BILL ANALYSIS                                                                                                                                                                                                    



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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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