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 ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: February 27, 2015 |Policy Vote: HEALTH 8 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: Yes | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- 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 ? 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 ? 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. -- END --