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 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 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 individuals 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 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 residents who 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 bill would require the department to adopt implementing regulations, and to advise appropriate long-term care facility residents and other specified personnel and health care facilities of the existence and availability of the home upkeep allowance and transitional personal needs fund. The bill would require the department, on or before July 1, 2016, 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 counties are required to make Medi-Cal eligibility determinations and this bill would impose new eligibility requirements for purposes of the home upkeep allowance, 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 these statutory provisions.

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 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 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 individuals 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 transitional personal needs fund, to a Medi-Cal patient patients residing in a long-term care facility. 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 residents who intend to leave the facility and establish a new home. home, who would establish a transitional personal needs fund, as part of the personal needs allowance provided to the resident. The bill would require the department to adopt conforming regulations implementing regulations, and to advise appropriate Medi-Cal patients long-term care facility residents and other specified personnel and health care facilities of the existence and availability of the home upkeep allowance and transitional personal needs fund. Because counties are required to make Medi-Cal eligibility determinations and this bill would impose new eligibility requirements for purposes of the home upkeep allowance, 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 these statutory provisions.

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 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 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 individuals 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 further declare the intent of the Legislature to enact legislation to prohibit the use of in-kind value of housing as a basis for calculating establish eligibility and other requirements for providing the home upkeep allowance for a patient to a Medi-Cal patient residing in a long-term care and prohibit eligibility for the allowance from being based on the date when patient status is established, and to require the calculation for the allowance to be based on the actual cost of maintaining the patients home. The bill would declare the intent of the Legislature to enact legislation to facility. 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, and residents who intend to leave the facility and establish a new home. The bill would require the department to adopt conforming regulations, and to notify specified parties of those regulatory changes. The bill would declare the Legislatures intent to enact legislation to require the department regulations and to advise appropriate Medi-Cal patients of the existence and availability of the home upkeep allowance. Because counties are required to make Medi-Cal eligibility determinations and this bill would impose new eligibility requirements for purposes of the home upkeep allowance, 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 these statutory provisions.

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 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 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 individuals home. This amount is also referred to as the home upkeep allowance.

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 above home upkeep allowance described above.

This bill would further declare the intent of the Legislature to enact legislation to prohibit the use of in-kind value of housing as a basis for calculating the home upkeep allowance for a patient in long-term care and prohibit eligibility for the allowance from being based on the date when patient status is established, and to require the calculation for the allowance to be based on the actual cost of maintaining the patients home. The bill would declare the intent of the Legislature to enact legislation to require the department to adopt conforming regulations, and to notify specified parties of those regulatory changes. The bill would declare the Legislatures intent to enact legislation to require the department to advise appropriate Medi-Cal patients of the availability of the home upkeep 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 individual 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 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 individuals home. This amount is also referred to as the home upkeep allowance.

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 above home upkeep allowance.

This bill would declare the intent of the Legislature to enact legislation to prohibit the use of in-kind value of housing as a basis for calculating the home upkeep allowance for a patient in long-term care and prohibit eligibility for the allowance from being based on the date when patient status is established, and to require the calculation for the allowance to be based on the actual cost of maintaining the patients home. The bill would declare the intent of the Legislature to enact legislation to require the department to adopt conforming regulations, and to notify specified parties of those regulatory changes. The bill would declare the Legislatures intent to enact legislation to require the department to advise appropriate Medi-Cal patients of the availability of the home upkeep allowance.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 1235 (Gipson) - Medi-Cal: beneficiary maintenance needs: home upkeep allowances: transitional personal needs funds

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 1235 would require the home upkeep allowance for Medi-Cal beneficiaries in long-term care facilities to be based on the actual cost to maintain the beneficiary’s home. The bill would allow Medi-Cal beneficiaries in long-term care facilities that do not have a home to establish a transitional needs fund to set aside up to $7,500 for the purpose of securing a home.

Fiscal Impact:

• One-time administrative costs in the hundreds of thousands for the Department of Health Care Services to develop a state plan amendment, develop regulations, and make necessary programming changes (General Fund and federal funds).

• Unknown increased Medi-Cal spending, at least in the millions, due to the increase in the home upkeep allowance (General Fund and federal funds). For example, for each 1,000 eligible beneficiaries who participate in the program under the bill (about 2% of the average Medi-Cal long-term care population), the annual costs would be about $5 million per year.

