BILL ANALYSIS
SB 1147
Page 1
Date of Hearing: June 17, 2008
ASSEMBLY COMMITTEE ON HEALTH
Mervyn M. Dymally, Chair
SB 1147 (Calderon) - As Amended: April 9, 2008
SENATE VOTE : 27-13
SUBJECT : Medi-Cal: eligibility: juvenile offenders.
SUMMARY : Prohibit the termination of Medi-Cal eligibility of a
child under age 21 because of the child's status as an inmate,
and requires the Department of Health Care Services (DHCS) to
establish the protocols and procedures necessary to ensure
Medi-Cal eligibility is not terminated. Specifically, this
bill :
1)Prohibits inmate status from being used to terminate the
Medi-Cal eligibility of a child under age 21, as defined in a
specified regulation.
2)Requires, commencing January 1, 2009, the DHCS, in
consultation with the Chief Probation Officers of California
(CPOC) and the County Welfare Directors Association (CWDA), to
establish the protocols and procedures necessary to ensure
both of the following:
a) Medi-Cal eligibility is not terminated in violation of
#1) above; and,
b) Claims for Medicaid-covered health care services for any
individual who is an inmate of an institution are made only
when federal financial participation (FFP) is available.
3)Requires DHCS to implement the above provisions by means of
all-county letters or similar instructions, without taking any
further regulatory action. Requires, by January 1, 2011, DHCS
to adopt regulations, as necessary, to implement the
provisions in #1) and #2) above in accordance with the
Administrative Procedure Act.
4)Requires DHCS, no later than July 1, 2009, in consultation
with stakeholders, including, but not limited to, county
probation departments, county human services agencies, and
consumer advocates, to develop a model notification letter for
use by juvenile detention facilities which meets the existing
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requirement that county juvenile detention facilities notify
the parent or guardian of a ward (a ward is a person in the
custody of a juvenile detention facility) of the facility's
intention to provide the county welfare department with the
ward's name, release date, any information regarding the
ward's Medi-Cal status prior to disposition, and sufficient
information when available for the county to begin the
Medi-Cal eligibility determination process.
5)Limits the requirement that county welfare departments
initiate a Medi-Cal application to wards that are not already
enrolled in the Medi-Cal program, when a county has received
information on a ward from a county juvenile detention
facility.
6)Requires county welfare departments to deny a minor's Medi-Cal
application in accordance with due process requirements if the
minor's parent or guardian fails to cooperate in completing
the application.
7)Requires DHCS, after the development and dissemination of the
model notification letter established pursuant to #4) above,
to convene a workgroup by January 1, 2010 for the purpose of
reviewing the implementation of existing law requirements
relating to wards and Medi-Cal, and the changes made by this
bill, and to make recommendations, if appropriate, to increase
the rate of successful Medi-Cal eligibility determinations and
minimize county administrative burden. The workgroup must
consider, at a minimum, whether to recommend an opt-in, rather
than an opt-out, process for parents of wards who are minors.
8)Requires the workgroup in #7) above to include representatives
of CPOC, CWDA, legislative staff, and consumer advocates.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by DHCS, which
provides comprehensive health benefits to low-income children,
their parents or caretaker relatives, pregnant women, elderly,
blind or disabled persons, nursing home residents, and
refugees who meet specified eligibility criteria. Medi-Cal
family income eligibility for children ages 0 to 1 extends up
to 200% of the federal poverty level (FPL), children ages 1 to
5 with family incomes up to 133% FPL, and children ages 6 to
19 with family incomes up to 100% FPL.
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2)Establishes a schedule of benefits under the Medi-Cal program
but excludes from the definition of "health care services,"
care or services for any individual who is an inmate of an
institution (except as a patient in a medical institution),
except to the extent permitted by federal law.
3)Requires county juvenile detention facilities, following the
issuance of an order of the juvenile court committing a county
ward to a juvenile hall, camp, or ranch for 30 days or longer,
to provide the appropriate county welfare department with the
ward's name, scheduled or actual release date, any known
information regarding the ward's Medi-Cal status prior to
disposition, and sufficient information, when available, for
the county welfare department to begin the process of
determining the ward's Medi-Cal eligibility, including, if the
ward is a minor, contact information for the ward's parent or
guardian, if available.
