BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1299 (Ridley-Thomas) - Medi-Cal: specialty mental health
services: foster children
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: July 16, 2015 |Policy Vote: HEALTH 9 - 0, |
| | HUMAN S. 5 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1299 would require the Department of Health Care
Services to develop policies and procedures establishing the
presumptive transfer of responsibility for providing and paying
for specialty mental health services for foster youth, from the
county of original jurisdiction to the county of residence.
Fiscal
Impact:
Minor anticipated costs for the Health and Human Services
Agency to coordinate with other Departments (General Fund).
Ongoing administrative costs of about $300,000 per year for
the Department of Health Care Services to develop policies,
adopt regulations, monitor disputes between counties, and
monitor the provision of services under the bill (General Fund
and federal funds).
AB 1299 (Ridley-Thomas) Page 1 of
?
Likely one-time administrative costs in the low hundreds of
thousands for the Department of Social Services to develop
policies in conjunction with the Department of Health Care
Services (General Fund).
Likely increase in county spending for specialty mental health
services in the low millions per year (local funds, General
Fund, federal funds). There are indications that foster youth
who are placed out-of-county are more likely to need mental
health services but are less likely to access such services.
In part, this reduced access to services is due to
administrative barriers that prevent county mental health
plans from determining which county is responsible for
providing services. By improving the system for assigning
responsibility for providing and paying for mental health
services, the bill is likely to increase utilization amongst
foster youth who are underserved under the current system.
Assuming that about 10% of foster youth in out-of-county
placements would access specialty mental health services for
an additional six months, the annual costs would be about $3
million per year. See below for more discussion about who
would pay for those services.
Unknown increase in state spending for services provided by
counties of residence (General Fund). Under current law, the
provision of specialty mental health services for foster youth
has been realigned to the counties. It is not clear whether
the responsibility to pay for additional services by a county
of residence under this bill would require additional state
funding to offset those county costs. See below.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary. Federal law requires the state to
provide a comprehensive set of benefits to Medi-Cal
beneficiaries under age 21 known as Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT). Under current law,
AB 1299 (Ridley-Thomas) Page 2 of
?
the provision of specialty mental health services covered under
EPSDT is the responsibility of county mental health plans.
Funding for those services generally comes from county
realignment funds and federal funds.
Under current law, county mental health plans are required to
establish procedures to ensure access to specialty mental health
services for children in foster care who have been placed
out-of-county. Unless there is a written agreement between the
county of original jurisdiction and the county of residence
transferring responsibility for paying for services, the county
of original jurisdiction retains the responsibility to arrange
for and pay for specialty mental health services provided by the
county of residence.
Proposed Law:
AB 1299 would require the Department of Health Care Services
to develop policies and procedures establishing the presumptive
transfer of responsibility for providing and paying for
specialty mental health services for foster youth, from the
county of original jurisdiction to the county of residence.
Specific provisions of the bill would:
Require the California Health and Human Services agency
to coordinate with the Department of Health Care Services
and the Department of Social Services to take specified
actions:
Require the Department of Health Care services to issue
policy guidance that establishes conditions for the
presumptive transfer of responsibility for providing mental
health services to foster youth, from the county of
original jurisdiction to the county of residence;
Require the procedures for implementing presumptive
transfer to be consistent with the requirements of EPSDT
and include a procedure for expedited transfer;
Provide authority for specified individuals to waive
presumptive transfer of responsibility;
Require that, upon presumptive transfer, the mental
health plan in the county of residence shall assume
responsibility for the provision of mental health services
and for paying for those services;
Require the Department to amend its contracts with
county mental health plans to ensure that county mental
AB 1299 (Ridley-Thomas) Page 3 of
?
health plans in counties of residence are reimbursed for
services provided under the bill;
Make implementation of the bill contingent on federal
approval.
Related
Legislation: AB 1808 (Galgiani, 2009) was substantially similar
to this bill. That bill was held on the Assembly Appropriations
Committee's Suspense File.
Staff
Comments: Pursuant to Government Code Section 30026.5,
legislation enacted after September 30, 2012, that has an
overall effect of increasing the costs already borne by a local
agency for programs or levels of service under the 2011
Realignment shall apply to local agencies only to the extent
that the state provides annual funding for the cost increase.
Local agencies are not be obligated to provide programs or
levels of service required by legislation above the level for
which funding has been provided. Both foster care and specialty
mental health services for foster youth are programs that have
been realigned to the counties.
The bill would not increase overall statewide responsibilities
for counties to provide mental health services. However, the
impact on individual counties will vary depending on how many
foster youth formerly residing in the county have been placed in
another county verses how many foster youth are now resident in
the county, having been moved from another county. There are
likely to be winners and losers amongst the counties - some
counties will experience a net reduction in foster youth
placements and the costs associated with those placements, while
other counties will experience a net gain.
Government Code Section 30026.5 requires additional state
funding to be provided whenever a state law or regulation
results in an increase in costs borne by a local agency. Under
this requirement, counties that experience an overall increase
in their costs are likely to request additional state funding
before complying with the requirements of the bill. It is not
likely that counties experiencing an overall reduction in their
costs would be willing to compensate counties experiencing
AB 1299 (Ridley-Thomas) Page 4 of
?
increased costs and the bill does not mandate that they do so.
Thus, the overall impact of the bill will be to increase state
costs relating to counties that experience cost increases while
the state is unlikely to recover any funds from counties that
experience cost savings.
In addition the bill is likely to increase overall utilization
of services by foster youth, due to the improved system of
assigning responsibility to the appropriate county. To the
extent that this does result in additional provision of
services, counties could seek additional state funding to offset
those increased costs.
-- END --