BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1319
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|AUTHOR: |Dababneh |
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|VERSION: |February 27, 2015 |
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|HEARING DATE: |July 8, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Medi-Cal benefits: share of cost requirements.
SUMMARY : Increases the personal and incidental needs deduction for
Medi-Cal beneficiaries residing in a licensed community care
facility from $20 to $50.
Existing law:
1)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Establishes Medi-Cal eligibility for medically needy persons
and medically needy family persons, provided Medi-Cal
eligibility criteria are met. (The medically needy Medi-Cal
eligibility category are individuals who fit into a federal
benefit program category but whose income or resources exceed
eligibility levels. Medically needy individuals become
Medi-Cal eligible by having a share of cost whereby the
individual "spends down" to Medi-Cal eligibility levels.)
3)Requires certain aged, blind, and disabled Medi-Cal recipients
to pay a share of cost as a condition of eligibility, with the
share of cost determined in accordance with specified
requirements.
4)Requires, in determining the countable income of a medically
needy individual residing in a licensed community care
facility, the individual to have deducted from his or her
income $20 as a personal and incidental needs deduction.
This bill increases the personal and incidental needs deduction
for Medi-Cal beneficiary residing in a licensed community care
AB 1319 (Dababneh) Page 2 of ?
facility from $20 to $50, to the extent that federal financial
participation is available and DHCS receives any necessary
federal approvals.
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 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.
PRIOR
AB 1319 (Dababneh) Page 3 of ?
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |18 - 0 |
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COMMENTS :
1)Author's statement. According to the author, this bill will
increase the personal and incidental needs deduction from $20
a month to $50 a month for an individual who qualifies for the
Medically Needy program under Medi-Cal. Medically Needy is a
federal Medicaid eligibility category option that provides
states with the option to extend Medicaid eligibility to
individuals with high medical expenses whose income exceeds
the federal poverty line but who would otherwise be eligible
for Medi-Cal. This program acts as a safety net for those who
are among the most vulnerable in our population -- people
whose medical costs overwhelm their income -- including more
than 8,000 financially needy older adults. Passing this bill
will truly provide seniors with dignity and greater financial
stability to cover life's basic necessitates.
2)Background. Individuals whose income exceeds the income levels
or who do not meet eligibility criteria for no-cost Medi-Cal
can quality as medically needy individuals. The medically
needy program is a way to extend Medi-Cal eligibility to
individuals who do not qualify for no-cost Medi-Cal, such as
those with high medical expenses whose income is too high to
meet the income eligibility threshold for no-cost Medi-Cal.
The program functions as a last resort for those whose incomes
are modest and are surpassed by their significant medical
expenses.
For Medi-Cal beneficiaries residing in a community care
facility, the share of cost calculation allows for a personal
and incidental needs deduction. This amount is set in statute,
is currently $20, and has been in effect since January 1,
1977. This amount is deducted from the individual's income in
determining their share of cost. For example, if an individual
with a monthly income of $1,300 who is residing in a licensed
AB 1319 (Dababneh) Page 4 of ?
community care facility would have the $20 personal and
incidental needs deduction subtracted from his or her monthly
income ($1,300 - $20 = $1,280). The $1,280 would be the
individual's monthly share of cost. Under this bill, $50 would
be subtracted, instead of $20.
3)Related legislation. AB 763 (Burke) 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 percent of the federal poverty level (FPL). AB 763 was
held on the Assembly Appropriations Committee suspense file.
AB 1235 (Gipson) requires the home upkeep allowance (HUA) for
Medi-Cal beneficiaries in long-term care facilities to be
based on the actual minimum cost of maintaining the resident's
home (the HUA is currently $209 a month). Allows a long-term
care facility resident who does not have a home to establish a
transitional personal needs fund to be set aside from the
income that otherwise would be applied toward the resident's
Medi-Cal share of cost for residing in the long term care
facility in an amount of up to $7,500. The personal needs fund
would be used to cover the costs of securing a home for the
individual. AB 1235 is pending in the Senate Appropriations
Committee.
4)Support. The California Advocates for Nursing Home Reform
(CAHNR) writes that the $20 deduction is used to offset
countable income and could mean the difference between
accessing affordable health care to making health care
completely unaffordable. CANHR writes that a $30 difference
may not seem like a lot, but many seniors are on a fixed
income with increasing medical needs and are overwhelmed by
the lack of affordable health care options available to them,
and this bill would give many seniors and persons with
disabilities much needed relief.
SUPPORT AND OPPOSITION :
Support: Los Angeles Jewish Home (sponsor)
American Federation of State, County, and Municipal
Employees
California Advocates for Nursing Home Reform
California Assisted Living Association
California Commission on Aging
AB 1319 (Dababneh) Page 5 of ?
Leading Age California
Ventura County Board of Supervisors
Oppose: None received
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