Bill Text: CA SB1124 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medi-Cal: estate recovery.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2014-09-25 - In Senate. Consideration of Governor's veto pending. [SB1124 Detail]

Download: California-2013-SB1124-Amended.html

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BILL NUMBER: SB 1124	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 26, 2014

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 19, 2014

   An act to amend Section  1367.23 of the Health and Safety
Code, relating to health care service plans   14009.5 of
the Welfare and Institutions Code, relating to Medi-Cal  .


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1124, as amended, Hernandez.  Health care service
plans.   Medi-Cal: estate recovery.  
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions.  
   Existing law, with certain exceptions, requires the department to
claim against the estate of a decedent, or against any recipient of
the property of that decedent by distribution or survival, an amount
equal to the payments for Medi-Cal services received or the value of
the property received by any recipient from the decedent by
distribution or survival, whichever is less. Existing law provides
for certain exemptions that restrict the department from filing a
claim against a decedent's property, including when there is a
surviving spouse during his or her lifetime. Existing law requires
the department, however, to make a claim upon the death of the
surviving spouse, as prescribed. Existing law, which has been held
invalid by existing case law, provides that the exemptions shall only
apply to the proportionate share of the decedent's state or property
that passes to those recipients, by survival or distribution, who
qualify for the exemptions.  
   This bill would instead provide that the department shall make
these claims only in specified circumstances and would define health
care services for these purposes. The bill would additionally provide
that health care services that federal law or guidance authorizes
the state to eliminate from recovery shall also be exempted. The bill
would delete the proportionate share provision and would delete the
requirement that the department make a claim upon the death of the
surviving spouse. The bill would provide that in meeting these
requirements the department shall only collect amounts identified as
being spent by either the department or a Medi-Cal managed care plan
for health care services actually received by the decedent, or the
per member per month payment, whichever is less in that month. The
bill would also require the department to provide a current or former
beneficiary, or his or her authorized representative, upon request
and free of charge, with the total amount of Medi-Cal expenses that
have been paid on his or her behalf that would be recoverable under
these provisions, as specified.  
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law requires that every group
health care service plan contract, issued, amended, or renewed,
include a provision requiring the health care service plan to notify
the group contractholders in writing of the cancellation of the plan
contract and shall include in their contract with group
contractholders a provision requiring the group contractholder to
mail promptly to each subscriber a legible, true copy of any notice
of cancellation of the plan contract that may be received from the
plan and to provide promptly to the plan proof of that mailing and
the date of that mailing.  
   This bill would authorize those contract provisions to allow those
mailings to be made by email. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 14009.5 of the  
Welfare and Institutions Code   is amended to read: 
   14009.5.  (a) Notwithstanding any other provision of this chapter,
the department shall claim against the estate of the decedent, or
against any recipient of the property of that decedent by
distribution or survival an amount equal to the payments for the
health care services received or the value of the property received
by any recipient from the decedent by distribution or survival,
whichever is  less.   less, only in either of
the following circumstances:  
   (b) The department may not claim in any of the following
circumstances:  
   (1) The decedent was under 55 when services were received, except
in the case of an individual who had been an inpatient in a nursing
facility.  
   (2) Where there is any of the following:  
   (1) Notwithstanding paragraph (2), against the real property of a
decedent who was an inpatient in a nursing facility in accordance
with Section 1396p(b)(1)(A) of Title 42 of the United States Code.
 
   (2) (A) The decedent was 55 years of age or older when the
individual received health care services.  
   (B) The department shall not claim under this paragraph when there
is any of the following:  
   (A) 
    (i)  A surviving spouse  during his or her
lifetime. However, upon the death of a surviving spouse, the
department shall make a claim against the estate of the surviving
spouse, or against any recipient of property from the surviving
spouse obtained by distribution or survival, for either the amount
paid for the medical assistance given to the decedent or the value of
any of the decedent's property received by the surviving spouse
through distribution or survival, whichever is less. Any statute of
limitations that purports to limit the ability to recover for medical
assistance granted under this chapter shall not apply to any claim
made for reimbursement  . 
   (B) 
    (ii)  A surviving child who is under age 21. 
   (C) 
    (iii)  A surviving child who is blind or permanently and
totally disabled, within the meaning of Section 1614 of the federal
Social Security Act (42  U.S.C.A.   U.S.C. 
Sec. 1382c). 
   (3) Any exemption described in paragraph (2) that restricts the
department from filing a claim against a decedent's property shall
apply only to the proportionate share of the decedent's estate or
property that passes to those recipients, by survival or
distribution, who qualify for an exemption under paragraph (2).
 
