BILL ANALYSIS Ó
AB 1299
Page 1
Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1299
(Ridley-Thomas) - As Amended April 21, 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)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,
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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)
program standards and requirements, and including a
procedure for expedited transfer within 48 hours.
1)Defines "presumptive transfer" to mean that responsibility for
providing or arranging for mental health services must
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.
2)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.
3)Requires DHCS, if it determines necessary, to seek approval
under the state's Section 1915(b) Medicaid waiver, as
specified. Further specifies that DHCS is not required to
implement any provision of this bill that the Centers for
Medicare and Medicaid Services (CMS) determines impermissible
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per the state's waiver.
EXISTING LAW:
1)Establishes California's Medicaid program, Medi-Cal, through
which eligible low-income individuals receive health care
services.
2)Establishes the federal EPSDT program to provide comprehensive
and preventive health services, including preventive, dental,
mental health, 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.
3)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.
4)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
any child in foster care who has been placed outside his or
her county of adjudication.
5)Establishes the Behavioral Health Subaccount within the
Support Services Account.
6)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.
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7)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.
8)States that the purpose of foster care law is to provide
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.
9)Establishes rights of foster children, including the right to
receive medical, dental, vision, and mental health services.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF 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. The author explains that 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 and that 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 problem results, the author explains because, when a
youth in foster care is placed out of county, the county of
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original jurisdiction remains responsible for providing or
arranging for necessary medical and mental health treatment
for that youth. Mental health services in Medi-Cal are
provided differently 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.
2)BACKGROUND.
a) 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.
b) 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
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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).
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.
c) County Mental Health Programs. California has a
decentralized public mental health system with most direct
services provided through the county mental health system.
Counties (i.e., county mental health plans) have the
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primary funding and programmatic responsibility for the
majority of local mental health programs. The state is
required to meet certain federal requirements, including
those set forth by Medicaid's child health component, known
as the EPSDT program. EPSDT is a Medi-Cal benefit for
individuals under the age of 21 who have full-scope
Medi-Cal eligibility. Federal law - including statutes,
regulations, and guidelines - requires that Medi-Cal cover
a very comprehensive set of benefits and services for
children, different from adult benefits. EPSDT provides
eligible children access to a range of mental health
services that include, but are not limited to:
i) Mental health assessment;
ii) Therapy;
iii) Rehabilitation;
iv) Mental health services;
v) Medication support services;
vi) Day rehabilitation;
vii) Day treatment intensive;
viii) Crisis intervention/stabilization;
ix) Targeted case management
x) Therapeutic behavioral services.
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1)SUPPORT. Supporters state the question of which county mental
health plan is responsible for providing children and youth in
foster care placed outside their counties of jurisdiction the
behavioral health services they need and to which they are
entitled has vexed California for over 20 years. According to
supporters, as a result, foster children and youth placed
across county lines often experience lengthy delays in
accessing behavioral health services or are denied service
altogether.
Supporters argue that this bill would ensure that foster
children and youth who are placed outside of their county of
jurisdiction, are able to access mental health services in a
timely manner responsive to their individual needs and
strengths, and consistent with the requirements of the
Medi-Cal EPSDT and Specialty Mental Health Services program
standards and requirements.
2)PREVIOUS LEGISLATION.
a) AB 1808 (Galgiani) of 2009 was substantially similar to
this bill. AB 1808 was held on the Suspense File of the
Assembly Appropriations Committee.
b) SB 785 (Steinberg), Chapter 469, Statutes of 2007
facilitates the access to mental health services for foster
children who are placed outside of the original county of
jurisdiction, including those being adopted or entering
into a guardianship with a relative.
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DOUBLE REFERRAL. This bill has been double referred. It passed
the Assembly Committee on Human Services with a vote of 7-0 on
April 14, 2015..
REGISTERED SUPPORT / OPPOSITION:
Support
California Alliance of Child and Family Services, (co sponsor
California Mental Health Advocates for Children and Youth,
(co-sponsor)
Women's Foundation of California (co-sponsor)
Alameda County Foster Youth Alliance
American Federation of State, County and Municipal employees,
AFL-CIO
Aviva Family and Children's Services
Bill Wilson Center
California Council of Community Mental Health Agencies
California Primary Care Association
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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.
First Place for Youth
Foster Youth Alliance
Fred Finch Youth Center
Hathaway Sycamores
Integral Community Solutions Group
Junior Blind of America
Lilliput Children's Services
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Lincoln Child Center
Maryvale
Mendocino County Health and Human Services Agency
National Association of Social Workers, CA Chapter
North Star Family Center
OPTIMIST
Orange County Alliance for Children and Families
San Diego Center for Children
Seneca Family of Agencies
Sierra Forever Families
Steinberg Institute
Sunny Hills Services
The Association of Community Human Services Agencies
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The Edgewood Center for Children and Families
The Village Family Services
The Women's Foundation of California
TLC Child and Family Services
Trinity Youth Services
United Advocates for Children and Families
Unity Care Group, Inc.
Valley Teen Ranch
WestCoast Children's Clinic
Young Minds Advocacy Project
Youth Homes Inc.
Opposition
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None on file.
Analysis Prepared by:Roger Dunstan / HEALTH / (916) 319-2097