Today's Law As Amended


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AB-2119 Foster care: gender affirming health care and mental health care.(2017-2018)



As Amends the Law Today
As Amends the Law on Nov 08, 2018


SECTION 1.
 The Legislature hereby finds and declares all of the following:
(a) It is the intent of the Legislature to ensure the health and well-being of all foster children and nonminor dependents, including those who are transgender or gender nonconforming (TGNC).
(b) When their families, schools, and communities support and nurture their developing identities, TGNC children, like all children, thrive and succeed.
(c) TGNC children and adolescents who experience rejection and mistreatment based on their gender identity or expression are at significantly elevated risk for negative health outcomes, school dropout or exclusion, homelessness, and involvement in foster care and juvenile justice systems.
(d) Based, in part, on family rejection and societal bias, TGNC children and adolescents experience worse outcomes than their nontransgender peers and are significantly overrepresented in California’s child welfare system.
(e) TGNC foster children and nonminor dependents need accurate and timely information related to gender identity and expression, and access to gender affirming medical and behavioral health care.
(f) TGNC foster children and nonminor dependents are at additional risk of harm because unclear policies and a shortage of knowledgeable gender affirming providers create barriers to accessing medically necessary care.
(g) Foster youth who are 12 years of age or older have established rights to privately seek and consent to outpatient mental health counseling and treatment, including pursuant to Section 6924 of the Family Code and Section 124260 of the Health and Safety Code.
(h) Depending on a foster youth’s custody situation, a foster youth’s parent, social worker, licensed caregiver, judge, or the youth may give consent for the foster youth’s medical, surgical, dental, or other remedial care.
(i) Nonminor dependents give consent for their own medical, surgical, dental, and other health care.
(j) The Insurance Gender Nondiscrimination Act, pursuant to Section 1365.5 of the Health and Safety Code and Section 10140 of the Insurance Code, prohibits health plans from discriminating against individuals because of a person’s sex, gender, gender identity, or gender expression.
(k) It is the role of the child welfare agency, within the parameters set forth in Section 369 of the Welfare and Institutions Code, to support dependent children’s ability to access medically necessary care, including gender affirming health care and gender affirming behavioral health services.
All children in foster care, as well as former foster youth up to 26 years of age, are entitled to Medi-Cal coverage without cost share or income or resource limits. The Medi-Cal program provides transition-related health care services when those services are determined to be medically necessary.

SEC. 2.

 Section 16001.9 of the Welfare and Institutions Code is amended to read:

