BILL ANALYSIS Ó
AB 1319
Page 1
ASSEMBLY THIRD READING
AB
1319 (Dababneh)
As Introduced February 27, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+---------------------+---------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Gonzalez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Patterson, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+------+---------------------+---------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
AB 1319
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| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Raises the current $20 per month incidental needs
deduction to $50 for the California Medical Assistance Program
(Medi-Cal) beneficiaries who qualify for personal and incidental
needs deductions and are residing in a community care facility,
provided all necessary federal approvals can be obtained.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Increased costs, likely in the range of $100,000 or less
(General Fund (GF)/federal), to allow certain Share-of-Cost
(SOC) Medi-Cal beneficiaries to retain the additional monthly
amount.
2)Unknown, likely significant costs for information technology
changes in the three local Medi-Cal eligibility and case
management systems (GF/federal).
3)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
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beneficiaries. However, staff notes the language appears to
apply only to SOC beneficiaries, so whether this shift would
actually occur is unclear.
4)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.
COMMENTS: According to the author, seniors on a fixed income who
receive a Medically Needy Only (MNO) benefit need extra help in
purchasing everyday items (toothpaste, soap, clothes, etc.) due to
their high medical expenses. Currently seniors in the MNO program
that live in assisted living facilities only keep the $20 income
deduction portion of their income every month. That $20 is
expected to cover all items the senior needs from shampoo and
toothpaste to clothing and other incidentals, but falls short.
This bill seeks to increase the $20 per month incidental needs
deduction to $50 for Medi-Cal beneficiaries who qualify for
personal and incidental needs deductions. This bill is needed to
allow seniors and the disabled to have more money to pay for
everyday expenses. This amount has not been raised since 1970 and
$20 covers very few expenses. Thus, raising the amount to $50
allows for a modest increase in the quality of life for these
seniors.
The MNO 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
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services, but the access is contingent upon a beneficiary sharing
the cost.
SOC 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. The share of cost
requirement begins anew the following month, so it is a month by
month eligibility which is quite different than the remainder of
Medi-Cal. In any given month only a small proportion,
approximately one in six, of the beneficiaries meet their share of
cost obligation and receive Medi-Cal. For those in nursing homes,
the proportion is much greater with nearly all meeting their share
of cost each month.
A share of cost is the difference between a beneficiary's
countable income and the maintenance need income level (MNIL), or
what the state considers to be the base amount of income a person
needs to survive on a monthly basis. The MNIL is $600 per month
and has not changed since 1989. As a result, anything an
individual earns over $600 a month (or a low-income family of four
earns over $1,100), becomes that individual's share of cost. For
example a 65 year-old individual with a monthly income of $1,250
would have a $650 share of cost, even though if she was 64, she
could be eligible for free Medi-Cal without a share of cost. The
beneficiary is now faced with over half of her income paying for
Medi-Cal.
For those beneficiaries residing in a community care facility, the
share of cost calculation allows for a personal and incidental
needs deduction. The amount is set in statute and is currently
$20.
The American Federation of State County and Municipal Employees
supports this bill because seniors on a fixed income need the
extra help in purchasing these everyday items due to their high
AB 1319
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medical expenses. The Commission on Aging supports this bill
because medically needy individuals who must pay a share-of cost
for their Medi-Cal community care facilities are left with few
resources to cover the cost of personal items they need. The
Ventura County Board of Supervisors points out in support, that
seniors and others living in licensed community care facilities
and receiving benefits from Medi-Cal are already the most
vulnerable in society and the current incidental needs deduction
is just too small. California Advocates for Nursing Home Reform,
also in support, argues the share of cost cliff impoverishes
individuals making it almost unaffordable to even pay for small
everyday items.
This bill has no known opposition.
Analysis Prepared by:
Roger Dunstan / HEALTH / (916) 319-2097 FN:
0000675