Bill Text: CA AB2823 | 2021-2022 | Regular Session | Amended
Bill Title: Medi-Cal: beneficiary maintenance needs: home upkeep allowance and transitional needs allowance.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Engrossed - Dead) 2022-08-11 - In committee: Held under submission. [AB2823 Detail]
Download: California-2021-AB2823-Amended.html
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Amended
IN
Senate
June 13, 2022 |
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Amended
IN
Assembly
March 28, 2022 |
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Amended
IN
Assembly
March 10, 2022 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 2823
| Introduced by Assembly Member Levine (Coauthor: Assembly Member Wood) |
February 18, 2022 |
An act to add Section 14005.125 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2823, as amended, Levine.
Medi-Cal: beneficiary maintenance needs: home upkeep allowance and transitional needs allowance.
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 person to meet their 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 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 an amount providing for the upkeep and maintenance of the 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 and a transitional needs allowance to Medi-Cal patients residing in a long-term care facility. The bill would prescribe general and specific requirements for both facility residents who intend to leave the facility and return to an existing home or to establish a home and who would receive the home upkeep allowance or transitional needs allowance.
The bill would require the department to implement, subject to federal approval and federal financial participation, these provisions, as specified, by means of various instructions, including provider bulletins, to adopt regulations within 2 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 notify specified personnel and health care facilities of the existence and availability of the home upkeep allowance and transitional needs allowance.
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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 14005.125 is added to the Welfare and Institutions Code, immediately following Section 14005.12, to read:14005.125.
(a) It is the intent of the Legislature to prevent homelessness for long-term care Medi-Cal beneficiaries who are temporarily residing in a skilled nursing facility and are no longer able to pay their housing expenses or establish a home in the community due to diverting their income toward share of cost.(b) (1) For purposes of this section, “home upkeep allowance” means the “allowance for home maintenance,” as 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) For purposes of this section, “transitional needs allowance” means income that otherwise would be applied toward the resident’s Medi-Cal share of cost used to cover the but is deducted 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.
(3) 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.
(4) A long-term care facility
resident who intends to leave the facility and return to their existing home shall be provided with a home upkeep allowance as follows:
(A) The home upkeep 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 home upkeep 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, utilities, and required insurance.
(C) The home upkeep 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 their home.
(5) 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 facility shall refer them to available home-based and community-based services programs.
(6) A long-term care resident who is a Medi-Cal recipient who intends to leave the facility and establish a home in the community, may establish a transitional needs allowance for the purpose of meeting the transitional costs of establishing a home, as follows:
(A) The transitional needs 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 transitional needs allowance shall be used to cover the
based on the actual 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.
(C) The transitional needs 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 the community.
(7) On or before July 1, 2023, 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. This subdivision may be implemented
if federal financial participation is available and any necessary federal approvals have been obtained for only parts of this subdivision.
(c) (1) The home upkeep allowance or transitional needs allowance shall not be approved if the resident has received a home upkeep allowance or transitional needs allowance for a full six-month period during a continuous period of institutionalization.
(2) If the resident receives a home upkeep allowance or transitional needs allowance for fewer than six months during the same continuous period of institutionalization, a home upkeep allowance or transitional needs allowance 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) Include information on the existence and availability of the home upkeep allowance and transitional needs allowance in the “Notice Regarding Standards for Medi-Cal Eligibility” provided for in Section 14006.4.
(2) Add questions to the “Additional Income and Property Information Needed for Medi-Cal” (MC 604 IPS) form or other form subsequently developed to collect income information from potential or current Medi-Cal residents of long-term care facilities to provide applicants an opportunity to apply for the home upkeep allowance or transitional needs allowance.
(3) Notify all Medi-Cal branches, eligibility workers, long-term care facilities, hospital discharge planners, and organizations receiving state funds to nursing home residents of the existence and availability of the home upkeep allowance and transitional needs allowance.
(4) Inform residents in all Medi-Cal funded long-term care facilities of the existence and availability of the home upkeep allowance and transitional needs allowance.
(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 two 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.
