BILL NUMBER: AB 1235 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 26, 2015
INTRODUCED BY Assembly Member Gipson
FEBRUARY 27, 2015
An act to amend Section 14005.12 of the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1235, as amended, Gipson. Long-term care:
Medi-Cal: beneficiary mainte nance needs: home
upkeep allowance: personal and incidental needs 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.
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.
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
above home upkeep allowance described above .
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.
This bill would further 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.
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: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14005.12 of the
Welfare and Institutions Code is amended to
read:
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
thirty-five dollars ($35) eighty dollars
($80) 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.
SECTION 1. SEC. 2. (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.
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.