BILL ANALYSIS Ó
AB 1299
Page 1
Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Kansen Chu, Chair
AB 1299
(Ridley-Thomas) - As Introduced February 27, 2015
SUBJECT: Medi-Cal: specialty mental health services: foster
children
SUMMARY: Transfers responsibility for providing or arranging
mental health services for foster youth from the county of
original jurisdiction to the foster child's county of residence.
Specifically, this bill:
1)States that it is the intent of the Legislature to ensure that
foster children who are placed in their county of original
jurisdiction are able to access mental health services, as
specified. Further states the intent of the Legislature to
overcome the barriers to mental health care existing in the
AB 1299
Page 2
current system for foster children who are placed outside
their county of original jurisdiction.
2)Defines "presumptive transfer" to mean that responsibility for
providing or arranging for mental health services shall
immediately transfer from a foster youth's county of original
jurisdiction to his or her county of residence, provided he or
she is placed in a county other than the county of original
jurisdiction and the request is made by specified entities or
individuals.
3)Requires the California Health and Human Services Agency to
coordinate with the Department of Health Care Services (DHCS)
and the Department of Social Services (DSS) to take the
following actions by July 1, 2016:
a) Requires DHCS to issue policy guidance, as specified,
that establishes the presumptive transfer of responsibility
for mental health services for a foster youth from his or
her county of original jurisdiction to his or her county of
residence;
b) Requires DHCS, in consultation with DSS and with the
input of specified stakeholders, to establish the
conditions of and exceptions to presumptive transfer,
intended to improve access to mental health care services
and not impede the continuity of existing care; and
c) Requires DHCS to establish procedures for implementing
presumptive transfer as specified and consistent with Early
Periodic Screening, Diagnosis, and Treatment (EPSDT)
AB 1299
Page 3
program standards and requirements, and including a
procedure for expedited transfer within 48 hours.
1)Requires the Department of Finance, by May 1, 2016, to set or
adjust its allocation schedule of the Behavioral Health
Subaccount, as specified, such that counties that pay or have
paid for specialty mental health services for foster children
placed out of county are fully reimbursed within the fiscal
year the services are provided.
2)Requires DHCS, if it determines necessary, to seek approval
under the state's Section 1915(b) Medicaid waiver, as
specified. Further specifies that DHCS shall not be required
to implement any provision of this bill that the Centers for
Medicare and Medicaid Services (CMS) determines impermissible
per the state's waiver.
EXISTING LAW:
1)Establishes a state and local system of child welfare
services, including foster care, for children who have been
adjudged by the court to have been abused or neglected, or at
risk of abuse or neglect, as specified. (WIC 202)
2)Allows a juvenile court to adjudge a child a ward or a
dependent of the court for specified reasons, including but
not limited to if the child has been left without any
provision for support, as specified. (WIC 300)
3)States that the purpose of foster care law is to provide
AB 1299
Page 4
maximum safety and protection for children who are currently
being physically, sexually, or emotionally abused, neglected,
or exploited, and to ensure the safety, protection, and
physical and emotional well-being of children who are at risk
of harm. (WIC 300.2)
4)Establishes rights of foster children, including the right to
receive medical, dental, vision, and mental health services.
(WIC 16001.9)
5)Establishes the federal Medicaid program to provide health
benefits to low-income individuals. (42 U.S.C. Section 1396
et seq.)
6)Establishes California's Medicaid program, Medi-Cal, through
which eligible low-income individuals receive health care
services. (WIC 14000 et seq.)
7)Establishes the federal Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) program to provide
comprehensive and preventive health services, including
preventive, dental, mental health, and developmental, and
specialty services, to Medicaid beneficiaries under the age of
21. Requires states to administer EPSDT as a condition of
receiving federal Medicaid funds. (42 USC Section 1396d)
8)Requires county mental health departments that receive full
system of care funding, as specified, to provide children
served by county social services and probation departments
mental health screening, assessment, participation in
multidisciplinary placement teams and specialty mental health
treatment services for children placed out of home in group
care, for those children who meet the definition of medical
necessity, to the extent resources are necessary. (WIC
5867.5)
9)Requires each local mental health plan to establish a
procedure to ensure access to outpatient specialty mental
health services, as required by EPSDT program standards, for
AB 1299
Page 5
any child in foster care who has been placed outside his or
her county of adjudication. (WIC 14716)
10)Establishes the Behavioral Health Subaccount within the
Support Services Account. (GOV 30025)
FISCAL EFFECT: Unknown
COMMENTS:
Child Welfare Services: The purpose of California's Child
Welfare Services (CWS) system is to protect children from abuse
and neglect and provide for their health and safety. When
children are identified as being at risk of abuse, neglect or
abandonment, county juvenile courts hold legal jurisdiction and
children are served by the CWS system through the appointment of
a social worker. Through this system, there are multiple
opportunities for the custody of the child, or his or her
placement outside of the home, to be 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. The CWS system seeks to help children
who have been removed from their homes reunify with their
parents or guardians, whenever appropriate, or unite them with
other individuals they consider to be family. There are
currently close to 63,000 children in California's child welfare
system.
