BILL ANALYSIS �
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THIRD READING
Bill No: AB 720
Author: Skinner (D), et al.
Amended: 9/6/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-2, 6/19/13
AYES: Hernandez, Beall, De Le�n, DeSaulnier, Monning, Pavley,
Wolk
NOES: Anderson, Nielsen
SENATE PUBLIC SAFETY COMMITTEE : 7-0, 7/2/13
AYES: Hancock, Anderson, Block, De Le�n, Knight, Liu, Steinberg
SENATE APPROPRIATIONS COMMITTEE : 6-1, 8/30/13
AYES: De Le�n, Gaines, Hill, Lara, Padilla, Steinberg
NOES: Walters
ASSEMBLY FLOOR : 56-19, 5/29/13 - See last page for vote
SUBJECT : Inmates: health care enrollment
SOURCE : Californians for Safety and Justice
DIGEST : This bill requires the board of supervisors in each
county to designate an entity to assist certain jail inmates to
apply for a health insurance affordability program, as defined.
Prohibits county jail inmates who are currently enrolled in the
Medi-Cal from being terminated from the program due to their
detention, unless required by federal law or they become
otherwise ineligible, as specified. Deletes the age restriction
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relating to Medi-Cal benefits provided to inmates of the public
institution.
Senate Floor Amendments of 9/6/13 (1) incorporate technical
changes suggested by the Department of Health Care Services
(DHCS) concerning the process for Medi-Cal eligibility of acute
inpatient treatment; (2) clarify that inmate status alone will
not preclude a county human services agency from processing an
inmate's Medi-Cal application; and (3) include a specific
statutory reference in the provisions concerning suspension of
Medi-Cal eligibility for jail inmates.
ANALYSIS :
Existing law:
1.Establishes the Medi-Cal program, administered by DHCS, which
provides comprehensive health benefits to various low-income
individuals.
2.Requires, under the federal Patient Protection and Affordable
Care Act (ACA), states to expand Medicaid coverage of adults
under age 65 who are not currently eligible with incomes up to
138% of the federal poverty level (FPL) (at or below $15,856
in 2013 for an individual). Allows states, under the June
2012 Supreme Court decision of National Federation of
Independent Business v. Sebelius, to opt-out of the Medicaid
expansion required by the ACA.
3.Makes inmates of public institutions (including individuals in
prison or county jails) ineligible for Medi-Cal. Prohibits
federal financial participation (FFP) for medical care
provided to inmates of a public institution, except when the
inmate is a patient in a medical institution.
4.Requires benefits provided under the Medi-Cal program to an
individual less than 21 years of age who is an inmate of a
public institution to be suspended on the date he/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.
5.Authorizes the California Department of Corrections and
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Rehabilitation (CDCR) and DHCS to develop a process to
maximize 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 Low Income Health Program.
6.Requires the Secretary of Health and Human Services, under
federal law, to develop and provide to each state a single,
streamlined form that may be used to apply for all state
health subsidy programs, as defined, within the state.
This bill:
1.Expresses intent of the Legislature in enacting the provisions
of this bill, among other things, to ensure that county human
services agencies recognize the following:
A. That federal law generally does not authorize FFP for
Medi-Cal when a person is an inmate of a public
institution, as defined in federal law, unless the inmate
is admitted as an inpatient to a non-correctional health
care facility;
B. FFP is available after an inmate is released from a
county jail, and
C. The fact that an applicant is currently an inmate does
not, in and of itself, preclude the county human services
agency from processing the application submitted to it by,
or on behalf of, that inmate.
1.Allows the board of supervisors in each county, in
consultation with the county sheriff, to designate an entity
or entities to assist county jail inmates, as defined, with
submitting an application for a health insurance affordability
program consistent with federal requirements.
2.Prohibits the board of supervisors from designating the county
sheriff as the entity to assist with submitting an application
for a health insurance affordability program for county jail
inmates, as defined, unless the county sheriff agrees to
perform this function.
3.Requires, if the board of supervisors designates a
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community-based organization as the entity to assist with
submitting an application for a health insurance affordability
program for county jail inmates, the designation to be subject
to approval by the jail administrator, or his/her designee.
4.Permits the jail administrator, or his/her designee, to
coordinate with the designated entity.
5.Specifies that county jail inmates who are currently enrolled
in the Medi-Cal program shall remain eligible for, and not be
terminated from the program due to his/her detention unless
required by federal law, he/she becomes otherwise ineligible,
or the inmate's suspension of benefits has ended, pursuant to
existing law.
6.Notwithstanding any other state law, and only to the extent
federal law allows and FFP is available, the designated entity
is authorized to act on behalf of a county jail inmate for the
purpose of applying for, or determinations of, Medi-Cal
eligibility for acute inpatient hospital services authorized,
pursuant to existing law. Prohibits a designated entity, as
defined, from determining or redetermining Medi-Cal
eligibility, unless the entity is the county human services
agency.
7.Prohibits the fact that an applicant is an inmate from, in and
of itself, precluding a county human services agency from
processing an application for the Medi-Cal program submitted
to it by, or on behalf of, that inmate.
8. Defines, for purposes of this bill, "health insurance
affordability program" to mean a program that is one of the
following:
A. The state's Medi-Cal program.
B. The state's children's health insurance program.
C. A program that makes coverage in a qualified health plan
(QHP) through the California Health Benefit Exchange
(Covered California) with advance payment of the premium
tax credit, as defined.
