BILL ANALYSIS
AB 1269
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 1269 (Brownley) - As Amended: April 14, 2009
SUBJECT : Medi-Cal: eligibility.
SUMMARY : Effective March 1, 2010, extends, and increases
eligibility for, the Medi-Cal California Working Disabled
Program (CWD Program). Specifically, this bill :
1)Effective March 1, 2010, permits individuals otherwise
eligible for the CWD Program, but who are temporarily not
working, to remain in the program for up to 26 weeks, provided
the individuals continue to pay premiums during the temporary
nonworking period. Makes this provision subject to federal
financial participation (FFP).
2)Clarifies that, to the extent that FFP is available, retained
earned income of an eligible individual who is receiving
health care benefits under the CWD Program will be considered
exempt when held in a separately identifiable account and not
commingled with other resources.
3)Makes exempt for purposes of eligibility for CWD, to the
extent permitted under federal law, social security disability
benefits that are received by an individual 65 years of age.
4)Requires assets that were exempt under the CWD Program to
continue to be exempt under any other Medi-Cal program for
which the beneficiary becomes available where eligibility is
based on age, blindness, or disability. States that if this
provision is held invalid, that invalidity shall not affect
other provisions or applications of the CWD Program.
5)Revises the level of participant premiums from the current
sliding scale to 5% of income, while maintaining current
minimum and maximum payments.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by Department
of Health Care Services (DHCS), which provides comprehensive
health benefits to low-income children, their parents or
AB 1269
Page 2
caretaker relatives, pregnant women, elderly, blind or
disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
2)Establishes the CWD Program for working disabled individuals
with net countable family income up to 250% of the federal
poverty level (FPL) and assets up to $2,000 for individuals
and $3,000 for couples. Requires monthly premiums ranging
from $20-$250 for individuals and $30-$375 for couples.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill,
which provides affordable health coverage for working disabled
individuals, is intended to reform program eligibility so more
disabled individuals can join the workforce and save their
earnings without penalties. The author states this bill is
expected to increase the number of participating disabled
individuals by extending Medi-Cal coverage during periods of
unemployment and permitting savings from other public sources.
The author notes that the provision in this bill to continue
eligibility for the CWD Program if an enrollee is unable to
work is similar to the federal Consolidated Omnibus Budget
Reconciliation Act of 1986 which allows individuals to keep
their job-based insurance for eighteen months after they leave
employment if the individual pays the full cost of the
coverage.
2)BACKGROUND . The CWD Program was implemented in 2000. Working
individuals with disabilities and with net countable family
incomes below 250% FPL and assets limited to $2,000 for
individuals and $3,000 for couples can enroll. The CWD
Program uses federal Supplemental Security Income rules for
income, including earned income disregards (which disregard
the first $20 of income regardless of source; the first $65 of
earnings; and, half of the remaining earnings). For married
applicants, some of the income of the spouse may be counted as
the applicant's income. Enrollees pay monthly premiums of $20
to $375 based on income and marital status. All of the
AB 1269
Page 3
applicant's disability related income is exempt from income
calculation. Certain retirement accounts and property are
also exempt from the asset calculation. Enrollees are
required to provide proof of employment. Enrollees who lose
their employment due to "good cause" can retain CWD Program
coverage for two months. For this purpose good cause includes
hospitalization, inability to work as a result of the
individual's disability, or other reasons beyond the control
of the enrollee. In 2004, 1,502 individuals were enrolled in
the CWD Program according to a 2007 Mathematica Policy
Research issue brief prepared for the federal Centers for
Medicare and Medicaid Services. According to Mathematica, as
of June 30, 2006, 33 states (including California) reported
covering 75,443 individuals in similar Medicaid buy-in
programs.
3)GOVERNOR'S COMMITTEE REPORT . On January 26, 2006, the
Governor's Committee on Employment of People with Disabilities
released a report, "California Comprehensive Strategy for the
Employment of People with Disabilities." The recommended
committee actions related to the CWD Program include
increasing participation, evaluating program effectiveness,
and making recommendations for improvement in the CWD Program,
such as adding a grace period for temporary lapses in
employment similar to the provisions of this bill.
4)SUPPORT . Provider and consumer advocacy groups supporting
this bill argue that ensuring the continuation of the program
is vital to enabling persons with disabilities to remain
eligible for affordable health coverage while working.
Supporters also argue that it makes fiscal sense to encourage
disabled people to work and contribute to the cost of health
coverage.
5)PREVIOUS LEGISLATION .
a) AB 1183 (Committee on Budget), Chapter 758, Statutes of
2008 made the CWD Program permanent by deleting the
September 1, 2008 sunset date.
b) AB 851 (Brownley) of 2008, which was similar to this
bill, was held on the Senate Appropriations suspense file.
AB 1269
Page 4
c) AB 1113 (Brownley) of 2007, which was similar to this
bill, was vetoed by Governor Schwarzenegger. In his veto
message, the Governor stated:
While I strongly support the California 250 Percent
Working Disabled Program and appreciate its role in
promoting work among persons who are aged and
disabled, I cannot support this bill. This bill
contains a drafting error that would result in
unequal treatment of similarly situated aged
persons, in direct conflict with federal Medicaid
law. Given my strong support of services for
persons with disabilities to allow them to safely
remain at home and lead productive and independent
lives, I am directing the DHCS to pursue legislation
to continue and improve this important program.
b) AB 925 (Aroner), Chapter 1088, Statutes of 2002,
requires the state to create a sustainable, comprehensive
strategy to accomplish various goals aimed at bringing
persons with disabilities into employment.
c) AB 155 (Migden), Chapter 820, Statutes of 1999,
established the CWD Program.
REGISTERED SUPPORT / OPPOSITION :
Support
AIDS Project Los Angeles
California Primary Care Association
California Medical Association
California Communities United Institute
Health Access California
World Institute on Disability
Opposition
None on file.
Analysis Prepared by : John Miller/ HEALTH / (916) 319-2097