BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 1091
S
AUTHOR: Hancock
B
AMENDED: April 5, 2010
HEARING DATE: April 21, 2010
1
CONSULTANT:
0
Dunstan/cjt
9
1
SUBJECT
Medi-Cal: individuals in county juvenile detention
facilities
SUMMARY
Enables counties to receive Medi-Cal reimbursement for
medical and mental health services they provide to eligible
individuals less than 21 years of age entering county
juvenile detention facilities for up to 30 days or until
adjudication.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Medicaid program to provide comprehensive health
benefits to specified groups of low-income persons. Prevents
Medicaid benefits from being paid for incarcerated individuals
except when the inmate is a patient in a medical institution.
Although an incarcerated individual's benefits are restricted,
federal law does not require that Medicaid eligibility be
terminated. Prohibits an inmate of a public institution from
receiving Medicaid benefits, but states that an individual is
not considered to be living in a public institution if the
individual is in a public institution for a temporary period
pending other arrangements appropriate to his needs.
Continued---
STAFF ANALYSIS OF SENATE BILL 1091 (Hancock)Page 2
Existing state law:
Establishes the Medi-Cal program, the state's Medicaid program,
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. Defines the health care benefits that are to be
offered by the Medi-Cal program. Excludes from the definition
of Medi-Cal health care benefits, care or services for any
individual who is an inmate of an institution (except as
permitted under federal law). Provides that a juvenile who is
an inmate of a public institution shall have their Medi-Cal
benefits suspended, as specified.
This bill:
This bill would enable counties to receive Medi-Cal
reimbursement for medical and mental health services they
provide to eligible individuals less than 21 years of age
entering county juvenile detention facilities for up to 30
days or until adjudication. Individuals must be receiving
Medi-Cal benefits at the time they are admitted to the
county facility or be found eligible by the county welfare
department. Limits these benefits for a period not to
exceed 30 days or until adjudication of the juvenile's
case, whichever is sooner.
Requires the county to pay the state's share of Medi-Cal
expenditures and for any state administrative costs through
an intergovernmental transfer of funds.
Establishes that this bill would be implemented on January
1, 2012 or whenever all necessary federal approvals or
waivers are obtained. Provides that this measure will take
effect only if federal financial participation is
available.
Grants DHCS an exemption from the Administrative Procedures
Act related to the development of regulations and allows
implementation by all-county letters or similar
instructions. Requires regulations be enacted for
subsequent actions.
FISCAL IMPACT
STAFF ANALYSIS OF SENATE BILL 1091 (Hancock)Page 3
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, this bill would enable counties to
use dollars they are already spending on health and mental
health services for eligible youth in their detention
facilities as the match for federal Medicaid funds. The
funds would only be available for services for those youth
who met Medi-Cal eligibility standards, and only for the
first 30 days of their stay at juvenile hall, or until they
are adjudicated, whichever occurs first. The author argues
that SB 1091 would help counties reduce the amount they
already spend providing medical and mental health services
by almost half by substituting federal funds for county
dollars at no cost to the state's general fund. As a
result, the author states, youth entering county detention
facilities can receive comprehensive mental and medical
health services. The author points out that one of the
most vexing struggles in juvenile justice is how to pay for
and provide mental health services.
Medical problems of juvenile inmates
Lack of access to medical care is an acute problem for
youth exiting the juvenile detention system. Many are in
need of psychotropic medicine or other medical care
necessary to treat severe health conditions. Failure of a
ward to receive treatment for a mental health or substance
abuse disorder can be a significant factor in the high rate
of recidivism among youth. In the state corrections
juvenile division's facilities alone, 85 percent of the
youth have substance abuse problems, and 71 percent have 3
or more diagnosable mental health disorders.
Since 2005, New Mexico has implemented a statewide program
that enables counties to draw down federal Medicaid funds
to provide comprehensive medical and mental health services
to individuals entering county juvenile detention
facilities for up to 60 days or before adjudication. For
this program, the federal Centers for Medicare and Medicaid
Services has determined that individuals temporarily in
detention are not considered "inmates of a public
institution," thus are eligible for federal Medicaid
funding.
