Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1235

Introduced by Assembly Member Gipson

February 27, 2015

An act begin insert to amend Section 14005.12 of the Welfare and Institutions Code, end insert relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1235, as amended, Gipson. begin delete Long-term care: end delete begin insert Medi-Cal: beneficiary maintenance needs: end insert home upkeep begin insert allowance: personal and incidental needs end insert allowance.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Qualified individuals under the Medi-Cal program include medically needy persons and medically needy family persons who meet the required eligibility criteria, including applicable income requirements.

Existing law requires the department to establish income levels for maintenance need at the lowest levels that reasonably permit a medically needy individual to meet his or her basic needs for food, clothing, and shelter, and for which federal financial participation will still be provided under applicable federal law. In calculating the income of a medically needy individual in a medical institution or nursing facility, or a person receiving institutional or noninstitutional services from a Program of All-Inclusive Care for the Elderly organization, the required monthly maintenance amount includes, among other things, an amount providing for the upkeep and maintenance of the individual’s home. This amount is also referred to as the home upkeep allowance.

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Existing law requires that the maintenance of need amount provide for personal and incidental needs in an amount not less than $35 for a person in a medical institution or nursing facility, or for a person receiving institutional or noninstitutional services from a Program of All-Inclusive Care for the Elderly organization.

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Existing law authorizes the Director of Health Care Services to adopt, amend, or repeal reasonable rules and regulations to carry out the purposes and intent of the Medi-Cal program, that are not inconsistent with any state statute. The department has adopted regulatory requirements relating to the determination of the begin delete above end delete home upkeep allowance begin insert described above end insert .

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This bill would increase the above-specified personal and incidental needs allowance to an amount not less than $80. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.

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This bill would begin insert further end insert declare the intent of the Legislature to enact legislation to prohibit the use of in-kind value of housing as a basis for calculating the home upkeep allowance for a patient in long-term care and prohibit eligibility for the allowance from being based on the date when patient status is established, and to require the calculation for the allowance to be based on the actual cost of maintaining the patient’s home. The bill would declare the intent of the Legislature to enact legislation to require the department to adopt conforming regulations, and to notify specified parties of those regulatory changes. The bill would declare the Legislature’s intent to enact legislation to require the department to advise appropriate Medi-Cal patients of the availability of the home upkeep allowance.

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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.

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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.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert Section 14005.12 of the end insert begin insert Welfare and Institutions
Code end insert begin insert is amended to read: end insert

14005.12.  

(a) For the purposes of Sections 14005.4 and
14005.7, the department shall establish the income levels for
maintenance need at the lowest levels that reasonably permit
medically needy persons to meet their basic needs for food,
clothing, and shelter, and for which federal financial participation
will still be provided under Title XIX of the federal Social Security
Act. It is the intent of the Legislature that the income levels for
maintenance need for medically needy aged, blind, and disabled
adults, in particular, shall be based upon amounts that adequately
reflect their needs.

(1) Subject to paragraph (2), reductions in the maximum aid
payment levels set forth in subdivision (a) of Section 11450 in the
1991-92 fiscal year, and thereafter, shall not result in a reduction
in the income levels for maintenance under this section.

(2) (A) The department shall seek any necessary federal
authorization for maintaining the income levels for maintenance
at the levels in effect June 30, 1991.

(B) If federal authorization is not obtained, medically needy
persons shall not be required to pay the difference between the
share of cost as determined based on the payment levels in effect
on June 30, 1991, under Section 11450, and the share of cost as
determined based on the payment levels in effect on July 1, 1991,
and thereafter.

(3) Any medically needy person who was eligible for benefits
under this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families
with Dependent Children program as set forth in Section 11452.018
made in the 1995-96 Regular Session of the Legislature shall not
be responsible for paying his or her share of cost if all of the
following apply:

(A) He or she had eligibility as categorically needy terminated
by the reductions in the minimum basic standards of adequate care.

(B) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.

(C) He or she is not eligible to receive benefits without a share
of cost as a medically needy person pursuant to paragraph (1) or
(2).

(b) In the case of a single individual, the amount of the income
level for maintenance per month shall be 80 percent of the highest
amount that would ordinarily be paid to a family of two persons,
without any income or resources, under subdivision (a) of Section
11450, multiplied by the federal financial participation rate.

(c) In the case of a family of two adults, the income level for
maintenance per month shall be the highest amount that would
ordinarily be paid to a family of three persons without income or
resources under subdivision (a) of Section 11450, multiplied by
the federal financial participation rate.

(d) For the purposes of Sections 14005.4 and 14005.7, for a
person in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from a Program
of All-Inclusive Care for the Elderly organization pursuant to
Chapter 8.75 (commencing with Section 14591), the amount
considered as required for maintenance per month shall be
computed in accordance with, and for those purposes required by,
Title XIX of the federal Social Security Act, and regulations
adopted pursuant thereto. Those amounts shall be computed
pursuant to regulations which include providing for the following
purposes:

(1) Personal and incidental needs in the amount of not less than
begin delete thirty-five dollars ($35) end delete begin insert eighty dollars ($80) end insert per month while a
patient. The department may, by regulation, increase this amount
as necessitated by increasing costs of personal and incidental needs.
A long-term health care facility shall not charge an individual for
the laundry services or periodic hair care specified in Section
14110.4.

(2) The upkeep and maintenance of the home.

(3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.

(4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent
children, dependent parents, or dependent siblings of either spouse,
provided the individuals are residing with the community spouse.

(5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396r-5(d)(1)(B)).

(6) The family allowance for each family member residing with
the community spouse shall be computed in accordance with the
formula established in Section 1924(d)(1)(C) of Title XIX of the
federal Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).

(e) For the purposes of Sections 14005.4 and 14005.7, with
regard to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be
computed pursuant to regulations adopted by the department which
provide for the support and care of his or her spouse, minor
children, or any disabled relative for whose support he or she has
contributed regularly.

(f) The income levels for maintenance per month, except as
specified in subdivisions (b) to (d), inclusive, shall be equal to the
highest amounts that would ordinarily be paid to a family of the
same size without any income or resources under subdivision (a)
of Section 11450, multiplied by the federal financial participation
rate.

(g) The “federal financial participation rate,” as used in this
section, shall mean 1331⁄3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec.
1396(b)), or its successor provisions.

(h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.

(i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for
each household in accordance with subdivisions (b) to (h),
inclusive. The total of these levels shall be the level for the single
eligibility unit.

(j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.

begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

(a) It is the intent of the Legislature to enact legislation
to do all of the following, with respect to the Medi-Cal home
upkeep allowance that may be available to long-term care residents:

(1) Prohibit the use of in-kind value of housing as a basis for
calculating the home upkeep allowance for a patient in long-term
care.

(2) Prohibit eligibility for the allowance being based on the date
when patient status is established.

(3) Require the calculation for the allowance to be based on the
actual cost of maintaining the patient’s home.

(b) It is the intent of the Legislature to enact legislation to require
the State Department of Health Care Services to do all of the
following:

(1)  Adopt or revise regulations to reflect the requirements of
paragraphs (1) to (3), inclusive, of subdivision (a).

(2) Notify all Medi-Cal branches, eligibility workers, long-term
care facilities, hospital discharge planners, and organizations
receiving state funds to assist nursing home residents, of the new
regulatory requirements.

(3) Ensure that all Medi-Cal patients who are discharged to or
residing in a long-term care facility are informed of the availability
of the allowance.

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begin insert SEC. 3. end insert   

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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.

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