16001.9.
 (a) All children placed in foster care, either voluntarily or after being adjudged a ward or dependent of the juvenile court pursuant to Section 300, 601, or 602, It is the policy of the state that all minors and nonminors in foster care  shall have the rights specified in this section. These rights also apply to nonminor dependents in foster care, except when they conflict with nonminor dependents’ retention of all their legal decisionmaking authority as an adult. The rights are as follows: following rights: 
(1) To live in a safe, healthy, and comfortable home where they are  he or she is  treated with respect. If the child is an Indian child, to live in a home that upholds the prevailing social and cultural standards of the child’s Indian community, including, but not limited to, family, social, and political ties. 
(2) To be free from physical, sexual, emotional, or other abuse, corporal punishment, and exploitation. or corporal punishment. 
(3) To receive adequate and healthy food, adequate clothing, grooming and hygiene products, and an age-appropriate allowance. Clothing and grooming and hygiene products shall respect the child’s culture, ethnicity, and gender identity and expression. and, for youth in group homes, an allowance. 
(4) To be placed in the least restrictive setting possible, regardless of age, physical health, mental health, sexual orientation, and gender identity and expression, juvenile court record, or status as a pregnant or parenting youth, unless a court orders otherwise. receive medical, dental, vision, and mental health services. 
(5) To be placed with a relative or nonrelative extended family member if an appropriate and willing individual is available. free of the administration of medication or chemical substances, unless authorized by a physician. 
(6) To not be locked in any portion of their foster care placement, unless placed in a community treatment facility.
(7) To have a placement that utilizes trauma-informed and evidence-based deescalation and intervention techniques, to have law enforcement intervention requested only when there is an imminent threat to the life or safety of a child or another person or as a last resort after other diversion and deescalation techniques have been utilized, and to not have law enforcement intervention used as a threat or in retaliation against the child.
(8) To not be detained in a juvenile detention facility based on their status as a dependent of the juvenile court or the child welfare services department’s inability to provide a foster care placement. If they are detained, to have all the rights afforded under the United States Constitution, the California Constitution, and all applicable state and federal laws.
(9) To have storage space for private use.
(10) To be free from unreasonable searches of personal belongings.
(11) (6)  To be provided the names and contact information for social workers, probation officers, attorneys, service providers,  contact family members, unless prohibited by court order, and social workers, attorneys,  foster youth advocates and supporters, Court Appointed Special Advocates (CASAs), and education rights holder if other than the parent or parents, and when applicable, representatives designated by the child’s Indian tribe to participate in the juvenile court proceeding, and to communicate with these individuals privately. probation officers. 
(12) (7)  To visit and contact siblings, family members, and relatives privately,  brothers and sisters,  unless prohibited by court order, and to ask the court for visitation with the child’s siblings. order. 
(8) To contact the Community Care Licensing Division of the State Department of Social Services or the State Foster Care Ombudsperson regarding violations of rights, to speak to representatives of these offices confidentially, and to be free from threats or punishment for making complaints.
(13) (9)  To make, send,  make  and receive confidential telephone calls and other electronic communications, and to  send and receive unopened mail, unless prohibited by court order.
(10) To attend religious services and activities of his or her choice.
(11) To maintain an emancipation bank account and manage personal income, consistent with the child’s age and developmental level, unless prohibited by the case plan.
(12) To not be locked in a room, building, or facility premises, unless placed in a community treatment facility.
(13) To attend school and participate in extracurricular, cultural, and personal enrichment activities, consistent with the child’s age and developmental level, with minimal disruptions to school attendance and educational stability.
(14) To work and develop job skills at an age-appropriate level, consistent with state law.
(14) (15)  To have social contacts with people outside of the foster care system, including, but not limited to, teachers, coaches, religious or spiritual community  including teachers, church  members, mentors, and friends. If the child is an Indian child, to have the right to have contact with tribal members and members of their Indian community consistent with the prevailing social and cultural conditions and way of life of the Indian child’s tribe. 
(16) To attend Independent Living Program classes and activities if he or she meets the age requirements.
(17) To attend court hearings and speak to the judge.
(18) To have storage space for private use.
(15) (19)  To attend religious services, activities, and ceremonies of the child’s choice, including, but  be involved in the development of his or her own case plan and plan for permanent placement. This involvement includes, but is  not limited to, engaging in traditional Native American religious practices. the development of case plan elements related to placement and gender affirming health care, with consideration of their gender identity. 
(16) (20)  To participate in extracurricular, cultural, racial, ethnic, personal enrichment, and social activities, including, but not limited to, access to computer technology and the internet, consistent with the child’s age, maturity, developmental level, sexual orientation, and gender identity and expression. review his or her own case plan and plan for permanent placement, if he or she is 12 years of age or older and in a permanent placement, and to receive information about his or her out-of-home placement and case plan, including being told of changes to the plan. 
(21) To be free from unreasonable searches of personal belongings.
(22) To the confidentiality of all juvenile court records consistent with existing law.
(17) (23)  To have fair and equal access to all available services, placement, care, treatment, and benefits, and to not be subjected to discrimination or harassment on the basis of actual or perceived race, ethnic group identification, ancestry, national origin, color, religion, sex, sexual orientation, gender identity and expression,  identity,  mental or physical disability, or HIV status.
(18) To have caregivers, child welfare and probation personnel, and legal counsel who have received instruction on cultural competency and sensitivity relating to sexual orientation, gender identity and expression, and best practices for providing adequate care to lesbian, gay, bisexual, and transgender children in out-of-home care.
(19) (24)  To be placed in out-of-home care according to their gender identity, regardless of the gender or sex listed in their court, child welfare, medical, or vital records, to be referred to by the child’s preferred name and gender pronoun, and to maintain privacy regarding sexual orientation and gender identity and expression, unless the child permits the information to be disclosed, or disclosure is required to protect their health and safety, or disclosure is compelled by law or a court order. court or child welfare records. 
(20) (25)  To have caregivers and  child welfare and probation personnel and legal counsel  personnel  who have received instruction on the federal Indian Child Welfare Act of 1978 (25 U.S.C. Sec. 1901 et seq.) and on  cultural competency and sensitivity relating to, and best practices for, providing adequate care to Indian children  lesbian, gay, bisexual, and transgender youth  in out-of-home care.
(21) To have recognition of the child’s political affiliation with an Indian tribe or Alaskan village, including a determination of the child’s membership or citizenship in an Indian tribe or Alaskan village; to receive assistance in becoming a member of an Indian tribe or Alaskan village in which the child is eligible for membership or citizenship; to receive all benefits and privileges that flow from membership or citizenship in an Indian tribe or Alaskan village; and to be free from discrimination based on the child’s political affiliation with an Indian tribe or Alaskan village.
