BILL ANALYSIS
SB 1091
Page 1
SENATE THIRD READING
SB 1091 (Hancock)
As Amended May 4, 2010
Majority vote
SENATE VOTE :35-0
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Fletcher, |Ayes:|Fuentes, Conway, |
| |Ammiano, Carter, De La | |Bradford, |
| |Torre, De Leon, Eng, | |Huffman, Coto, Davis, De |
| |Gaines, Hayashi, | |Leon, Gatto, Hall, |
| |Hernandez, Jones, | |Harkey, Miller, Nielsen, |
| |Bonnie Lowenthal, Nava, | |Norby, Skinner, Solorio, |
| |Salas, Smyth, Audra | |Torlakson, Torrico |
| |Strickland, Silva | | |
| | | | |
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SUMMARY : Authorizes 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 as specified. Specifically, this bill :
1)Requires the Department of Health Care Services (DHCS) to seek
federal approval or waiver as necessary in order to obtain
federal financial participation (FFP) for Medi-Cal benefits
provided to an individual under 21 for the shorter of 30 days
or until adjudication.
2)Conditions the implementation on a county voluntarily agreeing
to pay the state's share.
3)Limits eligibility to an individual who is receiving Medi-Cal
benefits at the time of admission or is subsequently
determined to be eligible.
4)Requires the provisions to be implemented on the later of
January 1, 2010 or when all federal approvals or waivers have
been obtained, whichever is later.
5)Specifies that this bill shall not be construed to require a
county to pay for the costs of Medi-Cal benefits that the
SB 1091
Page 2
state is obligated to provide under administrative action of
final court order.
6)Authorizes initial implementation by all-county letter and by
regulation thereafter.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Annual increased Medi-Cal costs of $10 million (50%
federal/50% local) to $15 million (50% federal/50% local) to
the extent counties opt into the funding mechanism established
by this bill and provide a month of Medi-Cal health services
to youth awaiting adjudication.
2)Unknown administrative workload to DHCS to seek federal
approval and administer the funding mechanism established this
bill. Counties are required to pay the cost of state
administrative workload.
COMMENTS : This bill, according to the sponsor, is intended to
take advantage of federal authority to use federal Medicaid
funds to reduce the costs of health and mental health services
that the county is already incurring for the first 30 days of a
youth's stay in juvenile hall. According to the sponsor, the
average length of stay is 24 days.
Medi-Cal regulations make individuals who are inmates of public
institutions ineligible for Medi-Cal. A 2004 letter to State
Medicaid directors from the federal Centers for Medicare and
Medicaid Services encourages states to "suspend" and not
"terminate" benefits while a person is in a public institution
or Institute for Mental Disease, noting the payment exclusion
(known as the "inmate exception") under Medicaid does not affect
the eligibility of an individual for the Medicaid program. This
policy was codified with regard to juveniles in SB 1147
(Calderon and Yee), Chapter 546, Statutes of 2008. DHCS
indicated that the necessary protocols to implement a suspension
of benefits were issued in March 2010.
Federal regulations also appear to allow states to claim FFP for
all Medicaid services provided to a person in a public
institution for a temporary period pending other arrangements as
an exception to unavailability of FFP for services provided to
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inmates. This bill is based on information from Pennsylvania
and New Mexico that have taken advantage of this opportunity.
Federal regulations also provide that FFP is available for an
individual under the age of 22 receiving inpatient psychiatric
services. A lawsuit brought by San Francisco and Santa Clara in
2007, ( City and County of San Francisco, County of Santa Clara
v. State of California, California Department of Health Care
Services , Case No. CGC-07-468241 (Cal. Super. Ct. Oct. 16,
2007)), challenged the state's practice and policy of denying
Medi-Cal coverage of inpatient psychiatric hospital services
provided to youths who are in custody. (The lawsuit also
challenged the legality of terminating wards because of their
status as inmates. This cause of action is moot due to the
passage of SB 1147.) In 2010, the County of San Francisco
Superior Court ruled that this practice violates federal and
state law and ordered the state to provide Medi-Cal coverage of
inpatient psychiatric hospital services for individuals under
age 21 regardless of their status as detainees. The state has
appealed the decision. This bill provides that it shall not be
construed to require a county to pay for services that are the
obligation of the state in order to avoid affecting the
litigation in and to preserve the ruling.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0005992