The bill increases the maximum home upkeep allowance over existing regulations, from $209 per month to the minimum amount necessary to maintain the beneficiary’s home. The actual cost of the bill will depend on the number of participating beneficiaries, which is not known at this time. The Department does not have information on the number of current participants in the home upkeep allowance program or the number of beneficiaries who would participate in the expanded program. Current participation in the program is thought be very low. However, since the financial benefits of the proposed program are much more substantial, increased participation is likely. According to the Department of Housing and Urban Development, the average rent for a one bedroom apartment in California’s metropolitan areas is over $900 per month.

• Unknown increased Medi-Cal spending, at least in the millions, due to Medi-Cal beneficiaries using the established transitional needs personal fund (General Fund and federal funds). Similar to above, the Department does not have information on the potentially eligible population. For each 1,000 participants (about 2% of the average long-term care population) annual costs would be about $9 million per year.

• Unknown impact on Medi-Cal spending due to individuals previously eligible for Share of Cost Medi-Cal newly becoming eligible for full scope Medi-Cal (General Fund and federal funds). The bill requires that the income set aside for both the increased home upkeep allowance and the new transitional needs account would not be counted when determining Medi-Cal eligibility. By setting aside a significant amount of monthly income, the bill is likely to shift some individuals from being eligible for Share of Cost Medi-Cal to full scope Medi-Cal. In doing so, the bill would increase state Medi-Cal spending substantially, by eliminating the requirement that the individual pay any amount of the cost of care.

Background:

Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. Medi-Cal provides coverage to childless adults and parents with household incomes up to 138% of the federal poverty level and to children with household incomes up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary.

Under current law, an individual whose income exceeds the Medi-Cal eligibility threshold can become eligible for Share of Cost Medi-Cal by “spending-down” his or her income due to significant health care costs (these beneficiaries are referred to as “medically needy”). Under this program, an individual must spend down all his or her monthly income (less certain set asides, for example a fixed amount to maintain their home for non-institutionalized patients or the personal needs allowance and home upkeep allowance for individuals in long-term care facilities). Once an individual has spent down his or her income (paying directly to health care providers or long-term care facilities) the state will pay the remaining costs for care through Medi-Cal. Under current regulation, the home upkeep allowance available to individuals in a long-term care facility is limited to $209 per month.

Proposed Law:

AB 1235 would require the home upkeep allowance for Medi-Cal beneficiaries in long term care facilities to be based on the actual cost to maintain the beneficiary’s home. The bill would allow Medi-Cal beneficiaries in long-term care facilities that do not have a home to establish a transitional needs fund to set aside up to $7,500 for the purpose of securing a home.

Specific provisions of the bill would:

• Authorize a home upkeep allowance for a long-term care facility resident who intends to return to an existing home;

• Require the home upkeep allowance to be set aside from the income otherwise be required to meet the individual’s share of cost;

• Require the home upkeep allowance to be an exempt resource for the purposes of determining Medi-Cal eligibility;

• Provide that the individual would only be eligible for the home upkeep allowance if a physician has certified that the individual is likely to return home within six months;

• Authorize a transitional personal needs fund for individuals in a long-term care facility who do not have a home, but intend to return to the community;

• Require the funds in the transitional personal needs fund to be set aside from the income that would otherwise be required to meet the individual’s share of cost;

• Limit the maximum amount in the fund to $7,500;

• Require the money in the fund to be an exempt asset for the purposes of determining Medi-Cal eligibility;

• Require the fund to be used to allow the individual to secure a home in the community;

• Make operation of the bill contingent on federal financial participation;

• Require the Department to perform specified outreach activities.

Related Legislation:

AB 1319 (Dababneh) would increase the personal and incidental needs allowance for Medi-Cal beneficiaries residing in a community care facility from $20 to $50. That bill will be heard in this committee.

Staff Comments:

As noted above, the provisions of the bill that would set-aside the expanded home upkeep allowance and the new transitional needs fund from the calculation of income when determining Medi-Cal eligibility have the potential to significantly increase Medi-Cal spending on qualifying individuals. An individual over age 65 with income at or below $1,200 per month is eligible for full-scope Medi-Cal with no cost sharing. Over income of $1,200 per month, an individual would have to “spend down” all of his or her income (less the existing allowances) before Medi-Cal would pay the remaining costs of care. In California, the average monthly cost of a place in a skilled nursing facility is over $7,000 per month.