(22) (A) To access and receive medical, dental, vision, mental health, and substance use disorder services, and reproductive and sexual health care, with reasonable promptness that meets the needs of the child, to have diagnoses and services explained in an understandable manner, and to participate in decisions regarding health care treatment and services. This right includes covered gender affirming health care and gender affirming mental health care, and is subject to existing laws governing consent to health care for minors and nonminors and does not limit, add, or otherwise affect applicable laws governing consent to health care.
(B) To view and receive a copy of their medical records to the extent they have the right to consent to the treatment provided in the medical record and at no cost to the child until they are 26 years of age.
(23) Except in an emergency, to be free of the administration of medication or chemical substances, and to be free of all psychotropic medications unless prescribed by a physician, and in the case of children, authorized by a judge, without consequences or retaliation. The child has the right to consult with and be represented by counsel in opposing a request for the administration of psychotropic medication and to provide input to the court about the request to authorize medication. The child also has the right to report to the court the positive and adverse effects of the medication and to request that the court reconsider, revoke, or modify the authorization at any time.
(24) (A) To have access to age-appropriate, medically accurate information about reproductive health care, the prevention of unplanned pregnancy, and the prevention and treatment of sexually transmitted infections.
(B) At any age, to consent to or decline services regarding contraception, pregnancy care, and perinatal care, including, but not limited to, abortion services and health care services for sexual assault without the knowledge or consent of any adult.
(C) At 12 years of age or older, to consent to or decline health care services to prevent, test for, or treat sexually transmitted diseases, including HIV, and mental health services, without the consent or knowledge of any adult.
(25) At 12 years of age or older, to choose, whenever feasible and in accordance with applicable law, their own health care provider for medical, dental, vision, mental health, substance use disorder services, and sexual and reproductive health care, if payment for the service is authorized under applicable federal Medicaid law or other approved insurance, and to communicate with that health care provider regarding any treatment concerns or needs and to request a second opinion before being required to undergo invasive medical, dental, or psychiatric treatment.
(26) To confidentiality of medical and mental health records, including, but not limited to, HIV status, substance use disorder history and treatment, and sexual and reproductive health care, consistent with existing law.
(27) To attend school, to remain in the child’s school of origin, to immediate enrollment upon a change of school, to partial credits for any coursework completed, and to priority enrollment in preschool, afterschool programs, a California State University, and each community college district, and to receive all other necessary educational supports and benefits, as described in the Education Code.
(28) (26)  To  At 16 years of age or older, to  have access to existing information regarding the educational options available, including, but not limited to, the coursework necessary for career, technical,  vocational  and postsecondary educational programs, and information regarding financial aid for postsecondary education, and specialized programs for current and former foster children available at the University of California, the California State University, and the California Community Colleges. education. 
(29) To attend Independent Living Program classes and activities, if the child meets the age requirements, and to not be prevented by caregivers from attending as a consequence or punishment.
(30) To maintain a bank account and manage personal income, consistent with the child’s age and developmental level, unless prohibited by the case plan.
(31) To work and develop job skills at an age-appropriate level, consistent with state law.
(32) For children 14 to 17 years of age, inclusive, to receive a consumer credit report provided to the child by the social worker or probation officer on an annual basis from each of the three major credit reporting agencies, and to receive assistance with interpreting and resolving any inaccuracies.
(33) To be represented by an attorney in juvenile court; to have an attorney appointed to advise the court of the child’s wishes, to advocate for the child’s protection, safety, and well-being, and to investigate and report to the court on legal interests beyond the scope of the juvenile proceeding; to speak to the attorney confidentially; and to request a hearing if the child feels their appointed counsel is not acting in their best interest or adequately representing their legal interests.
(34) To receive a notice of court hearings, to attend court hearings, to speak to the judge, to view and receive a copy of the court file, subject to existing federal and state confidentiality laws, and to object to or request the presence of interested persons during court hearings. If the child is an Indian child, to have a representative designated by the child’s Indian tribe be in attendance during hearings.
(35) To the confidentiality of all juvenile court records consistent with existing law.
(36) To view and receive a copy of their child welfare records, juvenile court records, and educational records at no cost to the child until the child is 26 years of age, subject to existing federal and state confidentiality laws.
(37) To be involved in the development of their own case plan, including placement decisions, and plan for permanency. This involvement includes, but is not limited to, the development of case plan elements related to placement and gender affirming health care, with consideration of the child’s gender identity. If the child is an Indian child, the case plan shall include protecting the essential tribal relations and best interests of the Indian child by assisting the child in establishing, developing, and maintaining political, cultural, and social relationships with the child’s Indian tribe and Indian community.
(38) To review the child’s own case plan and plan for permanent placement if the child is 10 years of age or older, and to receive information about their out-of-home placement and case plan, including being told of changes to the plan.
(39) To request and participate in a child and family team meeting, as follows:
(A) Within 60 days of entering foster care, and every 6 months thereafter.
(B) If placed in a short-term residential therapeutic program, or receiving intensive home-based services or intensive case coordination, or receiving therapeutic foster care services, to have a child and family team meeting at least every 90 days.
(C) To request additional child and family team meetings to address concerns, including, but not limited to, placement disruption, change in service needs, addressing barriers to sibling or family visits, and addressing difficulties in coordinating services.
(D) To have both informal and formal support people participate, consistent with state law.
(40) (27)  To be informed of these rights in an age and developmentally appropriate manner by the social worker or probation officer and to be provided a copy of the rights in this section at the time of placement, any placement change, and at least once every six months or at the time of a regularly scheduled contact with the social worker or probation officer. have access to age-appropriate, medically accurate information about reproductive health care, the prevention of unplanned pregnancy, and the prevention and treatment of sexually transmitted infections at 12 years of age or older. 
(41) To be provided with contact information for the Community Care Licensing Division of the State Department of Social Services, the tribal authority approving a tribally approved home, and the State Foster Care Ombudsperson, at the time of each placement, and to contact any or all of these offices immediately upon request regarding violations of rights, to speak to representatives of these offices confidentially, and to be free from threats or punishment for making complaints.
(b) The rights described in this section are broad expressions of the rights of children in foster care and are not exhaustive of all rights set forth in the United States Constitution and the California Constitution, federal and California statutes, and case law.
(c) (b)  This section does not require, require  and shall not be interpreted to require, require  a foster care provider to take any action that would impair the health and safety of children in out-of-home placement.
(d) (c)  The State Department of Social Services and each county welfare department are encouraged to work with the Student Aid Commission, the University of California, the California State University, and the California Community Colleges to receive information pursuant to paragraph (28) (26)  of subdivision (a).

