BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1089
AUTHOR: Mitchell
INTRODUCED: February 19, 2014
HEARING DATE: March 26, 2014
CONSULTANT: Bain
SUBJECT : Medi-Cal: juvenile inmates.
SUMMARY : Makes clarifying changes to provisions requiring the
Department of Health Care Services to develop a process to allow
counties to receive federal Medicaid funds to inpatient services
provided to otherwise Medi-Cal eligible juvenile inmates
admitted as inpatients in a medical institution off the grounds
of the correctional facility.
Existing law:
1.Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals, including children ages 0 to
19, receive health care services.
2.Requires DHCS 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 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. This process was enacted by AB 396 (Mitchell),
Chapter 394, Statutes of 2011.
3.Prohibits the process in 2) above from being 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 inmate.
4.Implements the process in 2) above only in those counties that
elect to provide the non-federal share of the state's
administrative costs associated with implementation of this
requirement, and the non-federal share of expenditures for
acute inpatient hospital services and inpatient psychiatric
services provided to eligible juvenile inmates.
Continued---
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This bill:
1. Clarifies that counties that implement AB 396 are only
required to provide their "pro rata portion" of the
non-federal share of the state's administrative costs,
instead of the non-federal share of the state's
administrative costs.
2.Prohibits a specific section of AB 396, rather than a specific
subsection of that bill, from being construed to alter or
abrogate any obligation of the state to reimburse counties
under the process established by AB 396.
3. Limits a provision of AB 396 to the state's obligation
to just "reimburse" counties (rather than "fund and
reimburse"), and limits the services under AB 396 to "acute
inpatient hospital services or inpatient psychiatric
services" provided to a juvenile inmate, rather than the
broader "medical services."
4.States legislative intent that implementation of the
provisions of AB 396 will result in no increased cost to the
state General Fund, and alters the uncodified intent language
of AB 396 to reflect the change made in 2) above.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, in 2011, AB 396
(Mitchell), Chapter 394, Statutes of 2011 established a
voluntary program to allow the State, on behalf of counties
and the California Department of Corrections and
Rehabilitation, to draw down federal financial participation
under Medi-Cal for hospital inpatient services and inpatient
psychiatric services for Medi-Cal eligible detained juveniles
at no cost to the State. Counties electing to voluntarily
participate would provide the non-federal share of
expenditures, and be paid the resulting federal funds. In the
case of a federal audit disallowance, the State will recoup
from the participating county the amount of the disallowance
plus any applicable interest. DHCS has expressed concerns that
AB 396 may subject the State's General Fund to cost pressures,
which was never the intent of the author or the sponsors of AB
396.
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2.Background. Under federal Medicaid law, payments for care and
services provided to inmates of a public institution are not
considered "medical assistance" (and thus are not eligible for
federal financial participation through Medicaid) unless the
inmate is a "patient in a medical institution." AB 396, SB 695
(Hancock), Chapter 647, Statutes of 2011, and AB 1628
(Committee on Budget) Chapter 729, Statutes of 2011 (the
corrections trailer bill) provided an opportunity to draw down
federal funds by establishing juvenile and adult inmate
eligibility for Medi-Cal when an individual is receiving
services at a medical facility off the grounds of the
correctional facility. This enables state and county savings
to be achieved by funding health care services with federal
Medicaid matching funds, rather than state and county general
funds. In January 2014, DHCS issued a letter to counties
informing them of the new Medicaid claiming options. Claims
under AB 396 are eligible retroactive to January 1, 2012.
3.Support. This bill is sponsored by the Los Angeles County
Board of Supervisors, which writes this bill is a technical
clean-up measure to AB 396 that contains clarifying language
required by DHCS to reaffirm that if counties choose to
participate in the program established by AB 396, they will
pay their pro rate share of the state's administrative costs.
LA County indicates DHCS requested the additional intent
language to further protect the state's General Fund.
DHCS writes that this bill provides clean-up language to make
technical and clarifying changes that the scope of services
under the AB 396 process is limited to acute inpatient
hospital and inpatient psychiatric services, emphasizing the
Legislature's intent that the implementation of the AB 396
process will result in no increased cost to the state General
Fund and that it agrees with the sponsor's intent that each
county will only pay its pro-rate share of the state's
administrative expenses.
SUPPORT AND OPPOSITION :
Support: Los Angeles County Board of Supervisors (sponsor)
Department of Health Care Services
Urban Counties Caucus
Oppose: None received
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