BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1849| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1849 Author: Gipson (D) Amended: 6/16/16 in Senate Vote: 21 SENATE HUMAN SERVICES COMMITTEE: 4-0, 6/14/16 AYES: McGuire, Hancock, Liu, Nguyen NO VOTE RECORDED: Berryhill SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/1/16 AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen ASSEMBLY FLOOR: 79-0, 4/21/16 (Consent) - See last page for vote SUBJECT: Foster youth: transition to independent living: health insurance coverage SOURCE: Children Now Youth Law Center DIGEST: This bill requires a child transitioning out of foster care be provided with written verification of enrollment 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. ANALYSIS: AB 1849 Page 2 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 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. AB 1849 Page 3 (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) 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 AB 1849 Page 4 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. Background 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 California Department of Social Services with the governor's budget. Existing law requires young people exiting foster care to be AB 1849 Page 5 automatically enrolled in the Medi-Cal program for former foster youth until age 26 with no interruption in coverage and with no application required. However, existing statute contains outdated instructions for social workers preparing youth to transition out of foster care requiring social workers to help youth obtain health benefits. 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. Health concerns. According to a 2015 report prepared by the American Academy of Pediatrics, 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 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. 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 AB 1849 Page 6 of state on their 18th birthday remain eligible for Medi-Cal. 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. 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 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/Prior Legislation SB 508 (Hernandez, Chapter 831, Statutes of 2014) required DHCS to implement federal provisions to provide Medi-Cal benefits to AB 1849 Page 7 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: Yes According to an analysis by the Senate Appropriations Committee, this bill will incur potential ongoing local-assistance cost of $36,158 ($28,959 GF)* per year to the extent that an additional 15 minutes of social worker time is needed per case to provide the required documentation for enrollment in Medi-Cal for youth who are leaving foster care and for verification of the social worker's steps in the youth's transition plan. *Proposition 30 (November 2012) eliminated any potential mandate funding liability for any new program or higher level of service mandated on local agencies related to realigned programs, including child welfare services and foster care. Rather, 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 mandated by realignment only apply to local agencies to the extent that the state provides annual funding for the cost increase. Local agencies are not obligated to provide programs or levels of service required by legislation above the level for which funding has been provided. SUPPORT: (Verified8/3/16) Children Now (co-source) AB 1849 Page 8 Youth Law Center (co-source) Alliance for Children's Rights CA Coverage and Health Initiatives California Alliance of Child and Family Services California Black Health Network California CASA California Pan- Ethnic Health Network California Primary Care Association California State PTA Child Abuse Prevention Center Children's Advocacy Institute Children's Law Center of California Community Clinic Association of Los Angeles County Community Health Councils Inc. Families Now First Place for Youth Hillsides Youth Moving On John Burton Foundation Journey House Junior League of San Diego Just in Time for Foster Youth Los Angeles Unified School District National Association of Social Workers - CA chapter National Center for Youth Law Orangewood Foundation Public Counsel Sanctuary of Hope SEIU South Bay Community Services St. Anne's The Children's Partnership The Community College Foundation United Way Western Center for Law and Poverty Young Minds Advocacy OPPOSITION: (Verified8/3/16) None received AB 1849 Page 9 ARGUMENTS IN SUPPORT: According to the Youth Law Center, a co-sponsor of the bill, despite the importance of former foster youth receiving uninterrupted, automatic Medi-Cal coverage, outdated provisions in the law have prevented or delayed young people receiving the coverage and care they deserve. "Existing state law requires young people existing foster care to be automatically transitioned into the Medi-Cal Program for former foster youth until age 26 with no interruption in coverage and no application required. However, several sections of the code still contain outdated instructions for social workers preparing youth to transition out of foster care." ASSEMBLY FLOOR: 79-0, 4/21/16 AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, 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, Quirk, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon NO VOTE RECORDED: Ridley-Thomas Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524 8/3/16 18:17:29 **** END **** AB 1849 Page 10