COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

June 14, 2007

BOARD MEETING DATE:

June 19, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John Maltbie, County Manager

SUBJECT:

County Manager’s Report #9

A.

Resolution in support of AB 423 (Beall), Health care coverage: mental health services

RECOMMENDATION:

Adopt a resolution in support of AB 423 (Beall), Health care coverage: mental health services.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 5—Residents have access to healthcare and preventative care.

BACKGROUND:

AB 423 would require health care service plans and health insurance policies to provide coverage for the diagnosis and medically necessary treatment of mental illnesses for an insured of any age. AB 423 would also define mental illness as a mental disorder defined in the Diagnostic and Statistical (DSM) IV.

Under existing law, health plans must provide coverage for the diagnosis and medically necessary treatment of severe and serious mental illness of a person of any age and of serious emotional disturbances of a child.

Similar legislation is pending in Congress—H.R. 1424 (Kennedy) and S. 558 (Domenici). Generally, these bills would require health insurance coverage to include mental health benefits similar to those provided for medical and surgical services. Financial requirements and limitations for mental health benefits could be no more restrictive than other benefits.

DISCUSSION:

A 2006 report to the Legislature highlighted a number of barriers that keep California from achieving greater mental health parity. The largest barrier is a lack of access. While there seems to be some understanding of what diagnoses are covered, the needed array and duration of services to be covered is unclear and varies from plan to plan. In addition, the report states there is confusion around what role health plans and health insurers play relative to the role of public agencies and their contracting organizations.

Proponents of AB 423 argue that there are many mental disorders not covered under current law. As a result, individuals with such mental illnesses must struggle to pay for care or receive no care at all. Some suffering with mental illnesses contact the criminal justice system due to the lack of appropriate care, which places pressure on the criminal justice system to provide mental health services. In other instances, the absence of adequate insurance for mental illness increases demand for publicly subsidized services.

Opponents note that federal efforts are pending and argue that AB 423 is premature and that should California act, such action should be consistent with federal law.

The Board approved a resolution in support of H.R. 1424.

FISCAL IMPACT:

Unknown.

B.

Resolution of support if amended regarding AB 508 (Swanson), Food stamps: eligibility: drug felonies

RECOMMENDATION:

Adopt a resolution in support if AB 508 (Swanson), Food stamps: eligibility: drug felonies is amended to preserve existing law that conditions receipt of food stamps on completion of, participation in, or placement on a waiting list for a treatment program or other evidence that the client no longer illegally uses controlled substances.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 8—Help vulnerable people achieve a better quality of life

BACKGROUND:

AB 508 would repeal all lifetime disqualifications from food stamps for persons convicted of a felony involving controlled substances.

As part of welfare reform efforts in 1996, federal law was changed to prohibit recipients of food stamps or other benefits funded by Temporary Assistance for Needy Families (TANF) from qualifying if they have been convicted of a felony related to controlled substances. However, federal law does include a provision allowing states to opt out of this prohibition.

There have been several efforts to modify California’s position on prohibiting convicted drug felons from receiving food stamps. The most recent modification to the prohibition occurred with AB 1796 (Leno, 2004), which exempted from the prohibition persons convicted of use or possession crimes if the person could provide proof of treatment or cessation of use.

Under current state law, persons convicted for transporting, selling, furnishing, manufacturing, possessing for sale controlled substances or other similar crimes are prohibited from receiving food stamps and TANF related benefits. Those convicted for possession or use are eligible to receive food stamps if they can prove completion of, participation in, or awaiting placement (on a waiting list) with a treatment program or if they can provide other evidence that they no longer illegally use controlled substances.

DISCUSSION:

Sponsored by the City of Oakland, AB 508 would opt out California from the prohibition, allowing, otherwise eligible, people convicted of drug-related felonies to receive food stamps. According to the Assembly Human Services Committee, 11 states (including New York, Oregon, Michigan and Oklahoma) and the District of Columbia have opted out entirely from the drug-conviction prohibition. Fourteen other states have partial opt-out provisions.

While there appears to be no formally stated basis for the inclusion of this prohibition in federal law, there was concern that public benefits, including food stamps, could be used in support of substance abuse. That is, there were concerns about using food stamps to purchase controlled substances rather than food. However, the implementation of the electronic benefit transfer (EBT), a debit-card-like system for recipients to use food stamps, has reduced the ability to abuse the food stamp program.

Critics of the lifetime ban note that permanently disqualifying a person due to a felony drug conviction ignores the basic needs of the individual. The prohibition is particularly awkward in instances when the conviction occurred in the distant past and the individual has no current substance abuse problem.

In addition, critics argue that denying food stamps to drug felons who have completed their sentences can run contrary to efforts to support prisoner reentry into society and efforts to reduce recidivism. Some critics note that this prohibition only impacts persons poor enough to quality for food stamps. Those who do not need government support are not subject to this penalty.

The Assembly Appropriations Committee estimates removing the prohibition will increase food stamp benefits by $1 million. These benefits are funded exclusively through federal funds.

FISCAL IMPACT:

Minor absorbable workload to serve the newly eligible applicants.

C.

Resolution in support of H.R. 1379 (Gutierrez), Citizenship Promotion Act of 2007

RECOMMENDATION:

Adopt a Resolution in support of H.R. 1379 (Gutierrez), Citizenship Promotion Act of 2007

VISION ALIGNMENT:

Commitment: Realize the potential of our diverse population

Goal(s): 1 Our diverse population works well together to build strong communities, effective government and a prosperous economy and 2—Civic engagement is uniformly high among the diverse population of San Mateo County.

BACKGROUND:

H.R. 1379 would prevent the United States Citizenship and Immigration Service (USCIS) from increasing the naturalization fee until it has reported to Congress the direct and indirect costs of providing relevant immigration services and the justification for a proposed fee increase. In turn, H.R. 1379 would appropriate the difference in funds between the amount of fees currently collected and the actual cost of providing services.

The bill would also prohibit the exclusive use of electronic filing of permanent residence or citizenship applications, generally require the Attorney General to complete background checks within 90 days and establish an $80 million citizenship promotion program intended to assist legal permanent residents in becoming citizens.

DISCUSSION:

USCIS proposed to increase the fee for citizenship applications from $330 to $595 to recover costs associated with the citizenship application process. Proponents of H.R. 1379 fear that such an increase could bar some people from applying, particularly the poor.

USCIS also proposed requiring all applications to be filed electronically. By prohibiting the department from requiring applicants to file electronic applications, H.R. 1379 recognizes that not all legal permanent residents have access to or the skills to access computers and the internet.

Congresswoman Eshoo is a co-sponsor of H.R. 1379.

FISCAL IMPACT:

None.