BILL NUMBER: SB 1089 ENROLLED
BILL TEXT
PASSED THE SENATE APRIL 10, 2014
PASSED THE ASSEMBLY AUGUST 14, 2014
INTRODUCED BY Senator Mitchell
FEBRUARY 19, 2014
An act to amend Section 14053.8 of the Welfare and Institutions
Code, and to amend Section 1 of Chapter 394 of the Statutes of 2011,
relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1089, Mitchell. Medi-Cal: juvenile inmates.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid provisions. Existing federal law, with certain exceptions,
excludes federal financial participation for medical care provided to
any individual who is an inmate in a public institution. Existing
law requires the State Department of Health Care Services to develop
a process to allow counties to receive any available federal
financial participation for acute inpatient hospital services and
inpatient psychiatric services provided to juvenile inmates, as
defined, who are admitted as inpatients in a medical institution, as
prescribed. Existing law requires that the process be implemented in
only those counties that elect to provide the nonfederal share of the
state's administrative costs associated with the implementation of
the process and the nonfederal share of the expenditures for those
services provided.
This bill would instead provide that the process developed be
implemented in only those counties that elect to provide the county's
pro rata portion of the nonfederal share of the state's
administrative costs.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14053.8 of the Welfare and Institutions Code is
amended to read:
14053.8. (a) Notwithstanding any other law, the department shall
develop a process to allow counties to receive any available federal
financial participation for acute inpatient hospital services and
inpatient psychiatric services provided to juvenile inmates who are
admitted as inpatients in a medical institution off the grounds of
the correctional facility, and who, but for their institutional
status as inmates, are otherwise eligible for Medi-Cal benefits
pursuant to this chapter. This process shall be coordinated, to the
extent possible, with the processes and procedures established
pursuant to Section 14053.7 of this code and Section 5072 of the
Penal Code. This section shall not 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
reimburse counties for any acute inpatient hospital services or
inpatient psychiatric services provided to a juvenile inmate.
(b) A juvenile inmate who is an inpatient in a medical institution
off the grounds of the correctional facility shall not be denied
eligibility for Medi-Cal benefits under this section because of his
or her institutional status as an inmate of a public institution.
(c) The department shall consult with counties in the development
of the process pursuant to this section.
(d) This section shall not be construed to limit the department's
authority to suspend or terminate Medi-Cal eligibility pursuant to
Section 14011.10, except during such times that the juvenile inmate
is receiving acute inpatient hospital services or inpatient
psychiatric services pursuant to subdivision (b).
(e) This section shall be implemented only if and to the extent
that existing levels of federal financial participation are not
otherwise jeopardized. To the extent that the department determines
that existing levels of federal financial participation are
jeopardized, this section shall no longer be implemented.
(f) The department shall seek any federal approvals necessary to
implement the process developed pursuant to this section. This
section shall be implemented only if and to the extent that any
necessary federal approvals have been obtained, and only to the
extent that federal financial participation is available.
(g) Notwithstanding any other law, as part of the process
developed pursuant to this section, the department may exempt
juvenile inmates from enrollment into new or existing managed care
health plans.
(h) The process developed pursuant to this section shall be
implemented in only those counties that elect to provide the county's
pro rata portion of the nonfederal share of the state's
administrative costs associated with implementation of this section
and the nonfederal share of expenditures for acute inpatient hospital
services and inpatient psychiatric services provided to eligible
juvenile inmates described in subdivision (a).
(i) (1) The federal financial participation received pursuant to
the process implemented under this section shall be paid to the
participating counties for services rendered to the juvenile inmates.
If a federal audit disallowance and interest results from claims
made under the process created pursuant to this section, the
department shall recoup from the county that received the disallowed
funds the amount of the disallowance and any applicable interest.
(2) It is the intent of the Legislature that implementation of
this section will result in no increased cost to the state General
Fund.
(j) (1) If there is a final judicial determination made by any
state or federal court that is not appealed, or by a court of
appellate jurisdiction that is not further appealed, in any action by
any party, or a final determination by the administrator of the
federal Centers for Medicare and Medicaid Services (CMS), that
disallows, defers, or alters the implementation of this section or,
to the extent applicable, Section 14053.7 of this code or Section
5072 of the Penal Code, including the rate methodology or payment
process established by the department that limits or affects the
department's authority to select the facilities used to provide acute
inpatient hospital services and inpatient psychiatric services to
juvenile inmates, then any provision of this section that is
inconsistent with the final judicial or CMS determination shall have
no force or effect.
(2) In addition, the department may, at its discretion, cease to
implement any other part of this section that is implicated by the
final judicial or CMS determination.
(k) For the purposes of Medi-Cal eligibility pursuant to this
section, "juvenile inmate" means an individual under 21 years of age
who is involuntarily residing in a public institution, including
state and local institutions.
(l) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may, without taking any further regulatory action,
implement this section by means of all-county letters or similar
instructions.
SEC. 2. Section 1 of Chapter 394 of the Statutes of 2011 is
amended to read:
Section 1. The Legislature finds and declares all of the
following:
(a) Federal financial participation may be available for counties
that provide health care services to juvenile inmates while the
juveniles are admitted as patients in a medical institution.
(b) Current law provides that an individual under 21 years of age
who is an inmate of a public institution shall have his or her
Medi-Cal services suspended for up to one year.
(c) The eligibility procedures of the State Department of Health
Care Services currently do not allow counties to obtain available
federal financial participation for health care services provided to
juvenile inmates when they have been transferred to a medical
institution for inpatient services.
(d) Pursuant to Section 5072 of the Penal Code and Section 14053.7
of the Welfare and Institutions Code, the department is authorized
to develop a process to maximize federal financial participation for
inpatient hospital services to adult inmates residing in a state
prison facility.
(e) To reduce the fiscal strain on counties, it is imperative that
the department work with counties to develop and implement a similar
process to allow counties to obtain federal financial participation
based on county expenditures for inpatient hospital services provided
to juveniles in their custody.
(f) It is not the intent of the Legislature to alter or abrogate
any obligation of the state under federal or state law to reimburse
under Medi-Cal any acute inpatient hospital services or inpatient
psychiatric services provided to a juvenile inmate.