BILL ANALYSIS                                                                                                                                                                                                    

                                                                    AB 1319

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          Date of Hearing:  May 20, 2015


                                 Jimmy Gomez, Chair

          1319 (Dababneh) - As Introduced February 27, 2015

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          Urgency:  No  State Mandated Local Program:  YesReimbursable:   


          This bill 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  


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          community care facility, provided all necessary federal  
          approvals can be obtained. 

          FISCAL EFFECT:

          1)Increased costs, likely in the range of $100,000 or less  
            (GF/federal), to allow certain Share-of-Cost (SOC) Medi-Cal  
            beneficiaries to retain the additional monthly amount.

          2)According to the Department of Health Care Services (DHCS), by  
            increasing the income deduction for SOC, individuals in the  
            SOC program with incomes slightly above the income threshold  
            for the Aged, Blind, and Disabled federal poverty level (FPL)  
            program, a full-scope program with no SOC, will be eligible to  
            transition to the FPL program.  If this dynamic occurs,  
            increasing the monthly income disregard by $30 would  
            essentially make the income threshold 2.5 percentage points  
            higher than it otherwise would be, for individuals residing in  
            community care facilities.  Increased enrollment in the FPL  
            program would cost in the range of $1 million annually  
            (GF/federal) for 200 additional beneficiaries.  However, staff  
            notes the language appears to apply only to SOC beneficiaries,  
            so whether this shift would actually occur is unclear.  

          3)This bill is tagged as a reimbursable mandate.  Eligibility  
            for Medi-Cal is administered by counties and administrative  
            costs are reimbursed through contract with the state.  This  
            change will require notification and minor adjustments in  
            county policies and practices.  The total cost pressure  
            associated with this small change is unknown but likely minor,  
            and it will not result in mandate claims due to the  
            reimbursement structure for Medi-Cal county administration.   
            Minor information technology automation changes may be  
            required as well.  


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          1)Purpose. This bill updates the personal and incidental needs  
            allowance to better reflect the costs of personal items  
            (toothpaste, soap, clothes, etc.) for individuals residing in  
            assisted living facilities. 

          2)Background.  The medically needy program is a way to extend  
            Medi-Cal eligibility to individuals with high medical expenses  
            whose income exceeds the income eligibility threshold for  
            Medi-Cal.  The program functions as a last resort for those  
            whose incomes are modest and are surpassed by their  
            significant medical expenses.  Medically needy eligibility  
            allows a beneficiary to gain access to Medi-Cal services, but  
            the access is contingent upon a beneficiary sharing the cost.

            Share of cost requires recipients to take full responsibility  
            for health care expenses up to a predetermined amount.  Once  
            they meet the full share of cost, they are certified and  
            Medi-Cal will cover eligible medical expenses for that month.   

            For those beneficiaries residing in a community care facility  
            (generally assisted living facilities, also called residential  
            care facilities for the elderly (RCFEs)), the share of cost  
            calculation allows for a personal and incidental needs  
            deduction.  The amount is set in statute and is currently $20.  

          3)Related Legislation. 

             a)   AB 763 (Burke), pending on the Suspense File of this  


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               Committee, increases the amount of income that is  
               disregarded in calculating eligibility for purposes of the  
               Medi-Cal aged and disabled (A&D) program which effectively  
               increases the upper limit of financial eligibility to 138%  
               of the federal poverty level (FPL).

             b)   AB 1235 (Gipson), pending on the Suspense File of this  
               Committee establishes the home upkeep allowance for certain  
               Medi-Cal eligible long-term care facility residents.  

          Analysis Prepared by:Lisa Murawski / APPR. / (916)