BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 720 (Skinner) - Inmates: health care enrollment.
Amended: July 9, 2013 Policy Vote: Health 7-2, Public
Safety 7-0
Urgency: No Mandate: Yes
Hearing Date: August 30, 2013
Consultant: Brendan McCarthy
SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Bill Summary: AB 720 would require each county to designate an
entity to assist county jail inmates with submitting an
application for health care coverage.
Fiscal Impact (as proposed to be amended):
Unknown increase in Medi-Cal expenditures for former
inmates, potentially in the low hundreds of millions per
year (General Fund and federal funds).
By assisting inmates with the application process, the bill
is likely to increase enrollment in Medi-Cal, at least in
the short term. Because of the individual mandate to have
health care coverage in the Affordable Care Act and the
general increase in public awareness of new health care
coverage options after 2014, it is likely that many current
jail inmates will apply for coverage at some point after
leaving jail. Under the bill, this process will be
accelerated and therefore the Medi-Cal program is likely to
incur costs to provide coverage sooner for eligible former
inmates. For example, assuming that 25% of inmates who are
eligible for assistance under the bill are eligible for
Medi-Cal and that applying for coverage before release
accelerates the average inmate's enrollment in Medi-Cal by
six months, total additional Medi-Cal costs would be about
$150 million per year.
In addition, under the bill, jail inmates who are enrolled
in Medi-Cal at the time of incarceration would be suspended
from the program, but would not be terminated from the
program. Upon their release, Medi-Cal benefits would be
immediately reactivated. This provision will increase
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Medi-Cal enrollment, because former inmates would not have
to re-apply for Medi-Cal upon their release. If 10% of the
jail population is enrolled in Medi-Cal upon incarceration
and is kept in the program due to changes in the bill, the
annual costs from the bill would likely be in the low tens
of millions per year.
Some inmates impacted by this bill would be eligible for the
current Medi-Cal program upon release, provided they are a
caretaker to a child and are eligible based on family
income. Other inmates may be eligible for expanded Medi-Cal
(which provides coverage for childless adults). Individuals
eligible for traditional Medi-Cal would be funded 50% from
the General Fund and 50% from federal funds. For individuals
who are eligible for the Medi-Cal expansion, the federal
government would pay 100% of the costs initially, dropping
to 90% of costs by 2020.
Background: Under state and federal law, the Department of
Health Care Services operates the Medi-Cal program, which
provides health care coverage to pregnant women, children and
their parents with incomes below 100 percent of the federal
poverty level, as well as blind, disabled, and certain other
populations. Generally, the federal government provides a 50
percent federal match for state Medi-Cal expenditures.
The federal Affordable Care Act allows states to expand Medicaid
(Medi-Cal in California) eligibility to persons under 65 years
of age, who are not pregnant, not entitled to Medicare Part A or
enrolled in Medicare Part B, and whose income does not exceed
133 percent of the federal poverty level (effectively 138
percent of the federal poverty level as calculated under the
Affordable Care Act). As enacted, the Affordable Care Act
required states to expand their Medicaid programs to 138 percent
of the federal poverty level. In June of 2012, the United States
Supreme Court ruled that mandating the Medicaid expansion is
unconstitutional. Subsequently, the federal Health and Human
Services Agency released guidance indicating that states may
only reject the Medicaid Expansion or fully enact the Medicaid
Expansion. California has opted to expand eligibility for
Medi-Cal up to 138 percent of the federal poverty level.
The Affordable Care Act provides a significantly enhanced
federal match for the Medicaid expansion. Under the law, the
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federal government will pay for 100 percent of the cost of the
Medicaid expansion in 2013-14 declining to a 90 percent federal
match in the 2020 federal fiscal year and thereafter.
Proposed Law: AB 720 would require each county to designate an
entity to assist county jail inmates with submitting an
application for health care coverage.
Specific provisions of the bill would:
Require each county to designate an entity to assist
inmates with the process of applying for health insurance
affordability programs;
Prohibit counties from designating the county sheriff as
the entity, without the sheriff's permission;
Require the entity to assist inmates that have been in
detention for at least 72 hours, may be eligible for
specified health insurance affordability programs, and do
not have health care coverage;
Prohibit the Department of Health Care Services from
terminating inmates in county jails from the Medi-Cal
program, unless they become ineligible;
Require the department to develop a process for counties to
receive available federal funding for administrative
activities under the bill;
Define health insurance affordability programs to include
Medi-Cal, Healthy Families, and subsidized health care
coverage provided through the California Health Benefit
Exchange.
Staff Comments: There is evidence that incarcerated individuals
have higher rates of mental health problems and substance abuse
problems than the general population. Under the Affordable Care
Act, expanded Medi-Cal coverage and subsidized health care
coverage purchased through the California Health Benefit
Exchange will cover mental health and substance abuse treatment
services. To the extent that this bill results in greater
numbers of former inmates being enrolled in comprehensive health
care coverage, access to such services is likely to reduce
recidivism rates for this population in the long-run.
Proposed author's amendments: would make it discretionary for
counties to assist inmates with applications. The amendments
would authorize a designated entity to act on behalf of an
inmate for the purposes of submitting an application. The
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amendments would also make technical changes to the bill.