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 14005.7 of the Welfare and Institutions
2Code is amended to read:
(a) Medically needy persons and medically needy
4family persons are entitled to health care services under Section
514005 providing all eligibility criteria established pursuant to this
6chapter are met.
7(b) Except as otherwise provided in this chapter or in Title XIX
8of the federal Social Security Act, no medically needy family
9person, medically needy person or state-only Medi-Cal persons
10shall be entitled to receive health care services pursuant to Section
1114005 during any month in which his or her share of cost has not
13(c) In the case of a medically needy person, monthly income,
14as determined, defined, counted, and valued, in accordance with
15Title XIX of the federal Social Security Act, in excess of the
16amount required for maintenance established pursuant to Section
1714005.12, exclusive of any amounts considered exempt as income
18under Chapter 3 (commencing with Section 12000), less amounts
19paid for Medicare and other health insurance premiums shall be
20the share of cost to be met under Section 14005.9.
21(d) In the case of a medically needy family person or state-only
22Medi-Cal person, monthly income, as determined, defined, counted,
23and valued, in accordance with Title XIX of the federal Social
24Security Act, in excess of the amount required for maintenance
25established pursuant to Section 14005.12, exclusive of any amounts
26considered exempt as income under Chapter 2 (commencing with
P3 1Section 11200), less amounts paid for Medicare and other health
2insurance premiums shall be the share of cost to be met under
4(e) In determining the income of a medically needy person
5residing in a licensed community care facility, income shall be
6determined, defined, counted, and valued, in accordance with Title
7XIX of the federal Social Security Act, any amount paid to the
8facility for residential care and support that exceeds the amount
9needed for maintenance shall be deemed unavailable for the
10purposes of this chapter.
11(f) (1) For purposes of this section the following definitions
13(A) “SSI” means the federal Supplemental Security Income
14program established under Title XVI of the federal Social Security
16(B) “MNL” means the income standard of the Medi-Cal
17medically needy program defined in Section 14005.12.
18(C) Board and care
“personal care services” or “PCS” deduction
19means the income disregard that is applied to a resident in a
20licensed community care facility, in lieu of the board and care
21deduction specified in subdivision
begin delete (e) of Section 14005.7,end delete
22 when the PCS deduction is greater than the board and care
24(2) (A) For purposes of this section, the SSI recipient retention
25amount is the amount by which the SSI maximum payment amount
26to an individual residing in a licensed community care facility
27exceeds the maximum amount that the state allows community
28care facilities to charge a resident who is an SSI recipient.
29(B) For purposes of this section, the personal and incidental
30needs deduction for an individual residing in a licensed community
31care facility is either of the following:
32(i) If the deduction specified in subdivision (e) is applicable to
33the individual, the amount, not to exceed the amount by which the
34SSI recipient retention amount exceeds
begin delete twenty dollars ($20),end delete nor to be less than zero, by which the sum of the
36amount that the individual pays to his or her licensed community
37care facility and the SSI recipient retention amount exceed the sum
38of the individual’s MNL, the individual’s board and care deduction,
begin delete twenty dollars ($20).end delete
P4 1(ii) If the deduction specified in paragraph (1) is applicable to
begin delete anend delete amount, not to exceed the amount by which
3the SSI recipient retention amount exceeds
begin delete twenty dollars ($20),end delete
4 nor to be less than zero, by which the sum of
5the amount which the individual pays to his or her
6 community care facility and the SSI recipient retention amount
7exceed the sum of the individual’s MNL, the individual’s PCS
begin delete twenty dollars ($20).end delete
9(3) In determining the countable income of a medically needy
10individual residing in a licensed community care facility, the
11individual shall have deducted from his or her income the amount
12specified in subparagraph (B) of paragraph (2).
later than one month after the effective date of
14subparagraph (B) of paragraph (2) of subdivision (f), the
15department shall submit to the federal medicaid administrator a
16state plan amendment seeking approval of the income deduction
17specified in subdivision (f), and of federal financial participation
18for the costs resulting from that income deduction.
19(h) The deduction prescribed by paragraph (3) of subdivision
20(f) shall be applied no later than the first day of the fourth month
21after the month in which the department receives approval for the
22federal financial participation specified in subdivision (g). Until
23approval for federal financial participation is received by the
24department, there shall be no deduction under paragraph (3) of
If the Commission on State Mandates determines that
33this act contains costs mandated by the state, reimbursement to
34local agencies and school districts for those costs shall be made
35pursuant to Part 7 (commencing with Section 17500) of Division
364 of Title 2 of the Government Code.