For example, under current law, an hypothetical individual over age 65 with a monthly income of $2,000 (and rent of $900 per month) would have to spend about $1,700 per month on his or her care (accounting for allowances) before the state would begin spending. Under the bill, that individual’s income for calculating Medi-Cal eligibility would be $1,100 per month ($2,000 in income less the actual cost of rent, in this case $900 per month). That individual would then be eligible for full-scope Medi-Cal coverage and the state would be required to pay the full cost of that coverage, $1,700 per month more than under current law.

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SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 1235

SUBJECT: Medi-Cal: beneficiary maintenance needs: home upkeep allowances and transitional personal needs funds.

SUMMARY:

Requires the home upkeep allowance (HUA) for eligible Medi-Cal beneficiaries in long-term care facilities to be based on the actual minimum cost of maintaining the resident’s home (the HUA is currently $209 a month). Allows a long-term care facility resident who does not have a home to establish a transitional personal needs fund of up to $7,500 to be set aside from the income that otherwise would be applied toward the resident’s Medi-Cal share of cost for residing in the long term care facility. The personal needs fund would be used to cover the costs of securing a home for the individual.

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care services. 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.
   
   

2. Requires DHCS to establish the income levels for maintenance need at the lowest levels that reasonably permit medically needy persons to meet their basic needs for food, clothing, and shelter, and for which federal financial participation (FFP) will still be provided under federal Medicaid law. (The medically needy Medi-Cal eligibility category are individuals who fit into a federal benefit program category but whose income or resources exceed eligibility levels. Medically needy individuals become Medi-Cal eligible by having a share of cost whereby the individual “spends down” to Medi-Cal eligibility levels.)
   
   

3. Requires, for a Medi-Cal beneficiary in a medical institution or nursing facility, the amount considered as required for maintenance per month to be computed in accordance with, and for those purposes required by federal Medicaid law and regulations. Requires those amounts to be computed pursuant to regulations which include providing for the following purposes:

   1. Personal and incidental needs in the amount of not less than $35 per month while a patient. This is referred to as the “personal needs allowance.” Permits DHCS to increase this amount, by regulation, as necessitated by increasing costs of personal and incidental needs. Prohibits a long term care (LTC) facility from charging an individual for the laundry services or periodic hair care; and,

   2. The upkeep and maintenance of the home. (This amount is referred to as the home upkeep allowance.)

4. Establishes, through regulation, the HUA, which allows a Medi-Cal beneficiary in a LTC facility to be able to retain an amount of income for upkeep of a home in addition to the personal and incidental needs allowance, if all of the following conditions are met:
   
   

   1. The LTC patient's spouse or a family member of the LTC patient is not living in the home;

   2. The home, whether rented or owned by the LTC patient, is actually being maintained for the return of the LTC patient;

   3. There is a verified medical determination that the LTC patient, or when both spouses are in LTC, either spouse, is likely to return home within six months of the date LTC patient status was established; and,

   4. The income is deducted for not more than the six-month period.
      
      

5. Establishes, through regulation, a formula for determining the amount of the HUA.

This bill:

1. Requires the HUA to be available to LTC recipients who are Medi-Cal recipients and meet the requirements of this bill.
   
   

2. Requires a LTC facility resident who intends to leave the facility and return to his or her existing home to be provided with a HUA as follows:
   
   

   1. Requires the allowance to be set aside from the income that otherwise would be applied toward the resident’s Medi-Cal share of cost (SOC) for residing in the facility;

   2. Requires the allowance to 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;

   3. Requires the allowance to be an exempt resource for purposes of determining eligibility for the Medi-Cal program; and,

   4. Requires the allowance to be available only if a physician has certified that the resident is likely to return to his or home within six months.
      
      

3. Requires a transitional personal needs fund to be available to long-term care recipients 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. Requires the transitional costs of establishing a home to be included in his or her personal needs allowance.
   
   

4. Permits a resident to establish a transitional personal needs fund, as follows:
   
   

   1. Requires the fund to be set aside from the income that otherwise would be applied toward the resident’s Medi-Cal SOC for residing in the facility;

   2. Caps the total amount of the fund at $7,500;

   3. Requires the fund to be an exempt resource for purposes of determining eligibility for the Medi-Cal program; and,

   4. Requires the fund to 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.
      
      

5. Requires, if the resident is unable to secure a home within four months after the transitional personal needs fund has reached the $7,500 amount, the fund to revert to the state to defray the costs of the resident’s care in the facility.
   
