BILL ANALYSIS �
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Loni Hancock, Chair A
2011-2012 Regular Session B
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AB 396 (Mitchell)
As Amended May 12, 2011
Hearing date: July 5, 2011
Welfare and Institutions Code
AA:dl
JUVENILE JUSTICE:
HEALTH CARE SERVICES COSTS
HISTORY
Source: Los Angeles County Board of Supervisors
Prior Legislation: AB 1628 (Committee on Budget) - Chapter 729,
Statutes of 2010
Support: California Probation Parole and Correctional
Association; California Public Defenders Association;
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO; California Association of Public Hospitals
and Health Systems; California Psychiatric Association;
California State Association of Counties; County Health
Executives Association of California; Sacramento County
Board of Supervisors; California Medical Association; Chief
Probation Officers of California; Los Angeles Probation
Officers' Union, AFSCME, Local 685; National Association of
Social Workers, California Chapter; Riverside Sheriffs'
Association; County of Santa Clara Board of Supervisors;
Monterey
County Board of Supervisors; California Correctional
Peace Officers Association; Laborers' Locals 777 and
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792
Opposition:None Known
Assembly Floor Vote: Ayes 75 - Noes 0
KEY ISSUE
SHOULD THE DEPARTMENT OF HEALTH CARE SERVICES DEVELOP PROCESSES
TO ALLOW COUNTIES AND DJJ TO RECEIVE FEDERAL FINANCIAL
PARTICIPATION THROUGH MEDICAID FOR HEALTH CARE SERVICES PROVIDED
TO DETAINED YOUTH, AS SPECIFIED?
PURPOSE
The purpose of this bill is to require the Department of Health
Care Services to develop processes to allow counties and the
Division of Juvenile Facilities within CDCR to receive federal
financial participation through Medicaid for health care
services provided to juvenile detainees or detained youth, as
applicable, who are admitted as inpatients in a medical
institution, as specified.
Current law establishes the Medi-Cal program, administered by
the Department of Health Care Services ("DHCS"), which provides
comprehensive health benefits to various groups, including
low-income children who meet specified eligibility criteria.
Medi-Cal family income eligibility for children ages 0 to 1
extends up to 200 percent of the federal poverty level (FPL),
for children ages 1 to 5 with up to 133 percent of the FPL, and
for children ages 6 to 19 up to 100 percent of the FPL.
(Welfare and Institutions Code (WIC) � 14000 et seq.)
Current law requires benefits provided under the Medi-Cal
program to an individual under 21 years of age who is an inmate
of a public institution to be suspended on the date he or she
becomes an inmate of a public institution. The suspension ends
on the date the individual is no longer an inmate of a public
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AB 396 (Mitchell)
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institution or one year from the date he or she becomes an
inmate of a public institution. Health care services under
Medi-Cal are not available to inmates of public institutions
whose Medi-Cal benefits have been suspended. (WIC � 14011.10)
Current law authorizes the California Department of Corrections
and Rehabilitation ("CDCR") and DHCS to develop a process to
maximize federal financial participation (FFP) through Medicaid
for the provision of inpatient hospital services rendered to
individuals who, but for their institutional status as inmates,
are otherwise eligible for Medi-Cal or for the Coverage
Expansion and Enrollment Demonstration (CEED) Project
established under SB 208 (Steinberg), Chapter 714, Statutes of
2010. (Penal Code � 5072.)
This bill would require DHCS, in consultation with counties, to
develop a process to allow counties and DJF in CDCR to receive
FFP for health care services provided to juvenile detainees who
are admitted as inpatients in a medical institution. The bill
would require this process to be coordinated, to the extent
possible, with the processes and procedures established to drawn
down FFP for inpatient hospital services provided to inmates
under existing law. The bill prohibits this provision from
being construed to alter or abrogate any obligation of the state
pursuant to an administrative action or a final court order to
fund and reimburse counties for any medical services provided to
a juvenile detainee.
This bill would require DHCS to seek any federal approvals
necessary to implement the process developed, and provides that
its provisions are implemented only if and to the extent that
any necessary federal approval is obtained, and only to the
extent that existing levels of FFP are not otherwise
jeopardized.