STAFF ANALYSIS OF SENATE BILL 1091 (Hancock)Page 4
In New Mexico, facilities have developed an intake process
that uniformly identifies youth with mental health needs
and diverts these youth to a community mental health clinic
fully funded by Medicaid. Youth brought to the detention
center undergo a comprehensive screening process. The
first part involves a brief screen to determine the youth's
immediate placement-either in juvenile detention; in the
community custody program, which is a probation monitored
diversion program; or released home. The second portion of
the process involves a medical intake screen, administered
by a nurse who is at the detention center 24 hours a day,
seven days a week. Both of these intake screens are
conducted immediately when a youth arrives at the detention
facility. In New Mexico, youth in pre-trial detention
maintain Medicaid eligibility for up to 60 days. Last
year, Medicaid supported $329,000 in mental health
services. Those receiving these services had a 33 percent
recidivism rate compared to the 88 percent rate that
existed prior to the program beginning.
Prior legislation
SB 1147 (Calderon and Yee), Chapter 546, Statutes of 2008,
requires the Department of Health Care Services to develop
procedures to ensure that the Medi-Cal eligibility of
minors is not terminated when they are incarcerated.
SB 648 (Calderon) of 2007 would have required DHCS to
suspend rather than terminate the Medi-Cal benefits of an
incarcerated minor. This bill was referred to Senate
Health Committee but was not heard.
SB 1469 (Cedillo), Chapter 657, Statutes of 2006, requires
county juvenile detention facilities to notify county
welfare departments about the release of a ward so that
eligibility for Medi-Cal can be determined prior to the
release of the inmate.
SB 1616 (Kuehl) of 2006 would have required the Department
of Corrections and Rehabilitation, to work with the federal
Social Security Administration and DHCS to ensure that
disabled wards are enrolled in Medi-Cal and that their
disability benefits are available to them when they are
released from incarceration at a state institution. This
bill was vetoed by the Governor.
AB 1945 (Coto) of 2006 among other provisions, would have
STAFF ANALYSIS OF SENATE BILL 1091 (Hancock)Page 5
required a juvenile detention facility, when a minor is
released from custody, to determine if the minor will have
health insurance after release, and if the minor will not,
to evaluate the eligibility of the minor for enrollment in
appropriate need-based programs. This bill was held in the
Assembly Health Committee.
AB 2004 (Yee) of 2006 was identical to SB 648 of 2007. This
bill was vetoed by the Governor.
AB 470 (Yee) of 2005 was a very similar bill to SB 648 of
2007. The bill failed passage on the Assembly floor.
Arguments in support
According to the supporters every county has an obligation
to tend to the health care needs of the persons detained in
its institutions. They report that their experience shows
that children in the juvenile justice system can have
significant behavioral, mental health and medical issues.
These issues make meeting the county's obligation very
challenging especially with the severe reductions in county
funds. Supporters also note that for many youths, the care
they receive in juvenile hall may be their first encounter
with medical personnel in many years; hence providing
medical, dental, and mental health to individuals entering
county juvenile detention facilities comes at a significant
cost to counties. Alameda County reports that it costs
them approximately $7 million annually to care for these
juveniles. Supporters argue that counties want to pursue
federal funds to offset the costs they already spend
delivering these services.
COMMENTS
Technical amendment
(i) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government
Code, initially the department shall implement this section
by means of all-county letters or similar instructions
without taking regulatory action. Thereafter, the
department shall adopt regulations in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code.
POSITIONS
STAFF ANALYSIS OF SENATE BILL 1091 (Hancock)Page 6
Support: Alameda County (sponsor)
Accessing Health Services for Californias Children
in Foster Care Task Force
California Medical Association (CMA)
California Probation, Parole and Correctional
Association (CPPCA)
California State Association of Counties (CSAC)
Chief Probation Officers (CPOC)
Children's Advocacy Institute
County Health Executives Association of California
(CHEAC)
Kern County Board of Supervisors
Marin County Board of Supervisors
Public Counsel
Sacramento County Board of Supervisors
Santa Clara County Board of Supervisors
Taxpayers for Improving Public Safety
Urban Counties Caucus
Oppose: None received