Amended in Senate March 11, 2015

Senate BillNo. 33


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 amended, 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.begin insert The bill would limit any claims against the estate of a decedent to only the real and personal property or other assets the state is required to seek recovery from under federal law.end insert 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:

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SECTION 1.  

Section 14009.5 of the Welfare and Institutions
2Code
is amended to read:

3

14009.5.  

(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 distributionbegin delete or survivalend delete 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 bybegin delete distribution or
9survival,end delete
begin insert distribution,end insert whichever is less, only in either of the
10following circumstances:

11(1) Notwithstanding paragraph (2), against the real property of
12a decedent who was an inpatient in a nursing facility in accordance
13with Section 1396p(b)(1)(A) of Title 42 of the United States Code.

P3    1(2) (A) The decedent was 55 years of age or older when the
2individual received health care services.

3(B) The department shall not claim under this paragraph when
4there is any of the following:

5(i) A surviving spouse.

6(ii) A surviving child who is under 21 years of age.

7(iii) A surviving child who is blind or permanently and totally
8disabled, within the meaning of Section 1614 of the federal Social
9Security Act (42 U.S.C. Sec. 1382c).

10(b) (1) The department shall waive its claim, in whole or in
11part, if it determines that enforcement of the claim would result in
12substantial hardship to other dependents, heirs, or survivors of the
13individual against whose estate the claim exists.

14(2) The department shall notify individuals of the waiver
15provision and the opportunity for a hearing to establish that a
16waiver should be granted.

17(c) (1) The department shall provide a current or former
18beneficiary, or his or her authorized representative designated
19under Section 14014.5, upon request and free of charge, with the
20total amount of Medi-Cal expenses that have been paid on behalf
21of that beneficiary that would be recoverable under this section.

22(2) The department shall permit a beneficiary to request the
23information described in paragraph (1) through the Internet, by
24telephone, by mail, in person, or through other commonly available
25electronic means.

26(3) The department shall conspicuously post on its Internet Web
27site, a description of the methods by which a request under this
28subdivision may be made, including, but not limited to, the
29department’s telephone number and any addresses that may be
30used for this purpose. The department shall also include this
31information in its pamphlet for the Medi-Cal Estate Recovery
32Program and any other notices the department distributes to
33beneficiaries regarding estate recovery.

begin insert

34(4) Upon receiving a request for the information described in
35paragraph (1), the department shall provide the information
36requested within 30 days after receipt of the request.

end insert

37(d) The following definitions shall govern the construction of
38this section:

39(1) “Decedent” means a beneficiary who has received health
40care under this chapter or Chapter 8 (commencing with Section
P4    114200) and who has died leaving property to others either through
2distribution or survival.

3(2) “Dependents” includes, but is not limited to, immediate
4family or blood relatives of the decedent.

begin insert

5(3) ”Estate” means all real and personal property and other
6assets that are required to be subject to a claim for recovery
7pursuant to Section 1396p(b)(4)(A) of Title 42 of the United States
8Code. “Estate” shall not include any other real and personal
9property or other assets in which the individual had any legal title
10or interest at the time of death, to the extent of that interest,
11including any assets conveyed to a survivor, heir, or assign of the
12decedent through joint tenancy, tenancy in common, survivorship,
13life estate, living trust, or other arrangement, consistent with
14Section 1396p(b)(4)(B) of Title 42 of the United States Code.

end insert
begin delete

15(3)

end delete

16begin insert(4)end insert “Health care services” means only those services required
17to be recovered under Section 1396p(b)(1)(B)(i) of Title 42 of the
18United States Code.

19(e) The amendments made to this section by the act that added
20this subdivision shall apply only to individuals who die on or after
21January 1, 2016.



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