BILL ANALYSIS
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THIRD READING
Bill No: AB 1269
Author: Brownley (D)
Amended: 9/1/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-3, 7/8/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Maldonado,
Negrete McLeod, Pavley, Wolk
NOES: Strickland, Aanestad, Cox
SENATE APPROPRIATIONS COMMITTEE : 8-5, 8/27/09
AYES: Kehoe, Corbett, Hancock, Leno, Oropeza, Price, Wolk,
Yee
NOES: Cox, Denham, Runner, Walters, Wyland
ASSEMBLY FLOOR : 50-29, 6/2/09 - See last page for vote
SUBJECT : Medi-Cal eligibility: California Working
Disabled Program
SOURCE : Author
DIGEST : This bill expands the Medi-Cal California
Working Disabled Program (CWD) by allowing additional
resource exemptions when determining initial and continued
eligibility for the program. The exempted resources would
include Social Security disability benefits and income, as
well as retained earned income which is held in a separate
account, provided that federal financial participation is
available. This bill also allows 26 weeks of continued
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eligibility for the Medi-Cal program when a disabled
participant is temporarily unemployed, provided they
continue to make premium payments. In addition, this bill
replaces the current sliding scale for premiums with a
monthly premium set at five percent of the individual's
countable income subject to a $20 minimum and a $250
maximum. This bill delays implementation until the federal
American Recovery and Reinvestment Act of 2009 (ARRA)
enhanced Federal Medical Assistance Percentage provisions
sunset, which will likely be January 1, 2011, so as to not
jeopardize ARRA funds. The federal Centers for Medicare
and Medicaid Services, the Medicaid regulating body, could
construe this bill to limit eligibility for CWD. In return
for receiving ARRA funds, ARRA prohibits states from
negatively impacting Medi-Cal eligibility. This bill
specifies that if any provision of this bill, or its
application, is held invalid by a final judicial
determination, it shall cease to be implemented. A
determination of invalidity shall not affect other
provisions or applications of this section that can be
given effect without the implementation of the invalid
provision or application.
ANALYSIS : Existing law established the CWD in 2000 and,
in 2008, the Budget Act made the program permanent. CWD
provides Medi-Cal health benefits to working disabled
individuals with a net family income of up to 250 percent
of the federal poverty level, or $25,525 for an individual.
CWD enrollees pay monthly premiums of $20-$375 depending
on the enrollee's countable income.
This bill permits CWD enrollees who were temporarily
unemployed to retain Medi-Cal coverage for up to 26 weeks
provided the enrollee continued to pay premiums during this
period. Currently, CWD enrollees whose employment was
terminated due to good cause may retain Medi-Cal coverage
for up to two months.
Additionally, this bill makes several changes to the
determination of CWD eligibility. It adds the following
types of income to those exempted when determining CWD
eligibility: (1) retained earned income held in a
separately identifiable account, and (2) social security
disability income that would convert to social security
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retirement income upon the retirement of an individual.
This bill requires the Department of Health Care Services
(DHCS) to submit a state plan amendment to the Centers for
Medicare and Medicaid specifically for the second exemption
and would provide that the exemption would go into effect
only if the state plan amendment was approved.
This bill requires that all resources in the form of
employer or individual retirement arrangements that are
currently exempt for CWD eligibility determination would be
exempt when determining a CWD enrollee's eligibility for
any other Medi-Cal program for which the enrollee may
eligible provided the eligibility is based on age,
blindness, or disability. This bill requires DHCS to seek
a state plan amendment for this provision and that this
provision would be implemented only if the state plan
amendment were approved by the Centers for Medicare and
Medicaid.
This bill provides that an individual's countable income
would be used to determine the amount of his/her monthly
premium and requires that disability income and converted
retirement income made exempt for purposes of CWD
eligibility determination be considered countable income
for purposes of determining the premium amount.
This bill eliminates the determination of a sliding premium
scale, and instead requires that each individual pay five
percent of his/her individual countable income as a
premium. The minimum monthly premium would be $20 and $250
would be the maximum.
This bill specifies that if any provision of this bill, or
its application, is held invalid by a final judicial
determination, it shall cease to be implemented. A
determination of invalidity shall not affect other
provisions or applications of this section that can be
given effect without the implementation of the invalid
provision or application.
Prior Legislation
AB 1183 (Assembly Budget Committee), Chapter 758, Statutes
of 2008, made the CWD program permanent by deleting the
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September 1, 2008 sunset date.
AB 851 (Brownley), 2007-08 Session, which was similar to
this bill, was held on the Senate Appropriations suspense
file.
AB 1113 (Brownley), 2007-08 Session, which was similar to
this bill, was vetoed by Governor Schwarzenegger. In his
veto message, the Governor stated: "While I strongly
support the California 250 Percent Working Disabled Program
and appreciate its role in promoting work among persons who
are aged and disabled, I cannot support this bill. This
bill contains a drafting error that would result in unequal
treatment of similarly situated aged persons, in direct
conflict with federal Medicaid law. Given my strong support
of services for persons with disabilities to allow them to
safely remain at home and lead productive and independent
lives, I am directing the DHCS to pursue legislation to
continue and improve this important program."
AB 155 (Migden), Chapter 820, Statutes of 1999, established
the CWD program.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Increase CWD caseload $0 $20-$30
$300-$350 General*/
benefits
Federal*
* October 1, 2008-December 31, 2010 FMAP = 38% GF
/ 62% FF
January 1, 2011 - ongoing FMAP = 50% GF / 50% FF
FMAP - the percent of total costs paid by the federal
government
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SUPPORT : (Verified 9/1/09)
Abilicorp
AIDS Project Los Angeles
American Federation of State, County and Municipal
Employees
Association of California State Employees with Disabilities
California Communities United Institute
California Foundation for Independent Living Centers
California Medical Association
California Primary Care Association
Disability Rights California
Easter Seals of Southern California
Health Access
National Multiple Sclerosis Society
Pacific Clinics
Project Return Peer Support Network
Resources for Independent Living
San Francisco AIDS Foundation
Southern California HIV Advocacy Coalition
World Institute on Disability
ARGUMENTS IN SUPPORT : Supporters argue that this bill
will encourage people to enter the labor force and the CWD
program, because if they become unemployed they could
continue to receive their coverage. They argue that many
individuals are afraid to enter the labor force for fear of
losing their affordable Medi-Cal coverage. Supporters
argue that the other eligibility changes will allow more
people with disabilities to become more independent and
productive while ensuring that they have access to critical
health services. Supporters note that it makes fiscal
sense to encourage disabled people to work and contribute
to the cost of health coverage.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Cook, Coto, Davis, De La Torre, De Leon, Eng, Evans,
Feuer, Fong, Fuentes, Furutani, Galgiani, Hall, Hayashi,
Hernandez, Hill, Huffman, Jones, Krekorian, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, John A. Perez, V.
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Manuel Perez, Portantino, Price, Ruskin, Salas, Saldana,
Skinner, Solorio, Swanson, Torlakson, Torres, Torrico,
Yamada, Bass
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Blakeslee, Conway, DeVore, Duvall, Emmerson, Fletcher,
Fuller, Gaines, Garrick, Gilmore, Hagman, Harkey, Huber,
Jeffries, Knight, Logue, Miller, Nestande, Niello,
Nielsen, Silva, Smyth, Audra Strickland, Tran, Villines
NO VOTE RECORDED: Block
DLW:mw 9/1/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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