BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 276 (Wolk) - Medi-Cal: local educational agencies
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|Version: April 20, 2015 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: May 4, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 276 would require the Department of Health Care
Services to seek federal funding for additional covered services
that are provided to Medi-Cal beneficiaries by local educational
agencies.
Fiscal
Impact:
One-time administrative costs of about $250,000 to develop a
state plan amendment and make system changes by the Department
of Health Care Services (General Fund and federal funds).
No additional General Fund costs for administering the
program. Under current practice, the Department of Health Care
Services retains a small portion of the available federal
matching funds to pay for state administrative costs.
SB 276 (Wolk) Page 1 of
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Unknown additional federal funding to local educational
agencies to pay for services to Medi-Cal beneficiaries
(federal funds). Recent federal guidance expands the
availability of federal matching funds for health care
services provided by local education agencies. This bill would
amend state law to allow local education agencies to draw down
additional federal funding. Under current law, the non-federal
share of costs is provided by local education agencies. There
is no General Fund contribution to the program.
Background: Under current law, local educational agencies who provide
covered health care services to certain Medi-Cal beneficiaries
can seek federal matching funds (generally 50%) to offset some
of their costs.
Federal guidance formerly limited federal matching funds for
"free care" - that is services provided to the public without
charge. In the case of schools, this meant that local education
agencies could only seek federal matching funds for up to 24
services per 12 month period when services are generally
available to students. There was an exception for services
provided under an Individualized Education Plan or an Individual
Family Service Plan (both of which are plans to provide services
to students with developmental disabilities).
In December 2014, the federal government released new guidance
on "free care". Under the new guidance, federal matching funds
are available for all eligible services provided to Medi-Cal
beneficiaries, even if the services are provided without charge.
This policy change eliminated the limitation of 24 services per
12 months for all Medi-Cal eligible students. The federal
guidance requires Medi-Cal to continue to be the payer of last
resort, so that if a Medi-Cal beneficiary also has other health
care coverage (for example a student with Medi-Cal coverage who
is also covered under a parent's health care coverage), the
local education agency would have to bill the other coverage
first.
Proposed Law:
SB 276 (Wolk) Page 2 of
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SB 276 would require the Department of Health Care Services to
seek federal funding for additional covered services that are
provided to Medi-Cal beneficiaries by local educational
agencies.
The bill would require local educational agencies to take all
reasonable measures to pursue claims against third party
coverage. The bill would require a liable third party to either
pay the claim from a local educational agency or provide notice
that the claim is denied. If there is no response from the
legally liable third party within 45 days, the local educational
agency could bill Medi-Cal for the service.
Staff
Comments: In 2009-10, local educational agencies received $130
million in federal funding under this program. Since that level
of funding was limited by federal policy, the total federal
funding that may be available to local educational agencies
under this bill could be significantly larger.
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