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AB-286 Medi-Cal: beneficiary maintenance needs: home upkeep allowances: transitional needs funds.(2017-2018)

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Date Published: 03/22/2017 04:00 AM
AB286:v98#DOCUMENT

Amended  IN  Assembly  March 21, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 286


Introduced by Assembly Member Gipson

February 02, 2017


An act to add Section 14005.125 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 286, as amended, Gipson. Medi-Cal: beneficiary maintenance needs: home upkeep allowances: transitional personal needs funds.
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 provisions. Qualified individuals under the Medi-Cal program include medically needy persons and medically needy family persons who meet the required eligibility criteria, including applicable income requirements.
Existing law requires the department to establish income levels for maintenance need at the lowest levels that reasonably permit a medically needy individual person to meet his or her basic needs for food, clothing, and shelter, and for which federal financial participation will still be provided under applicable federal law. In calculating the income of a medically needy individual person in a medical institution or nursing facility, or a person receiving institutional or noninstitutional services from a Program of All-Inclusive Care for the Elderly organization, the required monthly maintenance amount includes, among other things, an amount providing for the upkeep and maintenance of the individual’s person’s home. This amount is also referred to as the home upkeep allowance.
Existing law requires that the maintenance of need amount provide for personal and incidental needs in an amount not less than $35 for a person in a medical institution or nursing facility, or for a person receiving institutional or noninstitutional services from a Program of All-Inclusive Care for the Elderly organization.
Existing law authorizes the Director of Health Care Services to adopt, amend, or repeal reasonable rules and regulations to carry out the purposes and intent of the Medi-Cal program, that are not inconsistent with any state statute. The department has adopted regulatory requirements relating to the determination of the home upkeep allowance described above.
This bill would establish eligibility and other requirements for providing the home upkeep allowance or a transitional personal needs fund to Medi-Cal patients residing in a long-term care facility, as specified. The bill would prescribe general requirements as well as specific requirements both for facility residents who intend to leave the facility and return to an existing home, who would receive the home upkeep allowance, and for residents who do not have a home but intend to leave the facility and establish a new home, who would establish a transitional personal needs fund, as part of the personal needs allowance provided to the resident. The could establish a transitional needs fund for the purpose of meeting the transitional costs of establishing a home.
This bill would require the department to adopt implementing regulations and to advise implement, interpret, or make specific these provisions by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, to adopt regulations within 5 years of implementation of these provisions, and to provide a status report to the Legislature on a semiannual basis until regulations have been adopted. The bill would require the department to inform appropriate long-term care facility residents and other notify specified personnel and health care facilities of the existence and availability of the home upkeep allowance and the transitional personal needs fund. The bill would require the department, on or before July 1, 2018, to seek federal approval to implement these provisions, and would require these provisions to be implemented only if, and to the extent that, federal financial participation is available and any necessary federal approvals have been obtained. Because
Because counties are required to make Medi-Cal eligibility determinations, and this bill would impose new eligibility requirements for purposes of these allowances, this 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 the statutory provisions noted above.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14005.125 is added to the Welfare and Institutions Code, to read:

