BILL NUMBER: AB 1863 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 24, 2000
AMENDED IN ASSEMBLY MARCH 30, 2000
AMENDED IN ASSEMBLY MARCH 16, 2000
INTRODUCED BY Assembly Member Gallegos
FEBRUARY 10, 2000
An act to amend Section 14005.12 of, and to add Section 14005.32
to, the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1863, as amended, Gallegos. Medi-Cal: eligibility.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services. Existing
law establishes income eligibility levels for those persons not
automatically eligible for Medi-Cal by virtue of eligibility for
certain public assistance programs.
This bill would establish certain income deductions for aged,
blind, and disabled persons qualifying for Medi-Cal eligibility
benefits as medically needy recipients.
The bill would also require the department to implement an option
provided for under federal law modifying Medi-Cal benefit income
requirements for aged and disabled persons.
This bill would make implementation of its provisions subject to
the availability of federal financial participation, and would
require the department to seek any federal approvals necessary for
its implementation. If this federal approval is not obtained, it
would permit the Attorney General to file judicial proceedings.
Because each county is required to determine Medi-Cal eligibility,
and because the 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, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
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 14005.12 of the Welfare and Institutions Code
is amended to read:
14005.12. (a) (1) For the purposes of Sections 14005.4 and
14005.7, the department shall establish the income levels for
maintenance need at the levels that reasonably permit medically needy
persons to meet their basic needs for food, clothing, and shelter,
and for which federal financial participation will be maximized under
Title XIX of the federal Social Security Act. It is the intent of
the Legislature that the income levels for maintenance need for
medically needy aged, blind, and disabled adults, in particular,
shall be based upon amounts that adequately reflect their needs.
(2) (A) Reductions in the maximum aid payment levels set forth in
subdivision (a) of Section 11450 in the 1991-92 fiscal year, and
thereafter, shall not result in a reduction in the income levels for
maintenance under this section.
(B) The department shall seek any necessary federal authorization
for maintaining the income levels for maintenance at the levels in
effect June 30, 1991.
(C) If federal authorization is not obtained, medically needy
persons shall not be required to pay the difference between the share
of cost as determined based on the payment levels in effect on June
30, 1991, under Section 11450, and the share of cost as determined
based on the payment levels in effect on July 1, 1991, and
thereafter.
(D) Any medically needy person who was eligible for benefits under
this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families with
Dependent Children program as set forth in Section 11452.018 made in
the 1995-96 Regular Session of the Legislature shall not be
responsible for paying his or her share of cost if all of the
following apply:
(i) He or she had eligibility as categorically needy terminated by
the reductions in the minimum basic standards of adequate care.
(ii) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.
(iii) He or she is not eligible to receive benefits without a
share of cost as a medically needy person pursuant to subparagraph
(A) or (B).
(3) The income levels for maintenance under this section in effect
August 22, 1996, shall be increased on January 1, 2001, by a
percentage equal to the intervening consumer price index increases
but not more than 10 percent or 20 percent,
whatever is greater, except that implementation of this paragraph
shall be subject to federal financial participation . On
January 1 of each subsequent year, the income levels for maintenance
under this section shall be increased by a percentage equal to the
Consumer Price Index. By March 1, 2001, and each March 1 thereafter,
the department shall seek any approvals, including state plan
amendments, necessary to receive federal financial participation for
medical and remedial services payable by reason of the increases in
the income levels for maintenance under this section. If this
approval is not granted by the federal government, the Attorney
General may file all administrative and judicial proceedings
available under the law to obtain the approval. The state shall
be under no obligation to use state-only funds to pay for the
implementation of this paragraph.
(b) Except as provided for in paragraphs (2) and (3) of
subdivision (a), in the case of a single individual, the amount of
the income level for maintenance per month shall be 80 percent of the
highest amount that would ordinarily be paid to a family of two
persons, without any income or resources, under subdivision (a) of
Section 11450, multiplied by the federal financial participation
rate.
(c) Except as provided for in paragraphs (2) and (3) of
subdivision (a), in the case of a family of two adults, the income
level for maintenance per month shall be the highest amount that
would ordinarily be paid to a family of three persons without income
or resources under subdivision (a) of Section 11450, multiplied by
the federal financial participation rate.
