BILL NUMBER: SB 33 INTRODUCED
INTRODUCED BY Senator Hernandez
DECEMBER 1, 2014
An act to amend Section 14009.5 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
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 1. Section 14009.5 of the Welfare and Institutions Code is
amended to read:
14009.5. (a) Notwithstanding any other provision of this chapter,
the department shall claim against the estate of the decedent, or
against any recipient of the property of that decedent by
distribution or survival an amount equal to the payments for the
health care services received or the value of the property received
by any recipient from the decedent by distribution or survival,
less. less, only in either of
the following circumstances:
(b) The department may not claim in any of the following
(1) The decedent was under 55 when services were received, except
in the case of an individual who had been an inpatient in a nursing
(2) Where there is any of the following:
(1) Notwithstanding paragraph (2), against the real property of a
decedent who was an inpatient in a nursing facility in accordance
with Section 1396p(b)(1)(A) of Title 42 of the United States Code.
(2) (A) The decedent was 55 years of age or older when the
individual received health care services.
(B) The department shall not claim under this paragraph when there
is any of the following:
( i) A surviving spouse during his
or her lifetime. However, upon the death of a surviving spouse, the
department shall make a claim against the estate of the surviving
spouse, or against any recipient of property from the surviving
spouse obtained by distribution or survival, for either the amount
paid for the medical assistance given to the decedent or the value of
any of the decedent's property received by the surviving spouse
through distribution or survival, whichever is less. Any statute of
limitations that purports to limit the ability to recover for medical
assistance granted under this chapter shall not apply to any claim
made for reimbursement. spouse.
(ii) A surviving child who is under age 21.
21 years of age.
(iii) A surviving child who is blind or permanently and
totally disabled, within the meaning of Section 1614 of the federal
Social Security Act (42 U.S.C.A. U.S.C.
(3) Any exemption described in paragraph (2) that restricts the
department from filing a claim against a decedent's property shall
apply only to the proportionate share of the decedent's estate or
property that passes to those recipients, by survival or
distribution, who qualify for an exemption under paragraph (2).
( b) (1) The department shall waive its
claim, in whole or in part, if it determines that enforcement of the
claim would result in substantial hardship to other dependents,
heirs, or survivors of the individual against whose estate the claim
(2) The department shall notify individuals of the waiver
provision and the opportunity for a hearing to establish that a
waiver should be granted.
(c) (1) The department shall provide a current or former
beneficiary, or his or her authorized representative designated under
Section 14014.5, upon request and free of charge, with the total
amount of Medi-Cal expenses that have been paid on behalf of that
beneficiary that would be recoverable under this section.
(2) The department shall permit a beneficiary to request the
information described in paragraph (1) through the Internet, by
telephone, by mail, in person, or through other commonly available
(3) The department shall conspicuously post on its Internet Web
site, a description of the methods by which a request under this
subdivision may be made, including, but not limited to, the
department's telephone number and any addresses that may be used for
this purpose. The department shall also include this information in
its pamphlet for the Medi-Cal Estate Recovery Program and any other
notices the department distributes to beneficiaries regarding estate
(d) The following definitions shall govern the construction of
(1) "Decedent" means a beneficiary who has received health care
under this chapter or Chapter 8 (commencing with Section 14200) and
who has died leaving property to others either through distribution
(2) "Dependents" includes, but is not limited to, immediate family
or blood relatives of the decedent.
(3) "Health care services" means only those services required to
be recovered under Section 1396p(b)(1)(B)(i) of Title 42 of the
United States Code.
(e) The amendments made to this section by the act that added this
subdivision shall apply only to individuals who die on or after
January 1, 2016.