BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 1133
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          ASSEMBLY THIRD READING
          AB 1133 (Mitchell)
          As Amended  May 7, 2013
          Majority vote 

           HUMAN SERVICES      5-0                                         
           
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          |Ayes:|Stone, Maienschein,       |     |                          |
          |     |Ammiano,                  |     |                          |
          |     |Ian Calderon, Garcia      |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
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           SUMMARY  :  Requires social workers to give preference to a  
          licensed foster parent who is also a health care practitioner  
          for purposes of placement of a medically fragile foster child.   
          Specifically,  this bill  :   

          1)Requires placement preference be given to a foster parent who  
            is a nurse authorized to provide home- and community-based  
            services under the Early and Periodic Screening, Diagnosis and  
            Treatment (EPSDT) program. 

          2)Requires the preference to be subordinate to the preference  
            granted to a relative or nonrelative extended family member  
            (NREFM).

           EXISTING LAW  :

          1)Defines, under the Welfare and Institutions (W&I) Code a  
            "specialized foster care home" (SFCH) as any licensed foster  
            home that provides specialized in-home health care to foster  
            children, and limits their capacity to no more than two  
            children, as specified.

          2)Defines "Child with Special Health Care Needs" as a person who  
            is 22 years of age or younger who is completing a publicly  
            funded education program, who has a condition that can rapidly  
            deteriorate resulting in permanent injury or death or who has  
            a medical condition that requires specialized in-home health  
            care, and who either has been adjudged a dependent of the  
            court, is in the custody of the county welfare department, or  
            has a developmental disability and is receiving services and  







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            case management from a regional center.

           FISCAL EFFECT  :  None

           COMMENTS  :    

           Maintaining the Family  :  Historically, it has been the stated  
          policy of California that when a child is removed from the home,  
          first preference should be given to placing the child with  
          another parent, or with his or her relatives whenever possible  
          and appropriate.  This has helped to preserve and strengthen the  
          social bedrock of our society, by keeping families together and  
          reducing society's reliance on its social welfare system. 

           Child Welfare Services  :  The purpose of California's Child  
          Welfare Services (CWS) system is to provide for the protection  
          and the health and safety of children.  Within this purpose, the  
          desired outcome is to reunite children with their biological  
          parents, when appropriate, in order to help preserve and  
          strengthen families.  However, if reunification with the  
          biological family is not appropriate, children are placed in the  
          best environment possible, whether that is with a relative,  
          through adoption, or with a guardian, such as a NREFM.

          In the case of children who are at risk of abuse, neglect or  
          abandonment, county juvenile courts hold legal jurisdiction, and  
          children are served by CWS through the appointment of a social  
          worker.  Through this system, there are multiple stages where  
          the custody of the child or their placement are evaluated,  
          reviewed and determined by the judicial system, in consultation  
          with the child's social worker, to help provide the best  
          possible services to the child. 

          At the time a child is identified as needing child welfare  
          services and is in the temporary custody of a social worker, the  
          social worker is required to identify whether there is a  
          relative or guardian to whom a child may be released, unless the  
          social worker believes that the child would be at risk of abuse,  
          neglect or abandonment if placed with that relative or guardian.  
           (W&I Code Sections 306 and 309) 

          The Welfare and Institutions Code also lays out the conditions  
          under which a court may deem a child a dependent or ward of the  
          court, including when the parent has been incarcerated or  







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          institutionalized and is unable to arrange for care for the  
          child, such as placement with a known relative.  If the child is  
          deemed a dependent or ward of the court, the court may maintain  
          the child in his or her home, remove the child from the home but  
          with the goal of reunifying the child with his or her family, or  
          identify another form of permanent placement.  Unless the child  
          is unable to be placed with the parent, the court is required to  
          give preference to a relative of the child in order to preserve  
          the child's association with his or her family.  

          Associated with the placement process, the assigned social  
          worker develops a case plan for the child, which outlines the  
          placement for the child, sets forth services necessary for the  
          child, and outlines the provision of reunification services, if  
          necessary and appropriate.

           Need for the bill  :  The author states:

               AB 1133 is designed to improve the outcomes of  
               medically-fragile foster children.  Use of the  
               Nurse-foster parent program for this population has  
               been shown to decrease the time that medically-fragile  
               children are waiting for placement in the foster care  
               system, reduce hospital re-admission rates, and  
               improve medical, psychosocial, cognitive, language,  
               and motor neuro-developmental outcomes for medically  
               fragile foster children through early intervention  
               programs and dedicated nursing care. 

