BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Martha M. Escutia, Chair
BILL NO: AB 1863
A
AUTHOR: Gallegos
B
AMENDED: May 30, 2000
HEARING DATE: June 28, 2000
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FISCAL: Appropriations
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CONSULTANT:
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Miller / cg
SUBJECT
Medi-Cal: eligibility.
SUMMARY
Expands eligibility in the Medi-Cal program without a share
of cost requirement for aged, blind and disabled people and
reduces the Medi-Cal share of cost requirements for
medically needy people and families.
ABSTRACT
Existing law:
1.Provides for the "medically needy" program within
Medi-Cal, under which low-income persons or families who
are not categorically eligible for Medi-Cal can obtain
Medi-Cal benefits by paying a share of cost or
"deductible". For elderly or disabled individuals, all
income above $600.00 a month must be spent on health
expenses before Medi-Cal contributes. Eligible
individuals may earn $916.00 a month and eligible couples
may earn $1358.00 a month.
2.Establishes "maintenance need income levels" for the
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purposes of calculating an individual or family's share
of cost. The 1996 Welfare Reform Act increased medically
needy living allowance by increases in the consumers
price index.
This bill:
1.Increases, beginning January 1, 2001, the income levels
for maintenance in effect August 22, 1996, by a
percentage equal to the intervening consumer price index
increases but not more than 10%, and by a percentage
equal to the Consumer Price Index on January 1 of each
subsequent year for the next two subsequent years,
subject to federal financial participation. Requires
that the state is under no obligation to implement with
state funds. Authorizes the Attorney General to file
administrative and judicial proceedings to obtain federal
approval.
2.Requires, to the extent federal financial participation
is available, the Department of Health Services to
exercise its federal option to implement a program for
aged, blind and disabled persons, as described,
commencing April 1, 2001. Financial eligibility requires
that countable income that does not exceed 133% of the
applicable federal poverty level; and, countable
resources that do not exceed the maximum levels, as
defined. Blind individuals are specifically made
eligible.
3.Implementation is only done to the extent funds are
appropriated in the annual Budget Act, and requires the
Department of Health Services to seek approvals for
federal financial participation.
FISCAL IMPACT
According to the Assembly Appropriation Committee analysis:
1.$21.3 million General Fund in fiscal year 2000-2001 (half
year) for all increases.
2.$65.3 million General Fund in fiscal year 2001-2002 and
thereafter for all increases.
BACKGROUND AND DISCUSSION
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The author indicates that this bill is will provide relief
for low-income elderly and disabled individuals and
families who must pay expensive Medi-Cal deductibles before
Medi-Cal will cover health care expenses. For many, this
financial burden discourages early diagnosis and treatment,
and compliance with prescription medications and treatment
therapies, which can result in more expensive or
catastrophic outcomes.
Under the current system an individual is expected to
support him/herself on $600 a month plus deductions. Any
income received over that amount is obligated as "share of
cost" in any month services are needed. This $600 amount
has not been adjusted since 1989. The author asserts that
complaints about "share of cost" are among the most
frequent criticisms of the Medi-Cal program even though
only about 6% of the 5 million people qualified for
Medi-Cal are certified as "share of cost" eligibles. The
author also points out that seniors on Medicare who are
also eligible for Medi-Cal with a share of cost have access
to prescription drug coverage through Medi-Cal, but for
expensive share of cost barriers.
The Governor's 2000-2001 Budget proposes to expand Medi-Cal
coverage for the
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elderly, blind and disabled in a manner that would
eliminate share of cost for 13,000 individuals who have
income up to the poverty level (monthly income of $696).
This bill would enhance the Governor's proposal by
including couples and expanding eligibility to individuals
with monthly income of about $914 and couples with monthly
income of about $1,226 (based on 1999 federal poverty
levels). Both the Assembly and Senate budget proposals
have approved funding for this proposal. This bill also
reduces the share of cost for those who would not qualify
for free Medi-Cal under the enhanced program by raising the
maintenance need income level to $660 for individuals and
$1027 for couples and adjusting this amount annually for
two years in an amount equal to the consumer price index.
This measure would affect less that 40,000 persons based on
estimates of the Department of Health Services.
AB 2125 (Gallegos) of 1998 and AB 497 (Gallegos) of 1999
were introduced to reduce share of cost requirements for
the medically needy. AB 2125 was held in the Senate
Appropriations Committee and AB 497 was amended in the
Assembly Appropriations Committee. AB 2500 (Ashburn),
pending in the Assembly Health Committee, would establish
an income deduction in the Medi-Cal medically needy program
of 150% of the United States Department of Health and Human
Services poverty guidelines.
This measure affects code sections also in AB 2500
(Ashburn) and SB 87 (Escutia)
PRIOR ACTIONS
Assembly Floor: 50 - 28 Pass
Assembly Appropriations: 15 - 6 Do Pass as Amended
Assembly Health: 9 - 3 Do Pass as Amended
POSITIONS
Support: Western Center of Law and Poverty (sponsor)
Protection and Advocacy, Inc. (co-sponsor)
AARP
AFSCME
Association of Regional Center Agencies
Alzheimer's Association
California Association of Health Facilities
California Association of Public Hospitals
California Catholic Conference
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California Cerebral Palsy Associations
California Dialysis Council
California Primary Care Association
California Senior Coalition
California State Association of Counties
City and County of San Francisco
Congress of California Seniors
Consumers Union
Grey Panthers
Health Access California
Jerico
Legal Services of Northern California
Los Angeles County
National Multiple Sclerosis Society
National Senior Citizens Law Center
Older Women's League
Planned Parenthood
Regional Center of Orange County
Riverside County
San Gabriel/Pomona Regional Center
Oppose None reported