BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 1849
-----------------------------------------------------------------
|Author: |Gipson |
-----------------------------------------------------------------
|----------+-----------------------+-----------+-----------------|
|Version: |March 28, 2016 |Hearing |June 14, 2016 |
| | |Date: | |
|----------+-----------------------+-----------+-----------------|
|Urgency: |No |Fiscal: |Yes |
----------------------------------------------------------------
-----------------------------------------------------------------
|Consultant|Mareva Brown |
|: | |
-----------------------------------------------------------------
Subject: Foster youth: transition to independent living:
health insurance coverage
SUMMARY
This bill requires that documents provided to a youth who is
preparing to transition out of foster care to include written
verification that the child is enrolled in Medi-Cal and a
Medi-Cal Benefits Identification Card. It additionally mandates
that an eligible child's enrollment in Medi-Cal be continued and
uninterrupted eligibility up to 26 years of age, and requires a
description of how the youth's case will be transitioned into
the Medi-Cal program without interruption, as specified, prior
to the court's termination hearing when the youth turns 18.
ABSTRACT
Existing law:
1) Establishes a system of juvenile dependency for children
who are or are at risk of being physically, sexually or
emotionally abused, being neglected or being exploited to
ensure their safety, protection and physical and emotional
well-being. (WIC 300, et seq.)
2) Requires the status of every dependent child in foster
care to be reviewed no less often than once every six
months, and for the court to consider the continuing
necessity for placement, whether the placement is
AB 1849 (Gipson) PageB
of?
appropriate, and other factors. (WIC 366)
3) Requires that a child who was in foster care on his or
her 18th birthday must be enrolled to receive Medi-Cal
benefits without an interruption in coverage and without
requiring a new application. (WIC 14005.28)
4) Requires that, to the extent federal financial
participation is available pursuant to an approved state
plan amendment, the Department of Health Care Services
(DHCS) must exercise its option under federal law to extend
Medi-Cal benefits to independent foster care adolescents,
as defined, and requires semiannual reports to the
legislature of these efforts. (WIC 14005.285)
5) Requires that a written case plan be completed within a
maximum of 60 days of the initial removal of the child, or
by the date of the dispositional hearing, as specified,
which shall be updated as the service needs of the child
and family dictate. Requires, at a minimum, the case plan
be updated once every six months, as specified, and include
a description of the services that have been provided to
the child and the effectiveness of those services, among
other specified items. (WIC 16501.1 (e))
6) Requires that for a child who is 14 or 15 years of age,
the case plan shall include a written description of the
programs and services that will help the child to prepare
for the transition from foster care to successful
adulthood, including information about housing, health
insurance, educational and other options, as specified.
(WIC 16501.1(g) (16))
7) Establishes various steps and processes that a social
worker must complete to assist a youth to prepare for
transitioning from foster care at age 18, including
assistance and support in developing a personalized written
90-day transition plan, options regarding housing, health
insurance, education, local opportunities for mentors and
continuing support services, workforce supports and
employment services, information regarding the advance
health care directive form, and other information. (WIC
16501.1 (e)(16)(B)
AB 1849 (Gipson) PageC
of?
This bill:
1) Deletes the requirement that prior to a court
terminating dependency jurisdiction the county provide
assistance in completing an application for Medi-Cal or
assistance in obtaining other health insurance.
2) Replaces that language with the requirement that the
county provide written verification that the nonminor is
enrolled in Medi-Cal and the nonminor's Medi-Cal Benefits
Identification Card.
3) Prohibits the court from terminating dependency over a
nonminor unless, among other documents, the county can
verify continued and uninterrupted enrollment in Medi-Cal,
as established in existing statute.
4) Adds the requirement that information provided in a
minor's 90-day transition plan prior to his or her 18th
birthday shall include verification that the youth or
nonminor is enrolled in Medi-Cal and a description of the
steps that have been or will be taken by the youth's social
worker or probation officer to ensure that the youth or
nonminor is transitioned into the Medi-Cal program for
former foster youth upon case closure, with no interruption
in coverage and without a new application being required,
as specified.
5) Makes various non-substantial cleanup changes.
FISCAL IMPACT
An analysis by the Assembly Committee on Appropriations
identified minor costs to counties to include the required
information.
