BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 276 (Wolk) - Medi-Cal: local educational agencies ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 20, 2015 |Policy Vote: HEALTH 8 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 4, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- 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 ? 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 ? 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. -- END --