BILL ANALYSIS Ó
AB 1235
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Date of Hearing: May 13, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1235 (Gipson) - As Amended April 23, 2015
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill establishes the home upkeep allowance (HUA) for
certain Medi-Cal eligible long-term care facility residents, and
sets requirements for the allowance, as specified.
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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 value of $7,500 and
eligible uses of the HUA.
4)Requires the Department of Health Care Services (DHCS) to
perform specified outreach with respect to the HUA.
FISCAL EFFECT:
Any additional money the state allows individuals to keep as a
HUA results in a commensurate increase in Medi-Cal costs. The
HUA would be available only to a portion of the over 200,000
skilled nursing facility discharges every year that, according
to analysis of data published by the Office of State Health
Planning and Development, have Medi-Cal as a primary payer.
Federal law restricts the HUA to situations there is not a
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spouse or family member living in the individual's home.
1)For every 1,000 Medi-Cal enrollees in long-term care (LTC)
facilities that make use of the expanded HUA, and assuming the
additional HUA amount is $3,000 on average, the increased
state cost will be $1.5 million (50% GF, 50% federal). The
actual cost could be more, or less, depending on utilization.
Data is not readily available on what percentage of Medi-Cal
enrollees would be both eligible to use and would use the HUA,
but it would likely be a small portion of total discharges.
2)Unknown, significant increased costs associated with increased
information and outreach related to the availability of the
HUA, potentially in the hundreds of thousands or, if
considered in tandem with the higher HUA amounts, millions of
dollars (GF/federal). According to organizations familiar
with advocacy for long-term care residents, utilization and
knowledge of the current program is quite low.
3)Unknown, significant offsetting cost savings, to the extent
this higher HUA allows individuals, who otherwise would have
difficulty maintaining or establishing a home in the community
in the absence of this higher HUA, to be discharged from
institutional care. Because the HUA is restricted to
individuals with no spouse or family, allowing these
individuals to maintain a home would likely allow them to be
discharged more readily.
COMMENTS:
1)Purpose. The author states many individuals stay in nursing
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facilities indefinitely 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 for individuals to transfer back
into the community.
2)Background. 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 or other
medical facility. The HUA can be allowed for up to a
six-month period from the date the beneficiary enters the
nursing home. Because the HUA is not a payment from the
state, but instead reduces the share-of-cost an individual
would otherwise have to incur before Medi-Cal pays on the
individual's behalf, the HUA only applies to individuals with
incomes that are high enough to allow for exclusion of a
portion of the income for an HUA. For example, individuals
solely reliant on Supplemental Security Income (SSI) have
income too low to qualify for the HUA. To qualify for the
HUA, a beneficiary must also meet all of the following
requirements:
a) Intend to leave the nursing facility and to return home
within six months of the date the individual begins living
in the nursing home.
b) Obtain a written medical statement from the individual's
doctor certifying that he or she will be able to return
home within six months.
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c) The spouse or family of the individual must not live in
the home.
d) The home must be maintained for the individual's return.
1)Related Legislation. AB 1319 (Dababneh), pending in this
committee, 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.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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