BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Sheila J. Kuehl, Chair
BILL NO: SB 1147
S
AUTHOR: Calderon
B
AMENDED: As Introduced
HEARING DATE: March 12, 2008
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FISCAL: Appropriations
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4
CONSULTANT:
7
Dunstan/cjt
SUBJECT
Medi-Cal eligibility: juvenile offenders
SUMMARY
Requires the Department of Health Care Services (DHCS) to
develop procedures to ensure that the Medi-Cal eligibility
of minors is not terminated when they are incarcerated.
CHANGES TO EXISTING LAW
Existing law:
Existing federal law establishes the Medicaid program to
provide comprehensive health benefits to low-income
persons. Current federal law also provides that Medicaid
benefits generally cannot be paid for incarcerated
individuals except when the inmate is a patient in a
medical institution. Although an incarcerated individual's
benefits are restricted, federal law does allow that person
to retain their Medicaid eligibility.
Current state law establishes the Medi-Cal program as the
state's Medicaid program and establishes DHCS as the
Continued---
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administering agency. Existing state law defines the
health care benefits that are to be offered by the program.
State law also excludes from the definition of Medi-Cal
health care benefits, care or services for any individual
who is an inmate of an institution (except as permitted
under federal law).
This bill:
This bill would prohibit DHCS from terminating the Medi-Cal
eligibility of a minor under the Medi-Cal program for the
sole reason that the minor is incarcerated. This bill
would require DHCS to develop procedures to ensure that
Medi-Cal eligibility is not terminated and that any claims
for Medi-Cal benefits for incarcerated youth are paid only
as allowable under federal law. DHCS would be required by
this bill to develop the required procedures in
consultation with organizations representing probation
officers and county eligibility workers. This bill would
allow DHCS to implement its provisions through all-county
letters or similar methods without adopting regulations for
a period of two years. If DHCS uses county letters, the
bill would require DHCS to inform the appropriate
committees of the Legislature and consult with interested
parties.
This bill also would make technical and clarifying changes
in existing law directing county welfare offices to
determine Medi-Cal eligibility for minors who are
incarcerated in county institutions.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
Need for the bill
The author introduced this bill because the termination of
Medi-Cal eligibility presents serious problems when these
incarcerated youth are released from custody. According to
the author, parents and other caregivers are faced with
navigating the time-consuming, complicated re-application
process even though a young person was on the rolls before
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going into custody. The author argues that, for youth with
serious mental health service needs, this gap in coverage
may make the difference in getting needed medications
without which the person may spiral into a mental health
crisis or end up back in an institution- both with
substantial additional costs to public systems.
The author points out that this issue has repeatedly
surfaced as a barrier to providing an ongoing continuum of
care for youth in the juvenile justice system. In early
2008, it was given the highest priority in a survey
conducted in connection with the Healthy Returns
Initiative, a multi-year, five-site project funded through
the California Endowment. It was also raised as a critical
issue at a February 2008 statewide convening of Chief
Probation Officers and administrators.
The author argues that, apart from the human costs
resulting from the current process, the termination and
processing of re-applications impose an additional and
unnecessary burden on county and DHCS staff. The author
notes that, if DHCS placed incarcerated eligible young
people in a status that restricted their ability to request
reimbursement for services, but protected their underlying
eligibility, time and money could be saved, both in
eliminating extraneous paperwork, and in protecting this
vulnerable population upon release.
Medical problems of juvenile inmates
Lack of access to medical care is an acute problem for
youth exiting the juvenile detention system. Many are in
need of psychotropic medicine or other medical care
necessary to treat severe health conditions. Failure of a
ward to receive treatment for a mental health or substance
abuse disorder can be a significant factor in the high rate
of recidivism among youth. In the state corrections
juvenile division's facilities alone, 85 percent of the
youth have substance abuse problems, and 71 percent have 3
or more diagnosable mental health disorders.
Currently, under federal rules, if a youth is disenrolled,
Medicaid eligibility should be reinstated upon the release
of the person unless they are no longer eligible. States
can arrive at a decision on a person's eligibility only by
examining the potential for qualifying under all the
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state's eligibility categories.
As part of a federal effort to reduce homelessness, the
federal Center for Medicare and Medicaid Services (CMS)
sent a letter encouraging states to suspend, rather than
terminate, Medicaid benefits while a person is
incarcerated. The letter points out the difference between
prohibiting incarcerated individuals from receiving
benefits versus terminating their eligibility. The letter
also encourages state Medicaid agencies to work with
corrections officials.
