AB 1235,
as amended, Gipson. Medi-Cal: beneficiary maintenance needs: home upkeepbegin delete allowance.end deletebegin insert allowances and transitional personal needs funds.end insert
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 home upkeep allowance described above.
This bill would establish eligibility and other requirements for providing the home upkeep allowancebegin insert or transitional personal needs fund,end insert tobegin delete aend delete Medi-Calbegin delete patientend deletebegin insert patientsend insert residing in a long-term carebegin delete facility.end deletebegin insert facility, as specified.end insert
The bill would prescribe general requirements as well as specific requirements both for facility residents who intend to leave the facility and return to an existing home,begin insert who would receive the home upkeep allowance,end insert and residents who intend to leave the facility and establish a new begin deletehome.end deletebegin insert home, who would establish a transitional personal needs fundend insertbegin insert, as part of the personal needs allowance provided to the resident.end insert The bill would require the department to adoptbegin delete conforming regulationsend deletebegin insert
implementing regulations,end insert and to advise appropriatebegin delete Medi-Cal patientsend deletebegin insert long-term care facility residents and other specified personnel and health care facilitiesend insert of the existence and availability of the home upkeep allowancebegin insert and transitional personal needs fundend insert. Because counties are required to make Medi-Cal eligibility determinations and this bill would impose new eligibility requirements for purposes of the home upkeep allowance, this 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:
begin insertSection 14005.125 is added to the end insertbegin insertWelfare and
2Institutions Codeend insertbegin insert, to read:end insert
(a) For purposes of this section, “home upkeep
4allowance” means the “allowance for home maintenance”
5described in Section 435.725 (d) of Title 42 of the Code of Federal
6Regulations and the amount for the “upkeep and maintenance of
7the home,” described in paragraph (2) of subdivision (d) of Section
814005.12.
9(1) The home upkeep allowance shall be available to long-term
10care recipients who are Medi-Cal recipients and meet the
11requirements of this section.
12(2) In accordance with Section 435.725 (c)(1) of Title 42 of the
13Code of Federal Regulations and paragraph (1) of subdivision (d)
14of Section 14005.12, a transitional personal needs fund shall be
15available to long-term care
recipients described in this section.
16(b) A long-term care facility resident who intends to leave the
17facility and return to his or her existing home shall be provided
18with a home upkeep allowance as follows:
19(1) The allowance shall be set aside from the income that
20otherwise would be applied toward the resident’s Medi-Cal share
21of cost for residing in the facility.
22(2) The allowance shall be based on the actual minimum cost
23of maintaining the resident’s home, including, but not limited to,
24mortgage or rent, property taxes, and required insurance.
25(3) The allowance shall be an exempt resource for purposes of
26determining eligibility for the Medi-Cal program.
27(4) The allowance shall be
available only if a physician has
28certified that the resident is likely to return to his or home within
29six months.
30(c) If a long-term care facility resident does not have a home,
31but intends to leave the facility and establish a home in the
32community, the transitional costs of establishing a home shall be
33included in his or her personal needs allowance. The resident may
P4 1establish a transitional personal needs fund for this purpose, as
2follows:
3(1) The fund shall be set aside from the income that otherwise
4would be applied toward the resident’s Medi-Cal share of cost for
5residing in the facility.
6(2) The total amount of the fund shall not exceed seven thousand
7five hundred dollars ($7,500).
8(3) The fund shall be an exempt resource for purposes of
9
determining eligibility for the Medi-Cal program.
10(4) The fund shall be used to cover the costs of securing a home
11for the individual, including, but not limited to, rent, security and
12utility deposits, accessibility modifications necessary to meet the
13needs of the individual, and essential furnishings, including, but
14not limited to, stoves, refrigerators, beds, towels, and bed linens.
15(5) If the resident is unable to secure a home within four months
16after the transitional personal needs fund has reached the
17maximum amount specified in this subdivision, the fund shall revert
18to the state to defray the costs of the resident’s care in the facility.