   

6. Requires DHCS, in implementing this bill, to undertake all of the following information and outreach activities:

1. Inform residents in all Medi-Cal funded LTC facilities of the existence and availability of the HUA and the transitional needs personal needs fund;

2. Include information on the existence and availability of the HUA and the transitional personal needs fund in the “Notice Regarding Standards for Medi-Cal Eligibility;” and,

3. Notify all Medi-Cal branches, eligibility workers, LTC facilities, hospital discharge planners, and organizations receiving state funds to assist nursing home residents of the existence and availability of the HUA and the transitional personal needs fund.
   
   

1. Requires DHCS to adopt, revise, or repeal regulations as necessary to implement this bill. Requires regulations that are inconsistent with this bill to be inoperative until DHCS makes the regulatory changes required by this subdivision.

FISCAL EFFECT:

The current version of this bill has not been analyzed by a fiscal committee.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, AB 1235 seeks to improve the quality of life for Medi-Cal recipients in nursing facilities by increasing the HUA and providing greater opportunities for people to transfer back into a community. The current HUA is $209 a month, which is simply insufficient to provide for the maintenance and upkeep of most homes in California. This bill seeks to increase the allowance to ensure that nursing facility residents have an allocation that is enough for them to establish a home and will also save the state in long-term costs. Each resident who is able to transition out of a nursing home is one less resident that the state has to cover the high cost of nursing facility care under Medi-Cal. In addition, even if residents continued to use publicly funded services, such as IHSS, it would still be less expensive and would save money in the long-term. This recommendation came out of a report commissioned by the California Health and Human Services Agency in 2009, entitled, Home and Community-Based Long-Term Care: Recommendations to Improve Access for Californians.
   
   

2. Medi-Cal share of cost, HUA and personal needs allowance. Medi-Cal provides coverage up to 138% of the federal poverty level for parents and individuals age 65 and under (at or below $1,354 a month for a single person and at or below $21,187 for two people) at no cost. In addition, Medi-Cal provides coverage for to individuals who are aged or disabled up to of the 102% of the Federal Poverty Level (at or below $1,200 a month for an individual) at no cost.
   
   Individuals whose income exceeds the income levels or who do not meet eligibility criteria for no-cost Medi-Cal can quality as medically needy individuals. The medically needy program is a way to extend Medi-Cal eligibility to individuals who do not qualify for no-cost Medi-Cal, such as those with high medical expenses whose income is too high to meet the income eligibility threshold for no-cost Medi-Cal. The program functions as a last resort for those whose incomes are modest and are surpassed by their significant medical expenses.
   
   Federal Medicaid law authorizes states to have an optional deduction as allowance for home maintenance. California has adopted this option, whereby Medi-Cal beneficiaries living in, or who will be living in, a nursing home or other medical facility can qualify for a Medi-Cal deduction called the HUA. The Medi-Cal HUA enables a beneficiary to keep $209 a month of the individual’s income for the maintenance and upkeep of the person’s home while the individual is temporarily residing in the nursing home or other medical facility. To be eligible, a LTC resident must have a home (whether rented or owned) that is actually being maintained for the return of the LTC patient, and there must be a verified medical determination that the LTC patient is likely to return home within six months. The HUA allowance can be allowed for up to a six month period from the date the individual enters the nursing home.
   
   DHCS does not have data on the number of individuals using the HUA but the number is believed to be small. A 2008 paper prepared for the state Olmstead Advisory Committee indicated the Medi-Cal Eligibility Data System does not capture information on who utilizes the HUA, but a survey of counties identified low numbers of reported cases, and DHCS estimated that 100 beneficiaries statewide claimed the HUA in any given month.
   
