BILL NUMBER: AB 1269 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Brownley
FEBRUARY 27, 2009
An act to amend Section 14007.9 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1269, as introduced, 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, 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.
This bill would authorize individuals who are otherwise eligible
under this program but who are temporarily unemployed to elect to
remain on Medi-Cal pursuant to these provisions for a period up to 26
weeks, as provided. This bill would also provide additional resource
exemptions in determining Medi-Cal eligibility under these
provisions. The bill would extend specified resource exemptions to
apply for the beneficiary under any other Medi-Cal program under
which the beneficiary later becomes eligible for medical assistance
where that eligibility is based on age, blindness, or disability.
Existing law requires individuals who are eligible for Medi-Cal
benefits pursuant to these provisions to be subject to premiums that
are determined by a sliding scale that is based on countable income,
as provided.
This bill, not later than March 1, 2010, would, instead, require
each individual to pay a monthly premium that is equal to 5% of his
or her individual or spousal countable income, as described, except
that the premium cannot fall below or exceed a specified minimum and
maximum premium payment, as provided.
The bill would require the above-described provisions to be
implemented only to the extent that federal financial participation
is available, and only to the extent that the department seeks and
obtains approval of all necessary state plan amendments.
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 14007.9 of the Welfare and Institutions Code is
amended to read:
14007.9. (a) (1) 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)
(A) His or her net countable income is less than 250
percent of the federal poverty level for one person or, if the
deeming of spousal income applies to the individual, his or her net
countable income is less than 250 percent of the federal poverty
level for two persons.
(2)
(B) 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)
(C) 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.
(2) To the extent federal financial participation is available,
individuals otherwise eligible under this section, but who are
temporarily unemployed, may elect to remain on Medi-Cal under this
section for up to 26 weeks, provided the individuals continue to pay
premiums during the temporary period of unemployment.
(b) (1) Countable income shall be determined under Section 1612 of
the federal Social Security Act (42 U.S.C. Sec. 1382a), except that
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) To the extent that federal financial participation is
available under Section 1902(r)(2) of the federal Social Security Act
(42 U.S.C. Sec. 1396a(r)(2)), retained earned income of an eligible
individual who is receiving health care benefits under this section
shall be considered an exempt resource when held in a separately
identifiable account and not commingled with other resources.
(4) Social security disability income that converts to social
security retirement income upon the retirement of an individual,
including any increases in the amount of that income, shall be
exempt. The department shall submit a state plan amendment for this
specific exemption, and the exemption shall be implemented only if,
and to the extent that, the state plan amendment is approved.
(c) All resources exempted pursuant to paragraph (2) of
subdivision (b) for an individual who is receiving health care
benefits under this section shall continue to be exempt under any
other Medi-Cal program that is subject to Section 1902(r)(2) of the
federal Social Security Act (42 U.S.C. Sec. 1396a(r)(2)) under which
the beneficiary later becomes eligible for medical assistance where
that eligibility is based on age, blindness, or disability. The
department shall submit a state plan amendment for this specific
exemption, and the exemption shall be implemented only if, and to the
extent that, the state plan amendment is approved.
(d) After an individual is determined eligible for Medi-Cal
benefits under this section, the individual's countable income, as
determined under Section 1612 of the federal Social Security Act (42
U.S.C. Sec. 1382a), shall be used to determine the amount of the
individual's required premium payment, as described in subdivision
(f). Disability income and converted retirement income made exempt
under paragraph (1) of subdivision (b) for eligibility purposes shall
be considered countable income for purposes of determining the
amount of the required premium payment.
(c)
(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.
(d)
(f) (1) 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. Each individual shall pay a
monthly premium that is equal to 5 percent of his or her individual
countable income, as defined in subdivision (d), or if the deeming of
spousal income of an ineligible spouse applies, a monthly premium
that is equal to 5 percent of the total countable income of both
spouses, except that the minimum premium payment per eligible
individual shall be twenty dollars ($20) per month, and the maximum
premium payment per eligible individual shall be two hu
ndred fifty dollars ($250) per month.
(e) 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.
(2) The amendments made to this subdivision during the 2009-10
Regular Session shall be implemented no later than March 1, 2010.
(f)
(g) 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.
(g)
(h) 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.
(h)
(i) 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.) and only to the extent that the
department seeks and obtains approval of all necessary Medicaid state
plan amendments .
(i) Subject to subdivision (h), this section shall be implemented
commencing April 1, 2000.
(j) If any provision of this section, or its application, is held
invalid by a final judicial determination, it shall cease to be
implemented. A determination of invalidity shall not affect other
provisions or applications of this section that can be given effect
without the implementation of the invalid provision or application.
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.