This bill would prohibit a juvenile detainee who is an inpatient
in a medical institution from being denied Medi-Cal eligibility
because of his or her status as a detainee of a public
institution.
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This bill prohibits any youth detained in DJF who is an
inpatient in a medical institution from being denied Medi-Cal
eligibility because of his or her institutional status as a ward
committed to, or a youth housed in, DJF.
This bill would permit DHCS to exempt juvenile detainees from
enrollment into new or existing managed care health plans.
This bill would require the process developed under this bill to
be implemented in DJF and in only those counties that
voluntarily elect to provide the nonfederal share of
expenditures for health care services to juvenile detainees who,
but for their inpatient status, would be ineligible for Medi-Cal
as detainees of a public institution.
This bill would require the FFP received under this bill to be
paid to participating counties and CDCR for services rendered to
the juvenile detainees.
This bill would require DHCS, if a federal audit disallowance
and interest results from claims made under the process, to
recoup from the county that received the disallowed funds the
amount of the disallowance and any applicable interest.
This bill would permit DHCS to implement the county-related
provisions of this bill without taking any regulatory action by
means of all-county letters or similar instructions.
RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
For the last several years, severe overcrowding in California's
prisons has been the focus of evolving and expensive litigation.
As these cases have progressed, prison conditions have
continued to be assailed, and the scrutiny of the federal courts
over California's prisons has intensified.
On June 30, 2005, in a class action lawsuit filed four years
earlier, the United States District Court for the Northern
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District of California established a Receivership to take
control of the delivery of medical services to all California
state prisoners confined by the California Department of
Corrections and Rehabilitation ("CDCR"). In December of 2006,
plaintiffs in two federal lawsuits against CDCR sought a
court-ordered limit on the prison population pursuant to the
federal Prison Litigation Reform Act. On January 12, 2010, a
three-judge federal panel issued an order requiring California
to reduce its inmate population to 137.5 percent of design
capacity -- a reduction at that time of roughly 40,000 inmates
-- within two years. The court stayed implementation of its
ruling pending the state's appeal to the U.S. Supreme Court.
On May 23, 2011, the United States Supreme Court upheld the
decision of the three-judge panel in its entirety, giving
California two years from the date of its ruling to reduce its
prison population to 137.5 percent of design capacity, subject
to the right of the state to seek modifications in appropriate
circumstances.
In response to the unresolved prison capacity crisis, in early
2007 the Senate Committee on Public Safety began holding
legislative proposals which could further exacerbate prison
overcrowding through new or expanded felony prosecutions.
This bill does not aggravate the prison overcrowding crisis
described above.
COMMENTS
1. Stated Need for This Bill
The author states:
AB 396 would allow the counties and state to seek
reimbursement for treatment of minors who are outside
of the County or State detention facility or camp for
more than 24-hours.
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The Counties and State have been paying the full cost
of minors detained in juvenile detention facilities or
camps when they are treated outside of the facility.
This bill would allow counties and the state to seek
reimbursement from the federal government.
2. Background
The Senate Health Committee passed this bill on June 22, 2011
(9-0). The analysis prepared by that Committee includes the
following background information:
According to the author, this bill would allow the
counties and state to seek reimbursement for treatment
of minors who are outside of a county or state
detention facility or camp for more than 24 hours.
The author argues that counties and the state have
been paying the full cost of health services for
minors detained in juvenile detention facilities or
camps when they are treated outside of the facility.
This bill would allow counties to seek reimbursement
from the federal government through Medicaid for these
health care services.
Budget action last year
Under federal Medicaid law, payments for care and
services provided to inmates of a public institution
is not considered "medical assistance" (and thus is
not eligible for federal financial participation
through Medicaid) unless the inmate is a "patient in a
medical institution." (Section 1396d of Title 42 of
the Federal Social Security Act)
The corrections budget trailer bill from 2010, AB 1628
(Committee on Budget), Chapter 729, Statutes of 2010,
authorizes CDCR and DHCS, to the extent that FFP is
not jeopardized and federal approval is obtained, to
develop a process to draw down FFP for inpatient
hospital services provided to state and local inmates
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who would otherwise be eligible for Medi-Cal, or local
CEED project projects authorized under the federal
section 1115 Medi-Cal Demonstration Waiver, if these
inmates were not institutionalized. This trailer bill
provides an opportunity to draw down federal funds by
establishing inmate eligibility for Medi-Cal and local
county CEED projects so that state and county savings
can be achieved by funding health care services with
federal Medicaid matching funds.
