California Legislature—2015–16 Regular Session

Assembly Bill No. 1319

Introduced by Assembly Member Dababneh

February 27, 2015

An act to amend Section 14005.7 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1319, as introduced, Dababneh. Medi-Cal benefits: share of cost requirements.

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 Program provisions. Under existing law, certain aged, blind, and disabled Medi-Cal recipients are required to pay a share of cost as a condition of eligibility, with the share of cost determined in accordance with specified requirements. For purposes of determining the share of cost, existing law establishes a formula to calculate the personal and incidental needs deduction for an individual residing in a licensed community care facility. Existing law prohibits that deduction from exceeding the amount by which the Supplemental Security Income recipient retention amount, as defined, exceeds $20.

This bill would revise the formula to determine the personal and incidental needs deduction. By increasing the responsibility of the counties in determining Medi-Cal eligibility, this bill would impose a state-mandated local program. The bill would also require that its provisions be implemented only to the extent that federal financial participation is available and that the department receives any necessary federal approvals.

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 14005.7 of the Welfare and Institutions
Code is amended to read:

14005.7.  

(a) Medically needy persons and medically needy
family persons are entitled to health care services under Section
14005 providing all eligibility criteria established pursuant to this
chapter are met.

(b) Except as otherwise provided in this chapter or in Title XIX
of the federal Social Security Act, no medically needy family
person, medically needy person or state-only Medi-Cal persons
shall be entitled to receive health care services pursuant to Section
14005 during any month in which his or her share of cost has not
been met.

(c) In the case of a medically needy person, monthly income,
as determined, defined, counted, and valued, in accordance with
Title XIX of the federal Social Security Act, in excess of the
amount required for maintenance established pursuant to Section
14005.12, exclusive of any amounts considered exempt as income
under Chapter 3 (commencing with Section 12000), less amounts
paid for Medicare and other health insurance premiums shall be
the share of cost to be met under Section 14005.9.

(d) In the case of a medically needy family person or state-only
Medi-Cal person, monthly income, as determined, defined, counted,
and valued, in accordance with Title XIX of the federal Social
Security Act, in excess of the amount required for maintenance
established pursuant to Section 14005.12, exclusive of any amounts
considered exempt as income under Chapter 2 (commencing with
Section 11200), less amounts paid for Medicare and other health
insurance premiums shall be the share of cost to be met under
Section 14005.9.

(e) In determining the income of a medically needy person
residing in a licensed community care facility, income shall be
determined, defined, counted, and valued, in accordance with Title
XIX of the federal Social Security Act, any amount paid to the
facility for residential care and support that exceeds the amount
needed for maintenance shall be deemed unavailable for the
purposes of this chapter.

(f) (1) For purposes of this section the following definitions
apply:

(A) “SSI” means the federal Supplemental Security Income
program established under Title XVI of the federal Social Security
Act.

(B) “MNL” means the income standard of the Medi-Cal
medically needy program defined in Section 14005.12.

(C) Board and care “personal care services” or “PCS” deduction
means the income disregard that is applied to a resident in a
licensed community care facility, in lieu of the board and care
deduction specified in subdivision begin delete (e) of Section 14005.7, end delete begin insert (e), end insert
when the PCS deduction is greater than the board and care
deduction.

(2) (A) For purposes of this section, the SSI recipient retention
amount is the amount by which the SSI maximum payment amount
to an individual residing in a licensed community care facility
exceeds the maximum amount that the state allows community
care facilities to charge a resident who is an SSI recipient.

(B) For purposes of this section, the personal and incidental
needs deduction for an individual residing in a licensed community
care facility is either of the following:

(i) If the deduction specified in subdivision (e) is applicable to
the individual, the amount, not to exceed the amount by which the
SSI recipient retention amount exceeds begin delete twenty dollars ($20), end delete begin insert fifty
dollars ($50), end insert nor to be less than zero, by which the sum of the
amount that the individual pays to his or her licensed community
care facility and the SSI recipient retention amount exceed the sum
of the individual’s MNL, the individual’s board and care deduction,
and begin delete twenty dollars ($20). end delete begin insert fifty dollars ($50). end insert

(ii) If the deduction specified in paragraph (1) is applicable to
the individual, begin delete an end delete begin insert the end insert amount, not to exceed the amount by which
the SSI recipient retention amount exceeds begin delete twenty dollars ($20), end delete
begin insert fifty dollars ($50), end insert nor to be less than zero, by which the sum of
the amount which the individual pays to his or her begin insert licensed end insert
community care facility and the SSI recipient retention amount
exceed the sum of the individual’s MNL, the individual’s PCS
deduction and begin delete twenty dollars ($20). end delete begin insert fifty dollars ($50). end insert

(3) In determining the countable income of a medically needy
individual residing in a licensed community care facility, the
individual shall have deducted from his or her income the amount
specified in subparagraph (B) of paragraph (2).

(g) No later than one month after the effective date of
subparagraph (B) of paragraph (2) of subdivision (f), the
department shall submit to the federal medicaid administrator a
state plan amendment seeking approval of the income deduction
specified in subdivision (f), and of federal financial participation
for the costs resulting from that income deduction.

(h) The deduction prescribed by paragraph (3) of subdivision
(f) shall be applied no later than the first day of the fourth month
after the month in which the department receives approval for the
federal financial participation specified in subdivision (g). Until
approval for federal financial participation is received by the
department, there shall be no deduction under paragraph (3) of
subdivision (f).

begin insert

(i) The amendments to clauses (i) and (ii) of subparagraph (B)
of paragraph (2) of subdivision (f) made by the act that added this
subdivision during the 2015-16 Regular Session of the Legislature
shall be implemented only to the extent that federal financial
participation is available and that the department receives any
necessary federal approvals.

end insert

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.