DHCS view
In comments on AB 2004, an earlier bill that addressed the
same issue, DHCS stated that any individual taken into
custody loses Medi-Cal eligibility when he or she is booked
into a correctional facility for a criminal act. No
services provided by the correctional facility during the
time of incarceration can be billed to Medi-Cal. Any
individual who is booked will automatically be terminated
from Medi-Cal benefits. A match is run by Medi-Cal monthly
with the California Youth Authority System and with the
Jail Match Registry System to determine who has been
incarcerated if there has been no notification to the
county welfare system.
DHCS also provided other comments relevant to juvenile
Medi-Cal eligibility following release from custody. In
essence, these comments state that specific parties, either
the county social worker, probation officer, court, and/or
parents can and should take steps to help inmates gain
eligibility as soon as possible after release.
Current litigation
The City and County of San Francisco and the County of
Santa Clara have sued DHCS over the current treatment of
incarcerated minors. They have asked the court to halt the
current DHCS policy that terminates eligible minors and
then requires subsequent reapplication. The plaintiffs
specifically argue that that federal and state law requires
Medi-Cal recipients receive the benefits to which they are
entitled and the state is depriving eligible recipients of
those benefits by terminating and delaying the restoration
of eligibility. The case is currently in superior court.
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Prior legislation
SB 648 (Calderon) of 2007-2008, would have required DHCS
to suspend rather than terminate the Medi-Cal benefits of
an incarcerated minor. This bill was referred to Senate
Health Committee but was not heard.
SB 1469 (Cedillo), Chapter 657 of 2006, requires,
beginning January 1, 2008, county juvenile detention
facilities to notify county welfare departments about the
release of a ward so that eligibility for Medi-Cal can be
determined prior to the release of the inmate.
SB 1616 (Kuehl) of 2006, would have required the
Department of Corrections and Rehabilitation, to work
with the federal Social Security Administration and DHCS
to ensure that disabled wards are enrolled in Medi-Cal
and that their disability benefits are available to them
when they are released from incarceration at a state
institution. This bill was vetoed by the Governor.
AB 1945 (Coto) of 2006, among other provisions, would
have required a juvenile detention facility, when a minor
is released from custody, to determine if the minor will
have health insurance after release, and if the minor
will not, to evaluate the eligibility of the minor for
enrollment in appropriate need-based programs. This bill
was held in the Assembly Health Committee.
AB 2004 (Yee) of 2006, was identical to SB 648. This
bill was vetoed by the Governor.
AB 470 (Yee) of 2005) was a very similar bill to SB 648.
The bill failed passage on the Assembly floor.
Arguments in support
Supporters argue that this bill will help to ensure that
eligible youth leaving custody can access necessary health
care services provided by Medi-Cal. Supporters argue that
the current policy of termination requires a time-consuming
reapplication process that leaves many without needed
prescriptions, mental health services, and medical
treatment. They also argue that the state has violated
federal law by imposing delays in reinstating released
inmates whose eligibility has been terminated and, as a
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result, is faced with litigation over this very issue. The
Youth Law Center, the bill's sponsor, also points out that
CMS has issued guidance urging states to do exactly what SB
1147 would do, that is not to terminate otherwise eligible
individuals in public institutions.
COMMENTS AND QUESTIONS
1. This bill would clarify the authority of DHCS regarding
termination of benefits for incarcerated minors. This lack
of clarity has resulted in the lawsuit described in the
analysis. The ambiguity exists because Section 14053(b) of
the Welfare and Institutions Code prohibits incarcerated
juveniles from receiving care and services, except as
permitted under federal law. Federal law does permit
benefits to be paid for incarcerated juveniles while an
inpatient in a hospital or psychiatric hospital. Despite
these provisions of state and federal law, DHCS has
promulgated regulation and developed an eligibility manual
both of which require termination of eligibility for an
incarcerated individual.
2. Currently many incarcerated youths are not terminated
from Medi-Cal. For many, the stay in a facility is so
short that the state or county is not aware and takes no
action to terminate. Identifying and terminating the
benefits of these youth would be an administrative burden
and serve little purpose, as they are quickly released and
once again eligible for Medi-Cal health care services
POSITIONS
Support:Youth Law Center (Sponsor)
American Federation of State, County and Municipal
Employees
Board of Supervisors County of Santa Clara
Chief Probation Officers of California
County of Humboldt, Probation Department
Fight Crime: Invest in Kids California
Urban Counties Caucus
Western Center on Law and Poverty
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Oppose:None received
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