SB 1124, as amended, Hernandez. Medi-Cal: estate recovery.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions.
Existing law, with certain exceptions, requires the department to claim against the estate of a decedent, or against any recipient of the property of that decedent by distribution or survival, an amount equal to the payments for Medi-Cal services received or the value of the property received by any recipient from the decedent by distribution or survival, whichever is less. Existing law provides for certain exemptions that restrict the department from filing a claim against a decedent’s property, including when there is a surviving spouse during his or her lifetime. Existing law requires the department, however, to make a claim upon the death of the surviving spouse, as prescribed. Existing law, which has been held invalid by existing case law, provides that the exemptions shall only apply to the proportionate share of the decedent’s state or property that passes to those recipients, by survival or distribution, who qualify for the exemptions.
This bill would instead provide that the department shall make these claims only in specified circumstances and would define health care services for these purposes.begin delete The bill would additionally provide that health care services that federal law or guidance authorizes the state to eliminate from recovery shall also be exempted.end delete The bill would delete the proportionate share provision and would delete the requirement that the department make a claim upon the death of the surviving spouse.begin delete The bill would provide that in meeting these requirements the department shall only collect amounts identified as being spent by either the department or a Medi-Cal managed care plan for health care services actually received by the decedent, or the per member per month payment, whichever is less in that month.end delete
The bill would also require the department to provide a current or former beneficiary, or his or her authorized representative, upon request and free of charge, with the total amount of Medi-Cal expenses that have been paid on his or her behalf that would be recoverable under these provisions, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14009.5 of the Welfare and Institutions
2Code is amended to read:
(a) Notwithstanding any other provision of this
4chapter, the department shall claim against the estate of the
5decedent, or against any recipient of the property of that decedent
6by distribution or survival an amount equal to the payments for
7the health care services received or the value of the property
8received by any recipient from the decedent by distribution or
9survival, whichever is less, only in either of the following
10circumstances:
11(1) Notwithstanding paragraph (2), against the real property of
12a decedent who was an inpatient in a nursing facility in accordance
13with Section 1396p(b)(1)(A) of Title 42 of the United States Code.
14(2) (A) The decedent was 55 years of age or older when the
15individual received health care services.
16(B) The department shall not claim under this paragraph when
17there is any of the following:
18(i) A surviving spouse.
19(ii) A surviving child who is underbegin delete age 21.end deletebegin insert 21 years of age.end insert
P3 1(iii) A surviving child who is blind or permanently and totally
2disabled, within the meaning of Section 1614 of the federal Social
3Security
Act (42 U.S.C. Sec. 1382c).
4(iv) Any health care services that federal law or guidance
5authorizes the state to eliminate from recovery. The department
6shall adopt emergency regulations as necessary to implement this
7clause in accordance with Chapter 3.5 (commencing with Section
811340) of Part 1 of Division 3 of Title 2 of the Government Code.
9If emergency regulations are adopted pursuant to this clause, the
10department shall proceed under subdivision (e) of Section 11346.1
11of the Government Code for adoption of final regulations. If the
12process has not been completed within 180 days, the department
13shall readopt the emergency regulations in accordance with Section
1411346.1 of the Government Code, but no more than two times.
15The initial adoption and any readoptions of emergency regulations
16shall be deemed to be an emergency and necessary for immediate
17preservation of the public peace, health and safety, or general
18welfare, for purposes of Sections 11346.1 and 11349.6 of the
19
Government Code, and the department is hereby exempted for that
20purpose from the requirements of subdivision (b) of Section
2111346.1 of the Government Code.
22(b) (1) The department shall waive its claim, in whole or in
23part, if it determines that enforcement of the claim would result in
24substantial hardship to other dependents, heirs, or survivors of the
25individual against whose estate the claim exists.
26(2) The department shall notify individuals of the waiver
27provision and the opportunity for a hearing to establish that a
28waiver should be granted.
29(c) In meeting the requirement in subdivision (a), the department
30shall only collect amounts identified as being spent by either the
31department or a Medi-Cal managed care plan for health care
32services actually received by the decedent, or the per member per
33month payment, whichever is less in that month.
34(d)
end delete
35begin insert(c)end insert (1) The department shall provide a current or former
36beneficiary, or his or her authorized representative designated
37under Section 14014.5, upon request and free of charge, with the
38total amount of Medi-Cal expenses that havebegin insert beenend insert paid on behalf
39of that beneficiary that would be recoverable under this section.
P4 1(2) The department shall permit a beneficiary to request the
2information described in paragraph (1) via the Internet, by
3telephone, by mail, in person, or through other commonly available
4electronic means.
5(3) The department shall conspicuously post on its Internet Web
6site, a description of the methods by which a request under this
7subdivision may be made, including, but not limited to, the
8department’s telephone number and any addresses that may be
9used for this purpose. The department shall also include this
10information in its pamphlet for the Medi-Cal Estate Recovery
11Program and any other notices the department distributes to
12beneficiaries regarding estate recovery.
13(e)
end delete
14begin insert(d)end insert The following definitions shall govern the construction of
15this section:
16(1) “Decedent” means a beneficiary who has received health
17care under this chapter or Chapter 8 (commencing with Section
1814200) and who has died leaving property to others either through
19distribution or survival.
20(2) “Dependents” includes, but is not limited to, immediate
21family or blood relatives of the decedent.
22(3) “Health care services” means only those services required
23to be recovered under Section 1396p(b)(1)(B)(i) of Title 42 of the
24United Statesbegin delete Code and shall not include services provided to the begin insert Code.end insert
25decedent through the In-Home Supportive Services program.end delete
26(f)
end delete
27begin insert(e)end insert The amendments made to this section by the act that added
28this subdivision apply only to individuals who die on or after
29January 1, 2015.
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