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, AB 1299 Page 2 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 AB 1299 Page 3 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. AB 1299 Page 4 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 AB 1299 Page 5 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 AB 1299 Page 6 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 AB 1299 Page 7 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. AB 1299 Page 8 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. AB 1299 Page 9 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 AB 1299 Page 10 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 AB 1299 Page 11 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 AB 1299 Page 12 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 AB 1299 Page 13 None on file. Analysis Prepared by:Roger Dunstan / HEALTH / (916) 319-2097