BILL NUMBER: AB 55 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Dymally
DECEMBER 4, 2006
An act to amend Section 14005.40 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 55, as introduced, Dymally. Medi-Cal: aged and disabled
individuals.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Services and under
which qualified low-income persons receive health care services.
Existing law requires the department, to the extent federal financial
participation is available, to exercise an option to implement a
program to provide specified medical assistance for aged and disabled
persons, as described in a specified provision of federal law. Under
existing law, an individual satisfies the financial eligibility
requirement of the program if, among other conditions, the individual'
s countable income does not exceed an income standard equal to 100%
of the applicable federal poverty level, plus specified additional
amounts for individuals and couples.
This bill would revise the applicable income standard for purposes
of this program, by increasing the percentage of the federal poverty
level to 133%, and by deleting the specified additional income
amounts. To the extent that it would expand eligibility for the
Medi-Cal program, this bill would impose a state-mandated local
program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14005.40 of the Welfare and Institutions Code
is amended to read:
14005.40. (a) To the extent federal financial participation is
available, the department shall exercise its option under Section
1902(a)(10)(A)(ii)(X) of the federal Social Security Act (42 U.S.C.
Sec. 1396a(a)(10)(A)(ii)(X), to implement a program for aged and
disabled persons as described in Section 1902(m) of the federal
Social Security Act (42 U.S.C. Sec. 1396a(m)(1)).
(b) To the extent federal financial participation is available,
the blind shall be included within the definition of disabled for the
purposes of the program established in this section.
(c) An individual shall satisfy the financial eligibility
requirement of this program if both of the following conditions are
met:
(1) Countable income, as determined in accordance with Section
1902(m) of the federal Social Security Act (42 U.S.C. Sec. 1396a(m)),
does not exceed an income standard equal to 100
133 percent of the applicable federal poverty level,
plus two hundred thirty dollars ($230) for an individual or,
in the case of a couple, three hundred ten dollars ($310),
provided that the income standard so determined shall not be less
than the SSI/SSP payment level for a disabled individual or, in the
case of a couple, the SSI/SSP payment level for a disabled couple.
(2) Countable resources, as determined in accordance with Section
1902(m) of the federal Social Security Act (42 U.S.C. Sec. 1396a(m)),
do not exceed the maximum levels established in that section.
(d) The financial eligibility requirements provided in
subdivisions (c) may be adjusted upwards to reflect the cost of
living in California, contingent upon appropriation in the annual
Budget Act.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of all-county
letters or similar instructions, and without taking regulatory
action. Thereafter, the department shall adopt regulations in
accordance with the requirements of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
(f) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec. 401
et seq.) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the federal
poverty level requires the department to modify the income standard
described in subdivision (c).
(g) (1) For purposes of this section the following definitions
apply:
(A) "SSI" means the federal Supplemental Security Income program
established under Title XVI of the federal Social Security Act.
(B) "Income standard" means the applicable income standard
including the augmentations specified in paragraph
(1) of subdivision (c).
(C) The board and care "personal care services" or "PCS" deduction
refers to an income disregard that is applied to a resident in a
licensed community care facility in lieu of the board and care
deduction (equal to the amount by which the basic board and care rate
exceeds the income standard in subparagraph (B), of paragraph (1) of
subdivision (g)) when the PCS deduction is greater than the board
and care deduction.
(2) (A) For purposes of this section, the SSI recipient retention
amount is the amount by which the SSI maximum payment amount to an
individual residing in a licensed community care facility exceeds the
maximum amount that the state allows community care facilities to
charge a resident who is an SSI recipient.
(B) For the purposes of this section, the personal and incidental
needs deduction for an individual residing in a licensed community
care facility is either of the following:
(i) If the board and care deduction is applicable to the
individual, the amount, not to exceed the amount by which the SSI
recipient retention amount exceeds twenty dollars ($20), nor to be
less than zero, by which the sum of the amount which the individual
pays to his or her licensed community care facility and the SSI
recipient retention amount exceed the sum of the individual's income
standard, the individual's board and care deduction, and twenty
dollars ($20).
(ii) If the PCS deduction specified in paragraph (1) of
subdivision (g) is applicable to the individual, an amount, not to
exceed the amount by which the SSI recipient retention amount exceeds
twenty dollars ($20), nor to be less than zero, by which the sum of
the amount which the individual pays to his or her community care
facility and the SSI recipient retention amount exceed the sum of the
individual's income standard, the individual's PCS deduction and
twenty dollars ($20).
(3) In determining the countable income under this section of an
individual residing in a licensed community care facility, the
individual shall have deducted from his or her income the amount
specified in subparagraph (B) of paragraph (2).
(h) No later than one month after the effective date of
subdivision (g), the department shall submit to the federal medicaid
administrator a state plan amendment seeking approval of the income
deduction specified in paragraph (3) of subdivision (g), and of
federal financial participation for the costs resulting from that
income deduction.
(i) The deduction prescribed by paragraph (3) of subdivision (g)
shall be applied no later than the first day of the fourth month
after the month in which the department receives approval for the
federal financial participation specified in subdivision (h). Until
approval for federal financial participation is received, there shall
be no deduction under paragraph (3) of subdivision (g).
SEC. 2. If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.