BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 114
S
AUTHOR: Liu and Pavley
B
AMENDED: March 16, 2009
HEARING DATE: April 1, 2009
1
CONSULTANT:
1
Moreno/
4
SUBJECT
Medi-Cal: Independent foster care adolescents
SUMMARY
Requires independent foster care adolescents to be enrolled
in Medi-Cal without reapplication after April 1, 2010.
CHANGES TO EXISTING LAW
Existing federal law:
The federal Foster Care Independence Act authorizes states
to continue Medi-Cal eligibility for all children who are
in foster care beyond their 18th birthday. The eligibility
continues until they reach 21 and entitles eligible youth
to full scope, no share-of-cost, benefits. Existing
federal law also permits states to waive any income or
assets test for the eligible population.
Existing state law:
Existing state law establishes the state's Medicaid program
known as Medi-Cal, administered by the Department of Health
Care Services (DHCS), which provides comprehensive health
benefits to low-income children; their parents or caretaker
relatives; pregnant women; elderly, blind or disabled
persons; nursing home residents; and refugees who meet
specified eligibility criteria.
Existing state law provides that foster care youth are
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STAFF ANALYSIS OF SENATE BILL SB 114 (Liu) Page 2
"categorically eligible" for Medi-Cal. Existing state law
also requires that persons formerly in the foster care
program are eligible for Medi-Cal until they are 21,
provided they were foster youth immediately prior to their
18th birthday and meet other eligibility requirements.
This bill:
Requires an independent foster care adolescent, who is in
foster care on his or her 18th birthday, to be enrolled in
Medi-Cal without any interruption in coverage and without
requiring a new application.
Requires DHCS to develop and implement a simplified form
for redetermination, and requires independent foster care
adolescents to fill out and return this form only if
information previously reported is no longer accurate.
Provides that failure to return the form alone will not
constitute a basis for termination of Medi-Cal benefits so
long as all other eligibility requirements have been met.
Permits DHCS to terminate Medi-Cal eligibility of an
independent foster care adolescent who is no longer
eligible, but only after ineligibility is established and
all due process requirements are met, as specified.
Requires the bill's provisions to be implemented on April
1, 2010, only to the extent that federal financial
participation is available and any necessary federal
approvals are obtained.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
According to the author, the intent of this bill is to
ensure that independent former foster youth, defined as
those between the ages of 18 and 21, receive the medical
benefits they are legally entitled to and desperately need.
The author notes that the preponderance of research has
shown that independent former foster youth have acute
health care needs. The author argues that, given these
health care needs, it is appropriate that under current
law, these youth are eligible for Medi-Cal by virtue of
their status as former foster youth. Despite their
STAFF ANALYSIS OF SENATE BILL SB 114 (Liu) Page 3
eligibility, however, these former foster youth are
required to fill out Medi-Cal eligibility forms as a
prerequisite to getting the health care services to which
they are entitled.
The author argues that it does not make moral or fiscal
sense for the state to spend scarce dollars and staff hours
making these former foster youth fill out Medi-Cal
paperwork since they cannot, by law, be refused
eligibility. As a result of this current practice, these
foster youth risk losing their medical care when they
incorrectly fill out their forms, forms are sent to the
wrong addresses, or where there are other paperwork delays.
Background
According to the California Blue Ribbon Commission on
Children in Foster Care, courts are responsible for the
safety and well-being of children who have been removed
from their homes as a result of abuse or neglect. In 2007,
there were nearly 80,000 children in foster care, more than
75 percent of whom entered placement as a result of
neglect. Half of the children entering foster care in
California are age five or under. Domestic violence,
substance abuse, and mental illness are factors that
contribute to the removal of children from their homes.
There is a disproportionate number of African American and
Native American children in foster care, as these children
are more likely than other children to be reported as
abused, more likely to be removed from their homes, and
less likely to be reunified with their families or adopted.
