BILL ANALYSIS Ó
AB 1235
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1235
Gipson - As Amended April 23, 2015
SUBJECT: Medi-Cal: beneficiary maintenance needs: home upkeep
allowance.
SUMMARY: Establishes the home upkeep allowance (HUA) for
certain Medi-Cal eligible long-term care facility residents, and
sets requirements for the allowance, as specified.
Specifically, this bill:
1)Requires a HUA to be available to certain long-term care
facility residents to use for the maintenance or establishment
of a residence following their departure from a facility.
2)Requires a physician to determine the likelihood of a
resident's ability to return to the community.
3)Establishes eligibility requirements for individuals to
receive the HUA, and specifies maximum values and eligible
uses of the HUA.
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4)Requires the Department of Health Care Services (DHCS) to
perform specified outreach with respect to the HUA.
EXISTING LAW:
1)Establishes the Medi-Cal program to provide comprehensive
health benefits to low-income individuals who meet specified
eligibility criteria.
2)Requires DHCS to 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.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The author states the reason why many
individuals stay in nursing facilities indefinitely is in part
because the current HUA is insufficient to sustain the cost of
basic living needs. The author explains that the HUA is
underutilized due to the high cost of living in California, as
compared to other states, and the lack of affordable housing
programs. The author concludes that with the increase in the
HUA, this bill will improve the quality of life for Medi-Cal
recipients in nursing homes and provide greater opportunities
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for individuals to transfer back into the community.
2)BACKGROUND.
a) Long-term care in California. In 2007, California was
home to 4 million persons age 65 and older or representing
11% of the state's population. In 2010, the number of
Californians age 65 and older is projected to increase to
4.4 million or 14.7%, and is projected to increase to 8.3
million or 17.8% of all Californians in 2030.
Approximately 2.4 million persons in California report
having two or more disabilities and an estimated 400,000
plus have intellectual or developmental disabilities.
Long-term care services generally address an individual's
health, social, and personal needs, and are provided in
institutional care settings (for example, skilled nursing
facilities) and through community-based providers ranging from
nonmedical residential care facilities to services such as
transportation and meals to help individuals remain in their
homes instead of being placed in an facility. Long-term care
services are provided not only to the elderly (age 65 and
older), but also to younger persons with developmental, mental,
and/or physical disabilities. Many of the persons eligible for
long-term care services use multiple services provided by a
variety of programs operated by many state departments. Within
California, DHCS and the Departments of Aging, Health Care
Services, Social Services, Developmental Services, Mental
Health, Rehabilitation, and Veterans Affairs directly administer
long-term care programs.
b) Current standards of the HUA. Maintaining or
establishing a home in the community is a major obstacle
for Medicaid beneficiaries who want to return home after
admission to an institution. Medicaid eligibility rules
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give states the flexibility to support this goal and allow
states to exempt income to maintain a home. The HUA is a
Medi-Cal deduction for qualifying Medi-Cal beneficiaries
who are living in, or will be living in, a nursing home or
other medical facility. The HUA currently allows
beneficiaries to keep $209 per month of their monthly
income for maintenance and upkeep of their homes while they
are temporarily residing in the nursing home other medical
facility. The HUA can be allowed for up to a six month
period from the date the beneficiary enters the nursing
home. To qualify for the HUA, a beneficiary must meet all
of the following requirements:
i) Intend to leave the nursing facility and to return
home within six months of the date the individual begins
living in the nursing home.
ii) Obtain a written medical statement from the
individual's doctor certifying that he or she will be
able to return home within six months.
iii) The spouse or family of the individual must not live
in the home.
iv) The home must be maintained for the individual's
return.
Medically needy Medi-Cal beneficiaries who enter a nursing
facility apply all their income above a personal needs
allowance to the cost of care. State regulations allow
beneficiaries to retain 133% of the in-kind value of
housing for one person if the applicant or beneficiary has
been living alone in the home.
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3)SUPPORT. Disability Rights California, the sponsor of the
bill, states the current allowance given to long-term care
facility residents for the maintenance of their homes is
insufficient and highlights the rate has not been updated
since the 1970's. In addition, the sponsor states individuals
are taking full advantage of existing allowances for home
maintenance because they are not aware of its existence.
Finally, the sponsor states the allowance is too restrictive
and does not meet the needs of long-term care residents; for
example, it does not allow for residents who lost their homes
but want to find a new home to leave the facility. The
sponsor states the bill will allow for the HUA to be a useful
tool to help patients move into more home- and community-based
settings.
Supporters of the bill state the provisions will allow people
to better preserve their residences and will result in
significant cost savings to the state. The supporters content
that by calculating the HUA using the actual cost of
maintaining a patient's home, the bill will ensure that a
greater number of individuals who are eligible to return to
their homes will have a home to return to.
4)RELATED LEGISLATION. AB 1319 (Dababneh) raises the current
$20 per month incidental needs deduction to $50 for Medi-Cal
beneficiaries who qualify for personal and incidental needs
deductions and are residing in a community care facility,
provided all necessary federal approvals can be obtained. AB
1319 is set for hearing in this Committee on April 28, 2015.
5)POLICY COMMENTS. This bill establishes standards for a home
upkeep allowance to be available for certain long-term care
facility residents. The Committee may suggest a number of
amendments to clarify the bill language in a future committee,
as follows:
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a) This bill establishes the HUA in statute and
requirements for the allowance. However, state regulations
already define requirements for home maintenance income for
long-term residents. The current language of the bill
appears to create an allowance that would be supplemental
to the existing home maintenance income; however the author
has indicated the intent of this bill appears to be to
supplant existing requirements with new regulations for
this income. The Committee may suggest amending the
language to clarify the intent and providing defined
guidance to DHCS for the interaction of these two
allowances.
b) This bill specifies the HUA will apply to certain
long-term care facility residents. The Committee may
suggest specifying which types of long-term care facility
residents the HUA will apply to, and the associated
criteria for eligibility.
c) This bill requires DHCS to perform outreach regarding
the HUA. The language of the bill is currently confusing
with regard to the requirements on the adoption of
regulations for this outreach and related standards. The
Committee may suggest amending this bill to clarify these
standards in statute.
d) This bill requires DHCS to adopt or revise regulations
as necessary to reflect the requirements of this section;
however the bill provision appears to be incorrectly placed
within the language. The Committee may suggest amending
this bill to ensure this requirement applies to the
entirety of the bill language.
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REGISTERED SUPPORT / OPPOSITION:
Support
Disability Rights California (sponsor)
California Advocates for Nursing Home Reform (prior version)
California Association of Public Authorities for IHSS (prior
version)
California Commission on Aging (prior version)
California Long-Term Care Ombudsman Association (prior version)
County Board of San Bernardino (prior version)
United Domestic Workers of America / AFSCME Local 3930 / AFL-CIO
(prior version)
Opposition
None on file.
Analysis Prepared by:An-Chi Tsou / HEALTH / (916) 319-2097
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