Bill Text: CA AB1319 | 2015-2016 | Regular Session | Introduced


Bill Title: Medi-Cal benefits: share of cost requirements.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2016-11-30 - From Senate committee without further action. [AB1319 Detail]

Download: California-2015-AB1319-Introduced.html
BILL NUMBER: AB 1319	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Dababneh

                        FEBRUARY 27, 2015

   An act to amend Section 14005.7 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1319, as introduced, Dababneh. Medi-Cal benefits: share of cost
requirements.
   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. Under existing law, certain aged, blind,
and disabled Medi-Cal recipients are required to pay a share of cost
as a condition of eligibility, with the share of cost determined in
accordance with specified requirements. For purposes of determining
the share of cost, existing law establishes a formula to calculate
the personal and incidental needs deduction for an individual
residing in a licensed community care facility. Existing law
prohibits that deduction from exceeding the amount by which the
Supplemental Security Income recipient retention amount, as defined,
exceeds $20.
   This bill would revise the formula to determine the personal and
incidental needs deduction. By increasing the responsibility of the
counties in determining Medi-Cal eligibility, this bill would impose
a state-mandated local program. The bill would also require that its
provisions be implemented only to the extent that federal financial
participation is available and that the department receives any
necessary federal approvals.
   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 14005.7 of the Welfare and Institutions Code is
amended to read:
   14005.7.  (a) Medically needy persons and medically needy family
persons are entitled to health care services under Section 14005
providing all eligibility criteria established pursuant to this
chapter are met.
   (b) Except as otherwise provided in this chapter or in Title XIX
of the federal Social Security Act, no medically needy family person,
medically needy person or state-only Medi-Cal persons shall be
entitled to receive health care services pursuant to Section 14005
during any month in which his or her share of cost has not been met.
   (c) In the case of a medically needy person, monthly income, as
determined, defined, counted, and valued, in accordance with Title
XIX of the federal Social Security Act, in excess of the amount
required for maintenance established pursuant to Section 14005.12,
exclusive of any amounts considered exempt as income under Chapter 3
(commencing with Section 12000), less amounts paid for Medicare and
other health insurance premiums shall be the share of cost to be met
under Section 14005.9.
   (d) In the case of a medically needy family person or state-only
Medi-Cal person, monthly income, as determined, defined, counted, and
valued, in accordance with Title XIX of the federal Social Security
Act, in excess of the amount required for maintenance established
pursuant to Section 14005.12, exclusive of any amounts considered
exempt as income under Chapter 2 (commencing with Section 11200),
less amounts paid for Medicare and other health insurance premiums
shall be the share of cost to be met under Section 14005.9.
   (e) In determining the income of a medically needy person residing
in a licensed community care facility, income shall be determined,
defined, counted, and valued, in accordance with Title XIX of the
federal Social Security Act, any amount paid to the facility for
residential care and support that exceeds the amount needed for
maintenance shall be deemed unavailable for the purposes of this
chapter.
   (f) (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) "MNL" means the income standard of the Medi-Cal medically
needy program defined in Section 14005.12.
   (C) Board and care "personal care services" or "PCS" deduction
means the income disregard that is applied to a resident in a
licensed community care facility, in lieu of the board and care
deduction specified in subdivision  (e) of Section 14005.7,
  (e),  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 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 deduction specified in subdivision (e) is applicable to
the individual, the amount, not to exceed the amount by which the
SSI recipient retention amount exceeds  twenty dollars ($20),
  fifty dollars ($50),  nor to be less than zero,
by which the sum of the amount that the individual pays to his or her
licensed community care facility and the SSI recipient retention
amount exceed the sum of the individual's MNL, the individual's board
and care deduction, and  twenty dollars ($20). 
 fifty dollars ($50). 
   (ii) If the deduction specified in paragraph (1) is applicable to
the individual,  an   the  amount, not to
exceed the amount by which the SSI recipient retention amount exceeds
 twenty dollars ($20),   fifty dollars ($50),
 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 MNL, the individual's PCS deduction and twenty
dollars ($20).   fifty dollars ($50). 
   (3) In determining the countable income of a medically needy
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).
   (g) No later than one month after the effective date of
subparagraph (B) of paragraph (2) of subdivision (f), the department
shall submit to the federal medicaid administrator a state plan
amendment seeking approval of the income deduction specified in
subdivision (f), and of federal financial participation for the costs
resulting from that income deduction.
   (h) The deduction prescribed by paragraph (3) of subdivision (f)
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 (g). Until
approval for federal financial participation is received by the
department, there shall be no deduction under paragraph (3) of
subdivision (f). 
   (i) The amendments to clauses (i) and (ii) of subparagraph (B) of
paragraph (2) of subdivision (f) made by the act that added this
subdivision during the 2015-16 Regular Session of the Legislature
shall be implemented only to the extent that federal financial
participation is available and that the department receives any
necessary federal approvals. 
  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.
            
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