BILL ANALYSIS Ó AB 1235 Page 1 ASSEMBLY THIRD READING AB 1235 (Gipson) As Amended June 1, 2015 Majority vote ------------------------------------------------------------------ |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, | | AB 1235 Page 2 | | |Chang, Daly, | | | | |Eggman, Gallagher, | | | | | | | | | | | | | | |Eduardo Garcia, | | | | |Gordon, Holden, | | | | |Jones, Quirk, | | | | |Rendon, Wagner, | | | | |Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Defines a home upkeep allowance (HUA), require an HUA to be available to specified long-term care (LTC) facility recipients, and allow specified LTC facility residents to include the transitional costs of establishing a home in their personal needs allowance, as specified. Specifically, this bill: 1)Defines an HUA as the "allowance of home maintenance" in federal regulation and the amount for the "upkeep and maintenance of the home" described in existing law. 2)Requires the HUA to be available to Medi-Cal beneficiaries who receive LTC. 3)Requires a transitional personal needs fund, as defined by federal regulation, to be available to LTC recipients covered under this bill. 4)Requires an HUA, as defined by federal regulation, to be available to LTC recipients covered under this bill. AB 1235 Page 3 5)Requires an HUA to be made available to a LTC facility resident who intends to return to his or her home, as specified. 6)Allows the transitional costs of establishing home to be included in the personal needs allowance for all long-term facility residents who do not have a home but intend to leave a facility and establish a home in the community, as specified. 7)Requires the Department of Health Care Services to perform outreach activities to LTC residents, and to promulgate regulations regarding this bill's provisions, as specified. FISCAL EFFECT: This bill, as amended, 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 for individuals to transfer back into the community. 2)Background. 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 give states the flexibility to support this goal and allow states to exempt income to maintain a home. The AB 1235 Page 4 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: 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; c) The spouse or family of the individual must not live in the home; and, d) 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. 3)Support. On the previous version of the bill, Disability Rights California, the sponsor of the bill, states the current allowance given to LTC facility residents for the maintenance of their homes is insufficient and highlights the rate has not been AB 1235 Page 5 updated since the 1970's. The sponsor states the allowance is too restrictive and does not meet the needs of LTC residents. 4)Opposition. With the proposed amendments to this bill, there is no known opposition to this bill. 5)Policy Comments. a) The proposed amendments define the HUA as the "allowance for home maintenance" under federal regulation and the amount for the "upkeep and maintenance of the home" described in existing law. The proposed amendments do not specify how the HUA will be determined between these two amounts; the author may wish to consider clarifying changes in a future committee. In addition, the proposed amendments do not specify which code section the "upkeep and maintenance of home" amount refers to; the author may wish to make a technical change to refer to the specific code section in California statute for this amount. b) The proposed amendments to this bill reference current federal regulations. All regulations are subject to change by the respective federal or state agencies and departments; if the regulations referenced in the proposed amendments are modified, those changes would have a direct impact on this bill's provisions. The author may wish to amend the bill such that there are no direct references to federal or state regulations. c) The proposed amendments to this bill require an HUA to be provided to all LTC facility residents who intend to leave a facility and either return to his or her existing home, or establish a new home in the community. However the proposed language does not specify which entity would be responsible AB 1235 Page 6 for determining if a LTC facility resident does in fact intend to leave the facility, and what factors would be considered in that determination. The author may wish to amend the bill to specify these considerations. d) The proposed amendments require the transitional costs of establishing a home to be included in the personal needs allowance for a LTC facility resident, and allow the resident to establish a transitional personal needs fund for this purpose. Allowing the resident to maintain and establish his or her own fund may lead to potential conflicts of interest or other logistical challenges; the author may wish to consider if another entity would be more appropriate to maintain this fund. Analysis Prepared by: An-Chi Tsou / HEALTH / (916) 319-2097 FN: 0000831