BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1849|
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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:
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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.
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(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
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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
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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
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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
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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)
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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
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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
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