BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1147|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: SB 1147
Author: Calderon (D), et al
Amended: 4/9/06
Vote: 21
SENATE HEALTH COMMITTEE : 6-1, 3/12/08
AYES: Kuehl, Alquist, Cox, Negrete McLeod, Steinberg, Yee
NOES: Maldonado
NO VOTE RECORDED: Aanestad, Cedillo, Ridley-Thomas, Wyland
SENATE APPROPRIATIONS COMMITTEE : 9-3, 5/22/08
AYES: Torlakson, Cox, Cedillo, Corbett, Florez, Kuehl,
Oropeza, Simitian, Yee
NOES: Aanestad, Ashburn, Dutton
NO VOTE RECORDED: Ridley-Thomas, Runner, Wyland
SUBJECT : Medi-Cal: eligibility: juvenile offenders
SOURCE : Youth Law Center
DIGEST : This bill 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.
ANALYSIS :
Existing Federal Law
1.Establishes the Medicaid program to provide comprehensive
CONTINUED
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health benefits to low-income persons.
2.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.
Existing State Law
1.Establishes the Medi-Cal program as the state's Medicaid
program and establishes the Department of Health Care
Services (DHCS) as the administering agency.
2.Defines the health care benefits that are to be offered
by the program.
3.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
1.Prohibits DHCS from terminating the Medi-Cal eligibility
of a minor under the Medi-Cal program for the sole reason
that the minor is incarcerated.
2.Requires 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.
3.Requires DHCS to develop the required procedures in
consultation with organizations representing probation
officers and county eligibility workers.
4.Allows 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 requires DHCS to inform the
appropriate committees of the Legislature and consult
with interested parties.
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5.Requires DHCS, by January 1, 2010, to convene a workgroup
in order to review implementation and make
recommendations regarding eligibility, administrative
burdens, and an opt-in process for parent of wards who
are minors.
6.Makes technical and clarifying changes in existing law
directing county welfare offices to determine Medi-Cal
eligibility for minors who are incarcerated in county
institutions.
Background
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 three 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
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 (Yee), 2005-06 Session,
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
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
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Convene workgroup $ 0 $ 25
$ 0 General
Additionally, the bill will generate savings of $85,000
annually.
SUPPORT : (Verified 5/22/08)
Youth Law Center (source)
American Federation of State, County and Municipal
Employees
California Association of Counties
California State Sheriffs Association
Chief Probation Officers of California
County of Santa Clara Probation Department
County Welfare Directors Association of California
Fight Crime Invest in Kids
Humboldt County Probation Department
Juvenile Justice Program
Lambda Letters
Los Angeles County Office of Education
Western Center on Law and Poverty
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 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 this bill would do, that is not to terminate otherwise
eligible individuals in public institutions.
CTW:cm 5/23/08 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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