AB 1299
Page 6
Mental health needs of foster youth: Foster youth have a higher
likelihood of experiencing emotional, behavioral, and
developmental problems when compared to their non-foster peers.
Abuse and neglect and unstable placements can contribute to, and
exacerbate, mental health issues. These problems, in turn, can
lead to other problems, like difficulty forming stable
relationships and succeeding in school.
Research underscores the need for improved access to health and
mental health services for foster children and youth, and points
to the high incidence of behavioral or mental health problems
necessitating intervention among foster youth. The
disproportionately high rates of emotional and behavioral health
issues for youth placed in foster care, youth transitioning from
foster care, and former foster youth can be correlated with
other barriers foster youth face (such as higher rates of
incarceration and homelessness and diminished rates of high
school completion and college attendance).
EPSDT: One in three children under the age of six in the United
States is eligible for Medicaid. Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) is Medicaid's child health
component. Federal law requires a comprehensive set of benefits
and services to be provided to children and youth under the age
of 21 through Medicaid. On top of the standard benefits that
Medi-Cal beneficiaries receive, children and youth are eligible
for additional medically necessary services. Mental health
services are recognized as an important component of children's
health care. Comprehensive well-child examinations including
screening services through EPSDT, and screening for potential
developmental, mental, behavioral, and/or substance use
disorders are required by federal law.
AB 1299
Page 7
Need for this bill: According to the author, foster children
are three to six times more likely to experience emotional,
behavioral, and developmental problems compared to non-foster
children. When these mental health needs go unmet, placement
instability, disruptions in permanency plans, barriers to
educational attainment, and other consequences can result.
Youth dubbed "out-of-county" have been placed in a county other
than the one in which they originally enter foster care (i.e.,
the "county of original jurisdiction"). The author reports
that, as of July 2014, close to 20% of foster children (13,000)
were considered "out-of-county." "Out-of-county" foster youth
may be placed at greater risk because of lengthy delays or
denials in accessing mental health services that can result from
the way the system of care provision currently operates. This
is because, when a youth in foster care is placed out of county,
the county of original jurisdiction remains responsible for
providing or arranging for necessary medical and mental health
treatment for that youth. Mental health services - "Specialty
Mental Health Medi-Cal" - are separate from other medical
services and each county's mental health plan must authorize and
provide payment for the mental health services received by the
child.
There are indications that out-of-county foster youth may have
higher needs and less access when it comes to mental health
care. A 2011 report issued by the California Child Welfare
Council found that out-of-county foster youth were more likely
to have been diagnosed with a serious mental health disorder,
yet were 10 to 15% less likely to have received any mental
health services compared to their in-county peers. And among
those that did receive services, in-county foster youth fared
better, receiving more care and more intensive treatment.
AB 1299
Page 8
The author states that:
"The disparity in access to mental health services between
in-county and out-of-county children exists despite both
having the same entitlement to mental health services under
federal and state law.
The problem stems from California's county-based system of
mental health delivery. Medi-Cal Specialty Mental Health
Services are provided using a system of county-based managed
care agencies or Mental Health Plans (MHPs) under contract
with the Department of Health Care Services. Each MHP, in
turn, contracts with local private mental health service
providers (or uses county mental health staff) to deliver
services.
This system works efficiently for many children and youth.
However, the county-based MHPs face substantial administrative
barriers when services must be provided to children placed
out-of-county, that is, outside the service area for its
network of providers. These problems include difficulty: 1)
finding providers and services in the child's county of
residence; 2) contracting for care; 3) getting treatment
authorizations; 4) coordinating and monitoring care; and 5)
securing adequate reimbursements from responsible parties
including federal, state, and local agencies."
Recommended amendments:
1)Committee staff recommends the following technical amendments,
beginning on line 21 of page 2 of the bill:
8 (b) In order to facilitate the receipt of medically
necessary
AB 1299
Page 9
9 specialty mental health services by a foster child who is
placed
10 outside of his or her county of original jurisdiction, the
California
11 Health and Human Services Agency shall coordinate with the
12 department and the State Department of Social Services to
take
13 all of the following actions:
14 (1) On or before July 1, 2016, all of the following
shall occur:
15 (A) The department shall issue policy guidance,
pursuant to
16 Section 14716, that establishes the presumptive transfer of
17 responsibility for providing or arranging for mental
health services
18 to foster youth, consistent with the requirements of EPSDT
19 program standards and requirements, from the county of
original
20 jurisdiction to the foster child's county of residence.
