BILL ANALYSIS Ó AB 1299 Page 1 ASSEMBLY THIRD READING AB 1299 (Ridley-Thomas) As Amended April 21, 2015 Majority vote ------------------------------------------------------------------- |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 Page 2 | | |Gallagher, | | | | | | | | | | | | | | |Eduardo Garcia, | | | | |Gordon, Holden, | | | | |Jones, Quirk, | | | | |Rendon, Wagner, | | | | |Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------- 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 AB 1299 Page 3 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. AB 1299 Page 4 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 AB 1299 Page 5 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 AB 1299 Page 6 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 AB 1299 Page 7 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