BILL NUMBER: AB 1863 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Gallegos
FEBRUARY 10, 2000
An act to amend Sections 14005.7 and 14005.12 of the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1863, as introduced, Gallegos. Medi-Cal: eligibility.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services. Existing
law establishes income eligibility levels for those persons not
automatically eligible for Medi-Cal by virtue of eligibility for
certain public assistance programs.
This bill would, on January 1, 2001, and on each January 1
thereafter, increase these levels in a specified manner.
This bill would also establish certain income deductions for needy
families and aged, blind, and disabled persons qualifying for
Medi-Cal eligibility benefits as medically needy recipients.
This bill would make implementation of its provisions subject to
the availability of federal financial participation, and would
require the department to seek any necessary federal approvals for
its implementation.
Because each county is required to determine Medi-Cal eligibility,
and because the bill would expand Medi-Cal eligibility, the bill
would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14005.7 of the Welfare and Institutions Code is
amended to read:
14005.7. (a) Medically needy persons and medically needy family
persons are entitled to health care services under Section 14005
providing all eligibility criteria established pursuant to this
chapter are met.
(b) Except as otherwise provided in this chapter or in Title XIX
of the federal Social Security Act, no medically needy family person,
medically needy person or state-only Medi-Cal persons shall be
entitled to receive health care services pursuant to Section 14005
during any month in which his or her share of cost has not been met.
(c) (1) In the case of a medically needy person,
monthly income, as determined, defined, counted, and valued, in
accordance with Title XIX of the federal Social Security Act, in
excess of the amount required for maintenance established pursuant to
Section 14005.12, exclusive of any amounts considered exempt as
income under Chapter 3 (commencing with Section 12000), less amounts
paid for Medicare and other health insurance premiums shall be the
share of cost to be met under Section 14005.9.
(2) Individuals or couples qualifying for benefits under this
chapter as medically needy persons on the basis of age, blindness, or
disability shall additionally deduct as a special income deduction
an amount equal to the difference between the income level for
maintenance need for an individual or couple as set forth in
subdivisions (a), (b), and (c) of Section 14005.12 and the amount of
SSI/SSP the individual or couple would be entitled to receive under
Chapter 3 (commencing with Section 1300) if the individual or couple
had no income other than SSI/SSP.
(3) The department shall seek any necessary approvals, including
state plan amendments, for the changes in income methodologies
authorized in paragraph (2) by not later than March 1, 2001. The
income methodology change provided for in paragraph (2) shall be
implemented only to the extent federal financial participation is
available for health care benefits provided after the special income
deduction authorized in that paragraph.
(d) In the case of a medically needy family person or state-only
Medi-Cal person, monthly income, as determined, defined, counted, and
valued, in accordance with Title XIX of the federal Social Security
Act, in excess of the amount required for maintenance established
pursuant to Section 14005.12, exclusive of any amounts considered
exempt as income under Chapter 2 (commencing with Section 11200),
less amounts paid for Medicare and other health insurance premiums
shall be the share of cost to be met under Section 14005.9.
(e) In determining the income of a medically needy person residing
in a licensed community care facility, income shall be determined,
defined, counted, and valued, in accordance with Title XIX of the
federal Social Security Act, any amount paid to the facility for
residential care and support that exceeds the amount needed for
maintenance shall be deemed unavailable for the purposes of this
chapter.
SEC. 2. Section 14005.12 of the Welfare and Institutions Code is
amended to read:
14005.12. (a) (1) For the purposes of Sections 14005.4
and 14005.7, the department shall establish the income levels for
maintenance need at the lowest levels that
reasonably permit medically needy persons to meet their basic needs
for food, clothing, and shelter, and for which federal financial
participation will still be provided
maximized under Title XIX of the federal Social
Security Act. It is the intent of the Legislature that the income
levels for maintenance need for medically needy aged, blind, and
disabled adults, in particular, shall be based upon amounts that
adequately reflect their needs.
(1) Subject to paragraph (2), reductions
(2) (A) Reductions in the maximum aid payment levels set
forth in subdivision (a) of Section 11450 in the 1991-92 fiscal year,
and thereafter, shall not result in a reduction in the income levels
for maintenance under this section.
(2) (A)
(B) The department shall seek any necessary federal
authorization for maintaining the income levels for maintenance at
the levels in effect June 30, 1991.
(B)
(C) If federal authorization is not obtained, medically
needy persons shall not be required to pay the difference between the
share of cost as determined based on the payment levels in effect on
June 30, 1991, under Section 11450, and the share of cost as
determined based on the payment levels in effect on July 1, 1991, and
thereafter.
