BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1299|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: AB 1299
Author: Ridley-Thomas (D), et al.
Amended: 8/18/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/17/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE HUMAN SERVICES COMMITTEE: 5-0, 7/14/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
ASSEMBLY FLOOR: 80-0, 6/1/15 - See last page for vote
SUBJECT: Medi-Cal: specialty mental health services: foster
children
SOURCE: California Alliance of Child and Family Services
Steinberg Institute
The Womens Foundation of California/Womens Policy
Institute
DIGEST: This bill requires the California Health and Human
Services Agency (CHHSA) to coordinate with the Department of
Health Care Services (DHCS) and the Department of Social
Services (DSS) to facilitate the receipt of medically necessary
specialty mental health services for foster youth, as specified.
Requires DHCS to seek federal approval, as specified, to
implement the provisions in this bill.
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Senate Floor Amendments of 8/18/16 add coauthors, and change all
references to the added Welfare and Institutions Code Section
14717.5 in this bill and instead number it as 14717.1.
ANALYSIS:
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
children placed out of home in group care and 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
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the costs of services, unless there is a written contract in
which the county of residence accepts responsibility for
payment.
5)Establishes rights of foster youth, including the right to
receive medical, dental, vision, and MH services.
This bill:
1)Requires the CHHSA to coordinate with DHCS and DSS to
facilitate the receipt of medically necessary specialty MH
services by foster youth placed outside his or her county of
original jurisdiction, and to take specified actions on or
before July 1, 2017.
2)Requires DHCS to issue policy guidance concerning the
conditions for and exceptions to "presumptive transfer," as
defined, in consultation with DSS and with input of
stakeholders, as specified, to ensure that the transfer or
responsibility improves access to MH services and does not
impede the continuity of existing care, as well as other
specified criteria.
3)Defines "presumptive transfer" as, absent any exceptions
established by this bill, responsibility for providing or
arranging for specialty MH services is promptly transferred
from the county of original jurisdiction to the county in
which the foster child resides, as specified.
4)Allows, on a case-by-case basis and when consistent with the
medical rights of a foster child, presumptive transfer to be
waived and the responsibility for the provision of specialty
MH services to remain with the county of original jurisdiction
if any of the following exceptions exist:
a) The transfer would disrupt continuity of care or delay
access to services.
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b) The transfer would interfere with family reunification
efforts documented in the individual case plan.
c) The foster child's placement in the county other than
the county of original jurisdiction is expected to last
less than six months.
d) The foster child's residence is within 30 minutes of
travel time to his or her established specialty MH care
provider in the county of original jurisdiction.
5)Requires a waiver, as described in 4) above, to be contingent
upon specified criteria, including an MH plan in the county of
original jurisdiction demonstrating an existing contract with
a specialty MH services provider, and the ability to deliver
timely specialty MH services directly to a foster child.
6)Requires DSS and DHCS to adopt regulations by July 1, 2019, to
implement the provisions in this bill.
7)Requires DHCS, if it determines it is necessary, to seek
approval from the Centers for Medicare and Medicaid Services
(CMS) prior to implementing the provisions in this bill, and
to make an official request for approval from CMS no later
than January 1, 2017. Requires this provision in this bill to
be implemented only if and to the extent that federal
financial participation, as specified, is available and all
necessary federal approvals have been obtained.
Background
The purpose of the 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
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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.
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 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,
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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.
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
"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.
Related/Prior Legislation
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AB 1808 (Galgiani, 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee:
1)Minor anticipated costs for CHHSA to coordinate with other
departments (General Fund).
2)One-time costs of about $900,000 over two years and ongoing
administrative costs of about $130,000 per year for DHCS to
develop policies, adopt regulations, monitor disputes between
counties, and monitor the provision of services under the bill
(General Fund and federal funds).
3)Likely increase in county spending for specialty MH services
in the low millions per year (local realignment funds and
federal funds). There are indications that foster youth who
are placed out-of-county are more likely to need MH services
but are less likely to access such services. In part, this
reduced access to services is due to administrative barriers
that prevent county MH plans from determining which county is
responsible for providing services. By improving the system
for assigning responsibility for providing and paying for MH
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
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placements would access specialty MH services for an
additional six months, the annual costs would be about $3
million per year. Under the provisions of the bill, county
costs for services would be paid for with realignment growth
funding and would not be a state responsibility.
4)Projected ongoing shift of realignment funding between
counties of about $48 million per year (local realignment
funds). According to projections by DHCS, foster youth
impacted by the presumptive transfer process in the bill would
receive annual services costing about $48 million. Under the
bill, counties would be compensated for any increased cost
through the allocation of realignment growth funding.
SUPPORT: (Verified 8/17/16)
California Alliance of Child and Family Services (co-source)
Steinberg Institute (co-source)
The Women's Foundation of California - Women's Policy Institute
(co-source)
A Better Way, Inc.
Accessing Health Services for California's
Alameda Foster Youth Alliance
Alternative Family Services
Aspiranet
Association of Community Human Service Agencies
Aviva Family and Children's Services
Bayfront Youth and Family Services
Bill Wilson Center
Boys Republic
California Hospital Association
California Mental Health Advocacy for Children and Youth
California State Association of Counties
California State PTA
California Youth Connection
Casa Pacifica Centers for Children and Families
ChildNet Youth and Family Services
Children in Foster Care Task Force
Children Now
Children's Law Center of California
Children's Receiving Home of Sacramento
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County Welfare Directors Association
Crittenton Services for Children and Families
David and Margaret Youth and Family Services
Edgewood
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
John Burton Foundation
Junior Blind of America
Lilliput Children's Services
Maryvale
Mendocino County Health and Human Services Agency
National Association of Social Workers
National Center for Youth Law
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
Sierra Sacramento Valley Medical Society
Stars Behavioral Health Group
Sunny Hills Services
Tahoe Turning Point
The Village Family Services
TLC Child and Family Services
Trinity Youth Services
United Advocates for Children and Youth
Unity Care
Uplift Family Services
Valley Teen Ranch
Victor Treatment Center
Westcoast Children's Clinic
Young Minds Advocacy Project
Youth Homes, Inc.
OPPOSITION: (Verified8/17/16)
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None received
ARGUMENTS IN 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 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.
ASSEMBLY FLOOR: 80-0, 6/1/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
Prepared by:Reyes Diaz / HEALTH / (916) 651-4111
8/23/16 10:58:35
**** END ****
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