(d) For the purposes of Sections 14005.4 and 14005.7, for a person
in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from an
organization with a frail elderly demonstration project waiver
pursuant to Chapter 8.75 (commencing with Section 14590), the amount
considered as required for maintenance per month shall be computed in
accordance with Title XIX of the federal Social Security Act, and
regulations adopted pursuant thereto. Those amounts shall be
computed pursuant to regulations which include providing for the
following purposes:
(1) Personal and incidental needs in the amount of not less than
thirty-five dollars ($35) per month while a patient. The department
may, by regulation, increase this amount as necessitated by
increasing costs of personal and incidental needs. A long-term
health care facility shall not charge an individual for the laundry
services or periodic hair care specified in Section 14110.4.
(2) The upkeep and maintenance of the home.
(3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.
(4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent children,
dependent parents, or dependent siblings of either spouse, provided
the individuals are residing with the community spouse.
(5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396r-5(d)(1)(B)).
(6) The family allowance for each family member residing with the
community spouse shall be computed in accordance with the formula
established in Section 1924(d)(1)(C) of Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).
(e) For the purposes of Sections 14005.4 and 14005.7, with regard
to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be computed
pursuant to regulations adopted by the department which provide for
the support and care of his or her spouse, minor children, or any
disabled relative for whose support he or she has contributed
regularly.
(f) Except as provided for in paragraphs (2) and (3) of
subdivision (a), the income levels for maintenance per month, except
as specified in subdivisions (b) to (d), inclusive, shall be equal to
the highest amounts that would ordinarily be paid to a family of the
same size without any income or resources under subdivision (a) of
Section 11450, multiplied by the federal financial participation
rate.
(g) The "federal financial participation rate," as used in this
section, shall mean 1331/3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396
(b)), or its successor provisions.
(h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.
(i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for each
household in accordance with subdivisions (b) to (h), inclusive.
The total of these levels shall be the level for the single
eligibility unit.
(j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.
SEC. 2. Section 14005.32 is added to the Welfare and Institutions
Code, to read:
14005.32. (a) The department shall adopt the option made
available pursuant to Sections 1902(m) and 1902(a)(10)(A)(ii)(X) of
the federal Social Security Act (42 U.S.C. Sections 1396a(m) and
1396a(a)(10)(A)(ii)(X). In order to be eligible for benefits under
this section, an individual shall be required to meet all of the
following requirements:
(1) His or her net income shall not exceed 100 percent of the
federal poverty level.
(2) He or she is 65 years of age or older or is disabled as
determined under Section 1614(a)(3) of the federal Social Security
Act (42 U.S.C. Section 1382c(a)(3)).
(3) His or her net nonexempt resources, as determined under
Section 1613 of the federal Social Security Act (42 U.S.C. 1382b), do
not exceed the maximum amount allowable under Title XVI of the
federal Social Security Act (42 U.S.C. Section 1381 and following).
(b) For purposes of determining income eligibility pursuant to
paragraph (1) of subdivision (a), net countable income shall be
determined in accordance with both of the following:
(1) Earned and unearned income shall be reduced by the deductions,
exemptions, and disregards provided under Section 1612 of the
federal Social Security Act (42 U.S.C. Section 1382a).
(2) As authorized under Section 1902(r)(2) of the federal Social
Security Act (42 U.S.C. Section 1396a(r)(2), income shall be further
reduced by special income deductions of two hundred dollars ($200)
for eligible individuals and four hundred dollars ($400) for eligible
couples.
(c) Medi-Cal benefits provided pursuant to this section shall be
available in the same amount, duration, and scope as those benefits
are available for persons eligible as categorically needy persons,
except that benefits provided under this section shall be governed by
Section 14007.5.
(d) Subject to subdivision (e), benefits shall be provided
pursuant to this section commencing April 1, 2001.
(e) (1) The department shall immediately seek any federal
approvals, including state plan amendments, necessary to receive
federal financial participation for medical and remedial services to
be provided due to coverage of individuals authorized by Section 1902
(m) of the federal Social Security Act (42 U.S.C. Section 1396a(m))
and by the use of the income methodology set forth in paragraph (2)
of subdivision (b). If either or both of these federal approvals are
not obtained, the Attorney General may file all administrative and
judicial proceedings available under the law in order to obtain these
approvals.
(2) Notwithstanding any other provision of law, benefits shall be
provided pursuant to this section only if, and to the extent that,
the department determines that federal financial participation is
available pursuant to Title XIX of the federal Social Security Act
(42 U.S.C. Section 1396 and following).
(f) 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, without taking any regulatory action,
this section by means of an all-county letter or similar instruction.
Thereafter, the department shall adopt regulations in accordance
with Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code.
SEC. 3. Notwithstanding Section 17610 of the Government Code, 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. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.