BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 1466 (Mitchell) - Early and Periodic Screening, Diagnosis, and Treatment Program: trauma screening ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 14, 2016 |Policy Vote: HEALTH 9 - 0, | | | HUMAN S. 5 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 23, 2016 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 1466 would require additional screening for trauma in Medi-Cal eligible children. The bill would require Medi-Cal eligible children who are found to have experienced trauma and children who have been abused, neglected, or removed from the home to be referred to county mental health plans for assessment for specialty mental health services. Fiscal Impact: Increased costs in the low millions per year for additional screening provided to Medi-Cal eligible children (General Fund and federal funds). Under current federal and state law, children enrolled in Medi-Cal are eligible for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. This benefit covers screening for both physical and mental health issues. By specifically requiring screening for trauma, the bill is likely to increase the costs to provide screening services due to additional time spent by providers with SB 1466 (Mitchell) Page 1 of ? eligible children. It is not clear to what extent children are already being screened for trauma. It is likely that the specific requirement in the bill will lead to increased focus on trauma during screening. For example, if the cost to provide trauma screening increased the overall cost of screening under EPSDT by 5%, the cost would be about $2 million per year. Increased costs in the high hundreds of millions per year to provide assessments for specialty mental health services by county mental health plans (General Fund and federal funds). The bill would require all children that are found to have experienced trauma through an EPSDT screening and all children who have been abused, neglected, or removed from the home to be assessed by a county mental health plan for specialty mental health services. There are about 6.5 million children in Med-Cal who are eligible for EPSDT. The number of children who would are abused, neglected, or removed from the home is likely to be about 100,000 per year. The cost to provide an assessment for specialty mental health services is around $500. Assuming that 25% of children in Medi-Cal have experienced trauma, the cost to provide assessments for specialty mental health services would be about $750 million per year. Likely increase in specialty mental health services in the hundreds of millions per year (General Fund and federal funds). Given the very large number of children that are likely to be assessed for specialty mental health services and the currently low rate of utilization of specialty mental health services by Medi-Cal eligible children, it is likely that the requirement for additional assessments in the bill will result in a significant number of children receiving specialty mental health services who are not currently receiving them. Currently, 4.4% of children receive specialty mental health services, at an average annual costs of $6,000. If 5% of the children newly assessed for services under the bill were found to be eligible for specialty mental health services, the cost would be about $500 million per year. Background: Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. SB 1466 (Mitchell) Page 2 of ? Medi-Cal provides coverage to childless adults and parents with household income up to 138% of the federal poverty level and to children with household income up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary. Federal law requires the state to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) to all Medi-Cal eligible children. EPSDT provides comprehensive preventative, diagnostic, and treatment services for Medi-Cal beneficiaries under age 21. The state is required to provide any services determined to be medically necessary to correct or ameliorate any physical or behavioral health condition. Under current law, the provision of mental health services to Medi-Cal beneficiaries is divided between services for mild to moderate mental illness and services for severe mental illness. Mental health services for mild to moderate mental illness are provided by Medi-Cal managed care plans (for most beneficiaries) or Medi-Cal fee-for-service providers. Mental health services for severe mental illness are provided by county mental health plans. Proposed Law: SB 1466 would require additional screening for trauma in Medi-Cal eligible children. The bill would require Medi-Cal eligible children who are found to have experienced trauma and children who have been abused, neglected, or removed from the home to be referred to county mental health plans for assessment for specialty mental health services. Specific provisions of the bill would: Require screening services provided under EPSDT to include screening for trauma at all screenings; Require a child found to have experienced trauma through the screening process to be referred to the county mental health plan for assessment for specialty mental health services; Require a child who is abused, neglected, or removed from the home to be assessed by the county mental health plan for specialty mental health services; SB 1466 (Mitchell) Page 3 of ? Require a child who is found to have experienced trauma during screening to be assessed by the county mental health plan for specialty mental health services; If a child is determined not to be eligible for specialty mental health services, require the child to be referred for other necessary health care under the Medi-Cal program; Define trauma for the purposes of the bill. Related Legislation: SB 1291 (Beall) would require county mental health plans to submit an annual foster care mental health service plan to the Department of Health Care Services. The bill would require county mental health plans to be reviewed by an external quality review organization with specified requirements. The bill would require the Department to conduct annual audits of county mental health plans to assess the provision of services to foster youth. That bill is pending on this committee's Suspense File. Staff Comments: According to research compiled by the National Center for Children in Poverty, between 25% and 90% of children experience events that leave them traumatized. Children involved in the child welfare system, children involved in the juvenile justice system, and children who live in neighborhoods with high violent crime rates all have high levels of trauma. Under current law, both EPSDT and specialty mental health have been realigned to the counties. Generally, this require counties to provide the non-federal share of program costs using realignment funds. However, Proposition 30 of 2012 provides that any legislation enacted after September 30, 2012 that has an overall effect of increasing the costs already borne by a local agency for realigned services applies to local agencies only to the extent that the State provides annual funding for the cost increase. Therefore, any additional costs experienced by the counties due to increased EPSDT screening, assessments for specialty mental health services, or provision of specialty mental health services under the bill would be a state responsibility. SB 1466 (Mitchell) Page 4 of ? -- END --