BILL ANALYSIS Ó AB 1319 Page 1 Date of Hearing: May 20, 2015 ASSEMBLY COMMITTEE ON APPROPRIATIONS Jimmy Gomez, Chair AB 1319 (Dababneh) - As Introduced February 27, 2015 ----------------------------------------------------------------- |Policy |Health |Vote:|18 - 0 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- 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 Page 2 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. AB 1319 Page 3 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 AB 1319 Page 4 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