AB 763, as introduced, Burke. Medi-Cal: program for aged and disabled persons.
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. Existing law requires the department to exercise its option under federal law to implement a program for aged and disabled persons, as described. Existing law requires an individual under these provisions to satisfy certain financial eligibility requirements, including, among other things, that his or her countable income does not exceed an income standard equal to 100% of the applicable federal poverty level, plus an income disregard of $230 for an individual, or $310 in the case of a couple, except that the income standard determined may not be less than the SSI/SSP payment level for a disabled individual or couple, as applicable.
This bill would increase those income disregard amounts to $369 for an individual, or $498 in the case of a couple, and require that the income disregards be adjusted annually. The bill would provide, however, that the income standard determined may not be less than the SSI/SSP payment level the individual or couple, as applicable, receives or would receive as a disabled or blind individual or couple.
Because counties are required to make Medi-Cal eligibility determinations and this 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.
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 14005.40 of the Welfare and Institutions
2Code is amended to read:
(a) To the extent federal financial participation is
4available, the department shall exercise its option under Section
51902(a)(10)(A)(ii)(X) of the federal Social Security Act (42 U.S.C.
6Sec. 1396a(a)(10)(A)(ii)(X), to implement a program for aged and
7disabled persons as described in Section 1902(m) of the federal
8Social Security Act (42 U.S.C. Sec. 1396a(m)(1)).
9(b) To the extent federal financial participation is available, the
10blind shall be included within the definition of disabled for the
11purposes of the program established in this section.
12(c) An individual shall satisfy the financial eligibility
13requirement of this program if all of the following conditions are
15(1) Countable income, as determined in accordance with Section
161902(m) of the federal Social Security Act (42 U.S.C. Sec.
171396a(m)), does not exceed an income standard equal to 100
18percent of the applicable federal poverty level, plus
begin delete two hundred for an individual or, in the case of a
19thirty dollars ($230)end delete
begin delete three hundred ten dollars ($310), providedend delete that the income standard so
23determined shall not be less than the SSI/SSP payment level
begin delete for a individual or, in the case of a couple, the SSI/SSP payment
P3 1disabledend delete
begin delete for a disabledend delete couple.
17 (A) For the purposes of calculating countable income under
18this section, an income exemption shall be applied as necessary
19to adjust the SSI/SSP payment level as used in this section so that
20it is the same as the SSI/SSP payment level that was in place on
21May 1, 2009.
22(B) This additional income exemption shall
cease to be
23implemented when the SSI/SSP payment levels increase beyond
24those in effect on May 1, 2009.
25(C) Notwithstanding Chapter 3.5 (commencing with Section
2611340) of Part 1 of Division 3 of Title 2 of the Government Code,
27the department shall implement this paragraph by means of an
28all-county letter or similar instruction without taking regulatory
31 Countable resources, as determined in accordance with
32Section 1902(m) of the federal Social Security Act (42 U.S.C. Sec.
331396a(m)), do not exceed the maximum levels established in that
35(d) The financial eligibility requirements provided in subdivision
36(c) may be adjusted upwards to reflect the cost of living in
37California, contingent upon appropriation in the annual Budget
39(e) Notwithstanding Chapter 3.5 (commencing with Section
4011340) of Part 1 of Division 3 of Title 2 of the Government Code,
P4 1the department shall implement this section by means of all-county
2letters or similar instructions, and without taking regulatory action.
3Thereafter, the department shall adopt regulations in accordance
4with the requirements of Chapter 3.5 (commencing with Section
511340) of Part 1 of Division 3 of Title 2 of the Government Code.
6(f) For purposes of calculating income under this section during
7any calendar year, increases in social security benefit payments
8under Title II of the federal Social Security Act (42 U.S.C. Sec.
9401 et seq.) arising from cost-of-living adjustments shall be
10disregarded commencing in the month that these social security
11benefit payments are increased by the cost-of-living adjustment
12through the month before the month in which a change in the
13federal poverty level requires the department to modify the income
14standard described in subdivision (c).
15(g) (1) For purposes of this section the following definitions
17(A) “SSI” means the federal Supplemental Security Income
18program established under Title XVI of the federal Social Security
20(B) “Income standard” means the applicable income standard
begin delete including the augmentations specified in paragraph (1) of .
22subdivision (c)end delete
25(C) The board and care “personal care services” or “PCS”
26deduction refers to an income disregard that is applied to a resident
27in a licensed community care facility in lieu of the board and care
28deduction (equal to the amount by which the basic board and care
29rate exceeds the income standard in subparagraph
begin delete (B), of paragraph when the PCS deduction is greater than
30(1) of subdivision (g))end delete
31the board and care deduction.
32(2) (A) For purposes of this section, the SSI recipient retention
33amount is the amount by which the SSI maximum payment amount
34to an individual residing in a licensed community care facility
35exceeds the maximum amount that the state allows community
36care facilities to charge a resident who is an SSI recipient.
37(B) For the purposes of this section, the personal and incidental
38needs deduction for an individual residing in a licensed community
39care facility is either of the following:
P5 1(i) If the board and care deduction is applicable to the individual,
2the amount, not to exceed the amount by which the SSI recipient
3retention amount exceeds twenty dollars ($20), nor to be less than
4zero, by which the sum of the amount which the individual pays
5to his or her licensed community care facility and the SSI recipient
6retention amount exceed the sum of the individual’s income
7standard, the individual’s board and care deduction, and twenty
9(ii) If the PCS deduction specified in paragraph (1) of
10subdivision (g) is applicable to the individual, an amount, not to
11exceed the amount by which the SSI recipient retention amount
12exceeds twenty dollars ($20), nor to be less than zero, by which
13the sum of the amount which the individual pays to his or her
14community care facility and the SSI recipient retention amount
15exceed the sum of the individual’s income standard, the
begin delete deductionend delete and twenty dollars ($20).
17(3) In determining the countable income under this section of
18an individual residing in a licensed community care facility, the
19individual shall have deducted from his or her income the amount
20specified in subparagraph (B) of paragraph (2).
21(h) No later than one month after the effective date of
22subdivision (g), the department shall submit to the federal
begin delete medicaidend delete
23 administrator a state plan amendment seeking approval
24of the income deduction specified in paragraph (3) of subdivision
25(g), and of federal financial participation for the costs resulting
26from that income deduction.
27(i) The deduction prescribed by paragraph (3) of subdivision
28(g) shall be applied no later than the first day of the fourth month
29after the month in which the department receives approval for the
30federal financial participation specified in subdivision (h). Until
31approval for federal financial participation is received, there shall
32be no deduction under paragraph (3) of subdivision (g).
If the Commission on State Mandates determines that
34this act contains costs mandated by the state, reimbursement to
35local agencies and school districts for those costs shall be made
36pursuant to Part 7 (commencing with Section 17500) of Division
374 of Title 2 of the Government Code.