BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
1091 (Hancock)
Hearing Date: 5/27/2010 Amended: 5/4/2010
Consultant: Katie Johnson Policy Vote: Health 5-0
_________________________________________________________________
____
BILL SUMMARY: SB 1091 would permit counties to pay the
non-federal share of Medi-Cal for eligible youth temporarily
placed in a county juvenile detention facility for up to 30 days
or until their case is adjudicated, whichever is shorter, in
order to access available federal Medi-Cal funding.
_________________________________________________________________
____
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Federal funds match to likely in the millions County/*
counties for Medi-Cal benefits of dollars annually Federal
DHCS administration likely up to $100 annually
ongoingCounty/*
Federal
*About 50 percent county funds, 50 percent federal funds
_________________________________________________________________
____
STAFF COMMENTS: SUSPENSE FILE.
Commencing January 1, 2012, or upon federal approval, whichever
is later, this bill would permit all counties to receive federal
funds for Medi-Cal eligible youth temporarily placed in a county
juvenile detention facility prior to adjudication for up to 30
days or until adjudication, whichever time period is less,
provided the county pay the state share of matching funds.
Currently, counties pay for the full cost of health care for
these individuals, including for medical and behavioral health
needs. These youth are residents of the facility temporarily
while awaiting adjudication. To the extent that the Centers for
Medicare and Medicaid Services (CMS) determine that their
temporary residence does not make them inmates of a non-medical
public institution, they could be eligible for Medi-Cal benefits
and the counties could access federal funds.
This bill would be contingent upon federal approval and the
availability of federal financial participation and on the
county's commitment to pay the state's share of Medi-Cal
expenditures and administrative costs through intergovernmental
transfers (IGTs) of funds. It is unclear whether or not the
federal government would approve such a system of reimbursement.
There would be increased costs in federal and county funds due
to approximately up to one month of Medi-Cal eligibility for
youth who continue their coverage and who enroll in Medi-Cal
while temporarily placed in the facility, likely in the hundreds
of thousands of dollars. For example, Alameda County states that
it spends about $7 million annually on health care for its
juvenile detention facility. If the county could receive federal
matching
Page 2
SB 1091 (Hancock)
funds for even half of its population, this would equate to
$1.75 million in federal funds annually at a sharing ratio of 50
percent county and 50 percent federal funds. Although there
would be an expenditure of federal funds because of this bill,
the federal financial participation would be part of the
Medicaid entitlement program. There would be no upper limit on
the amount of federal funds that a county could access, provided
they provided the appropriate matching funds.
It is unknown how many counties would choose to seek Medi-Cal
reimbursement for services provided to these youth. However,
since counties currently pay all of these costs, there would be
an incentive to seek matching federal funds. Impacts on federal,
county, and state General Funds would depend upon the number of
participating counties.
The Department of Health Care Services (DHCS) would likely need
staff to process and monitor IGTs at an estimated cost of
$50,000 - $100,000, which would be shared 50 percent county and
50 percent federal funds. Since Medi-Cal pays for eligibility
determination performed at the county level, presumably the
county would pay for any necessary eligibility determinations
that would take place pursuant to this bill. For example, in
order to access federal funds, a county could choose to
determine if a youth placed temporarily in a facility is
Medi-Cal eligible.
Additionally, if a county chooses to determine the eligibility
of unenrolled youth, since they are minors, it would be
reasonable to assume that a county welfare department would
contact their families for financial eligibility information and
would subsequently work to enroll any eligible family member as
well. The costs of intake and benefits in Medi-Cal for the
family members for one month of Medi-Cal that they would not
have accessed otherwise would be indeterminate. Associated costs
would be shared 50 percent General Fund and 50 percent federal
funds. Also, currently, when a youth's eligibility is suspended
upon entrance into a juvenile detention facility, their families
could potentially lose eligibility as well. To the extent that a
family continues to remain Medi-Cal eligible for an extra month
when they would not have been otherwise, there could again be
indeterminate General Fund and federal fund costs.