BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1147|
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UNFINISHED BUSINESS
Bill No: SB 1147
Author: Calderon (D), et al
Amended: 8/8/08
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
SENATE FLOOR : 27-13, 5/27/08
AYES: Alquist, Calderon, Cedillo, Corbett, Correa, Cox,
Denham, Ducheny, Florez, Kehoe, Kuehl, Lowenthal,
Machado, Migden, Negrete McLeod, Oropeza, Padilla,
Perata, Ridley-Thomas, Romero, Scott, Simitian,
Steinberg, Torlakson, Vincent, Wiggins, Yee
NOES: Aanestad, Ackerman, Ashburn, Battin, Cogdill,
Dutton, Harman, Hollingsworth, Maldonado, Margett,
McClintock, Runner, Wyland
ASSEMBLY FLOOR : 48-30, 8/13/08 - See last page for vote
SUBJECT : Medi-Cal: eligibility: juvenile offenders
SOURCE : Youth Law Center
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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.
Assembly Amendments conform the bill to federal law and
made clarifying changes.
ANALYSIS :
Existing Federal Law
1.Establishes the Medicaid program to provide comprehensive
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.Requires Medi-Cal benefits to an individual under 21
years of age who is an inmate of a public institution (a
state or federal prison, correctional facility,
county/city jail or detention center) to be suspended in
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accordance with a specified provision of federal law
(current state Medi-Cal regulations make individuals who
are inmates of public institutions ineligible for
Medi-Cal).
2.Requires, if a Medi-Cal beneficiary is under age 21 on
the date he/she becomes an inmate of a public
institution, h is or her Medi-Cal benefits to be
suspended effective the date he or she becomes an inmate
of a public institution. Requires the suspension to end
on the date he/she is no longer an inmate of a public
institution or one year form the date he/she becomes an
inmate of a public institution, whichever is sooner.
3.Requires county welfare departments to notify DHCS within
10 days of receiving information that an individual under
21 years of age on Medi-Cal in the county is or will be
an inmate of a public institution.
4.Prohibits the bill from creating a state-funded benefit
or program, and prohibits health care services under the
Medi-Cal program from being provided to inmates of public
institutions whose Medi-Cal benefits have been suspended.
5.Requires this bill to be implemented only if and to the
extent allowed by federal law, and only to the extent
that any necessary federal approvals are obtained. Make
this bill inoperable if it is in conflict with or does
not comply with federal law. Requires this bill be
implemented on January 1, 2010, or when all necessary
federal approvals are obtained, whichever is later.
6.Requires DHCS, by January 1, 2010 or when all necessary
federal approvals are obtained, in consultation with the
Chief Probation Officers of California and the County
Welfare Directors Association, to establish the protocols
and procedures necessary to implement this bill,
including any needed changes to the protocols and
procedures previously established to implement a
specified provision of existing law.
7.Requires DHCS to implement this bill by all-county
letters or similar instructions without taking regulatory
action. Thereafter, DHCS must implement this bill
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through regulation.
8.Limits the existing law requirement that county welfare
departments initiate a Medi-Cal application to only those
wards not already enrolled in the Medi-Cal program, when
a county has received information on a ward from a county
juvenile detention facility.
9.Requires county welfare departments to deny a minor's
Medi-Cal application in accordance with due process
requirements if the cooperation of the minor's parent or
guardian is necessary to complete the application, but
the minor's parent or guardian fails to cooperate in
completing the application.
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
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corrections officials.
DHCS View . In comments on AB 2004 (Yee), 2005-06 Session,
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
According to the Assembly Appropriations Committee:
1.Annual increased Medi-Cal costs of $250,000 (50% General
Fund [GF]) to $500,000 (50% GF) to provide 150 to 300
formerly incarcerated youth per month with two months of
Medi-Cal benefits immediately upon return to the
community, rather than youth having to reapply for
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benefits.
2.This estimate reflects updated information on caseload,
Medi-Cal eligibility, administrative savings, county
variability with respect to Medi-Cal termination, youth
disposition in terms of length of stay in placement, and
current law provisions codified by SB 1469 (Cedillo),
Chapter 657, Statutes of 2006.
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 the area would have
serious GF implications.
SUPPORT : (Verified 8/15/08)
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
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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.
ASSEMBLY FLOOR :
AYES: Aghazarian, Arambula, Beall, Berg, Brownley,
Caballero, Charles Calderon, Carter, Coto, Davis, De La
Torre, De Leon, DeSaulnier, Dymally, Eng, Evans, Feuer,
Fuentes, Furutani, Galgiani, Hancock, Hayashi, Hernandez,
Huffman, Jones, Karnette, Krekorian, Laird, Leno, Levine,
Lieber, Lieu, Ma, Mendoza, Mullin, Nava, Nunez, Parra,
Portantino, Price, Ruskin, Salas, Saldana, Solorio,
Swanson, Torrico, Wolk, Bass
NOES: Adams, Anderson, Benoit, Berryhill, Blakeslee, Cook,
DeVore, Duvall, Emmerson, Fuller, Gaines, Garcia,
Garrick, Horton, Houston, Huff, Jeffries, Keene, La
Malfa, Maze, Nakanishi, Niello, Plescia, Silva, Smyth,
Spitzer, Strickland, Tran, Villines, Walters
NO VOTE RECORDED: Sharon Runner, Soto
CTW:cm 8/16/08 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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