21 (B) "Presumptive transfer" for the purposes of this
section means
22 that absent any conditions or exceptions as established
pursuant
23 to this article, responsibility for providing or arranging
for mental
24 health services shall immediately transfer from the county
of
25 original jurisdiction to the county of residence, when the
all of the
26 following conditions occur:
27 (i) A foster child is placed in a county other than
the county of
28 original jurisdiction.
29 (ii) The transfer of responsibility is requested by the
county
30 child welfare services agency, county probation
department, foster
31 caregiver, or any other person authorized to make medical
decisions
AB 1299
Page 10
32 on behalf of the foster child.
33 (C) (B) The department shall establish the conditions
and exceptions
34 to presumptive transfer in consultation with the State
Department
35 of Social Services, and with the input of stakeholders
that include
36 the County Welfare Directors Association of California,
the County
37 Behavioral Health Directors Association of California,
provider
38 representatives, and family and youth advocates. The
conditions
39 and exceptions to presumptive transfer are intended to
ensure that
1 the transfer of responsibility improves access to mental
health care
2 services and does not impede the continuity of existing
care.
3 (D) (C) The department shall establish the procedures for
4 implementing presumptive transfer that are consistent with
the
5 purposes and intent of this section and Early Periodic
Screening
6 Diagnosis and Treatment program standards and requirements,
7 and shall include a procedure for expedited transfer within
48
8 hours.
(c) "Presumptive transfer" for the purposes of this section
means
that absent any conditions or exceptions as established
pursuant
to this article, responsibility for providing or arranging for
mental
health services shall immediately transfer from the county of
original jurisdiction to the county of residence, when all of
the
following conditions occur:
(1) A foster child is place in a county other than the county
AB 1299
Page 11
of
original jurisdiction.
(2) The transfer of responsibility is requested by the county
child welfare services agency, county probation department,
foster
caregiver, or any other person authorized to make medical
decisions
on behalf of the foster child.
9 14695.2. By May 1, 2016, the Department of Finance
shall set
10 or adjust its allocation schedule of the Behavioral Health
11 Subaccount pursuant to the requirements of Senate Bill 1020
12 (Chapter 40, Statutes of 2012), in order that counties that
have
13 paid, or will pay, for specialty mental health services for
foster
14 children placed out of county pursuant to this article, are
fully
15 reimbursed during the fiscal year in which the services are
16 provided.
2)In order to clarify the deadline for seeking CMS waiver
approval being placed upon DHCS, committee staff recommends
the following amendment be made on line 25 of page 4 of the
bill:
17 14695.3. (a) If the department determines it is
necessary, it
18 shall seek approval under the state's Section 1915(b)
Medicaid
19 waiver from the United States Department of Health and
Human
20 Services, Centers for Medicare and Medicaid Services (CMS)
prior
21 to implementing this article.
22 (b) If the department makes the determination that it
is necessary
23 to seek CMS approval pursuant to subdivision (a), the
AB 1299
Page 12
department
24 shall make an official request for approval from CMS no
later than
25 July 1, 2016, and shall do everything within its power
necessary to secure
26 an expeditious approval from CMS.
27 (c) The department shall not be required to implement
any
28 provision of this article that CMS determines is not
permitted under
29 the state's waiver.
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Committee on Health.
REGISTERED SUPPORT / OPPOSITION:
Support
California Alliance of Child and Family Services, co-sponsor
California Mental Health Advocates for Children and Youth
(CMHACY), co-sponsor
Women's Foundation of California (co-sponsor)
AB 1299
Page 13
American Federation of State, County and Municipal employees
(AFSCMEE), AFL-CIO
Aviva Family and Children's Services
Bill Wilson Center
California Council of Community Mental Health Agencies
California Primary Care Association (CPCA)
Crittenton Services for Children and Families
David &Margaret Youth and Family Services
EMQ Families First
Ettie Lee Youth & Family Services
Families NOW
Family Care Network, Inc.
Foster Youth Alliance
Fred Finch Youth Center (FFYC)
AB 1299
Page 14
Hathaway Sycamores
Junior Blind of America
Maryvale
Mendocino County Health and Human Services Agency
National Association of Social Workers, CA Chapter (NASW-CA)
OPTIMIST
Orange County Alliance for Children and Families
San Diego Center for Children (the Center)
Seneca Family of Agencies
Sierra Forever Families
Steinberg Institute
Sunny Hills Services
The Association of Community Human Services Agencies (ACHSA)
AB 1299
Page 15
The Village Family Services
The Women's Foundation of California
TLC Child and Family Services
Trinity Youth Services
United Advocates for Children and Families (UACF)
Valley Teen Ranch
Young Minds Advocacy Project
Youth Homes Inc.
Opposition
None on file.
AB 1299
Page 16
Analysis Prepared by:Daphne Hunt / HUM. S. / (916) 319-2089