BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 1133|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 1133
Author: Mitchell (D), et al.
Amended: 9/3/13 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 6-0, 6/25/13
AYES: Yee, Berryhill, Emmerson, Evans, Liu, Wright
ASSEMBLY FLOOR : 74-0, 5/9/13 - See last page for vote
SUBJECT : Foster children: special health care needs
SOURCE : Angels In Waiting
DIGEST : This bill requires that when determining the
placement of a foster child who is medically fragile, priority
consideration be given to placement with a foster parent who is
an individual nurse provider (INP), and who provides health
services under the federal Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) program, unless the child has
the option of placement with a relative, as specified.
Senate Floor Amendments of 9/3/13 clarify that a medically
fragile child meets the definition of a "child with special
health care needs," as defined in statute.
ANALYSIS :
Existing law:
CONTINUED
AB 1133
Page
2
1. Establishes within state law a system of care for children
who have been removed from their homes and made dependent
wards of the juvenile court because the child has suffered,
or there is a substantial risk that the child will suffer,
serious physical harm inflicted non-accidentally upon the
child by the child's parent or guardian, or because the child
has suffered, or there is a substantial risk that the child
will suffer, serious physical harm or illness, as a result of
the failure or inability of his/her parent or guardian to
adequately supervise or protect the child, as defined.
2. Provides for the licensure and regulation of various
out-of-home settings for children who need residential care,
including establishing licensing standards, and requires that
a placing agency consider the individual child's needs, the
ability of the facility to meet those needs, the needs of
other children in the facility, the licensing requirements of
the facility as determined by the licensing agency, and the
impact of the placement on the family reunification plan.
3. Defines a "medically fragile child" as having an acute or
chronic health problem which requires therapeutic
intervention and skilled nursing care during all or part of
the day.
4. Establishes in federal law payment for services to patients
who are younger than 21 and who qualify for EPSDT services as
Medicaid beneficiaries.
5. Establishes the role of INP as those providers authorized
under certain Medicaid home- and community-based waivers and
under the Medicaid state plan to provide nursing services to
Medi-Cal recipients in the recipients' own homes rather than
in institutional settings.
6. Requires in federal law that for states to receive funding,
they must consider giving preference to an adult relative
over a non-related caregiver when determining a placement for
a child, provided that the relative caregiver meets all
relevant state child protection standards.
7. Requires in state law that when a child is removed from the
physical custody of his/her parents and made a dependent of
the court, that preferential consideration be given to a
CONTINUED
AB 1133
Page
3
request by a relative of the child for placement of the child
with the relative, regardless of the relative's immigration
status. Existing statute defines what factors should be used
to determine if a placement is appropriate.
8. Defines "preferential consideration" to mean that the
relative seeking placement shall be the first placement to be
considered and investigated.
9. Defines "relative" as an adult who is related to the child by
blood, adoption, or affinity within the fifth degree of
kinship, including stepparents, stepsiblings, and all
relatives whose status is preceded by the words "great,"
"great-great," or "grand," or the spouse of any of these
persons even if the marriage was terminated by death or
dissolution. However, statute establishes that only the
following relatives shall be given preferential consideration
for the placement of the child: an adult who is a
grandparent, aunt, uncle, or sibling.
This bill:
1. Makes the following legislative findings and declarations:
A. There are growing numbers of medically fragile infants
entering the foster care system.
B. Local resources have been, and continue to be,
strained to the limit in providing services to the
expanding number of these and other medically fragile
foster children.
C. These children are harder to place with the typical
foster parent because of their special needs, and they
become forgotten members of our society.
D. Encouraging trained nurses to be foster parents for
medically fragile infants and children results in more
positive outcomes for these placements. The children
placed with trained nurses receive consistent medical
care, and benefit from the home environment and the
relationship with the foster family.
2. Requires that when determining the placement of a foster
CONTINUED
AB 1133
Page
4
child who is medically fragile, priority consideration be
given to placement with a foster parent who is an INP, and
who provides health services under the federal EPSDT program.
3. Specifies that this priority consideration be subordinate to
the preference granted to a relative of the child.
4. Establishes that a child welfare agency or a juvenile court
may place a medically fragile child in a specialized foster
care home with appropriate support services or another
appropriate placement if it is deemed to be in the best
interest of the child.
5. Clarifies that a medically fragile child meets the definition
of a "child with special health care needs," as specified in
statute.
