Amended in Assembly March 18, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2025

Introduced by Assembly Member Dickinson

February 20, 2014

An act to amend Section 14005.40 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 2025, as amended, 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 begin delete person, end delete begin insert persons, end insert 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 begin insert an income disregard of end insert $230 for an individual, or $310 in the case of a couple, begin delete as prescribed end delete begin insert except that the income standard determined may not be less than SSI/SSP payment level for a disabled individual or couple, as applicable end insert .

begin delete

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.

end delete begin insert

This bill would increase those income disregard amounts to $369 for an individual, or $498 in the case of a couple, and require that the income disregards be adjusted annually. The bill would provide, however, that the income standard determined may not be less than the SSI/SSP payment level the individual or couple, as applicable, receives or would receive as a disabled or blind individual or couple.

end insert

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 1.  

Section 14005.40 of the Welfare and Institutions
Code is amended to read:

14005.40.  

(a) To the extent federal financial participation is
available, the department shall exercise its option under Section
1902(a)(10)(A)(ii)(X) of the federal Social Security Act (42 U.S.C.
Sec. 1396a(a)(10)(A)(ii)(X)), to implement a program for aged
and disabled persons as described in Section 1902(m) of the federal
Social Security Act (42 U.S.C. Sec. 1396a(m)(1)).

(b) To the extent federal financial participation is available, the
blind shall be included within the definition of disabled for the
purposes of the program established in this section.

(c) An individual shall satisfy the financial eligibility
requirement of this program if all of the following conditions are
met:

(1) Countable income, as determined in accordance with Section
1902(m) of the federal Social Security Act (42 U.S.C. Sec.
1396a(m)), does not exceed an income standard equal to begin delete 138 end delete begin insert 100 end insert
percent of the applicable federal poverty level, begin insert plus an income
disregard of three hundred sixty-nine dollars ($369) for an
individual, or in the case of a couple, four hundred ninety- end insert begin insert eight
dollars ($498), end insert except that the income standard so determined
shall not be less than the SSI/SSP payment level begin delete for end delete begin insert the individual
receives or would receive as end insert a disabled begin insert or blind end insert individual or, in
the case of a couple, the SSI/SSP payment level begin delete for end delete begin insert the couple
receives or would receive as end insert a disabled begin insert or blind end insert couple.

begin insert

(2) The income disregard amounts in paragraph (1) are based
on the 2014 federal poverty levels, so that the income standard
plus the income disregard totals 138 percent of the federal poverty
level. The income disregard amounts shall be adjusted annually
and applied when the federal poverty levels take effect in order to
maintain the income standard at 138 percent of the federal poverty
level, except that the income standard shall not be less than the
SSI/SSP payment level the individual receives or would receive as
a disabled or blind individual, or in the case of a couple, the
SSI/SSP payment level the couple receives or would receive as a
disabled or blind couple.

end insert begin delete

(2)

end delete

begin insert (3) end insert  (A) For the purposes of calculating countable income under
this section, an income exemption shall be applied as necessary
to adjust the SSI/SSP payment level as used in this section so that
it is the same as the SSI/SSP payment level that was in place on
May 1, 2009.

(B) This additional income exemption shall cease to be
implemented when the SSI/SSP payment levels increase beyond
those in effect on May 1, 2009.

(C) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department shall implement this paragraph by means of an
all-county letter or similar instruction without taking regulatory
action.

begin delete

(3)

end delete

begin insert (4) end insert  Countable resources, as determined in accordance with
Section 1902(m) of the federal Social Security Act (42 U.S.C. Sec.
1396a(m)), do not exceed the maximum levels established in that
section.

(d) The financial eligibility requirements provided in subdivision
(c) may be adjusted upwards to reflect the cost of living in
California, contingent upon appropriation in the annual Budget
Act.

(e) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department shall implement this section by means of all-county
letters or similar instructions, and without taking regulatory action.
Thereafter, the department shall adopt regulations in accordance
with the requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.

(f) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec.
401 et seq.) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the
federal poverty level requires the department to modify the income
standard described in subdivision (c).

(g) (1) For purposes of this section the following definitions
apply:

(A) “SSI” means the federal Supplemental Security Income
program established under Title XVI of the federal Social Security
Act.

(B) “Income standard” means the applicable income standard
specified in subdivision (c) begin insert , including the augmentations specified
in paragraphs (1) and (2) of that subdivision end insert .

(C) The board and care “personal care services” or “PCS”
deduction refers to an income disregard that is applied to a resident
in a licensed community care facility in lieu of the board and care
deduction (equal to the amount by which the basic board and care
rate exceeds the income standard in subparagraph begin delete (B), of paragraph
(1) of subdivision (g)) end delete begin insert (B)) end insert when the PCS deduction is greater than
the board and care deduction.

(2) (A) For purposes of this section, the SSI recipient retention
amount is the amount by which the SSI maximum payment amount
to an individual residing in a licensed community care facility
exceeds the maximum amount that the state allows community
care facilities to charge a resident who is an SSI recipient.

(B) For the purposes of this section, the personal and incidental
needs deduction for an individual residing in a licensed community
care facility is either of the following:

(i) If the board and care deduction is applicable to the individual,
the amount, not to exceed the amount by which the SSI recipient
retention amount exceeds twenty dollars ($20), nor to be less than
zero, by which the sum of the amount which the individual pays
to his or her licensed community care facility and the SSI recipient
retention amount exceed the sum of the individual’s income
standard, the individual’s board and care deduction, and twenty
dollars ($20).

(ii) If the PCS deduction specified in paragraph (1) of
subdivision (g) is applicable to the individual, an amount, not to
exceed the amount by which the SSI recipient retention amount
exceeds twenty dollars ($20), nor to be less than zero, by which
the sum of the amount which the individual pays to his or her
community care facility and the SSI recipient retention amount
exceed the sum of the individual’s income standard, the
individual’s PCS deduction begin insert , end insert and twenty dollars ($20).

(3) In determining the countable income under this section of
an individual residing in a licensed community care facility, the
individual shall have deducted from his or her income the amount
specified in subparagraph (B) of paragraph (2).

(h) No later than one month after the effective date of
subdivision (g), the department shall submit to the federal begin delete medicaid end delete
begin insert Medicaid end insert administrator a state plan amendment seeking approval
of the income deduction specified in paragraph (3) of subdivision
(g), and of federal financial participation for the costs resulting
from that income deduction.

(i) The deduction prescribed by paragraph (3) of subdivision
(g) shall be applied no later than the first day of the fourth month
after the month in which the department receives approval for the
federal financial participation specified in subdivision (h). Until
approval for federal financial participation is received, there shall
be no deduction under paragraph (3) of subdivision (g).

SEC. 2.  

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.