D. A program that makes available coverage in a QHP through
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Covered California.
1. Permits DHCS to implement this bill by means of all-county
letters or similar instructions, without taking regulatory
action.
2. Deletes the age restriction relating to Medi-Cal benefits
provided to an inmate of a public institution.
3. Requires DHCS to determine whether FFP is jeopardized by
this bill and implement the provisions of this bill only if,
and to the extent that, FFP is not jeopardized.
Background
Federal guidance to suspend but not terminate Medi-Cal
eligibility. This bill prohibits, individuals who are currently
enrolled in the Medi-Cal program from being terminated from
coverage unless required by federal law, or they otherwise
become ineligible.
According to the Senate Health Committee analysis, federal
guidance indicates that, while states cannot claim Medicaid
funding for services furnished to people who are incarcerated or
served in an Institute for Mental Disease (IMD), it is not a
federal requirement that Medicaid eligibility be terminated
while individuals are in jail or a mental health facility.
Instead, a state may place the person in suspended status and
return the individual to active Medicaid eligibility upon
release from jail (including release to parole or probation) or
discharge from the mental health facility.
Prior Legislation
SB 695 (Hancock), Chapter 847, Statutes of 2011, permitted
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 FFP is available.
SB 1091 (Hancock) of 2010 was similar to SB 695 (Hancock). SB
1091 was vetoed by Governor Schwarzenegger. In his veto
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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 1147 (Calderon), Chapter 546, Statutes of 2007 required, to
the extent permitted under federal law, Medi-Cal benefits
provided to an individual under 21 years of age who is an inmate
of a public institution to be suspended, rather than terminated.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee, 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 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
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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.
SUPPORT : (Verified 9/9/13)
Californians for Safety and Justice (source)
American Civil Liberties Union
American Federation of State, County and Municipal Employees
Berkeley Organizing Congregations for Action
Board of Supervisors County of Santa Clara
California Association of Alcohol and Drug Program Executives
California Attorneys for Criminal Justice
California Council of Community Mental Health Agencies
California Latinas for Reproductive Justice
California Nurses Association
California Pan-Ethnic Health Network
California Primary Care Association
California Public Defenders Association
California State Association of Counties
California State Conference of the National Association for the
Advancement of Colored People
California State Sheriffs' Association
Californians for Safety and Justice
Chief Probation Officers of California
Chief Probation Officers of Contra Costa County
County Alcohol and Drug Program Administrators of California
County of Lassen
County of Sacramento
County of San Diego
Drug Policy Alliance
Ella Baker Center for Human Rights
Friends Outside
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Greenlining Institute
Housing California
Legal Services for Prisoners with Children
Local Health Plans of California
Los Angeles Regional Reentry Partnership
National Association of Social Workers - California Chapter
National Council of La Raza
Rural Counties Representatives of California
San Francisco Sheriff
Taxpayers for Improving Public Safety
Urban Strategies Council
Women's Foundation of California
ARGUMENTS IN SUPPORT : According to the author's office, this
bill requires counties to enroll eligible inmates into the
Medi-Cal program before being released. This would address one
of the main barriers to re-entry by helping formerly
incarcerated inmates access physical, mental health and
substance abuse services. Research shows that formerly
incarcerated individuals who have access to medical services
upon release have reduced recidivism rates, increasing the
likelihood they will become productive citizens. A 2009 CDCR
report showed a 61% recidivism reduction for female inmates who
underwent substance abuse treatment and a 29% reduction for male
inmates who underwent such treatment.
This bill is sponsored by Californians for Safety and Justice
(CSJ) and is designed to take advantage of newly available
Medicaid funds under the ACA, to improve reentry for thousands
of Californians being released from county jails, to address key
drivers of crime, reduce justice system costs and make
communities safer. CSJ argues the first component of this bill
(requiring counties to complete and submit an application for
coverage) is to address individuals being released from county
jails who are uninsured and potentially eligible for coverage,
many of whom have chronic conditions and a higher prevalence of
mental health and substance abuse disorders. The second portion
of the bill (requiring Medi-Cal eligibility be suspended but not
terminated) is to allow for continuity of care for individuals,
to ensure individuals have are covered upon release, and to
provide federal Medicaid matching funds when incarcerated
individuals receive inpatient services from a facility outside
the jail.
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ASSEMBLY FLOOR : 56-19, 5/29/13
AYES: Achadjian, Alejo, Ammiano, Atkins, Bloom, Blumenfield,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chesbro, Cooley, Daly, Dickinson,
Eggman, Fong, Fox, Frazier, Garcia, Gatto, Gomez, Gonzalez,
Gordon, Hall, Roger Hern�ndez, Jones-Sawyer, Levine,
Lowenthal, Medina, Melendez, Mitchell, Mullin, Muratsuchi,
Nazarian, Nestande, Pan, Perea, V. Manuel P�rez, Quirk,
Quirk-Silva, Rendon, Skinner, Stone, Ting, Waldron, Weber,
Wieckowski, Wilk, Williams, Yamada, John A. P�rez
NOES: Allen, Bigelow, Ch�vez, Conway, Dahle, Donnelly, Beth
Gaines, Grove, Hagman, Harkey, Jones, Logue, Maienschein,
Mansoor, Morrell, Olsen, Patterson, Salas, Wagner
NO VOTE RECORDED: Gorell, Gray, Holden, Linder, Vacancy
JL:MW:nl 9/9/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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