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