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, 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) 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 resident may establish a transitional needs fund for 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 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.
(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.
(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 fund.
(2) Include information on the existence and availability of the home upkeep allowance and the transitional 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 needs fund.
(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.