BACKGROUND AND DISCUSSION
Purpose of the bill:
Existing law requires young people exiting foster care to be
automatically enrolled in the Medi-Cal program for former foster
AB 1849 (Gipson) PageD
of?
youth until age 26 with no interruption in coverage and with no
application required. However, the author points out, WIC
sections 391 and 16501.1 contain outdated instructions for
social workers preparing youth to transition out of foster care
to help them obtain health benefits. For example, as the author
additionally states, some sections of code still require social
workers to assist the youth in completing a Medi-Cal application
despite the fact that as of January 1, 2014, youth should be
receiving uninterrupted and continuous coverage with no
application needed. The statutes also require social workers to
provide information about options for health care coverage to
youth exiting foster care, but do not explain that information
about automatic Medi-Cal eligibility until age 26 should be
provided. As a result, the author states, some youth have been
incorrectly dropped from coverage as they transition out of care
or have left care without receiving information about their
ongoing eligibility and/or without a copy of their Medi-Cal
benefits identification card.
Foster Youth
California's county-based child welfare system is intended to
protect children at risk of child abuse and neglect or
exploitation by providing intensive services to families to
allow children to remain in their homes, or by arranging
temporary or permanent placement of the child in the safest and
least restrictive environment possible. Approximately 62,000
children were in the custody of the child welfare system as of
October 2015, according to the state's child welfare case
management system. About 45,000 children were placed in
out-of-home situations in 2016, according to data released by
CDSS with the governor's budget.
Health concerns
According to a 2015 report prepared by the American Academy of
Pediatrics,<1> children and adolescents involved with the child
welfare system often have complex and serious physical, mental
health, developmental and psychosocial problems "rooted in
childhood adversity and trauma." This is especially true of
children placed in out-of-home care. Among the barriers to
---------------------------
<1> Szilagyi, Moira, et al. Health Care Issues for Children and
Adolescents in Foster Care and Kinship Care, Pedatrics, Volume
138, No. 4, October 2105
AB 1849 (Gipson) PageE
of?
providing high-quality and comprehensive health coverage are the
diffusion of authority among parents, child welfare
professionals and the courts, a lack of health history
information, consent and confidentiality barriers, the transient
nature of many adolescents in foster care and the fact that
health care is often provided on a crisis basis, rather than
planned or preventative care.<2>
Former Foster Care Children's Program
Foster youth in California who have aged out of the foster care
system at age 18 are eligible under the Affordable Care Act to
have Medi-Cal coverage until age 26. Former foster youth who
were placed out of state on their 18th birthday remain eligible
for Medi-Cal.<3> Youth who are turning 18 and still in the
foster care system in their county of origin should see a
seamless transition into the Former Foster Care Children's
Program and are eligible for coverage until age 26. Former
foster youth may need to apply under the Former Foster Care
Children's program for benefits depending on their individual
circumstances, according to an all-county letter issued by the
Department Health Care Services in 2015.<4>
SB X1 1 (Hernandez, Chapter 4, Statutes of 2014) required, to
the extent federal financial participation is available, DHCS to
provide Medi-Cal benefits to any individual who is in foster
care on his or her 18th birthday until the individual turns age
26. In addition, SB X1 1 required DHCS to adopt the federal
option to provide Medi-Cal benefits to individuals that were in
foster care and enrolled in Medicaid in another state but who
now live in California.
To ensure that former foster youth are not disenrolled from
Medi-Cal coverage because they have moved and their
redetermination form is returned in the mail as undeliverable,
SB X1 1 also required DHCS to seek federal approval to institute
a renewal process that allows a beneficiary to remain in
fee-for-service Medi-Cal after a redetermination form is
returned as undeliverable and the county is otherwise unable to
---------------------------
<2> Szilagyi, et all, page 7
<3> Medi-Cal Eligibility Division Information Letter No.: I
14-05, Department of Health Care Services, January 17, 2014
<4> All County Welfare Directors Letter No.: 15-32, Department
of Health Care Services, October 2015
AB 1849 (Gipson) PageF
of?
establish contact.