4)Requires, if the ward is a minor, prior to providing
information to the county welfare department pursuant to #3)
above, the county juvenile detention facility to notify the
parent or guardian of its intention to submit the information
required by #3) above to the county welfare department. The
parent or guardian must be given a reasonable time to opt out
of the Medi-Cal eligibility determination.
5)Requires the county welfare department, upon receipt of the
information in #3) above and pursuant to the protocols and
procedures developed, to initiate an application and determine
the individual's eligibility for Medi-Cal benefits. The
county welfare department, if the ward is a minor, must
promptly contact the parent or guardian to arrange for
completion of the application.
FISCAL EFFECT : According to the Senate Appropriations
Committee, on-going increased Medi-Cal benefit costs of $50,000
General Fund (GF), one-time increased computer-related
reprogramming costs of $85,000 GF, and one-time increased costs
to convene a workgroup of $25,000. On-going savings of $43,000
(GF) by eliminating the Medi-Cal eligibility redetermination
cost for 350 minors.
COMMENTS :
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1)PURPOSE OF THIS BILL . The author states this bill prohibits
inmate status from being used to terminate the eligibility of
a child under the Medi-Cal program and requires DHCS to
develop protocols and policies to ensure that a juvenile
beneficiary's eligibility for Medi-Cal is not terminated if
inmate status is the reason for the termination.
When a juvenile Medi-Cal enrollee is admitted to a locked state
or county facility, they lose their eligibility to participate
in the Medi-Cal program. Because their eligibility is
terminated, the juvenile must re-apply for Medi-Cal upon
release. Under state law, Medi-Cal applications may take 45
days for processing, and in reality may take much longer.
This can result in extended gaps in treatment and access to
needed medications. Because many juvenile wards suffer from
physical and mental illnesses, the author argues the existing
termination requirements are dangerous to the juvenile,
difficult for caregivers, and costly to the community.
According to the author, this bill ensures that California
complies with a federal recommendation that juvenile inmates
not lose their Medi-Cal eligibility simply because they have
been an inmate in a county-run facility
2)BACKGROUND . State Medi-Cal regulations make individuals who
are inmates of public institutions ineligible for Medi-Cal.
However, a 1997 letter from the federal Department of Health
and Human Services indicates FFP is available through Medicaid
when an inmate becomes a patient in a medical institution on
an inpatient basis. Additionally, a 2004 letter to State
Medicaid directors from the federal Centers for Medicare and
Medicaid Services (CMS) encourages states to "suspend" and not
"terminate" benefits while a person is in a public institution
or Institute for Mental Disease, noting the payment exclusion
(known as the "inmate exception") under Medicaid does not
affect the eligibility of an individual for the Medicaid
program.
CMS indicated that individuals who meet the requirements for
eligibility for Medicaid may be enrolled in the program
before, during, and after the time in which they are held
involuntarily in secure custody. CMS recommends the state
establish a process under which an eligible inmate or resident
is placed in a suspended status so that the state does not
claim FFP for services the individual receives, but the person
remains on the state's rolls as being eligible for Medicaid
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(assuming the person continues to meet all applicable
eligibility requirements). Once discharge from the facility
is anticipated, CMS indicates the state should take whatever
steps are necessary to ensure that an eligible individual is
placed in payment status so that he or she can begin receiving
Medicaid-covered services immediately upon leaving the
facility. If an individual is not already eligible for
Medicaid prior to discharge from the facility, but has filed
an application for Medicaid, CMS suggests the state should
take whatever steps are necessary to ensure that the
application is processed in a timely manner so that the
individual can receive Medicaid-covered services upon
discharge from the facility.
3)LEGISLATIVE ANALYST'S OFFICE . A letter from the Legislative
Analyst's Office (LAO) to the author on the potential costs
and savings associated with this bill indicates the parents or
guardians of Medi-Cal enrolled youth who enter a juvenile
hall, county probation camp or ranch are responsible for
notifying the county eligibility office so the county can
disenroll the child from Medi-Cal. The LAO indicates it is
uncertain how often disenrollment occurs because county
eligibility offices may not know when a child is incarcerated
and parents have little incentive to report because many of
these parents likely receive Medi-Cal through their children
and would lose their own benefits when their child's
disenrollment occurred.
