BILL ANALYSIS Ó
AB 1133
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CONCURRENCE IN SENATE AMENDMENTS
AB 1133 (Mitchell)
As Amended September 3, 2013
Majority vote
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|ASSEMBLY: |74-0 |(May 9, 2013) |SENATE: |39-0 |(September 9, |
| | | | | |2013) |
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Original Committee Reference: HUM. S.
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 priority 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).
3)Provides that priority consideration does not prohibit a child
welfare agency or the juvenile court from placing a medically
fragile foster 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.
The Senate amendments :
1)Add legislative findings and declarations relating to the need
for the bill.
2)Specify that a "medically fragile child" shall be deemed to
meet the definition of a "child with special health care
needs," as defined.
3)Clarify that priority rather than preferential placement
consideration shall be given to the home of a foster parent
who is a nurse authorized to provide home- and community-based
services under the EPSDT program.
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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
case management from a regional center.
AS PASSED BY THE ASSEMBLY :
1)Required placement preference be given to a foster parent who
is a nurse authorized to provide home- and community-based
services under the EPSDT program.
2)Required the preference to be subordinate to the preference
granted to a relative or NREFM.
FISCAL EFFECT : None
COMMENTS :
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.
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
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child, and outlines the provision of reunification services, if
necessary and appropriate.
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) :
EPSDT 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.
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.
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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
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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