|Budget Issue:||Fund Medi-Cal Eligibility of Juvenile Offenders Mandate|
|Finding or Recommendation:||Appropriate $27,469 to fund prior year reimbursements related to the Medi-Cal Eligibility of Juvenile Offenders mandate.|
In 2006, the Legislature enacted Chapter 657, Statutes of 2006 (SB 1469, Cedillo) to require that the Medi-Cal application process for a juvenile in a county detention facility be initiated before the juvenile is released from custody so that eligibility can be established immediately upon release. In 2013, the Commission on State Mandates (CSM) determined that several activities carried out by county detention facilities and county welfare departments pursuant to Chapter 657 (collectively referred to as the Medi-Cal Eligibility of Juvenile Offenders mandate) are state-reimbursable mandates:
County detention facilities must provide information necessary to determine a juvenile’s Medi-Cal eligibility to county welfare departments and, for minors, provide notice the juvenile’s parents that an application for Medi-Cal has been initiated.
Upon receiving information from the county detention facility, county welfare departments must initiate an application for Medi-Cal on behalf of the juvenile and, for minors, contact the juvenile’s parents to arrange for completion of the application. If eligible, the county welfare department must provide the juvenile with sufficient documentation to enable him or her to obtain medical care upon release.
In early 2015, the CSM approved a statewide cost estimate of prior year state reimbursement costs related to the Medi-Cal Eligibility of Juvenile Offenders mandate totaling $27,469.
The Governor proposes to suspend the Medi-Cal Eligibility of Juvenile Offenders mandate in 2015-16. Suspending the mandate would make local compliance with its requirements optional in 2015-16. Suspension also would allow the state to defer payment on $27,469 of prior year costs related to the mandate.
Mandate Helps Ensure Continuity of Care for Juveniles. It is the state’s policy to provide health care coverage to low-income children through the Medi-Cal Program, thereby giving them access to a broad array of health services at little or no cost to themselves or their families. The mandate requirements help to ensure that qualified low-income children will have access to health services immediately upon release from county detention facilities by beginning the Medi-Cal enrollment process while these children are still in the detention facility. This mandate helps promote better health outcomes for these children by facilitating continuity of care.
For juveniles receiving treatment for a medical condition while in a county detention facility, maintaining access to medical care, so that they can continue to receive treatment upon release, may be critical to ensuring their ongoing health and welfare. For example, a juvenile inside a detention facility who is taking prescription drugs to treat a medical condition could decompensate upon release from the detention facility if unable to continue to obtain and take these prescription drugs. Such disruptions to a child’s care can result in episodes of care, such as emergency room visits, that are costly (potentially costing thousands or even tens of thousands of dollars in state funds per episode) and avoidable.
Maintaining Coverage Can Reduce State Criminal Justice System Costs. Research suggests that juvenile offenders who are enrolled in Medi-Cal prior to their release may be less likely to reoffend. This is because such offenders are more likely to access services, such as mental health treatment, that can help them be successful in the community. Offenders who commit new crimes following their release can create significant costs for the state, as they may serve their sentence in a state correctional facility. For example, the average cost of housing a ward in the state Division of Juvenile Justice is $246,000 per year. Given the relatively high potential state cost of housing these individuals if they reoffend, and the apparently low cost of the Medi-Cal Eligibility of Juvenile Offenders mandate, it appears likely that maintaining the mandate would result in net state correctional savings.
For the reasons outlined above, we generally find that the Medi-Cal Eligibility of Juvenile Offenders mandate is good public policy and, furthermore, could result in potentially significant net savings to the state and counties. We, therefore, recommend the Legislature reject the Governor’s proposal to suspend the mandate and instead appropriate $27,469 in the 2015-16 budget to fund prior year costs related this mandate.