The LAO reports DHCS had no data on how many youth are
disenrolled from Medi-Cal as a result of entering juvenile
hall or a similar facility, although a 2006 analysis of a
similar bill estimated that 310 youth were terminated from
Medi-Cal because of incarceration. The state Department of
Justice (DOJ) reports, for calendar year 2005, approximately
45,000 juveniles were referred for detention, and while some
portion of these juveniles were probably Medi-Cal eligible or
already enrolled, neither DOJ nor DHCS collect the data that
identifies that portion.
The LAO indicates savings could occur because suspension of
enrollment, instead of disenrollment, would avoid the
administrative cost of processing a new application when the
youth is released from incarceration, and these reenrollment
costs are currently estimated at $190 per application by DHCS.
DHCS indicated to the LAO that the cost of programming new
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aid codes through the database used to track Medi-Cal
recipients (the Medi-Cal Eligibility Determination System)
would be approximately $100,000 to $300,000 ($25,000 to
$75,000 GF).
4)SUPPORT . This bill is sponsored by the Youth Law Center
(YLC) to ensure that eligible young people leaving detention
do not have to reapply for Medi-Cal, thereby supporting prompt
and continuous access to prescription medication, mental
health services and medical treatment. YLC argues requiring
formal terminations of Medi-Cal eligibility and subsequent
reapplications is costly and makes little sense for children
who may only be in custody for a period of days or weeks.
Supporters of this bill argue this measure will improve
continuity of care for youth, support rehabilitation,
particularly for youth who need mental health services, reduce
the cost to the state for delayed medical and mental health
care costs, reduce the time and money spent on the Medi-Cal
reapplication process, and bring California into compliance
with federal guidance.
5)LAWSUIT . A lawsuit ( City and County of San Francisco, County
of Santa Clara v. State of California, California Department
of Health Care Services, and Does 1 to 10 , Superior Court,
County of San Francisco, No. CGC007-468241) filed in San
Francisco County in November 2007 is challenging the legality
of terminating of terminating wards because of their status as
inmates. That case is currently awaiting trial.
6)AUTHOR'S AMENDMENT . The author intends to offer an amendment
to include the definition of "child" as any individual less
than 21 years of age, and delete the current reference in this
bill to a regulation in Title 22.
7)PREVIOUS LEGISLATION .
a) SB 1469 (Cedillo), Chapter 657, Statutes of 2007,
requires county juvenile detention facilities, following
the issuance of an order of the juvenile court committing a
county ward to a juvenile hall, camp, or ranch for 30 days
or longer, to provide the county welfare department with
the ward's name, his or her scheduled or actual release
date, any known information regarding the ward's Medi-Cal
status prior to disposition, and sufficient information,
when available, for the county welfare department to begin
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the process of determining the ward's Medi-Cal eligibility.
b) AB 2004 (Yee) of 2006 would have prohibited the use of
inmate status to terminate the Medi-Cal eligibility of a
minor, and would have required DHCS to suspend the health
care benefits, but not terminate the Medi-Cal eligibility
of, a minor who is an inmate of an institution. AB 2004
was vetoed by Governor Schwarzenegger. In his veto
message, the Governor stated the bill did not address the
need for better coordination between county welfare, county
probation, and juvenile detention facilities, and he
expressed concern that suspension of Medi-Cal eligibility
would require costly automation changes, be
administratively complex and may lead to increased fraud or
abuse.
REGISTERED SUPPORT / OPPOSITION :
Support
Youth Law Center (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Mental Health Directors Association
California Psychological Association
California State Association of Counties
California State Sheriffs' Association
Chief Probation Officers of California
City and County of San Francisco
Commonweal - The Juvenile Justice Program
County of Santa Barbara
County Welfare Directors Association
Fight Crime: Invest in Kids California
Humboldt County Probation Department
Lambda Letters Project
Los Angeles County Office of Education
Protection & Advocacy, Inc.
Regional Council of Rural Counties
Santa Clara County Board of Supervisors
Urban Counties Caucus
Ventura County Board of Supervisors
Western Center on Law & Poverty
Opposition
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None on file.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097