BILL ANALYSIS
SB 1147
Page 1
Date of Hearing: July 2, 2008
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mark Leno, Chair
SB 1147 (Calderon) - As Amended: June 19, 2008
Policy Committee: Health Vote:12-5
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill addresses the Medi-Cal eligibility status of
incarcerated persons under 21 years of age to conform to federal
law. Specifically, this bill:
1)Prohibits the California Department of Health Care Services
(DHCS) from terminating the Medi-Cal eligibility of a ward due
to the youth's status as an inmate.
2)Requires 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 Medi-Cal eligibility is not terminated and
claims for Medi-Cal services provided to a ward are made only
when federal financial participation is available.
3)Specifies the processes and contents for development of
related notifications for use by juvenile detention facilities
to communicate with families with regard to Medi-Cal status.
4)Requires DHCS to review implementation of requirements of this
bill by January 2010.
FISCAL EFFECT
1)Annual increased Medi-Cal benefit costs of $3 million (50% GF)
to $5 million to provide formerly incarcerated youth with
Medi-Cal immediately upon return to the community, rather than
providing Medi-Cal after initiating eligibility, which can
take several months. One-time costs of approximately $100,000
(75% GF) to DHCS to convene stakeholder groups and modify
processes accordingly.
SB 1147
Page 2
2)The average daily population in California's juvenile halls
and camps is a combined 14,000 youth. The average length of
stay for this population is generally very short, with
releases occurring after, on average, 30 days for juvenile
hall and 100 days for juvenile camps. The proportion of
Medi-Cal eligible in this population is unknown, though higher
than the general population. This estimate assumes
approximately one-third of minors released from institutions
receive Medi-Cal benefits two months earlier as a result of
this bill.
3)Potentially significant loss of federal funds to the extent
continued non-compliance results in punitive action from the
federal government. Medi-Cal GF spending is matched dollar for
dollar with federal financial support. Therefore a reduction
in this area would have serious GF implications.
COMMENTS
1)Rationale . This bill is sponsored by the Youth Law Center to
conform state Medi-Cal eligibility for wards to federal law.
Under federal law, inmates in locked facilities are not
eligible for federal financial participation (FFP) under
Medi-Cal. Due to this ineligibility for payment, DHCS has
historically terminated, rather than suspended a ward's
Medi-Cal eligibility status. California is one of the only
states in the country to terminate benefits under these
circumstances. Because eligibility has been terminated, a
juvenile must re-apply for Medi-Cal upon release, which can
result in a several month delay in care.
According to many stakeholders, including the plaintiffs in the
San Francisco case, current California law contravenes federal
law with respect to these issues. Therefore, California may
risk loss of federal funding for continued non-compliance in
this area.
2)Current Law Results in Termination of Eligibility . Under
current law, Medi-Cal applications take 45 days for
processing, and may take much longer, leading to significant
and unnecessary lapses in care for a population with
significant health and mental health needs. In addition,
SB 1147
Page 3
because their eligibility has been terminated while they are
inmates, they are not eligible for FFP in other settings, such
as state psychiatric care, which may be authorized for payment
under federal law. This bill codifies ongoing efforts,
including an MOU between DHCS and the California Department of
Corrections and Rehabilitation (CDCR) and litigation in which
San Francisco has filed against DHCS to address these issues
and increase access to care for wards leaving locked
facilities.
3)Related Legislation . SB 1469 (Cedillo), Chapter 657, Statutes
of 2007, requires county juvenile detention facilities
committing a county ward to a juvenile hall, camp, or ranch
for 30 days or longer, to provide the county welfare
department with any known information regarding the ward's
Medi-Cal status prior to disposition, and sufficient
information for the county welfare department to begin the
process of determining the ward's Medi-Cal eligibility.
AB 2004 (Yee) in 2006 prohibited the use of inmate status to
terminate the Medi-Cal eligibility of a youth ward, and
required DHCS to suspend, but not terminate, the Medi-Cal
eligibility of a ward. AB 2004 was vetoed because, according
to the governor, the bill did not address the need for better
coordination between county welfare, county probation, and
juvenile detention facilities.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081