BILL ANALYSIS Ó
AB 1299
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CONCURRENCE IN SENATE AMENDMENTS
AB
1299 (Ridley-Thomas)
As Amended August 18, 2016
Majority vote
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|ASSEMBLY: |80-0 |(June 1, 2015) |SENATE: |39-0 |(August 23, |
| | | | | |2016) |
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Original Committee Reference: HUM. S.
SUMMARY: Provides for the presumptive transfer of
responsibility from the county of original jurisdiction to the
foster child's county of residence for providing or arranging
mental health services for foster youth, as specified.
The Senate amendments:
1)Move provisions of the bill to a different section of the
Welfare and Institutions Code.
2)Delete provisions requiring, as specified, presumptive
transfer to occur immediately when a foster child is placed in
a county other than the county of original jurisdiction and
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when the request for transfer of responsibility is made by
specified entities or individuals, and instead require
transfer to take place promptly when either of the following
conditions exist:
a) A foster child is placed in a county other than the
county of original jurisdiction on or after July 1, 2017;
or
b) A foster youth who resides in a county other than the
county of original jurisdiction after June 30, 2017, and is
not receiving specialty mental health services, as
specified, requests transfer of responsibility.
3)Require a foster youth who resided in a county other than the
county of original jurisdiction after June 30, 2017, and who
continues to reside outside the county of original
jurisdiction after December 31, 2017, to have jurisdiction
transferred no later than the child's first regularly
scheduled status review hearing, as specified.
4)Delete provisions requiring the California Health and Human
Services Agency (HHS) to coordinate with the Department of
Health Care Services (DHCS) and the Department of Social
Services (DSS) to take specified actions regarding
establishing presumptive transfer by July 1, 2016, and
instead, require HHS to coordinate with DHCS and DSS to, by
July 1, 2017, have DHCS issue policy guidance concerning the
conditions for and exceptions to presumptive transfer, as
specified, in consultation with specified parties, and that
ensures that certain conditions are met, including, but not
limited to, presumptive transfer not interrupting the
continuity of care.
5)Provide for conditions under which presumptive transfer made
be waived, and establish related requirements and processes,
as specified.
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6)Require a county in which a foster child resides to accept an
assessment of needed services for that child completed in the
county of original jurisdiction and further, authorize the
county in which a child resides to conduct additional
assessments, as specified.
7)Require a county in which a child resides to assume
responsibility for the authorization and provision of
specialty mental health services and payments for services
upon presumptive transfer.
8)Require a foster child transferred to the mental health plan
in the county in which the child resides to be considered part
of the county of residence caseload for claiming purposes from
the Behavioral Health Subaccount and the Behavioral Health
Services Growth Special Account, as specified.
9)Require DSS and DHCS to adopt regulations to implement the
provisions of this bill by July 1, 2019, and further,
authorize DSS and DHCS to implement and administer the changes
made by this bill through all-county letters, information
notices, or similar written instruction, as specified, until
regulations are adopted.
10)Modify requirements related to DHCS seeking federal approval
for implementation of the provisions of this bill by:
a) Maintaining that, if DHCS determines it necessary, it
shall seek approval from the federal Centers for Medicare
and Medicaid Services (CMS), but removing the requirement
that approval be sought specifically under the state's
Section 1915(b) Medicaid waiver;
b) Moving the deadline by which approval must be sought
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from CMS from not later than July 1, 2016, to no later than
January 1, 2017;
c) Removing the requirement that DHCS do everything within
its power necessary to secure an expeditious approval from
CMS; and
d) Removing the statement that DHCS shall not be required
to implement any provision of the bill that CMS determines
is not permitted under the state's waiver and, instead,
requiring the provisions of 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.
11)Make technical amendments.
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)
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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 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: Unknown.
COMMENTS:
Mental health needs of foster youth: Foster youth have a higher
likelihood of experiencing emotional, behavioral, and
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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
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
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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 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: 0004753