BILL ANALYSIS Ó
AB 1299
Page 1
ASSEMBLY THIRD READING
AB
1299 (Ridley-Thomas)
As Amended April 21, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+---------------------+---------------------|
|Human Services |7-0 |Chu, Mayes, | |
| | |Calderon, Lopez, | |
| | |Maienschein, Mark | |
| | |Stone, Thurmond | |
| | | | |
|----------------+------+---------------------+---------------------|
|Health |19-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Gonzalez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+------+---------------------+---------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
AB 1299
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| | |Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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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
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
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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) 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, by July
1, 2016. 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.
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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. (Welfare and Institutions Code (WIC)
Section 202)
2)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. (WIC
Section 300.2)
3)Establishes rights of foster children, including the right to
receive medical, dental, vision, and mental health services. (WIC
Section 16001.9)
4)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
United States Code Section 1396 ( d))
5)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
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are necessary. (WIC Section 5867.5)
6)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.
(WIC Section 14716)
7)Establishes the Behavioral Health Subaccount within the Support
Services Account. (Government Code Section 30025)
FISCAL EFFECT: According to the Assembly Appropriations Committee,
this bill will result in annual increased costs in the EPSDT program
in the low millions (approximately 50% General Fund), possibly more
to the extent this bill increases access to mental health services
for youth who face treatment and service barriers when placed
out-of-county.
COMMENTS:
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
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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. 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.
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
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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.
Analysis Prepared by:
Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0000626