BILL ANALYSIS Ó
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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