BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1299
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|AUTHOR: |Ridley-Thomas |
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|VERSION: |April 21, 2015 |
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|HEARING DATE: |June 17, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Medi-Cal: specialty mental health services: foster
children.
SUMMARY : Requires the California Health and Human Services Agency to
coordinate with the Departments of Health Care Services (DHCS)
and Social Services to facilitate the receipt of medically
necessary specialty mental health services by foster youth, as
specified, and for DHCS to meet specific conditions on or before
July 1, 2016. Requires the Department of Finance to set or
adjust its allocation schedule of the Behavioral Health
Subaccount, as specified. Requires DHCS to seek federal
approval, as specified, to implement the provisions in this
bill.
Existing law:
1)Establishes California's Medicaid program, Medi-Cal, through
which eligible low-income individuals receive health care
services.
2)Establishes the federal Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) program to provide
comprehensive and preventive health services, including
preventive, dental, Mental Health (MH), developmental, and
specialty services to Medi-Cal beneficiaries under the age of
21 who have full-scope Medi-Cal eligibility. Requires states
to administer EPSDT as a condition of receiving federal
Medicaid funds.
3)Requires county MH departments that receive full system of
care funding, as specified, to provide children who are served
by county social services and probation departments with MH
screening, assessment, participation in multidisciplinary
placement teams, and specialty MH treatment services for
AB 1299 (Ridley-Thomas) Page 2 of ?
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 MH plan to establish a procedure to ensure
access to outpatient specialty MH services, as required by
EPSDT program standards, for any child in foster care who has
been placed outside his or her county of adjudication.
Requires the local MH plan of the county of original
jurisdiction for a foster youth to remain responsible for
providing or arranging for specialty MH services, including
the costs of services, unless there is a written contract in
which the county of residence accepts responsibility for
payment.
5)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.
6)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.
7)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.
8)Establishes rights of foster youth, including the right to
receive medical, dental, vision, and MH services.
9)Establishes the Behavioral Health Subaccount, within the
Support Services Account, which funds specialty MH, Drug
Medi-Cal, residential perinatal drug services and treatment;
drug court operations, and other non-Drug Medi-Cal programs.
This bill:
1)Requires the California Health and Human Services Agency
(CHHSA) to coordinate with DHCS and Department of Social
Services (DSS) to facilitate the receipt of medically
necessary specialty MH services by foster youth placed outside
AB 1299 (Ridley-Thomas) Page 3 of ?
his or her county of original jurisdiction. Requires DHCS to
do the following on or before July 1, 2016:
a) Issue policy guidance that establishes the
"presumptive transfer," as defined, of responsibility
for providing or arranging MH services to foster
youth, consistent with EPSDT standards and
requirements, from the county of original jurisdiction
to the foster youth's county of residence;
b) Establish conditions and exceptions to
presumptive transfer in consultation with DSS and with
input from stakeholders, including the County Welfare
Directors Association of California, the California
Behavioral Health Directors Association of California,
provider representatives, and family and youth
advocates. The conditions and exceptions to
presumptive transfer are intended to ensure that the
transfer or responsibility improves access to MH
services and does not impede the continuity of
existing care; and,
c) Establish procedures for implementing
presumptive transfer that are consistent with the
purpose and intent of the provisions of this bill and
EPSDT standards and requirements. Requires DHCS to
include a procedure for expedited transfer within 48
hours.
2)Defines "presumptive transfer" as responsibility for providing
or arranging for MH services being immediately transferred
from the county of original jurisdiction to the county of
residence, when the following occur:
a) A foster child is placed in a county other
than the county of original jurisdiction; and,
b) 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.
3)Requires Department of Finance (DOF), by May 1, 2016, to set
or adjust its allocation schedule of the Behavioral Health
Subaccount so that counties that have paid, or will pay, for
specialty MH services for foster youth placed out-of-county,
pursuant to the provisions in this bill, are fully reimbursed
AB 1299 (Ridley-Thomas) Page 4 of ?
during the fiscal year in which the services were provided.
4)Requires DHCS, if it determines it is necessary, to seek
approval under the state's Section 1915(b) Medicaid Waiver
from the Centers for Medicare and Medicaid Services (CMS)
prior to implementing the provisions in this bill. Prohibits
DHCS from implementing any provision that CMS determines is
not permitted under the state's 1915(b) waiver. (The state's
specialty MH services are operated under a section of the
1915(b) waiver.)
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 MH
services for youth who face treatment and service barriers when
placed out-of-county.
PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Human Services Committee: |7 - 0 |
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COMMENTS :
1)Author's statement. According to the author, foster youth are
three to six times more likely than non-foster youth to
experience emotional, behavioral, and developmental problems.