19(d) In implementing this section, the department shall undertake
20all of the following information and outreach activities:
21(1) Inform residents in all Medi-Cal funded long-term care
22facilities of the existence and availability of the home upkeep
23allowance and the transitional needs personal needs fund.
24(2) Include information on the existence and availability of the
25home upkeep allowance and the transitional personal needs fund
26in the “Notice Regarding Standards for Medi-Cal Eligibility”
27provided for in Section 14006.4.
28(3) Notify all Medi-Cal branches, eligibility workers, long-term
29care facilities, hospital discharge planners, and organizations
30receiving state funds to assist nursing home residents of the
31existence and availability of the home upkeep allowance and the
32transitional personal needs fund.
33(e) The department shall adopt, revise, or repeal regulations
34as necessary to
implement this section, including, but not limited
35to, Section 50605 of Title 22 of the California Code of Regulations.
36To the extent Section 50605 of Title 22 of the California Code of
37Regulations is inconsistent with this section, those regulations
38shall be inoperative until the department makes the regulatory
39changes required by this subdivision.
Section 14005.125 is added to the Welfare and
2Institutions Code, to read:
(a) As authorized under federal Medicaid law, and
4in accordance with subdivisions (b) and (c), a home upkeep
5allowance shall be available to certain long-term care facility
6residents, who will be allowed to use that income to maintain or
7establish a home in which they intend to reside after leaving the
8facility.
9(b) The likelihood of the resident’s ability to return to the
10community shall be certified by a physician, pursuant to Section
1150605 of Title 22 of the California Code of Regulations.
12(c) The home upkeep allowance shall be subject to all of the
13following requirements:
14(1) For a resident who intends to
leave the facility and return
15to his or her existing home, the allowance shall be available to for
16up to six months while the person resides in the facility. The
17allowance shall be based on the actual minimum cost of
18maintaining the home, such as mortgage or rent, property taxes,
19and required insurance.
20(2) For a resident who intends to leave the facility and establish
21a home, the allowance shall be available for up to three months.
22The allowance shall be used to cover the costs of securing a home,
23such as rent, security and utility deposits, and accessibility
24modifications necessary to meet the needs of the person. The
25allowance shall be subject to all of the following:
26(A) The allowance shall be set aside from the income that
27provides the resident’s share of cost for care in the facility.
28(B) The total allowance
shall not exceed seven thousand five
29hundred dollars ($7,500).
30(C) The allowance shall be an exempt resource for purposes of
31determining the value of the resident’s assets.
32(D) If the resident is unable secure a home within the time period
33prescribed by this section, the allowance shall revert to the state
34to defray the costs of the resident’s care in the facility.
35(d) The department shall take the following information and
36outreach activities with respect to the existence and availability of
37the home upkeep allowance:
38(1) Adopt or revise regulations as necessary to reflect the
39requirements of this section.
P6 1(2) Inform residents in all Medi-Cal funded long-term care
2facilities of the
existence and availability of the home upkeep
3allowance. The department shall provide information to Medi-Cal
4funded long-term care facilities, which shall be posted in prominent
5locations in the facility that are accessible to both the public and
6to the facility’s family council.
7(3) Include information regarding the availability of the home
8upkeep allowance in the “Notice Regarding Standards for
9Medi-Cal Eligibility” provided for in Section 14006.4.
10(4) Notify all Medi-Cal branches, eligibility workers, long-term
11care facilities, hospital discharge planners, and organizations
12receiving state funds to assist nursing home residents of the new
13regulatory requirements.
14(5) Ensure that all Medi-Cal patients discharged to a long-term
15care facility are informed of the existence
and availability of the
16home upkeep allowance.
If the Commission on State Mandates determines that
18this act contains costs mandated by the state, reimbursement to
19local agencies and school districts for those costs shall be made
20pursuant to Part 7 (commencing with Section 17500) of Division
214 of Title 2 of the Government Code.
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