BILL NUMBER: AB 1235 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 7, 2015
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 allowances and allowances:
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. 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. 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, these allowances, 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) (1) 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)
(2) 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)
(3) 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)
(A) 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)
(B) 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)
(C) The allowance shall be an exempt resource for
purposes of determining eligibility for the Medi-Cal program.
(4)
(D) The allowance shall be available only if a
physician has certified that the resident is likely to return to his
or her home within six months.
(c) If
(4) On or before July 1, 2016, the department shall seek federal
approval to implement the requirements of this subdivision. This
subdivision shall be implemented only if, and to the extent that,
federal financial participation is available and any necessary
federal approvals have been obtained.
(b) (1) 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.
(2) 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)
(A) 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)
(B) The total amount of the fund shall not exceed seven
thousand five hundred dollars ($7,500).
(3)
(C) The fund shall be an exempt resource for purposes
of determining eligibility for the Medi-Cal program.
(4)
(D) 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)
(E) 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
(3) On or before July 1, 2016, the department shall seek federal
approval to implement the requirements of this subdivision. This
subdivision shall be implemented only if, and to the extent that,
federal financial participation is available and any necessary
federal approvals have been obtained.
(c) 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)
(d) 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.
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.