(3)
(D) Any medically needy person who was eligible for benefits
under this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families with
Dependent Children program as set forth in Section 11452.018 made in
the 1995-96 Regular Session of the Legislature shall not be
responsible for paying his or her share of cost if all of the
following apply:
(A)
(i) He or she had eligibility as categorically needy
terminated by the reductions in the minimum basic standards of
adequate care.
(B)
(ii) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.
(C)
(iii) He or she is not eligible to receive benefits without
a share of cost as a medically needy person pursuant to
paragraph (1) or (2) subparagraph (A) or (B) .
(3) (A) The income levels for maintenance under this section in
effect July 1, 1989, shall be increased on January 1, 2001, by a
percentage equal to the intervening consumer price index increases
but not more than 20 percent. On January 1 of each subsequent year,
the income levels for maintenance under this section shall be
increased by a percentage equal to the lesser of the Consumer Price
Index or the Social Security Cost-of-Living Allowance increases. The
department shall seek any necessary federal approvals, including
state plan amendments and federal waivers, for increasing the federal
financial participation for all or part of the cost-of-living
increases in the income levels for maintenance under this section.
(B) Any person qualifying for benefits under this chapter on the
basis of age, blindness, or disability in accordance with Section
14005.7 shall be entitled to a special income deduction in an amount
equal to the amount of income by, if any, which the SSI/SSP grants
and nonexempt income allowed for the categorically needy exceeds the
medically needy income level as set forth in subparagraph (A).
(C) Notwithstanding any other provision of law, the income of any
person qualifying for benefits under this chapter as a medically
needy family person pursuant to Section 14005.7 shall be subject to
the same deductions provided to individuals who are recipients of
services under Section 1396u-1 of Title 42 of the United States Code,
including any options under Section 1396u-1(b)(2)(C) exercised by
the state.
(D) The department shall seek any necessary federal approvals,
including state plan amendments and waivers, for federal financial
participation for the increases in the income levels for maintenance
under this section. Subparagraphs (A) and (B) shall be implemented
only to the extent federal financial participation is available for
the increases in the medically needy income levels provided for in
those subparagraphs.
(b) In Except as provided for in
paragraphs (2) and (3) of subdivision (a), in the case of a
single individual, the amount of the income level for maintenance per
month shall be 80 percent of the highest amount that would
ordinarily be paid to a family of two persons, without any income or
resources, under subdivision (a) of Section 11450, multiplied by the
federal financial participation rate.
(c) In Except as provided for in
paragraphs (2) and (3) of subdivision (a), in the case of a
family of two adults, the income level for maintenance per month
shall be the highest amount that would ordinarily be paid to a family
of three persons without income or resources under subdivision (a)
of Section 11450, multiplied by the federal financial participation
rate.
(d) For the purposes of Sections 14005.4 and 14005.7, for a person
in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from an
organization with a frail elderly demonstration project waiver
pursuant to Chapter 8.75 (commencing with Section 14590), the amount
considered as required for maintenance per month shall be computed in
accordance with , and for those purposes required by,
Title XIX of the federal Social Security Act, and
regulations adopted pursuant thereto. Those amounts shall be
computed pursuant to regulations which include providing for the
following purposes:
(1) Personal and incidental needs in the amount of not less than
thirty-five dollars ($35) per month while a patient. The department
may, by regulation, increase this amount as necessitated by
increasing costs of personal and incidental needs. A long-term
health care facility shall not charge an individual for the laundry
services or periodic hair care specified in Section 14110.4.
(2) The upkeep and maintenance of the home.
(3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.
(4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent children,
dependent parents, or dependent siblings of either spouse, provided
the individuals are residing with the community spouse.
(5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396r-5(d)(1)(B)).
(6) The family allowance for each family member residing with the
community spouse shall be computed in accordance with the formula
established in Section 1924(d)(1)(C) of Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).
(e) For the purposes of Sections 14005.4 and 14005.7, with regard
to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be computed
pursuant to regulations adopted by the department which provide for
the support and care of his or her spouse, minor children, or any
disabled relative for whose support he or she has contributed
regularly.
(f) The Except as provided for in
paragraphs (2) and (3) of subdivision (a), the income levels
for maintenance per month, except as specified in subdivisions (b) to
(d), inclusive, shall be equal to the highest amounts that would
ordinarily be paid to a family of the same size without any income or
resources under subdivision (a) of Section 11450, multiplied by the
federal financial participation rate.
(g) The "federal financial participation rate," as used in this
section, shall mean 1331/3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396
(b)), or its successor provisions.
(h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.
(i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for each
household in accordance with subdivisions (b) to (h), inclusive.
The total of these levels shall be the level for the single
eligibility unit.
(j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.
SEC. 3. Notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
costs mandated by the state, reimbursement to local agencies and
school districts for those costs shall be made pursuant to Part 7
(commencing with Section 17500) of Division 4 of Title 2 of the
Government Code. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.