BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1319 (Dababneh) - Medi-Cal benefits:  share of cost  
          requirements
          
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          |Version: February 27, 2015      |Policy Vote: HEALTH 8 - 0       |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: August 17, 2015   |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.


          Bill  
          Summary:  AB 1319 would increase the personal and incidental  
          needs deduction for Medi-Cal beneficiaries residing in a  
          licensed community care facility from $20 to $50 per month.


          Fiscal  
          Impact:  
           One-time administrative costs in the hundreds of thousands for  
            the Department of Health Care Services to develop a state plan  
            amendment, develop regulations, and make necessary programming  
            changes (General Fund and federal funds).
            
           Unknown increased Medi-Cal spending, likely in the millions  
            per year, due to the increase in the personal needs allowance  
            (General Fund and federal funds). For example, for each 3,000  
            eligible beneficiaries who participate in the program under  
            the bill (about 4% of the estimated number of Medi-Cal  
            beneficiaries in community care facilities), the annual costs  
            would be about $1 million per year.







          AB 1319 (Dababneh)                                     Page 1 of  
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            The bill increases the personal needs allowance over existing  
            law, from $20 per month to $50 per month. The actual cost of  
            the bill will depend on the number of participating  
            beneficiaries. The Department does not have information on how  
            many Share of Cost Medi-Cal beneficiaries reside in community  
            care facilities.  
            
           Unknown impact on Medi-Cal spending due to individuals  
            previously eligible for Share of Cost Medi-Cal newly becoming  
            eligible for full scope Medi-Cal (General Fund and federal  
            funds). It appears that current law requires that the amount  
            of the personal needs allowance must be deducted from an  
            individual's income when determining Medi-Cal eligibility. By  
            increasing the allowance by $30 per month, the bill is likely  
            to shift some individuals from being eligible for Share of  
            Cost Medi-Cal to full scope Medi-Cal. In doing so, the bill  
            would increase state Medi-Cal spending, by eliminating the  
            requirement that the individual pay any amount of the cost of  
            care.  


          Background:  Under state and federal law, the Department of Health Care  
          Services operates the Medi-Cal program, which provides health  
          care coverage to low income individuals, families, and children.  
          Medi-Cal provides coverage to childless adults and parents with  
          household incomes up to 138% of the federal poverty level and to  
          children with household incomes up to 266% of the federal  
          poverty level. The federal government provides matching funds  
          that vary from 50% to 90% of expenditures depending on the  
          category of beneficiary.
          Under current law, an individual whose income exceeds the  
          Medi-Cal eligibility threshold can become eligible for share of  
          cost Medi-Cal by "spending-down" their income due to significant  
          health care costs (these beneficiaries are referred to as  
          "medically needy"). Under this program, an individual must spend  
          down all his or her monthly income (less certain set asides, for  
          example a fixed amount to maintain their home for  
          non-institutionalized patients or the personal and incidental  
          needs allowance for individuals in community care facilities).  
          Once an individual has spent down his or her income (paying  
          directly to health care providers or long-term care facilities)  
          the state will pay the remaining costs for care through  
          Medi-Cal. Under current law, the personal and incidental needs  








          AB 1319 (Dababneh)                                     Page 2 of  
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          allowance available to individuals in a licensed community care  
          facility is $20 per month.




          Proposed Law:  
            AB 1319 would increase the personal and incidental needs  
          deduction for Medi-Cal beneficiaries residing in a licensed  
          community care facility from $20 to $50 per month.
          The changes made in the bill to current law would only be  
          implemented by the Department of Health Care Services to the  
          extent that federal financial participation is available.




          Related  
          Legislation:  AB 1235 (Gipson) would require the home upkeep  
          allowance for Medi-Cal beneficiaries in long term care  
          facilities to be based on the actual cost to maintain the  
          beneficiary's home. The bill would allow Medi-Cal beneficiaries  
          in long-term care facilities that do not have a home to  
          establish a transitional needs fund to set aside up to $7,500  
          for the purpose of securing a home. That bill will be heard in  
          this committee.


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