BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Tom Torlakson, Chairman
1147 (Calderon)
Hearing Date: 04/14/08 Amended: 04/09/08
Consultant: John Miller Policy Vote: Health 6 - 1
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BILL SUMMARY: SB 1147 requires the Department of Health Care
Services to develop procedures to ensure that the Medi-Cal
eligibility of minors is not terminated when they are
incarcerated.
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Fiscal Impact (in thousands)
Major Provisions 2008-09 2009-10 2010-11 Fund
Medi-Cal benefits $ 50 $ 100 $ 100 General
New aid code $ 85 $ 0 $ 0 General
Convene workgroup $ 0 $ 25 $ 0 General
Additionally, the bill will generate savings of eighty five
thousand dollars annually.
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would prohibit the Department of Health Care Services
from terminating Medi-Cal eligibility for minors for the sole
reason that the minor is incarcerated. The bill would require
the Department to develop protocols, in concert with probation
departments and county eligibility staff, to withhold Medi-Cal
services during a minor's incarceration, but will facilitate
restoration of medical services upon release of the minor. A
high percentage of incarcerated youth have serious mental health
and drug abuse problems, and the current practice of requiring
youth and caregivers to repeat the complex, month's long process
of re-qualifying for Medi-Cal, produces a gap in care which
frequently contributes to recidivism. This issue has been the
focus of a number of bills (SB 648, Calderon, 07; SB 1469,
Cedillo, 06; AB 2004, Yee, 06) and has been identified as a
policy priority among expert researchers and law enforcement
groups.
Both state and federal law specify that the health care of
inmates and wards is the responsibility of corrections
departments. In California, upon incarceration and according to
state regulation, the Department of Health Care Services
automatically terminates Medi-Cal eligibility for all minors,
even for holds of a few weeks. The federal government does not
require this termination of eligibility, but recommends a
temporary suspension of benefits. A number of states, including
New York, New Mexico and Florida suspend rather than terminate
eligibility. Neither the State nor counties maintain data on the
termination of medical benefits; however the Department of
Finance estimates that approximately 350 minors are terminated
for incarceration each year.
This proposal will generate both costs and savings to the state.
The bill will reduce the number eligibility redeterminations by
the state; would provide earlier benefits to an undetermined
number of eligible beneficiaries who might have otherwise
delayed care; and would require some new administrative costs to
the department to electronically
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SB 1147 (Calderon)
limit the benefits of incarcerated, but eligible, wards. Prior
analysis have estimated that approximately 15 percent of
terminated eligibles would, for one reason or another, not
immediately seek to re-establish eligibility and that the state
would realize savings as a result. However, Medi-Cal benefits
are retroactive for up to two months and thus delayed
eligibility for terminated minors will, in all likelihood, be
paid even if eligibility is delayed by termination. Further,
incarcerated individuals have more immediate and critical
medical needs, and are more likely than the general public to
reestablish eligibility and receive benefits. The effect of
retroactive eligibility and high usage means there will be very
little savings from delaying the eligibility of these minors.
Estimates by law enforcement indicate that roughly two thirds of
youth in juvenile justice are prescribed medications. The
Committee estimates that some smaller percentage of eligibles
will be served more quickly by the provisions of this bill, but
that costs will more realistically be estimated at two hundred
thousand dollars ($100,000 GF). Restoration of Medi-Cal will
also, presumably, generate undetermined savings by reducing
recidivism among these young offenders. Several studies indicate
that access to appropriate therapy can reduce recidivism by 50%.
The bill will require the department to create and employ a new
aid code to identify Medi-Cal minors and implement temporary
ineligibility when the youth are incarcerated. The department
currently employs more than 50 aid codes, several of which
indicate temporary ineligibility. We estimate that the costs of
defining a new aid code would be minor. The costs for completing
redeterminations of Medi-Cal eligibility under current practice
are estimated by the LAO to be between $180 and $305 per case.
Elimination of these redetermination costs for 350 minors would
save roughly $85,000 under this bill and would off- set the
costs of establishing a new aid code.