of an individual detained in county jail, for
purposes of applying for, or a determination of, eligibility
for a health insurance affordability program.
7)Defined "health insurance affordability program" as a program
that is one of the following:
a) The state's Medi-Cal program under Title XIX of the
federal Social Security Act.
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b) The state's children's health insurance program under
title XXI of the federal Social Security Act.
c) A program that makes coverage in a qualified health plan
through the California Health Benefit Exchange with advance
payment of the premium tax credit established under the
Section 36B of the Internal Revenue Code available to
qualified individuals.
d) A program that makes available coverage in a qualified
health plan through the California Health Benefit Exchange
with cost-sharing reductions established under the federal
Patient Protection and Affordable Care Act and any
subsequent amendments to that act.
8)Specified notwithstanding existing provisions of law related
to administrative regulations and rulemaking, DHCS may
implement provisions in this bill by means of all-county
letters or similar instructions, without taking regulatory
action.
FISCAL EFFECT : According to the Senate Appropriations
Committee, 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 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.
In addition, under the bill, jail inmates who are enrolled in
Medi-Cal at the time of incarceration would be suspended from
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the program, but would not be terminated from the program. Upon
their release, Medi-Cal benefits would be immediately
reactivated. This provision will increase Medi-Cal enrollment,
because former inmates would not have to re-apply for Medi-Cal
upon their release. If 10% of the jail population is enrolled
in Medi-Cal upon incarceration and is kept in the program due to
changes in the bill, the annual costs from the bill would likely
be in the low tens of millions per year.
Some inmates impacted by this bill 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.
COMMENTS : 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, .)
Please see the policy committee analysis for a full discussion
of this bill.
Analysis Prepared by : Stella Choe / PUB. S. / (916) 319-3744
AB 720
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