SB 33, as introduced, Hernandez. Medi-Cal: estate recovery.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions.
Existing federal law requires the state to seek adjustment or recovery from an individual’s estate for specified medical assistance, including nursing facility services, home and community-based services, and related hospital and prescription drug services, if the individual was 55 years of age or older when he or she received the medical assistance. Existing federal law allows the state, at its own option, to seek recovery for any items or services covered under the state’s Medicaid plan.
Existing state law, with certain exceptions, requires the department to claim against the estate of a decedent, or against any recipient of the property of that decedent by distribution or survival, an amount equal to the payments for Medi-Cal services received or the value of the property received by any recipient from the decedent by distribution or survival, whichever is less. Existing law provides for certain exemptions that restrict the department from filing a claim against a decedent’s property, including when there is a surviving spouse during his or her lifetime. Existing law requires the department, however, to make a claim upon the death of the surviving spouse, as prescribed. Existing law, which has been held invalid by existing case law, provides that the exemptions shall only apply to the proportionate share of the decedent’s estate or property that passes to those recipients, by survival or distribution, who qualify for the exemptions.
This bill would instead require the department to make these claims only in specified circumstances for those health care services that the state is required to recover under federal law, and would define health care services for these purposes. The bill would delete the proportionate share provision and would delete the requirement that the department make a claim upon the death of the surviving spouse. The bill would also require the department to provide a current or former beneficiary, or his or her authorized representative, upon request and free of charge, with the total amount of Medi-Cal expenses that have been paid on his or her behalf that would be recoverable under these provisions, as specified. The bill would apply the changes made by these provisions only to individuals who die on or after January 1, 2016.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14009.5 of the Welfare and Institutions
2Code is amended to read:
(a) Notwithstanding any other provision of this
4chapter, the department shall claim against the estate of the
5decedent, or against any recipient of the property of that decedent
6by distribution or survival an amount equal to the payments for
7the health care services received or the value of the property
8received by any recipient from the decedent by distribution or
9survival, whichever isbegin delete less.end deletebegin insert less, only in either of the following
10circumstances:end insert
11(b) The department may not claim in any of the following
12circumstances:
13(1) The decedent was under 55 when services were received,
14except in the case of an individual who had been an inpatient in a
15nursing facility.
16(2) Where there is any of the following:
end delete
17(1) Notwithstanding paragraph (2), against the real property
18of a decedent who was an inpatient in a nursing facility in
P3 1accordance with Section 1396p(b)(1)(A) of Title 42 of the United
2States Code.
3(2) (A) The decedent was 55 years of age or older when the
4individual received health care services.
5(B) The department shall not claim under this paragraph when
6there is any of the following:
7(A)
end delete
8begin insert(end insertbegin inserti)end insert A survivingbegin delete spouse during his or her lifetime. However, upon
9the death of a surviving spouse, the department shall make a claim
10against the estate of the surviving spouse, or against any recipient
11of property from the surviving spouse obtained by distribution or
12survival, for either the amount paid for the medical assistance
13given to the decedent or the value of any of the decedent’s property
14received by the surviving spouse through distribution or survival,
15whichever is less. Any statute of limitations that purports to limit
16the ability to recover for medical assistance granted under this
17chapter shall not apply to any claim made for
reimbursement.end delete
18begin insert spouse.end insert
19(B)
end delete
20begin insert(ii)end insert A surviving child who is underbegin delete age 21.end deletebegin insert 21 years of age.end insert
21(C)
end delete
22begin insert(iii)end insert A surviving child who is blind or permanently and totally
23disabled, within the meaning of Section 1614 of the federal Social
24Security Act (42begin delete U.S.C.A.end deletebegin insert U.S.C.end insert Sec. 1382c).
25(3) Any exemption described in paragraph (2) that restricts the
26department from filing a claim against a decedent’s property shall
27apply only to the proportionate share of the decedent’s estate or
28property that passes to those recipients, by survival or distribution,
29who qualify for an exemption under paragraph (2).
30(c)
end delete
31begin insert(end insertbegin insertb)end insert (1) The department shall waive its claim, in whole or in
32part, if it determines that enforcement of the claim would result in
33substantial hardship to other dependents, heirs, or survivors of the
34individual against whose estate the claim exists.
35(2) The department shall notify individuals of the waiver
36provision and the opportunity for a hearing to establish that a
37waiver should be granted.
38(c) (1) The department shall provide a current or former
39beneficiary, or his or her authorized
representative designated
40under Section 14014.5, upon request and free of charge, with the
P4 1total amount of Medi-Cal expenses that have been paid on behalf
2of that beneficiary that would be recoverable under this section.
3(2) The department shall permit a beneficiary to request the
4information described in paragraph (1) through the Internet, by
5telephone, by mail, in person, or through other commonly available
6electronic means.
7(3) The department shall conspicuously post on its Internet Web
8site, a description of the methods by which a request under this
9subdivision may be made, including, but not limited to, the
10department’s telephone number and any addresses that may
be
11used for this purpose. The department shall also include this
12information in its pamphlet for the Medi-Cal Estate Recovery
13Program and any other notices the department distributes to
14beneficiaries regarding estate recovery.
15(d) The following definitions shall govern the construction of
16this section:
17(1) “Decedent” means a beneficiary who has received health
18care under this chapter or Chapter 8 (commencing with Section
1914200) and who has died leaving property to others either through
20distribution or survival.
21(2) “Dependents” includes, but is not limited to, immediate
22family or blood relatives of the decedent.
23(3) “Health care services” means
only those services required
24to be recovered under Section 1396p(b)(1)(B)(i) of Title 42 of the
25United States Code.
26(e) The amendments made to this section by the act that added
27this subdivision shall apply only to individuals who die on or after
28January 1, 2016.
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