BILL ANALYSIS Ó
AB 1235
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ASSEMBLY THIRD READING
AB
1235 (Gipson)
As Amended April 23, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+----------------------|
|Health |19-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, | |
| | |Santiago, | |
| | |Steinorth, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+--------------------+----------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
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| | |Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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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.
4)Requires the Department of Health Care Services (DHCS) to
perform specified outreach with respect to the HUA.
FISCAL EFFECT: According to the Assembly Appropriations
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Committee, 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 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% General Fund (GF), 50% federal
funds). 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 funds). 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.
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COMMENTS: According to the Assembly Health Committee, 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:
1)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.
2)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.
3)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.
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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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 for individuals to transfer back into the community.
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. The sponsor states
the allowance is too restrictive and does not meet the needs of
long-term care residents. Supporters of the bill state the
provisions will allow people to better preserve their residences
and will result in cost savings to the state.
There is no opposition to this bill.
Analysis Prepared by:
An-Chi Tsou / HEALTH / (916) 319-2097 FN: 0000768
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