Under AB 1628, CEED projects are required to provide
reimbursement for inpatient hospital services provided
to an inmate whose county of last legal residence
participates in the CEED project. Additionally, AB
1628 permits, to the extent FFP is available, DHCS to
provide Medi-Cal eligibility and reimbursement for
inpatient hospital services to inmates, as defined.
Finally, AB 1628 also authorizes a county to seek
reimbursement from the Medi-Cal program or the
responsible CEED program for the provision of
inpatient hospital services to adults in county
facilities.
DHCS began processing Medi-Cal applications under this
trailer bill provision on April 1, 2011. As of June
3, 2011, DHCS indicates it has received 49
applications, and 18 applications have been approved.
CDCR staff indicates it estimates that approximately
50 percent of inmates refuse to sign the Medi-Cal
application, which prevents the state from drawing
down federal Medicaid matching funds. CDCR indicates
it is pursuing trailer bill language that authorizes
CDCR or its designee to act on behalf of an inmate for
purposes of applying for, or redeterminations of,
Medi-Cal.
Relationship to court order and actions on state
reimbursement of counties
Medi-Cal is funded, with some exceptions, with state
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GF dollars and federal matching funds. This bill
requires DHCS to develop a process to allow counties
to receive FFP for health care services provided to
juvenile detainees who are admitted as inpatients in a
medical institution. This bill also states that this
provision cannot be construed to alter or abrogate any
obligation of the state pursuant to an administrative
action or a court order that is final and no longer
subject to appeal to fund and reimburse counties for
any medical services provided to a juvenile detainee.
This provision is included in this measure at the
request of the City Attorney of the City and County of
San Francisco in response to litigation filed by the
Office of the City Attorney of San Francisco and the
County of Santa Clara against DHCS over the obligation
of the state to provide inpatient psychiatric hospital
services for individuals under age 21. In that case,
the Superior Court issued an order stating that DHCS'
policy of denying Medi-Cal coverage of inpatient
psychiatric hospital services to youth who are in
custody violates federal and state law. That case is
currently on appeal. The language in this bill is not
specific to inpatient psychiatric hospital services
and would apply to other court orders that are final
and no longer subject to appeal.
Related bills
SB 695 (Hancock) permits Medi-Cal benefits to be
provided to an individual awaiting adjudication in a
county juvenile detention facility if the individual
is eligible for Medi-Cal at admission or is
subsequently determined to be eligible to receive
Medi-Cal benefits, the county agrees to pay the
state's share of Medi-Cal expenditures and
administrative costs, and federal financial
participation (FFP) is available. SB 695 passed the
Senate on June 1, 2011 by a 40 to 0 vote.
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Prior legislation
SB 1091 (Hancock) of 2010 was similar to SB 695
(Hancock). SB 1091 was vetoed by Governor
Schwarzenegger. In his veto message, the Governor
stated this bill was inconsistent with federal law and
exposed the state to potentially significant costs.
The Governor concluded his veto message by stating
that if the author wishes to craft workable
legislation that allows for additional federal funds,
but also adheres to federal Medicaid law and
regulations, DHCS would be willing to assist in that
effort next year.
SB 817 (Hancock) of 2010 was also similar to SB 1091
except that it only applied to Alameda County. That
bill originally dealt with vote by mail provisions in
the Election Code and was gutted and amended on August
3, 2010 to require Medi-Cal benefits to be provided to
an individual awaiting adjudication in Alameda County
Juvenile Hall if the individual was receiving Medi-Cal
benefits at the time the individual was admitted to
Alameda County Juvenile Hall or the individual is
subsequently determined to be eligible for Medi-Cal
and benefits, and Alameda County agreed to pay the
state's share of Medi-Cal expenditures and the state's
administrative costs for benefits. SB 817 was never
heard in a policy or fiscal committee in that form.
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SB 1147 (Calderon and Yee) - Chapter 546, Statutes of
2008, requires DHCS 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 CDCR 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 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. This bill failed passage on the Assembly
floor.
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