BILL ANALYSIS
SB 771
Page 1
Date of Hearing: June 29, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 771 (Alquist) - As Amended: June 22, 2010
SENATE VOTE : Not relevant
SUBJECT : Medi-Cal: foster children: eligibility
SUMMARY : Requires the Department of Health Care Services (DHCS)
to extend Medi-Cal, including Early Periodic Screening Diagnosis
and Treatment (EPSDT) eligibility to emancipated former foster
youth who are under 26 years of age, effective January 1, 2014,
to the extent federal financial participation is available, and
per requirements of federal health reform, the Patient
Protection and Affordable Care Act (PPACA) (Public Law 111-148).
Authorizes initial implementation by all-county letter or
similar instructions without the requirement of regulatory
action.
EXISTING LAW :
1)Establishes the Medi-Cal Program, administered by DHCS, to
provide comprehensive health care and long-term care services
to pregnant women, children, and people who are aged, blind,
and disabled.
2)Authorizes, under federal law, states to continue Medicaid
(Medi-Cal in California) 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. Permits states to
waive any income or assets test for the eligible population.
3)Provides that foster care youth are eligible for Medi-Cal.
Allows persons formerly in the foster care program to be
eligible for Medi-Cal until they are 21, provided they were
foster youth immediately prior to their 18th birthday and meet
other eligibility requirements. Independent former foster
youth are eligible to receive Medi-Cal health benefits up to
age 21 with no other eligibility requirement.
4)Requires, under federal law effective January 1, 2014, states
to provide Medicaid coverage to individuals who were in foster
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care at the time of enactment, up to age 26.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . This bill establishes California's
conformity with a federal health reform requirement to extend
Medi-Cal categorical eligibility to former foster youth to age
26. Under current law, youth who are in foster care when they
reach their 18th birthday have categorical eligibility until
their 21st birthday. This bill extends that eligibility until
their 26th birthday. Some view this federal foster
care-related provision as in line with another health reform
requirement to make dependent health coverage available until
young adults are 26. According to the author, in addition to
conforming to federal law, this bill provides key support to
former foster youth who face numerous barriers to stable
living after leaving foster care. The author states that
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, major health
issues, mental illness, and involvement with the criminal
justice system. This bill ensures these independent former
foster youth will have continuation of Medi-Cal coverage.
2)BACKGROUND . 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.
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 could
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% by the county,
are undocumented immigrants, or are incarcerated. However,
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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.
3)FOSTER CARE YOUTH . There are more than 75,000 children in
foster care in California. Many will spend only a short time
in foster care and then be reunified with their family of
origin or be adopted. Others may spend several years in
foster care and emancipate or age-out of the foster care
system when they turn 18. 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, 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. More than 4,000 youth
each year leave foster care in California at the age of 18.
4)FEDERAL HEALTH CARE REFORM . On March 23, 2010, President
Obama signed PPACA. Among other provisions, it requires
states to cover former foster care children under age 26.
Implementation details have not yet been provided and will
most likely be done through guidance to states, including
through State Medicaid Director and State Health Official
letters. PPACA also prohibits as of September 23, 2010 the
limiting age for dependents covered by health plan contracts
and health insurance policies from being less than 26 years of
age
Under the new law, beginning in 2014, states must provide
Medicaid coverage to all former foster youth who have aged out
as of 2014 up to the young person's 26th birthday. To be
eligible, the youth needs to have been in foster care at least
at their 18th birthday (or at a higher age. This will require
the development of a system to document and verify the prior
status of persons who are eligible but are no longer in foster
care.
5)EPSDT PROGRAM. EPSDT is a federally-mandated benefit under
Medi-Cal. States must provide medically necessary services to
specified children. If a physician screening determines a
child needs additional treatment, Medi-Cal must provide the
service according to the federal mandate. EPSDT is the source
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of funding for a majority of mental health treatment for
children in foster care. Mental health services provided to
foster youth include outpatient services, medication support,
behavioral therapy, and 24-hour care.
6)SUPPORT . Western Center on Law and Poverty (WCLP) supports
this bill's focus on providing comprehensive and affordable
health coverage for former foster youth by implementing the
PPACA provisions and extending Medi-Cal to former foster youth
until their 26th birthday. WCLP writes in support that former
foster youth often have higher needs for mental health
services as well as other types of services such as dental
care. WCLP further states that providing the full EPSDT
benefit package with Medi-Cal's nominal cost-sharing will help
this vulnerable population access the health care services
they need.
7)PRIOR LEGISLATION . SB 114 (Liu) of 2009 would have required
independent foster care adolescents to be enrolled in Medi-Cal
without reapplication after April 1, 2010. SB 114 was held on
Senate Appropriations Committee Suspense File.
SB 1132 (Migden) of 2008 contained substantially similar
language to this bill and was vetoed by the Governor due to
concerns about conflicts with federal law regarding Medi-Cal
eligibility determinations.
SB 147 (Alpert) of 2000 would have required DHCS to eliminate
income and asset tests when determining Medi-Cal eligibility
of independent foster care adolescents. SB 147 was vetoed.
AB 2877 (Thomson), Chapter 93, Statutes of 2000, extends
Medi-Cal eligibility to foster youth up to age 21, in
accordance with a new federal option.
8)POLICY QUESTION: This bill is conditioned on federal
financial participation. Does the author intend to foreclose
any possibility of a state-only program or implementation
prior to January 1, 2014? If not language should be added as
follows:
Nothing in this section is intended to prevent the
department from extending Medi-Cal eligibility, including
eligibility for the EPSDT Program, to children who were
formerly in foster care and are under 26 years of age
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without federal financial participation or prior to January
1, 2014.
REGISTERED SUPPORT / OPPOSITION :
Support
Western Center on Law and Poverty
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097