BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 1466 (Mitchell) - Early and Periodic Screening, Diagnosis,  
          and Treatment Program:  trauma screening
          
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          |Version: April 14, 2016         |Policy Vote: HEALTH 9 - 0,      |
          |                                |          HUMAN S. 5 - 0        |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: May 23, 2016      |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.

          Bill  
          Summary:  SB 1466 would require additional screening for trauma  
          in Medi-Cal eligible children. The bill would require Medi-Cal  
          eligible children who are found to have experienced trauma and  
          children who have been abused, neglected, or removed from the  
          home to be referred to county mental health plans for assessment  
          for specialty mental health services.


          Fiscal  
          Impact:  
           Increased costs in the low millions per year for additional  
            screening provided to Medi-Cal eligible children (General Fund  
            and federal funds). Under current federal and state law,  
            children enrolled in Medi-Cal are eligible for the Early and  
            Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit.  
            This benefit covers screening for both physical and mental  
            health issues. By specifically requiring screening for trauma,  
            the bill is likely to increase the costs to provide screening  
            services due to additional time spent by providers with  







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            eligible children. It is not clear to what extent children are  
            already being screened for trauma. It is likely that the  
            specific requirement in the bill will lead to increased focus  
            on trauma during screening. For example, if the cost to  
            provide trauma screening increased the overall cost of  
            screening under EPSDT by 5%, the cost would be about $2  
            million per year.

           Increased costs in the high hundreds of millions per year to  
            provide assessments for specialty mental health services by  
            county mental health plans (General Fund and federal funds).  
            The bill would require all children that are found to have  
            experienced trauma through an EPSDT screening and all children  
            who have been abused, neglected, or removed from the home to  
            be assessed by a county mental health plan for specialty  
            mental health services. There are about 6.5 million children  
            in Med-Cal who are eligible for EPSDT. The number of children  
            who would are abused, neglected, or removed from the home is  
            likely to be about 100,000 per year. The cost to provide an  
            assessment for specialty mental health services is around  
            $500. Assuming that 25% of children in Medi-Cal have  
            experienced trauma, the cost to provide assessments for  
            specialty mental health services would be about $750 million  
            per year.

           Likely increase in specialty mental health services in the  
            hundreds of millions per year (General Fund and federal  
            funds). Given the very large number of children that are  
            likely to be assessed for specialty mental health services and  
            the currently low rate of utilization of specialty mental  
            health services by Medi-Cal eligible children, it is likely  
            that the requirement for additional assessments in the bill  
            will result in a significant number of children receiving  
            specialty mental health services who are not currently  
            receiving them. Currently, 4.4% of children receive specialty  
            mental health services, at an average annual costs of $6,000.  
            If 5% of the children newly assessed for services under the  
            bill were found to be eligible for specialty mental health  
            services, the cost would be about $500 million per year.


          Background:  Under state and federal law, the Department of Health Care  
          Services operates the Medi-Cal program, which provides health  
          care coverage to low income individuals, families, and children.  








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          Medi-Cal provides coverage to childless adults and parents with  
          household income up to 138% of the federal poverty level and to  
          children with household income up to 266% of the federal poverty  
          level. The federal government provides matching funds that vary  
          from 50% to 90% of expenditures depending on the category of  
          beneficiary.
          Federal law requires the state to provide Early and Periodic  
          Screening, Diagnosis, and Treatment (EPSDT) to all Medi-Cal  
          eligible children. EPSDT provides comprehensive preventative,  
          diagnostic, and treatment services for Medi-Cal beneficiaries  
          under age 21. The state is required to provide any services  
          determined to be medically necessary to correct or ameliorate  
          any physical or behavioral health condition.


          Under current law, the provision of mental health services to  
          Medi-Cal beneficiaries is divided between services for mild to  
          moderate mental illness and services for severe mental illness.  
          Mental health services for mild to moderate mental illness are  
          provided by Medi-Cal managed care plans (for most beneficiaries)  
          or Medi-Cal fee-for-service providers. Mental health services  
          for severe mental illness are provided by county mental health  
          plans. 




          Proposed Law:  
            SB 1466 would require additional screening for trauma in  
          Medi-Cal eligible children. The bill would require Medi-Cal  
          eligible children who are found to have experienced trauma and  
          children who have been abused, neglected, or removed from the  
          home to be referred to county mental health plans for assessment  
          for specialty mental health services.
          Specific provisions of the bill would:
                 Require screening services provided under EPSDT to  
               include screening for trauma at all screenings;
                 Require a child found to have experienced trauma through  
               the screening process to be referred to the county mental  
               health plan for assessment for specialty mental health  
               services;
                 Require a child who is abused, neglected, or removed  
               from the home to be assessed by the county mental health  
               plan for specialty mental health services;








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                 Require a child who is found to have experienced trauma  
               during screening to be assessed by the county mental health  
               plan for specialty mental health services;
                 If a child is determined not to be eligible for  
               specialty mental health services, require the child to be  
               referred for other necessary health care under the Medi-Cal  
               program;
                 Define trauma for the purposes of the bill.


          Related  
          Legislation:  SB 1291 (Beall) would require county mental health  
          plans to submit an annual foster care mental health service plan  
          to the Department of Health Care Services. The bill would  
          require county mental health plans to be reviewed by an external  
          quality review organization with specified requirements. The  
          bill would require the Department to conduct annual audits of  
          county mental health plans to assess the provision of services  
          to foster youth. That bill is pending on this committee's  
          Suspense File.


          Staff  
          Comments:  According to research compiled by the National Center  
          for Children in Poverty, between 25% and 90% of children  
          experience events that leave them traumatized. Children involved  
          in the child welfare system, children involved in the juvenile  
          justice system, and children who live in neighborhoods with high  
          violent crime rates all have high levels of trauma.
          Under current law, both EPSDT and specialty mental health have  
          been realigned to the counties. Generally, this require counties  
          to provide the non-federal share of program costs using  
          realignment funds. However, Proposition 30 of 2012 provides that  
          any legislation enacted after September 30, 2012 that has an  
          overall effect of increasing the costs already borne by a local  
          agency for realigned services applies to local agencies only to  
          the extent that the State provides annual funding for the cost  
          increase. Therefore, any additional costs experienced by the  
          counties due to increased EPSDT screening, assessments for  
          specialty mental health services, or provision of specialty  
          mental health services under the bill would be a state  
          responsibility.










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