BILL ANALYSIS �
AB 2025
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Date of Hearing: March 25, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2025 (Dickinson) - As Amended: March 18, 2014
SUBJECT : Medi-Cal: program for aged and disabled persons.
SUMMARY : Increases the amount of the income that is disregarded
in calculating eligibility for purposes of the Medi-Cal aged and
disabled (A&D) program which effectively increases the upper
limit of financial eligibility to 138% of the federal poverty
level (FPL).
EXISTING LAW :
1)Establishes the Medi-Cal program as California's version of
the federal Medicaid program. Medi-Cal provides comprehensive
health benefits to low-income children, their parents or
caretaker relatives, pregnant women, elderly, blind or
disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
2)Requires Medi-Cal coverage of adults under age 65 who are not
currently eligible with incomes up to 138% of the FPL or below
$15,856 in 2013 for an individual.
3)Establishes, to the extent that federal financial
participation is available, the Medi-Cal A&D program. Sets
the upper limit of financial eligibility for this program at
100% FPL plus a specified additional amount ($230 for an
individual; $310 for a couple) that is disregarded in
calculating eligibility.
4)Prohibits the income standard for the A&D program from being
less than the Supplemental Security Income/ Supplemental State
Payment (SSI/SSP) payment level for a disabled individual or,
in the case of a couple, the SSI/SSP payment level for a
disabled couple.
5)Permits the financial eligibility requirements for the A&D
program to be adjusted upwards to reflect the cost of living
in California, contingent upon appropriation in the annual
Budget Act.
AB 2025
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FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, as the cost of
living rises and the income disregard remains static, the A&D
program income level loses real value every year. The author
notes when a senior or person with a disability with an income
at 130% of the FPL applies for Medi-Cal today, if they are
over the income level for the A&D Program, they are instead
enrolled in Medically Needy Medi-Cal, which requires
beneficiaries to pay a share of cost. The author notes, even
if someone's income is just $1.00 over the allowable amount,
he or she falls off a cliff and must spend the difference
between that income and $600 before Medi-Cal kicks in. Given
that the Medi-Cal expansion is more generous in income
eligibility, the argument for parity for elderly and disabled
persons with some income is a strong one.
The author argues the eligibility criteria have serious
consequences for affording healthcare. The author recounts
cases of beneficiaries with a share of cost who are living
with serious illnesses that they cannot afford to treat. The
author states as an example, the case of a 67 year old married
woman with cancer, whose spouse earns $1,700 monthly. Given
the upper limit for the A&D program for a couple is $1,603,
she would be pushed into a share of cost of $766 monthly
before Medi-Cal would cover her, leaving the family to live on
$934 for the rest of the month. However, if that woman were
50 years old, with that income, she would qualify for free,
full-scope Medi-Cal because her income is below 138% FPL.
Spending any of her family's modest income for expensive
radiation treatments, drugs, or chemotherapy is a major
hardship.
2)BACKGROUND .
a) A&D program . AB 2877 (Thomson), Chapter 93, Statutes of
2000, the health budget trailer bill, established the A&D
FPL program, a no share-of-cost Medi-Cal benefit for many
elderly and disabled recipients who previously had to pay a
significant share of cost to access Medi-Cal services. The
income cutoff under the A&D FPL program was set at 100% FPL
plus either $230 a month for individuals or $310 a month
for couples. At the time of enactment that formula created
AB 2025
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an income cutoff of approximately 133% FPL. However, with
time and increases in the cost of living, that formula has
not kept pace with the cost of living. As a result, the
upper limit of financial eligibility is now 124% FPL. That
number will continue to drop when the cost of living
increases, making fewer people eligible for the program.
Formerly eligible beneficiaries, whose Social Security
income rises with the cost of living, are forced off the
A&D FPL program on to the more costly share-of-cost
Medi-Cal.
b) Medi-Cal for people with disabilities . People with
disabilities have more ways they can qualify for Medi-Cal
if they don't meet the standard income eligibility rules.
The A&D program is one way, another is the aged, blind, and
disabled medically needy program Medi-Cal program (ABD-MN).
For the A&D program, while income is an important factor
in determining eligibility, there are various calculations
made in eligibility determination which can result in
people with higher incomes being eligible. This reflects
one of the goals of the program which is to allow disabled
people to work without forfeiting eligibility for the
program. To determine eligibility for the A&D program,
there are different deductions from earned and unearned
income. Earned income is not entirely counted and
deductions are made for specified work expenses and payment
of any health insurance premiums. A maintenance need
allowance based on family size is also deducted. It is the
remaining amount that must be below the upper income limit
of eligibility, $1188 for a single individual.
c) Medically needy . If an individual cannot meet the
requirements of the A&D program, they may be able to
qualify for ABD-MN. The ABD-MN program requires a share of
cost and the payment can be a very large proportion of
income for the beneficiary. A single individual whose
income is $1.00 greater than the countable income maximum
of $1188 in the A&D program faces a share of cost of
approximately $700 monthly. The share of cost is
calculated by taking the applicants net income, higher than
countable, and deducting $600 for monthly needs. The
beneficiary must then live on the monthly needs amount and
can easily devote more than 50% of their gross income to
paying for Medi-Cal.
3)SUPPORT . The Western Center on Law & Poverty, the sponsor,
AB 2025
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states this bill is a modest step in helping low-income
seniors and persons with disabilities avoid the high share of
cost many are forced to incur if their income rises above the
current threshold. They argue the A&D program is a critical
part of the Medi-Cal program as it provides free comprehensive
coverage to persons over the age of 65 and those with
disabilities while simultaneously allowing them to have a
monthly income. Western Center also notes advocates have for
years attempted to help beneficiaries with high share of cost
and many A&D enrollees suffer from conditions that they cannot
afford to treat due to their share of cost. Other supporters
note it is unfair that under the Patient Protection and
Affordable Care Act (ACA) almost all other persons who qualify
for Medi-Cal can have income up to 138% of the FPL, but the
medically frail and vulnerable individuals at the same income
level may pay more than half their income before they can
receive no-cost care.
4)PREVIOUS LEGISLATION .
a) AB1 X1 (John A. P�rez), Chapter 3, Statutes of 2013-14
First Extraordinary Session, implements the Medicaid
provisions (Medicaid is known as Medi-Cal in California) in
the federal ACA, including the expansion of federal
Medicaid coverage to low-income adults with incomes between
0% and 138% of FPL, establishes the existing Medi-Cal
benefit package supplemented by the essential health
benefits (EHBs) adopted by the Legislature last session as
the benefit package for the expansion population, and
requires the existing Medi-Cal population to receive the
EHBs adopted by the Legislature. Implements a number of
the Medicaid ACA provisions to simplify the eligibility,
enrollment, and renewal processes for Medi-Cal.
b) AB 969 (Chan) of 2001 would have incorporated annual
cost of living increases in the A&D FPL formula. AB 969
was held in the Senate Appropriations Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Western Center on Law & Poverty (sponsor)
Asian Law Alliance
Bay Area Legal Aid
AB 2025
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California Advocates for Nursing Home Reform
California Association of Public Authorities for IHSS
California Health Advocates
California Primary Care Association
Consumers Union
County Welfare Directors Association of California
Golden Umbrella
Health Access California
Legal Aid Society of Orange County
Multipurpose Senior Services Program Site Association
National Health Law Program
National Senior Citizens Law Center
Poway Adult Day Health Care
Rehabilitation Services of Northern California
San Francisco IHSS Task Force
Self Help for the Elderly Adult Day Services
State Independent Living Council
United Domestic Workers/American Federation of State, County and
Municipal Employees Local 3930
Opposition
None on file.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097