SEC. 3.

 Section 16010.2 of the Welfare and Institutions Code is amended to read:

16010.2.
 (a) The department, in consultation with pediatricians, other health care experts, including public health nurses, and experts in and recipients of child welfare services, including parents, shall develop a plan for the ongoing oversight and coordination of health care services for a child in a foster care placement. The plan shall ensure a coordinated strategy to identify and respond to the health care needs of foster children, including mental health and dental needs, consistent with Section 205 of the federal Fostering Connections to Success and Increasing Adoptions Act of 2008 (Public Law 110-351).
(b) (1) The right of minors and nonminors in foster care to health care and mental health care described in paragraph (4) of subdivision (a) of Section 16001.9 includes covered gender affirming health care and gender affirming mental health care. This right is subject to existing laws governing consent to health care for minors and nonminors and does not limit, add, or otherwise affect applicable laws governing consent to health care.
(2) The department shall, in consultation with the State Department of Health Care Services and other stakeholders, develop guidance and describe best practices to identify, coordinate, and support foster youth seeking access to gender affirming health care and gender affirming mental health care and shall incorporate current guidance on ensuring access to Medi-Cal services for transgender beneficiaries. This consultation may be incorporated into existing departmental workgroups focused on foster youth rights or on foster youth sexual orientation, gender identity, and gender expression. The department shall issue written guidance by January 1, 2020.
(3) For purposes of this section, the following definitions apply:
(A) “Gender affirming health care” means medically necessary health care that respects the gender identity of the patient, as experienced and defined by the patient, and may include, but is not limited to, the following:
(i) Interventions to suppress the development of endogenous secondary sex characteristics.
(ii) Interventions to align the patient’s appearance or physical body with the patient’s gender identity.
(iii) Interventions to alleviate symptoms of clinically significant distress resulting from gender dysphoria, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
(B) “Gender affirming mental health care” means mental health care or behavioral health care that respects the gender identity of the patient, as experienced and defined by the patient, and may include, but is not limited to, developmentally appropriate exploration and integration of identity, reduction of distress, adaptive coping, and strategies to increase family acceptance.