          Writing in support of the bill as the sponsor, Angels-in-Waiting  
          states:

               The mission of Angels-in-Waiting is to recruit  
               qualified nurses to care for California's medically  
               fragile foster care infants and children.  As their  
               foster parents and nurses, Angels-in-Waiting recruits  
               Independent Nurse Providers, who provide loving homes,  
               nursing care and the needed wrap-around services to  
               medically fragile infants and children.  Otherwise,  
               these same infants and children would be placed into  
               institutional care, group homes or ill-educated,  
               poorly supported foster care homes, a lifestyle no  
               child should endure, let alone innocent, high-risk  
               premature infants. 







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               In California, nurses can become independent providers  
               for foster children, billing Medi-Cal directly for  
               their in-home nursing hours.  Nurses can also become  
               licensed foster parents and have a child placed in  
               their care.  This combination of nursing and foster  
               parenting provides a loving home environment, while  
               offering nurses a special way to serve the pediatric  
               population.  Within our program, we see greater  
               positive outcomes for medically fragile babies and  
               children and a decrease in hospital admissions. 

           Early Periodic Screening, Diagnosis, and Treatment (EPSDT)  :   
          ESPDT is a federal child health benefit under Medicaid for  
          children under the age of 21 that provides comprehensive and  
          preventive health care services to help ensure children and  
          adolescents receive appropriate preventive, dental, mental  
          health, and developmental and specialty services.  Most children  
          who meet Medicaid eligibility requirements are from families  
          with annual incomes up to approximately 100% of the federal  
          poverty level, or have been removed from their homes and made  
          dependents of the court.  For the most part, children and  
          adolescents who meet Medi-Cal medical necessity criteria have a  
          recognized mental disorder; are not developing appropriately;  
          and interventions have been identified that are likely to help  
          the child to progress developmentally as appropriate.

          In cases where medical services can be provided in the home  
          rather than through a licensed institutional care, EPSDT funding  
          can support Medi-Cal eligible children to be served through home  
          and community based services (HCBS).  Through HCBS, which are  
          not part of the Medi-Cal State Plan benefit, but are provided  
          under a waiver not typically part of the benefit package under  
          federal Medicaid, EPSDT-funded services can be provided in a  
          home or community based setting to specified populations, which  
          include assisted living and pediatric palliative care. 

          Services for children provided for in EPSDT-funded HCBS are  
          authorized through specified licensed or certified home or  
          community based facilities requirements.  They are also required  
          to have an identified support network system available to them  
          in the event the HCBS provider is unable to provide necessary  
          care. 








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           Specialized Foster Care  :  Unlike general foster care placements,  
          such as foster family homes, specialized foster care is a form  
          of care that provides for and supports the medical,  
          developmental, or mental health needs of the child. Services can  
          range from acute level medical care to therapeutic and  
          behavioral services depending on the needs of the child.  Foster  
          parents who operate licensed foster homes that provide  
          specialized foster care are required to undergo increased levels  
          of training and receive a greater array of support services to  
          provide for the outcomes of the child. 

          Foster family homes licensed to provide specialized foster care  
          are limited to two children or less and are required to be  
          provided in a family environment, in close proximity to the  
          parent's home, and consistent with the best interest and special  
          needs of the child.  Specialized foster care homes are also  
          provided a higher foster care rate to help support and  
          accommodate the greater level of need associated with the care  
          provided. 

          According to the Department of Social Services (DSS),  
          California's county welfare departments are responsible for  
          developing, maintaining, and administering county-specific  
          specialized care systems.  The state provides technical  
          assistance to counties to modify or adopt a system. Currently 54  
          counties have specialized care systems.

           Supply versus Demand  :  As of January 1, 2013, there were  
          approximately 56,495 children in foster care, according to the  
          California Welfare Dynamic Report System, a statewide child  
          welfare database operated in collaboration by DSS and the  
          University of California at Berkeley.  This number far outweighs  
          the availability of licensed foster care homes in the state.   
          According to DSS, as of January 1, 2013, there were 7,007  
          licensed foster care homes with a capacity to serve 15,731  
          foster youth. 

          Additionally, there are another 6,422 certified family homes  
          operated by foster family agencies.  Because DSS does not  
          license certified family homes, it does not track their total  
          statewide licensed capacity.  However, the number of certified  
          family homes is less than the total number of licensed foster  
          homes, which indicates that even if they were operating at the  
          maximum licensed capacity of six children, there would still not  







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          be enough to provide family home environments for all foster  
          youth. 

          These numbers demonstrate that, although the state has  
          significantly reduced its foster care population over the past  
          12 years, it still leaves much progress to be made in  
          identifying and maintaining home-based placements that can  
          provide family-like environments for our foster youth. 
           

          Analysis Prepared by  :    Chris Reefe / HUM. S. / (916) 319-2089 


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