BILL NUMBER: AB 1235 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 1, 2015
AMENDED IN ASSEMBLY APRIL 23, 2015
AMENDED IN ASSEMBLY MARCH 26, 2015
INTRODUCED BY Assembly Member Gipson
FEBRUARY 27, 2015
An act to add Section 14005.125 to the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1235, as amended, Gipson. Medi-Cal: beneficiary maintenance
needs: home upkeep allowance. allowances and
transitional personal needs funds.
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 allowance or transitional personal
needs fund, to a Medi-Cal patient
patients residing in a long-term care
facility. facility, as specified. 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, who would receive the home upkeep
allowance, and residents who intend to leave the facility and
establish a new home. home, who would
establish a transitional personal needs fund , as part of
the personal needs allowance provided to the resident. The bill
would require the department to adopt conforming
regulations implementing regulations, and to
advise appropriate Medi-Cal patients
long-term care facility residents and other specified personnel and
health care facilities of the existence and availability of the
home upkeep allowance and transitional personal needs fund
. 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:
SECTION 1. Section 14005.125 is added to the
Welfare and Institutions Code , to read:
14005.125. (a) For purposes of this section, "home upkeep
allowance" means the "allowance for home maintenance" described in
Section 435.725 (d) of Title 42 of the Code of Federal Regulations
and the amount for the "upkeep and maintenance of the home,"
described in paragraph (2) of subdivision (d) of Section 14005.12.
(1) The home upkeep allowance shall be available to long-term care
recipients who are Medi-Cal recipients and meet the requirements of
this section.
(2) In accordance with Section 435.725 (c)(1) of Title 42 of the
Code of Federal Regulations and paragraph (1) of subdivision (d) of
Section 14005.12, a transitional personal needs fund shall be
available to long-term care recipients described in this section.
(b) A long-term care facility resident who intends to leave the
facility and return to his or her existing home shall be provided
with a home upkeep allowance as follows:
(1) The allowance shall be set aside from the income that
otherwise would be applied toward the resident's Medi-Cal share of
cost for residing in the facility.
(2) The allowance shall be based on the actual minimum cost of
maintaining the resident's home, including, but not limited to,
mortgage or rent, property taxes, and required insurance.
(3) The allowance shall be an exempt resource for purposes of
determining eligibility for the Medi-Cal program.
(4) The allowance shall be available only if a physician has
certified that the resident is likely to return to his or home within
six months.
(c) If a long-term care facility resident does not have a home,
but intends to leave the facility and establish a home in the
community, the transitional costs of establishing a home shall be
included in his or her personal needs allowance. The resident may
establish a transitional personal needs fund for this purpose, as
follows:
(1) The fund shall be set aside from the income that otherwise
would be applied toward the resident's Medi-Cal share of cost for
residing in the facility.
(2) The total amount of the fund shall not exceed seven thousand
five hundred dollars ($7,500).
(3) The fund shall be an exempt resource for purposes of
determining eligibility for the Medi-Cal program.
(4) The fund shall be used to cover the costs of securing a home
for the individual, including, but not limited to, rent, security and
utility deposits, accessibility modifications necessary to meet the
needs of the individual, and essential furnishings, including, but
not limited to, stoves, refrigerators, beds, towels, and bed linens.
(5) If the resident is unable to secure a home within four months
after the transitional personal needs fund has reached the maximum
amount specified in this subdivision, the fund shall revert to the
state to defray the costs of the resident's care in the facility.
(d) In implementing this section, the department shall undertake
all of the following information and outreach activities:
(1) Inform residents in all Medi-Cal funded long-term care
facilities of the existence and availability of the home upkeep
allowance and the transitional needs personal needs fund.
(2) Include information on the existence and availability of the
home upkeep allowance and the transitional personal needs fund in the
"Notice Regarding Standards for Medi-Cal Eligibility" provided for
in Section 14006.4.
(3) 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
existence and availability of the home upkeep allowance and the
transitional personal needs fund.
(e) The department shall adopt, revise, or repeal regulations as
necessary to implement this section, including, but not limited to,
Section 50605 of Title 22 of the California Code of Regulations. To
the extent Section 50605 of Title 22 of the California Code of
Regulations is inconsistent with this section, those regulations
shall be inoperative until the department makes the regulatory
changes required by this subdivision.
SECTION 1. Section 14005.125 is added to the
Welfare and Institutions Code, to read:
14005.125. (a) As authorized under federal Medicaid law, and in
accordance with subdivisions (b) and (c), a home upkeep allowance
shall be available to certain long-term care facility residents, who
will be allowed to use that income to maintain or establish a home in
which they intend to reside after leaving the facility.
(b) The likelihood of the resident's ability to return to the
community shall be certified by a physician, pursuant to Section
50605 of Title 22 of the California Code of Regulations.
(c) The home upkeep allowance shall be subject to all of the
following requirements:
(1) For a resident who intends to leave the facility and return to
his or her existing home, the allowance shall be available to for up
to six months while the person resides in the facility. The
allowance shall be based on the actual minimum cost of maintaining
the home, such as mortgage or rent, property taxes, and required
insurance.
(2) For a resident who intends to leave the facility and establish
a home, the allowance shall be available for up to three months. The
allowance shall be used to cover the costs of securing a home, such
as rent, security and utility deposits, and accessibility
modifications necessary to meet the needs of the person. The
allowance shall be subject to all of the following:
(A) The allowance shall be set aside from the income that provides
the resident's share of cost for care in the facility.
(B) The total allowance shall not exceed seven thousand five
hundred dollars ($7,500).
(C) The allowance shall be an exempt resource for purposes of
determining the value of the resident's assets.
(D) If the resident is unable secure a home within the time period
prescribed by this section, the allowance shall revert to the state
to defray the costs of the resident's care in the facility.
(d) The department shall take the following information and
outreach activities with respect to the existence and availability of
the home upkeep allowance:
(1) Adopt or revise regulations as necessary to reflect the
requirements of this section.
(2) Inform residents in all Medi-Cal funded long-term care
facilities of the existence and availability of the home upkeep
allowance. The department shall provide information to Medi-Cal
funded long-term care facilities, which shall be posted in prominent
locations in the facility that are accessible to both the public and
to the facility's family council.
(3) Include information regarding the availability of the home
upkeep allowance in the "Notice Regarding Standards for
Medi-Cal Eligibility" provided for in Section 14006.4.
(4) 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.
(5) Ensure that all Medi-Cal patients discharged to a long-term
care facility are informed of the existence and availability of the
home upkeep allowance.
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.