AB 1235,
as amended, Gipson. Medi-Cal: beneficiary maintenance needs: home upkeepbegin delete allowances andend deletebegin insert allowances:end insert 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 Medi-Cal patients residing in a long-term care 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, 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 implementing regulations, and to advise appropriate 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.begin insert The bill would require the department, on or before July 1, 2016, to seek federal approval to implement these provisions, and would require these provisions to be implemented only if, and to the extent that, federal financial participation is available and any necessary federal approvals have been obtained.end insert Because counties are required to make Medi-Cal eligibility determinations and this bill would impose new eligibility requirements for purposes ofbegin delete the home upkeep allowance,end deletebegin insert these allowances,end insert 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 14005.125 is added to the Welfare and
2Institutions Code, to read:
(a) begin insert(1)end insertbegin insert end insertFor purposes of this section, “home upkeep
4allowance” means the “allowance for home maintenance” described
5in 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)
end delete
10begin insert(2)end insert The home upkeep allowance shall be available to long-term
11care recipients who are Medi-Cal recipients and meet the
12requirements of this section.
13(2) In accordance with Section 435.725 (c)(1) of Title 42 of the
14Code of Federal Regulations and paragraph (1) of subdivision (d)
15of Section 14005.12,
a transitional personal needs fund shall be
16available to long-term care recipients described in this section.
17(b)
end delete
18begin insert(3)end insert A long-term care facility resident who intends to leave the
19facility and return to his or her existing home shall be provided
20with a home upkeep allowance as follows:
21(1)
end delete
22begin insert(A)end insert The allowance shall be set aside from the income that
23otherwise
would be applied toward the resident’s Medi-Cal share
24of cost for residing in the facility.
25(2)
end delete
26begin insert(B)end insert The allowance shall be based on the actual minimum cost
27of maintaining the resident’s home, including, but not limited to,
28mortgage or rent, property taxes, and required insurance.
P4 1(3)
end delete
2begin insert(C)end insert The allowance shall be an exempt resource for purposes of
3determining eligibility for the Medi-Cal program.
4(4)
end delete
5begin insert(D)end insert The allowance shall be available only if a physician has
6certified that the resident is likely to return to his orbegin insert herend insert home
7within six months.
8(c) If
end delete
9(4) On or before July 1, 2016, the department shall seek federal
10approval to implement the requirements of this subdivision. This
11subdivision shall be implemented only if, and to the extent that,
12federal financial participation is available and any necessary
13federal approvals have been obtained.
14(b) (1) In accordance with Section 435.725 (c)(1) of Title 42
15of the Code of Federal Regulations and paragraph (1) of
16subdivision (d) of Section 14005.12, a transitional personal needs
17fund shall be available to long-term care recipients described in
18this section.
19begin insert(2)end insertbegin insert end insertbegin insertIfend insert a long-term care facility
resident does not have a home,
20but intends to leave the facility and establish a home in the
21community, the transitional costs of establishing a home shall be
22included in his or her personal needs allowance. The resident may
23establish a transitional personal needs fund for this purpose, as
24follows:
25(1)
end delete
26begin insert(A)end insert The fund shall be set aside from the income that otherwise
27would be applied toward the resident’s Medi-Cal share of cost for
28residing in the facility.
29(2)
end delete
30begin insert(B)end insert The total amount of the fund shall not exceed seven thousand
31five hundred dollars ($7,500).
32(3)
end delete
33begin insert(C)end insert The fund shall be an exempt resource for purposes of
34
determining eligibility for the Medi-Cal program.
35(4)
end delete
36begin insert(D)end insert The fund shall be used to cover the costs of securing a home
37for the individual, including, but not limited to, rent, security and
38utility deposits, accessibility modifications necessary to meet the
39needs of the individual, and essential furnishings, including, but
40not limited to, stoves, refrigerators, beds, towels, and bed linens.
P5 1(5)
end delete
2begin insert(E)end insert If the resident is unable to secure a home within four months
3after the transitional personal needs fund has reached the maximum
4amount specified in this subdivision, the fund shall revert to the
5state to defray the costs of the resident’s care in the facility.
6(d) In
end delete
7(3) On or before July 1, 2016, the department shall seek federal
8approval to implement the requirements of
this subdivision. This
9subdivision shall be implemented only if, and to the extent that,
10federal financial participation is available and any necessary
11federal approvals have been obtained.
12begin insert(c)end insertbegin insert end insertbegin insertInend insert implementing this section, the department shall undertake
13all of the following information and outreach activities:
14(1) Inform residents in all Medi-Cal funded long-term care
15facilities of the existence and availability of the home upkeep
16allowance and the transitional needs personal needs fund.
17(2) Include information on the existence and availability of the
18home upkeep allowance and the transitional personal needs fund
19in the “Notice
Regarding Standards for Medi-Cal Eligibility”
20provided for in Section 14006.4.
21(3) Notify all Medi-Cal branches, eligibility workers, long-term
22care facilities, hospital discharge planners, and organizations
23receiving state funds to assist nursing home residents of the
24existence and availability of the home upkeep allowance and the
25transitional personal needs fund.
26(e)
end delete
27begin insert(d)end insert The department shall adopt, revise, or repeal regulations as
28necessary to implement this section, including, but not limited to,
29Section 50605 of Title 22 of the
California Code of Regulations.
30To the extent Section 50605 of Title 22 of the California Code of
31Regulations is inconsistent with this section, those regulations
32shall be inoperative until the department makes the regulatory
33changes required by this subdivision.
If the Commission on State Mandates determines that
35this act contains costs mandated by the state, reimbursement to
36local agencies and school districts for those costs shall be made
37pursuant to Part 7 (commencing with Section 17500) of Division
384 of Title 2 of the Government Code.
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