BILL ANALYSIS Ó
AB 1319
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Date of Hearing: May 20, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1319 (Dababneh) - As Introduced February 27, 2015
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
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
AB 1319
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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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COMMENTS:
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)
319-2081