African-American children constitute seven percent of the
state's child population but are more than 30 percent of
the children in foster care. Native American children are
0.84 percent of the state's child population but represent
1.41 percent of the children in foster care. Youth who
"age out" of foster care often leave the system
ill-prepared to live as adults, and face a significantly
increased risk of unemployment, homelessness, mental
illness, and involvement with the criminal justice system.
Health care needs of foster children
Substantial evidence over the past 20 years indicates that
foster care children enter the system in a poor state of
health. According to an article in the journal Pediatrics,
published in October 2000, in addition to the abuse or
neglect that commonly results in out-of-home placement,
STAFF ANALYSIS OF SENATE BILL SB 114 (Liu) Page 4
poor health of foster care children reflects exposure to
poverty, poor prenatal care, prenatal infection, prenatal
maternal substance abuse, family and neighborhood violence,
and parental mental illness. Children entering foster care
are also more likely than their peers to have received
inadequate routine preventive health care before placement.
A 1990 study published in the American Journal of Diseases
of Children reviewed the physical examination findings of
5,181 children taken into protective custody in Chicago
over a 22-month period and found that nearly half had an
identified health problem, including acute infections,
anemia, and lead poisoning. In addition, approximately
five percent of the children evaluated for physical abuse
were found to have fractures that were not visible by x-ray
and were not suspected by their caseworkers. A 1994 study
published in Pediatrics reported that, of 2,419 children
assessed shortly after placement in foster care in
Baltimore, 92 percent had at least one abnormality on
physical examination, including disorders of the upper
respiratory tract, skin, genitals, eyes, abdomen, lungs,
and extremities.
Medi-Cal eligibility for foster youth
Foster youth have been granted what is termed "categorical
eligibility" for Medi-Cal, meaning that they are eligible
solely because they are in foster care. An application is
generally required, and a child in foster care is eligible
for full scope Medi-Cal regardless of immigration status,
except for those who are undocumented.
California has adopted the state option to provide Medicaid
coverage for independent foster children between the ages
of 18 and 21 that was made available under the federal
Foster Care Independence Act of 1999. As of 2000, children
transitioning out of foster care on their 18th birthday can
apply for Medi-Cal. Coverage continues until they reach
their 21st birthday. A simplified application is required
to obtain eligibility. The state does not require an
income or asset test for these children leaving foster
care. There are certain exceptions to this categorical
eligibility, including children in foster care who are
supported 100 percent by the county, are undocumented
immigrants, or are incarcerated. However, some of these
individuals may be eligible under other Medi-Cal
categories, and the county is required to make eligibility
determinations under these other categories.
STAFF ANALYSIS OF SENATE BILL SB 114 (Liu) Page 5
Prior legislation
SB 1132 (Migden) of 2008 contained substantially similar
language to this bill and was vetoed by the Governor, who
stated: "?federal law currently requires states to conduct
annual eligibility determinations for Medi-Cal
beneficiaries." According to the author, SB 114 has been
drafted with assistance from DHCS to address the Governor's
concerns.
SB 147 (Alper,2000) would have required eliminated income
and asset tests when determining Medi-Cal eligibility of
independent foster care adolescents. This bill was vetoed.
AB 2877 (Thompson), Chapter 93, Statutes of 2000, extended
Medi-Cal eligibility to foster youth up to age 21, in
accordance with a new federal option.
Arguments in support
Supporters argue that SB 114 would clarify current law and
procedures to ensure that youth who have left foster care
are able to receive services with minimal action on their
part, which will ensure ongoing health care coverage for
these young adults, who often face tremendous odds against
their success.
POSITIONS
Support: Alliance for Children's Rights (sponsor)
Children's Advocacy Institute (sponsor)
County Welfare Directors Association of California
(sponsor)
Western Center on Law and Poverty (sponsor)
American Federation of State, County and Municipal
Employees
California Communities United Institute
California Medical Association
California Nurses Association
California State Association of Counties
Chief Probation Officers of California
City and County of San Francisco
Health Access California
Legal Advocates for Children and Youth
Public Counsel Law Center
Youth Law Center
STAFF ANALYSIS OF SENATE BILL SB 114 (Liu) Page 6
Oppose: None received
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