AB 2025, as introduced, Dickinson. Medi-Cal: program for aged and disabled persons.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law requires the department to exercise its option under federal law to implement a program for aged and disabled person, as described. Existing law provides that an individual under these provisions shall satisfy certain financial eligibility requirements, including, among other things, that his or her countable income does not exceed an income standard equal to 100% of the applicable federal poverty level, plus $230 for an individual, or $310 in the case of a couple, as prescribed.
This bill would instead provide that the individual’s countable income shall not exceed an income standard equal to 138% of the applicable federal poverty level.
Because counties are required to make Medi-Cal eligibility determinations and this 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.
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 14005.40 of the Welfare and Institutions
2Code is amended to read:
(a) To the extent federal financial participation is
4available, the department shall exercise its option under Section
51902(a)(10)(A)(ii)(X) of the federal Social Security Act (42 U.S.C.
6Sec. 1396a(a)(10)(A)(ii)(X)begin insert)end insert, to implement a program for aged
7and disabled persons as described in Section 1902(m) of the federal
8Social Security Act (42 U.S.C. Sec. 1396a(m)(1)).
9(b) To the extent federal financial participation is available, the
10blind shall be included within the definition of disabled for the
11purposes of the program established in this section.
12(c) An individual shall satisfy the financial eligibility
13requirement of this program if all of the following conditions are
14met:
15(1) Countable income, as determined in accordance with Section
161902(m) of the federal Social Security Act (42 U.S.C. Sec.
171396a(m)), does not exceed an income standard equal tobegin delete 100end deletebegin insert 138end insert
18 percent of the applicable federal poverty level,begin delete plus two hundred begin insert exceptend insert that the income
19thirty dollars ($230) for an individual or, in the case of a couple,
20three hundred ten dollars ($310), providedend delete
21standard so determined shall not be less than
the SSI/SSP payment
22level for a disabled individual or, in the case of a couple, the
23SSI/SSP payment level for a disabled couple.
24(2) (A) For the purposes of calculating countable income under
25this section, an income exemption shall be applied as necessary
26to adjust the SSI/SSP payment level as used in this section so that
27it is the same as the SSI/SSP payment level that was in place on
28May 1, 2009.
P3 1(B) This additional income exemption shall cease to be
2implemented when the SSI/SSP payment levels increase beyond
3those in effect on May 1, 2009.
4(C) Notwithstanding Chapter 3.5 (commencing with Section
511340) of Part 1 of Division 3 of Title 2 of the Government Code,
6the department shall implement this paragraph by means of an
7all-county letter or similar instruction without taking regulatory
8
action.
9(3) Countable resources, as determined in accordance with
10Section 1902(m) of the federal Social Security Act (42 U.S.C. Sec.
111396a(m)), do not exceed the maximum levels established in that
12section.
13(d) The financial eligibility requirements provided in subdivision
14(c) may be adjusted upwards to reflect the cost of living in
15California, contingent upon appropriation in the annual Budget
16Act.
17(e) Notwithstanding Chapter 3.5 (commencing with Section
1811340) of Part 1 of Division 3 of Title 2 of the Government Code,
19the department shall implement this section by means of all-county
20letters or similar instructions, and without taking regulatory action.
21Thereafter, the department shall adopt regulations in accordance
22with the requirements of Chapter 3.5 (commencing with Section
2311340) of Part 1 of Division 3 of
Title 2 of the Government Code.
24(f) For purposes of calculating income under this section during
25any calendar year, increases in social security benefit payments
26under Title II of the federal Social Security Act (42 U.S.C. Sec.
27401 et seq.) arising from cost-of-living adjustments shall be
28disregarded commencing in the month that these social security
29benefit payments are increased by the cost-of-living adjustment
30through the month before the month in which a change in the
31federal poverty level requires the department to modify the income
32standard described in subdivision (c).
33(g) (1) For purposes of this section the following definitions
34apply:
35(A) “SSI” means the federal Supplemental Security Income
36program established under Title XVI of the federal Social Security
37Act.
38(B) “Income standard” means the applicable income standard
39begin delete including the augmentations specified in paragraph (1) ofend deletebegin insert specified
40inend insert
subdivision (c).
P4 1(C) The board and care “personal care services” or “PCS”
2deduction refers to an income disregard that is applied to a resident
3in a licensed community care facility in lieu of the board and care
4deduction (equal to the amount by which the basic board and care
5rate exceeds the income standard in subparagraph (B), of paragraph
6(1) of subdivision (g)) when the PCS deduction is greater than the
7board and care deduction.
8(2) (A) For purposes of this section, the SSI recipient retention
9amount is the amount by which the SSI maximum payment amount
10to an individual residing in a licensed community care facility
11exceeds the maximum amount that the state allows community
12care facilities to charge a resident who is an SSI recipient.
13(B) For the purposes of this section, the
personal and incidental
14needs deduction for an individual residing in a licensed community
15care facility is either of the following:
16(i) If the board and care deduction is applicable to the individual,
17the amount, not to exceed the amount by which the SSI recipient
18retention amount exceeds twenty dollars ($20), nor to be less than
19zero, by which the sum of the amount which the individual pays
20to his or her licensed community care facility and the SSI recipient
21retention amount exceed the sum of the individual’s income
22standard, the individual’s board and care deduction, and twenty
23dollars ($20).
24(ii) If the PCS deduction specified in paragraph (1) of
25subdivision (g) is applicable to the individual, an amount, not to
26exceed the amount by which the SSI recipient retention amount
27exceeds twenty dollars ($20), nor to be less than zero, by which
28the sum of the amount which the
individual pays to his or her
29community care facility and the SSI recipient retention amount
30exceed the sum of the individual’s income standard, the
31individual’s PCS deduction and twenty dollars ($20).
32(3) In determining the countable income under this section of
33an individual residing in a licensed community care facility, the
34individual shall have deducted from his or her income the amount
35specified in subparagraph (B) of paragraph (2).
36(h) No later than one month after the effective date of
37subdivision (g), the department shall submit to the federal medicaid
38administrator a state plan amendment seeking approval of the
39income deduction specified in paragraph (3) of subdivision (g),
P5 1and of federal financial participation for the costs resulting from
2that income deduction.
3(i) The deduction prescribed by paragraph
(3) of subdivision
4(g) shall be applied no later than the first day of the fourth month
5after the month in which the department receives approval for the
6federal financial participation specified in subdivision (h). Until
7approval for federal financial participation is received, there shall
8be no deduction under paragraph (3) of subdivision (g).
If the Commission on State Mandates determines that
10this act contains costs mandated by the state, reimbursement to
11local agencies and school districts for those costs shall be made
12pursuant to Part 7 (commencing with Section 17500) of Division
134 of Title 2 of the Government Code.
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