BILL ANALYSIS Ó
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
SB 1466 (Mitchell) Page 1 of
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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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