When a foster youth's MH needs are not met, the result is
often placement instability; disruptions in permanency plans;
school failure; costly care in group homes, residential
treatment facilities, and psychiatric hospitals; delinquency;
and even death. Especially at risk are foster youth placed
across county lines, who often experience lengthy delays or
denials in accessing MH services. According to the most recent
data from the California Child Welfare Indicators Project at
UC Berkeley, almost one-in-five foster youth statewide (an
estimated 13,000) live in placements across county lines, or
AB 1299 (Ridley-Thomas) Page 5 of ?
"out-of-county." This disparity in access to MH services
between in-county and out-of-county youth exists despite both
having the same entitlement to MH services under federal and
state law.
2)Background. The purpose of state'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 the state's CWS.
California has a decentralized public MH system with most
direct services provided through the county MH system.
Counties (county MH plans) have the primary funding and
programmatic responsibility for the majority of local MH
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. Federal
law-including statutes, regulations, and guidelines-requires
Medi-Cal to cover a very comprehensive set of benefits and
services for children, different from adult benefits. EPSDT
provides eligible children access to a range of MH services
that include, but are not limited to, MH assessment and
services, therapy, rehabilitation, medication support
services, day rehabilitation, day treatment intensive, crisis
intervention/stabilization, targeted case management, and
therapeutic behavioral services.
3)MH 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 MH issues. These problems can
lead to other problems, like difficulty forming stable
AB 1299 (Ridley-Thomas) Page 6 of ?
relationships and succeeding in school. Research underscores
the need for improved access to health and MH services for
foster youth, and points to the high incidence of behavioral
or MH 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, diminished
rates of high school completion and college attendance, and
disproportionate prescribing of antipsychotic and psychotropic
medications, as highlighted in an 2014 exposé by the San Jose
Mercury News.
There are indications that out-of-county foster youth may have
higher needs and less access when it comes to MH treatment. 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 MH disorder, yet were 10-15
percent less likely to have received any MH 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.
4)Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate Human
Services Committee.
5)Prior legislation. AB 1808 (Galgiani), of 2009, was
substantially similar to this bill. AB 1808 was held on the
suspense file of the Assembly Appropriations Committee.
SB 785 (Steinberg), Chapter 469, Statutes of 2007, facilitates
the access to MH services for foster youth who are placed
outside of the original county of jurisdiction, including
those being adopted or entering into a guardianship with a
relative.
6)Support. Supporters of this bill, largely behavioral health
and family advocates, argue that the question of which MH plan
is responsible for providing much-needed services to foster
youth who have been placed outside of their counties of
jurisdiction has vexed California for more than 20 years. They
state that foster youth go through transitions where their
mental stability takes a toll and that this bill will ensure
AB 1299 (Ridley-Thomas) Page 7 of ?
that the MH needs of these foster youth will not be delayed or
denied as the youth transition to a new county of residence.
Supporters further argue that foster youth already have a
rough start in life, and not being able to access MH services,
which they are entitled to, in a timely and efficient manner
puts them at an even greater risk of serious harm and
potentially permanent negative outcomes.
SUPPORT AND OPPOSITION :
Support: California Alliance of Child and Family Services
(co-sponsor)
Steinberg Institute (co-sponsor)
Women's Foundation of California/Women's Policy
Institute (co-sponsor)
Accessing Health Services for California's Children in
Foster Care Task Force
Alameda County Faith Initiative Office Faith Advisory
Council
Alameda County Foster Youth Alliance
Alternative Family Services
American Federation of State, County and Municipal
Employees
Association of Community Human Services Agencies
Aviva Family and Children's Services
Bienvenidos Children's Center
Bill Wilson Center
California Council of Community Mental Health Agencies
California Mental Health Advocates for Children and
Youth
California State PTA
Casa Pacifica Centers for Children and Families
ChildNet Youth and Family Services
Crittenton Services for Children and Families
David and Margaret Youth and Family Services
Ella Baker Center for Human Rights
EMQ Families First
Ettie Lee Youth and Family Services
Families Now
Family Care Network, Inc.
First Place for Youth
Fred Finch Youth Center
Hathaway-Sycamores Child and Family Services
Humboldt County Transition Age Youth Collaboration
Integral Community Solutions Institute
Junior Blind of America
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Junior League of San Francisco
Junior Leagues of California State Public Affairs
Committee
Lilliput Children's Services
Lincoln Child Center
Maryvale
Mendocino County Health and Human Services Agency
National Association of Social Workers - California
Chapter
North Star Family Center
Optimist Youth Homes and Family Services
Orange County Alliance for Children and Families
Sacramento Children's Home
San Diego Center for Children
Seneca Family of Agencies
Sierra Forever Families
Stars Behavioral Health Group
Summitview Child & Family Services, Inc.
The Village Family Services
TLC Child and Family Services
Trinity Youth Services
United Advocates for Children and Families
Unity Care Group, Inc.
West Coast Children's Clinic
Young Minds Advocacy Project
Youth Homes, Inc.
Oppose: None received.
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