   (iv) Any health care services that federal law or guidance
authorizes the state to eliminate from recovery. The department shall
adopt emergency regulations as necessary to implement this clause in
accordance with Chapter 3.5 (commencing with Section 11340) of Part
1 of Division 3 of Title 2 of the Government Code. If emergency
regulations are adopted pursuant to this clause, the department shall
proceed under subdivision (e) of Section 11346.1 of the Government
Code for adoption of final regulations. If the process has not been
completed within 180 days, the department shall readopt the emergency
regulations in accordance with Section 11346.1 of the Government
Code, but no more than two times. The initial adoption and any
readoptions of emergency regulations shall be deemed to be an
emergency and necessary for immediate preservation of the public
peace, health and safety, or general welfare, for purposes of
Sections 11346.1 and 11349.6 of the Government Code, and the
department is hereby exempted for that purpose from the requirements
of subdivision (b) of Section 11346.1 of the Government Code. 

   (c) 
    (b)  (1) The department shall waive its claim, in whole
or in part, if it determines that enforcement of the claim would
result in substantial hardship to other dependents, heirs, or
survivors of the individual against whose estate the claim exists.
   (2) The department shall notify individuals of the waiver
provision and the opportunity for a hearing to establish that a
waiver should be granted. 
   (c) In meeting the requirement in subdivision (a), the department
shall only collect amounts identified as being spent by either the
department or a Medi-Cal managed care plan for health care services
actually received by the decedent, or the per member per month
payment, whichever is less in that month.  
   (d) (1) The department shall provide a current or former
beneficiary, or his or her authorized representative designated under
Section 14014.5, upon request and free of charge, with the total
amount of Medi-Cal expenses that have paid on behalf of that
beneficiary that would be recoverable under this section.  
   (2) The department shall permit a beneficiary to request the
information described in paragraph (1) via the Internet, by
telephone, by mail, in person, or through other commonly available
electronic means.  
   (3) The department shall conspicuously post on its Internet Web
site, a description of the methods by which a request under this
subdivision may be made, including, but not limited to, the
department's telephone number and any addresses that may be used for
this purpose. The department shall also include this information in
its pamphlet for the Medi-Cal Estate Recovery Program and any other
notices the department distributes to beneficiaries regarding estate
recovery.  
   (d) 
    (e)  The following definitions shall govern the
construction of this section:
   (1) "Decedent" means a beneficiary who has received health care
under this chapter or Chapter 8 (commencing with Section 14200) and
who has died leaving property to others either through distribution
or survival.
   (2) "Dependents" includes, but is not limited to, immediate family
or blood relatives of the decedent. 
   (3) "Health care services" means only those services required to
be recovered under Section 1396p(b)(1)(B)(i) of Title 42 of the
United States Code and shall not include services provided to the
decedent through the In-Home Supportive Services program.  
   (f) The amendments made to this section by the act that added this
subdivision apply only to individuals who die on or after January 1,
2015.  
  SECTION 1.    Section 1367.23 of the Health and
Safety Code is amended to read:
   1367.23.  (a)  Every group health care service plan contract,
which is issued, amended, or renewed, shall include a provision
requiring the health care service plan to notify the group
contractholders in writing of the cancellation of the plan contract
and shall include in their contract with group contractholders a
provision requiring the group contractholder to mail promptly or
email to each subscriber a legible, true copy of any notice of
cancellation of the plan contract which may be received from the plan
and to provide promptly to the plan proof of that mailing or
emailing and the date of that mailing or emailing.
   (b)  The notice of cancellation from the group contractholder to
the subscriber required by subdivision (a) shall include information
regarding the conversion rights of persons covered under the plan
contract upon termination of the plan contract. This information
shall be in clear and easily understandable language.