BILL NUMBER: AB 1113 AMENDED BILL TEXT AMENDED IN SENATE JULY 18, 2007 AMENDED IN ASSEMBLY APRIL 24, 2007 AMENDED IN ASSEMBLY APRIL 12, 2007 INTRODUCED BY Assembly Member Brownley (Principal coauthor: Senator Migden) FEBRUARY 23, 2007 An act to amend Section 14007.9 of the Welfare and Institutions Code, and to amend Section 1 of Chapter 1088 of the Statutes of 2002, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST AB 1113, as amended, Brownley. Medi-Cal: eligibility. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is partially governed and funded by federal Medicaid provisions. Existing law, until September 1, 2008, and subject to the receipt of federal financial participation, requires the department to adopt a federal option under which any employed individual with a disability who meets specified income and resource requirements, shall be eligible for benefits under the Medi-Cal program, subject to the payment of premiums. These provisions are repealed on January 1, 2009. This bill would delete the inoperative and repeal dates of these provisions and thereby would extend their operation indefinitely. This bill would provide for additional resource exemptions in determining Medi-Cal eligibility under this program. It would also apply this program to individuals who would be eligible for Medi-Cal under these provisions but who are temporarily not working, for an eligibility period for up to 18 months. Because counties are required to make Medi-Cal eligibility determinations and this bill would extend the expansion of Medi-Cal eligibility, the 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 1 of Chapter 1088 of the Statutes of 2002 is amended to read: Section 1. The Legislature finds and declares all of the following: (a) Historically, federal programs for adults with disabilities have encouraged dependency on income supports and have created barriers to employment and economic self-sufficiency. Even in strong economic times, adults with disabilities have had limited options and faced major barriers to achieve economic self-sufficiency, resulting in prolonged reliance upon public assistance programs and an unacceptably high unemployment rates statewide. (b) Federal laws enacted during the 1990s offered significant public policies and fiscal incentives designed to assist states to restructure workforce development programs into integrated workforce investment systems that will respond to the employment, training, and education needs of its citizens. (c) Since 1998, employment-focused reforms for adults with disabilities in the workforce have been enacted into Medicare, Medicaid, the Supplemental Security Income
Program(SSI) Program , the Social Security Disability Insurance Program(SSDI) Program , and with respect to programs administered by the United States Department of Labor, and the United States Department of Education. (d) The federal Workforce Investment Act of 1998 (WIA) (Public Law 105-220) redesigned major federal public employment programs and included a requirement that services for employers and employees be centered in accessible, community-based one-stop centers. (e) The federal Ticket to Work and Work Incentives Improvement Act of 1999, (Public Law 106-170) increased opportunities for states to remove and minimize barriers to employment for people with disabilities by improving access to health care coverage available under Medicare and Medicaid. (f) Beginning February 1, 2002, the Social SecurityTicket to Work program(TTW) program began a state-by-state phase-in period nationally, allowing SSI and SSDI beneficiaries to receive a "ticket" from the Social Security Administration that can be assigned for employment services to a wider pool of rehabilitation, employment, or other employment support service providers. The Ticket to Work program(TTW) program is scheduled for implementation in California in July 2003. (g) The programs and consumer options provided under Public Law 106-170 are based upon public policies that respect the rights of consumers to control decisions related to health care, rehabilitation, and employment within the framework of independent living principles and guidelines that include, but are not limited to, providing consumers of these services with an array of choices to promote independence and financial stability. (h) California took a significant step forward in removing barriers to work for Californians with disabilities when it enacted Chapter 820 of the Statutes of 1999 (Assembly Bill 155, introduced by Assembly Member Migden, which has been referred to as the "250% California Working Disabled Program" or "CWD") under which any employed individual who is disabled and whose countable income, as determined pursuant to Section 14007.9 of the Welfare and Institutions Code, does not exceed 250 percent of the federal poverty level shall be eligible for Medi-Cal benefits, subject to the payment of sliding-scale premiums set by the State Department of Health Services. Two years after its implementation, CWD programProgram enrollment is just above 500, which is significantly below budgeted projections. (i) California received a "Medicaid Infrastructure Grant" (MIG) that is expected to continue for a second year, and that allows the State Department of Health Services to administer the California Health Incentive Improvement Project with the assistance of a project steering committee in order to bolster the state's efforts to conduct outreach, research, and analysis related to the implementation of Chapter 820 of the Statutes of 1999. (j) California will have the opportunity to coordinate its activities with privately funded initiatives to identify potential cost savings that could be achieved if California adopted additional policies available to the state through the federal Balanced Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act of 1999 , including, but not limited to, raising the income standard, changing rules related to disregarding or exempting resources, providing adjustments to the amount of premiums paid on a sliding scale, including adjustments based on the amount paid for other health insurance, and providing an allowance for coverage for up to 18 months in the case of loss of employment. (k) The California Governor's Committee on Employment of Disabled Persons, through its staff and