14005.125.
 (a) (1) For purposes of this section, “home upkeep allowance” means the “allowance for home maintenance” described in Section 435.725 (d) of Title 42 of the Code of Federal Regulations and the amount for the “upkeep and maintenance of the home,” described in paragraph (2) of subdivision (d) of Section 14005.12.
(2) The home upkeep allowance shall be available to long-term care facility residents who are Medi-Cal recipients and meet the requirements of this section.
(3) A long-term care facility resident who intends to leave the facility and return to his or her existing home shall be provided with a home upkeep allowance as follows:
(A) The allowance shall be set aside from the income that otherwise would be applied toward the resident’s Medi-Cal share of cost for residing in the facility.
(B) The allowance shall be based on the actual minimum cost of maintaining the resident’s home, including, but not limited to, mortgage or rent, property taxes, and required insurance. insurance, but shall not exceed the monthly amount of 100 percent of the federal poverty level for one person.
(C) The allowance shall be an exempt resource for purposes of determining eligibility for the Medi-Cal program.
(D) The allowance shall be deducted for not more than six months and shall be available only if a physician has certified that the resident is likely to return to his or her home within six months.
(4) On or before July 1, 2018, the department shall seek federal approval to implement the requirements of this subdivision. This subdivision shall be implemented only if, and to the extent that, federal financial participation is available and any necessary federal approvals have been obtained.
(b) (1) In accordance with Section 435.725 (c)(1) of Title 42 of the Code of Federal Regulations and paragraph (1) of subdivision (d) of Section 14005.12, a transitional personal A transitional needs fund shall be available to long-term care facility residents described in this section.
(2) If a long-term care facility resident does not have a home, but intends to leave the facility and establish a home in the community, the transitional costs of establishing a home shall be included in his or her personal needs allowance. The resident may establish a transitional personal needs fund for this purpose, the purpose of meeting the transitional costs of establishing a home, as follows:
(A) The fund shall be set aside from the income that otherwise would be applied toward the resident’s Medi-Cal share of cost for residing in the facility.
(B) The total amount of the fund shall not exceed seven thousand five hundred dollars ($7,500). resident’s transitional needs fund shall not exceed the monthly amount of 100 percent of the federal poverty level for one person for a total of six months.
(C) The fund shall be an exempt resource for purposes of determining eligibility for the Medi-Cal program.
(D) The fund shall be used to cover the costs of securing a home for the individual, including, but not limited to, rent, security and utility deposits, accessibility modifications necessary to meet the needs of the individual, and essential furnishings, including, but not limited to, stoves, refrigerators, beds, towels, and bed linens. furnishings.

(E)If the resident is unable to secure a home within four months after the transitional personal needs fund has reached the maximum amount specified in this subdivision, the fund shall revert to the state to defray the costs of the resident’s care in the facility.

(E) The allowance shall be deducted for not more than six months and shall be available only if a physician has certified that the resident is likely to return to his or her community within six months.
(3) On or before July 1, 2018, the department shall seek federal approval to implement the requirements of this subdivision. This subdivision shall be implemented only if, and to the extent that, federal financial participation is available and any necessary federal approvals have been obtained.
(c) (1) The six-month period described in subparagraph (D) of paragraph (3) of subdivision (a) and subparagraph (E) of paragraph (2) of subdivision (b) is cumulative. An allowance under subdivision (a) or (b) shall not be approved if the resident has received a home upkeep allowance for a full six-month period or a transitional needs fund for a full six-month period during a continuous period of institutionalization.
(2) If the resident receives either a home upkeep allowance or a transitional needs fund for fewer than six months during the same continuous period of institutionalization, a home upkeep allowance or a transitional needs fund may be approved for any remaining portion of the maximum six-month period.

(c)

(d) In implementing this section, the department shall undertake all of the following information and outreach activities:
(1) Inform residents in all Medi-Cal funded long-term care facilities of the existence and availability of the home upkeep allowance and the transitional needs personal needs fund.
(2) Include information on the existence and availability of the home upkeep allowance and the transitional personal needs fund in the “Notice Regarding Standards for Medi-Cal Eligibility” provided for in Section 14006.4.
(3) Notify all Medi-Cal branches, eligibility workers, long-term care facilities, hospital discharge planners, and organizations receiving state funds to assist nursing home residents of the existence and availability of the home upkeep allowance and the transitional personal needs fund.

(d)The department shall adopt, revise, or repeal regulations as necessary to implement this section, including, but not limited to, Section 50605 of Title 22 of the California Code of Regulations. To the extent Section 50605 of Title 22 of the California Code of Regulations is inconsistent with this section, those regulations shall be inoperative until the department makes the regulatory changes required by this subdivision.

(e) (1) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.
(2) The department shall adopt regulations within five years of implementation of this section, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(3) Beginning six months after the effective date of this section, notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.

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.