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 27, 2016      |Consultant: Brendan McCarthy    |
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          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.


          *********** ANALYSIS ADDENDUM - SUSPENSE FILE ***********
             The following information is revised to reflect amendments 
                      adopted by the committee on May 27, 2016




          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,  







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            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  
            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 of $5 million to $10 million 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 who have been removed from  
            the home to be assessed by a county mental health plan for  
            specialty mental health services. There are about 15,000 new  
            foster care placements per year in the stat. The cost to  
            provide an assessment for specialty mental health services is  
            around $500. 

           Likely increase in specialty mental health services in the  
            hundreds of millions per year (General Fund and federal  
            funds). Under the bill, about 6.5 million children are likely  
            to get additional screening for trauma. Currently, there is a  
            very low rate of utilization of specialty mental health  
            services by Medi-Cal eligible children. It is likely that the  
            requirement for additional screening in the bill will result  
            in a significant number of children receiving being referred  
            for specialty mental health services who are not currently  
            receiving those services. Currently, 4.4% of children receive  
            specialty mental health services, at an average annual costs  
            of $6,000. If 5% of the children who are likely to be found to  
            have experienced trauma under the bill are subsequently found  
            to be eligible for specialty mental health services, the cost  
            would be about $500 million per year.

           Unknown potential future costs savings for Medi-Cal services  
            (General Fund, federal funds, local funds). Under the bill, it  
            is likely that a significant number of Medi-Cal children will  
            be determined to have experienced trauma and are in need of  








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            mental health services - over and above those who are  
            currently being identified. By identifying those children, it  
            is possible that early mental health interventions could  
            improve those children's long-term prognoses and reduce future  
            costs, such as psychiatric hospitalizations and other health  
            care costs associated with trauma (for example health care  
            services related to alcohol or substance abuse). The extent to  
            which those would occur is unknown.


          Committee  
          Amendments:  Delete the requirement that children found to have  
          experienced trauma through EPSDT screening shall be  
          automatically assessed for specialty mental health services and  
          limit automatic referral for specialty mental health screening  
          to children removed from the home.


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