BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 396|
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THIRD READING
Bill No: AB 396
Author: Mitchell (D), et al.
Amended: 9/2/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/22/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Rubio, Wolk
SENATE PUBLIC SAFETY COMMITTEE : 7-0, 7/5/11
AYES: Hancock, Anderson, Calderon, Harman, Liu, Price,
Steinberg
SENATE APPROPRIATIONS COMMITTEE : 9-0, 8/25/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Runner, Steinberg
ASSEMBLY FLOOR : 75-0, 5/26/11 (Consent) - See last page
for vote
SUBJECT : Medi-Cal: juvenile detention facilities
SOURCE : Los Angeles County
Los Angeles County Board of Supervisors
DIGEST : This bill requires the Department of Health Care
Services to develop a process to allow counties and the
Division of Juvenile Facilities within the California
Department of Corrections and Rehabilitation to receive any
available federal financial participation for health care
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services provided to juvenile detainees who are admitted as
inpatients in a medical institution and who are eligible
for Medi-Cal.
Senate Floor Amendments of 9/2/11 clarify liability
coverage regarding the Department of Health Care Services.
ANALYSIS :
Existing law :
1. 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 zero- to one -years old
extends up to 200 percent of the federal poverty level
(FPL), for children ages one- to five-years old with up
to 133 percent of the FPL, and for children ages six- to
19-years old up to 100 percent of the FPL.
2. 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 institution or one year from the
date he/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.
3. 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.
This bill requires DHCS, in consultation with counties and
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DJF, to develop a process to allow counties and CDCR to
access federal financial participation for juvenile inmates
who are eligible for Medi-Cal benefits and who are admitted
as inpatients in a medical institution and to coordinate
that process with the one that exists for adult inmates.
Medical institutions would include acute psychiatric,
sub-acute psychiatric, and general acute care hospitals.
This bill permits eligible inmates to be exempted from
enrollment into a managed health care plan. DHCS would be
directed to seek any necessary federal approvals. This
bill provided that these provisions will only be
implemented to the extent that federal approval is obtained
and that existing levels of federal financial participation
are not jeopardized. DHCS is permitted to recoup payments
if the federal government determined them to not be
allowable.
This bill implemented only in those counties that is
elected to voluntarily provide the nonfederal share of
expenditures and if DJF voluntarily elects to provide the
nonfederal share of expenditures. This bill specifies that
participating counties and DHCS will annually negotiate the
amount of administrative costs that the county would pay.
This bill states that counties shall agree to pay the
nonfederal share of the department's administrative costs.
Background
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."
The corrections Budget Trailer Bill from 2010, AB 1628
(Assembly Budget Committee), 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 who would otherwise be
eligible for Medi-Cal, or local CEED project projects
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
DHCS start-up and ongoing $50 $100 $100
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County/*
administrative costs
Federal
Increased federal likely significant, in the
millions Federal
matching funds for of dollars annually, upon federal
counties and CDCR approval and implementation
Cost avoidance for DJFunknown, likely in the hundreds
County
and county inpatient of thousands to millions of
dollars,
upon federal approval and
implementation
*50 percent federal funds, 50 percent county funds and
possibly General Funds if county funds are insufficient to
cover the full non-federal share of administrative costs.
SUPPORT : (Verified 9/6/11)
Los Angeles County (co-source)
Los Angeles County Board of Supervisors (co-source)
AFSCME
California Association of Public Hospitals and Health
Systems
California Correctional Peace Officers Association
California Medical Association
California Mental Health Directors Association
California Psychiatric Association
California Public Defenders Association
California State Association of Counties
California Probation, Parole and Correctional Association
Chief Probation Officers of California
County Health Executives Association of California
County of Santa Clara
LA County Probation Officers Union
Monterey County Board of Supervisors
National Association of Social Workers, CA Chapter
Riverside Sheriffs' Association
Sacramento County
Santa Clara Board of Supervisors
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ARGUMENTS IN SUPPORT : The Los Angeles County Board of
Supervisors, the sponsor of this bill, writes that this
bill allows counties to draw down federal matching funds to
reimburse them for the medical treatment of minors who are
hospitalized and outside of the County's detention facility
for more than 24 hours. According to the sponsor, the Los
Angeles County Probation Department operates three juvenile
detention facilities and 18 juvenile camps. The sponsor
states that most of the minors taken into custody are from
low-income families, which make them eligible for Medi-Cal.
The sponsor also states that minors detained in local
detention facilities often require medical care which is
outside the scope of medical services available at the
facility. According to the sponsor, medical conditions
requiring hospitalization include complications from
asthma, diabetes, epilepsy, or heart problems. The sponsor
concludes that, in cases where minors require
hospitalization for a contagious or communicable disease,
care at a medical facility is vital not only for their
health and well-being, but for the other detainees and
probation staff before the minor returns to the detention
facility.
ASSEMBLY FLOOR : 75-0, 5/26/11
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Carter,
Chesbro, Conway, Cook, Dickinson, Donnelly, Eng, Feuer,
Fletcher, Fong, Fuentes, Furutani, Beth Gaines, Galgiani,
Garrick, Gatto, Gordon, Grove, Hagman, Halderman, Hall,
Harkey, Hayashi, Roger Hern�ndez, Hill, Huber, Hueso,
Huffman, Jeffries, Knight, Lara, Logue, Bonnie Lowenthal,
Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell,
Nestande, Nielsen, Norby, Olsen, Pan, Perea, V. Manuel
P�rez, Portantino, Silva, Skinner, Smyth, Solorio,
Swanson, Torres, Valadao, Wagner, Wieckowski, Williams,
Yamada, John A. P�rez
NO VOTE RECORDED: Campos, Cedillo, Davis, Gorell, Jones
CTW:do 9/6/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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