volunteers, promotes in the private and public sectors understanding and information on employment supports and benefits for people with disabilities who transition from benefits as the sole source of income to gainful employment. (l) The state's experience with enrollment in the Medi-Cal 250% California Working Disabled Program, or CWD Program , pursuant to Section 14007.9 of the Welfare and Institutions Code, continues in 2007 not to meet expectations of any of the parties. Therefore, additional steps need to be taken to remove barriers to improve the quality of life for participants enrolled in the program, a major purpose of the changes proposed by the act adding this subdivision. SEC. 2. Section 14007.9 of the Welfare and Institutions Code is amended to read: 14007.9. (a) The department shall adopt the option made available under Section 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(ii)(XIII). In order to be eligible for benefits under this section, an individual shall be required to meet all of the following requirements: (1) His or her net countable income is less than 250 percent of the federal poverty level for one person. As authorized by Section 1902(r)1902(r)(2) of the federal Social Security Act (42 U.S.C. Sec.1396a(r))Sec. 1396a(r)(2)) , the income of a spouse shall be disregarded when determining eligibility or the amount of the premium. (2) He or she is disabled under Title II of the federal Social Security Act (Subch. 2 (commencing with Sec. 401), Ch. 7, Title 42 U.S.C.), Title XVI of the federal Social Security Act (Subch. 16 (commencing with Sec. 1381), Ch. 7, Title 42, U.S.C.), or Section 1902(v) of the federal Social Security Act (42 U.S.C. Sec. 1396a(v)). An individual shall be determined to be eligible under this section without regard to his or her ability to engage in, or actual engagement in, substantial gainful activity, as defined in Section 223(d)(4) of the federal Social Security Act (42 U.S.C. Sec. 423(d)(4)). (3) Except as otherwise provided in this section, his or her net nonexempt resources, which shall be determined in accordance with the methodology used under Title XVI of the federal Social Security Act (42 U.S.C. Sec. 1381 et seq.), are not in excess of the limits provided for under those provisions. (b) (1) Countable income shall be determined under Section 1612 of the federal Social Security Act (42 U.S.C. Sec. 1382a), except that spousal income, as provided in paragraph (1) of subdivision (a), and the individual's disability income, including all federal and state disability benefits and private disability insurance, shall be exempted. Resources excluded under Section 1613 of the federal Social Security Act (42 U.S.C. Sec. 1382b) shall be disregarded. (2) Resources in the form of employer or individual retirement arrangements authorized under the Internal Revenue Code shall be exempted as authorized by Section 1902(r) of the federal Social Security Act (42 U.S.C. Sec. 1396a(r)). (3) Resources that are above the limits referenced in paragraph (3) of subdivision (a), but that were accumulated while the individual was working and qualified for Medi-Cal under this section, shall be exempted as authorized by Section 1902(r) of the federal Social Security Act (42 U.S.C. Sec. 1396a(r)). (4) Spousal resources up to the amount allowed in California under the spousal impoverishment cap of the Medicare Catastrophic Coverage Act, Section 1924 of the federal Social Security Act (42 U.S.C. Sec. 1396r-5) shall be exempted as authorized by Section 1902 (r) of the federal Social Security Act (42 U.S.C. Sec. 1396a(r)). (c) Retirement income received by individuals at and after 65 years of age shall be exempt for those individuals who qualified for Medi-Cal under this section before 65 years of age. (d) (1) Individuals otherwise eligible under this section but who are temporarily not working may elect to remain on Medi-Cal under this section for up to 18 months, provided the individuals continue to pay premiums during the temporary nonworking period. (2) Resources that were exempt under this section shall continue to be exempt under any other Medi-Cal program where eligibility is based on age, blindness, or disability. (e) Medi-Cal benefits provided under this chapter pursuant to this section shall be available in the same amount, duration, and scope as those benefits are available for persons who are eligible for Medi-Cal benefits as categorically needy persons and as specified in Section 14007.5. (f) Individuals eligible for Medi-Cal benefits under this section shall be subject to the payment of premiums determined under this subdivision. The department shall establish sliding-scale premiums that are based on countable income, with a minimum premium of twenty dollars ($20) per month and a maximum premium of two hundred fifty dollars ($250) per month, and shall, by regulations, annually adjust the premiums. Prior to adjustment of any premiums pursuant to this subdivision, the department shall submit a report of proposed premium adjustments to the appropriate committees of the Legislature as part of the annual budget act process. (g) The department shall adopt regulations specifying the process for discontinuance of eligibility under this section for nonpayment of premiums for more than two months by a beneficiary. (h) In order to implement the collection of premiums under this section, the department may develop and execute a contract with a public or private entity to collect premiums, or may amend any existing or future premium-collection contract that it has executed. Notwithstanding any other provision of law, any contract developed and executed or amended pursuant to this subdivision is exempt from the approval of the Director of General Services and from the Public Contract Code. (i) Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement, without taking any regulatory action, this section by means of an all-county letter or similar instruction. 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. (j) Notwithstanding any other provision of law, this section shall be implemented only if, and to the extent that, the department determines that federal financial participation is available pursuant to Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.). SEC. 3. 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.