Background
Medically fragile children . According to California statute,
"medically fragile" means having an acute or chronic health
problem which requires therapeutic intervention and skilled
nursing care during all or part of the day. Medically fragile
problems include, but are not limited to, HIV disease, severe
lung disease requiring oxygen, severe lung disease requiring
ventilator or tracheostomy care, complicated spina bifida, heart
disease, malignancy, asthmatic exacerbations, cystic fibrosis
exacerbations, neuromuscular disease, encephalopathy, and
seizure disorders.
According to the Department of Health Care Services (DHCS),
there are approximately 3,600 children statewide who are
designated as medically fragile and receiving private duty
nursing services within the EPSDT program. Los Angeles County
has approximately 600 children identified as medically fragile
at any given time.
Placement options for medically fragile children . In
California, there is a critical shortage of foster care
placements for children with special health care needs,
including, at the higher end of care, medically fragile
children. Currently, counties use a variety of options for
placing these children.
CONTINUED
AB 1133
Page
5
Social workers can place a medically fragile child in the home
of a foster parent with specialized training related to the
individual needs of the child and provide additional services,
as needed. There is much greater need for these homes than
there are parents able to take these children.
A second choice is in an intermediate care facility, often for
children with developmental disabilities. Social workers have
said that these facilities can be difficult to place children
into because many facilities now require the child to be
assessed and entered into the Regional Center system prior to
placement to ensure that there is state funding to support the
child. This process can take weeks or months. Anecdotally,
social workers who place special needs children say they may
leave a child in the hospital for days or weeks longer than they
need to while trying to locate an appropriate placement.
An emerging third option is the INP.
INPs . California law defines an INP as a nurse who is
authorized under certain home- and community-based waivers and
under the state plan to provide nursing services to Medi-Cal
recipients in the recipients' own homes, rather than in an
institutional setting. Neither the DHCS, which approves
treatment authorizations for in-home care, nor Department of
Social Services, which oversees much of the state's home-based
social services programs, track the number of INPs as the
designation does not require a unique license.
EPSDT . Federal law - including statutes, regulations, and
guidelines - requires that Medicaid cover a very comprehensive
set of benefits and services for children, different from adult
benefits. Since one in three United States children under age
six is eligible for Medicaid, EPSDT offers a critical way to
ensure that young children receive appropriate health, mental
health, and developmental services.
In addition to the standard Medi-Cal benefits that other
qualifying beneficiaries receive, an EPSDT patient under age 21
may receive additional medically necessary services, typically
for a recognized mental disorder or a developmental disability
where interventions have been identified that are likely to help
the child to progress developmentally as appropriate. Children
with special medical needs also would fall into the EPSDT
CONTINUED
AB 1133
Page
6
category.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
SUPPORT : (Verified 9/4/13)
Angels In Waiting (source)
California Black Health Network
California State PTA
Children Now and The Children's Partnership
National Association of Social Workers, California Chapter
Special Discoveries Educational Services, Inc.
The ARC and United Cerebral Palsy in California
The Children's Partnership
ARGUMENTS IN SUPPORT : According to the author's office, there
are growing numbers of medically fragile infants entering the
foster care system. Some of these cases are attributable to
epidemic drug use by pregnant women, which have resulted in
premature births and children with medical and developmental
complications, the author states. In other cases, the child may
have become medically fragile at the hands of their parents and
a return to their biological home is not in the child's best
interest. The author's office states that the foster care
system is heavily burdened with an influx of medically fragile
infants and children who need help.
According to the author's office, creating preferential
placement for an INP, who is trained to care for complicated
pediatric medical cases, results in more positive outcomes for
medically fragile children in foster care. The children have
consistent medical care, and they benefit from the home
environment and the relationship within the foster family, the
author states.
ASSEMBLY FLOOR : 74-0, 5/9/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gray, Grove,
Hagman, Hall, Harkey, Roger Hernández, Jones, Jones-Sawyer,
Levine, Linder, Lowenthal, Maienschein, Mansoor, Medina,
CONTINUED
AB 1133
Page
7
Melendez, Mitchell, Morrell, Mullin, Muratsuchi, Nazarian,
Nestande, Olsen, Pan, Patterson, Perea, V. Manuel Pérez,
Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting,
Torres, Wagner, Weber, Wieckowski, Wilk, Williams, Yamada,
John A. Pérez
NO VOTE RECORDED: Donnelly, Gorell, Holden, Logue, Waldron,
Vacancy
JL:k 9/4/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED