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.