Former foster youth additionally retain their right to Medi-Cal
coverage if they move within the state, obtain a job and have an
increase in income or obtain other health insurance (in which
case Medi-Cal coverage would be the secondary insurer).
Related legislation:
SB 508 (Hernandez, Chapter 831, Statutes of 2014) required DHCS
to implement federal provisions to provide Medi-Cal benefits to
a former foster youth until his or her 26th birthday if he or
she was in foster care on his or her 18th birthday. It
additionally required DHCS to exercise its option under federal
law to extend Medi-Cal benefits to independent foster care
adolescents, as specified.
COMMENTS
Not every former foster child is enrolled in Medi-Cal. According
to DHCS, nonminors who are incarcerated or out of state on their
18th birthday may not be enrolled. The language of this bill
should clarify that the requirement to verify Medi-Cal
enrollment applies to those youth who are participating in the
Medi-Cal program. Staff recommends the following amendments:
WIC 391 (e) The court shall not terminate dependency
jurisdiction over a nonminor who has attained 18 years of age
until a hearing is conducted pursuant to this section and the
department has submitted a report verifying that the following
information, documents, and services have been provided to the
nonminor, or in the case of a nonminor who, after reasonable
efforts by the county welfare department, cannot be located,
verifying the efforts made to make the following available to
the nonminor:
(2) The following documents:
(K) Written verification that the eligible nonminor is enrolled
in Medi-Cal, and the nonminor's Medi-Cal Benefits Identification
Card.
(3) Continued and uninterrupted enrollment in Medi-Cal for
eligible nonminors pursuant to Section 14005.28 or 14005.285.
Section 16501.1 (g)(16)(B) During the 90-day period prior to the
AB 1849 (Gipson) PageG
of?
participant attaining 18 years of age or older as the state may
elect under Section 475(8)(B)(iii) of the federal Social
Security Act (42 U.S.C. Sec. 675(8)(B)(iii)), whether during
that period foster care maintenance payments are being made on
the child's behalf or the child is receiving benefits or
services under Section 477 of the federal Social Security Act
(42 U.S.C. Sec. 677), a caseworker or other appropriate agency
staff or probation officer and other representatives of the
participant, as appropriate, shall provide the youth or nonminor
dependent with assistance and support in developing the written
90-day transition plan, that is personalized at the direction of
the child, information as detailed as the participant elects
that shall include, but not be limited to, options regarding
housing, health insurance, education, local opportunities for
mentors and continuing support services, and workforce supports
and employment services, a power of attorney for health care,
and information regarding the advance health care directive
form. Information provided regarding health insurance options
shall include verification that the eligible youth or nonminor
is enrolled in Medi-Cal , and a description of the steps that
have been or will be taken by the youth's social worker or
probation officer to ensure that the eligible youth or nonminor
is transitioned into the Medi-Cal program for former foster
youth upon case closure with no interruption in coverage and
without a with no new application being required, as provided in
Section 14005.28.
PRIOR VOTES
-----------------------------------------------------------------
|Assembly Floor: |79 - |
| |0 |
|-----------------------------------------------------------+-----|
|Assembly Appropriations Committee: |20 - |
| |0 |
|-----------------------------------------------------------+-----|
|Assembly Human Services Committee: |6 - |
| |0 |
-----------------------------------------------------------------
POSITIONS
Support:
AB 1849 (Gipson) PageH
of?
Children Now (Co- Sponsor)
The Youth Law Center (Co-Sponsor)
California Black Health Network
California CASA Association
California Coverage and Health Initiatives
Children's Advocacy Institute
Children's Law Center
Community Clinic Association of Los Angeles County
Community Health Council (CHC)
Families NOW
First Place for Youth
Hillsides
Journey House, Inc.
Just in Time for Foster Youth
Los Angeles County Unified School District
National Center for Youth Law
Orangewood Foundation
Sanctity of Hope
Service Employees International Union
St. Anne's
The Alliance for Children's Rights
The California Alliance of Child and Family Services
The California Pan-Ethnic Health Network
The California Primary Care Association
The Child Abuse Prevention Center
The Children's Partnership
The Community College Foundation
The John Burton Foundation for Children Without Homes
The National Association of Social Workers
United ways of California
Young Minds Advocacy
Oppose:
None
-- END --