   Individuals likely to use the HUA are more likely to be single adults as current regulations prohibit the LTC’s patient’s spouse or family member from living in the beneficiary’s home. In addition, the resources and income of a Medi-Cal nursing home resident with a spouse or dependent at home (referred to as the “community spouse”) is treated differently from that of a resident who has no spouse or dependent in the home. If a nursing home resident on Medi-Cal has a community spouse living at home, the community spouse is allowed to keep a greater amount of the family income and assets in order that he or she does not become impoverished. In contrast, a single person with no spouse or dependent at home can retain only the $35 for personal and incidental needs when the beneficiary will reside in the facility for the entire month. This is also called the “personal needs allowance.” The state does not have a transitional personal need fund as an exemption or deduction from income in determining a beneficiary’s Medi-Cal SOC as this bill proposes.

The personal needs deduction and HUA are deducted from the individual’s income in determining their share of cost for LTC. For example, if an individual with a monthly income of $1,300 who is residing in a skilled nursing facility (SNF) would have the $35 personal needs deduction and $209 home upkeep allowance subtracted from his or her monthly income ($1,300 - $35 - $209 = $1,056). The remaining amount of $1,056 would be the individual’s monthly SOC.

3. Related legislation. AB 1319 (Dababneh), increases the personal and incidental needs deduction for Medi-Cal beneficiaries residing in a licensed community care facility from $20 to $50. AB 1319 is currently pending in the Senate Rules Committee.

4. Support. This bill is sponsored by Disability Rights California (DRC) to help people who are in nursing homes return to the community if that is their preference. DRC writes that people trying to leave nursing homes face daunting challenges, and none is more daunting than lack of affordable accessible housing. DRC states that, as California seeks federal funds to develop new housing, it also forces people to lose the homes they already have when they enter a SNF, in a policy which hasn’t changed since the 1970s. This means that people who can go home end up languishing in these facilities, with the state paying ever-rising Medi-Cal SNF rates, in contradiction of the wishes and civil rights of the residents, fiscal responsibility, and common sense.

DRC explains that Medi-Cal beneficiaries who go into nursing homes have to turn over some of their income as a SOC if their income exceeds certain levels, and depending on whether there is a spouse living in the family home. Federal Medicaid law allows an alternative for people who intend to return home can use that SOC money to maintain their home. DRC states the problem with the current $209 HUA is it is unchanged since the 1970s and the amount is insufficient. DRC states this bill makes the home upkeep allowance a useful tool by tying the allowance to the HUA amount to what is actually needed to maintain the beneficiary’s home as anything less than that does not achieve the desired policy outcome. In addition, this bill requires the state to publicize the HUA to nursing home residents, prospective residents, discharge planners, and Medi-Cal offices, as the existence of the HUA is not widely known.

In addition to being an inadequate dollar amount, DRC states the HUA does not help people who lost their homes but want to find a new home and leave a long-term care facility. This bill proposes a new transitional personal needs fund that would be deducted from the long-term care Medi-Cal beneficiary’s SOC so they can save income for up to three months to secure a home or apartment. DRC states individual can accumulate up to $7,500 (this amount was chosen because it is the maximum grant amount in the California Community Transitions program), and if the money is not used, it would revert to the state General Fund. DRC states Medi-Cal would make up the beneficiary’s SOC so the nursing home would be made whole, and the short-term cost of the new fund would be far outweighed by the cost savings as people are able to leave facilities and use community-based services, which are almost always less costly.

5. Recommended amendment. This bill creates a new code section but the provisions are not contingent upon the changes made by this bill being contingent upon receipt of federal Medicaid matching funds (commonly referred to as financial participation) and federal approval. Staff recommends this change be made to this bill.
   
   

6. Policy questions.

   1. Should there be an upper limit on the HUA? The HUA enables a beneficiary to keep $209 a month of his/her income for the maintenance and upkeep of their home while the individual is temporarily residing in the nursing home or other medical facility. DHCS did not have data on the number of individuals using the HUA allowance but the number is generally believed to be very low as this option is not well known. Instead of the current $209 established through a formula in regulation, this bill would set in statute the allowance as an amount 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. A 2009 report prepared for California Community Choices and the CA Health and Human Services Agency indicated the existing $209 is too low to maintain a home in California.
      
      The argument for not having a fixed dollar amount is that is insufficient, and it prevents the option from being usable as a low dollar amount is considerably less than the typical cost of mortgage or rent payments. Increasing the HUA will allow institutionalized individuals to keep more income for maintenance and upkeep of their home, would provide with individual with enough income to be helpful in offsetting rental/mortgage costs, and an increased HUA deduction would enable more people to be able to return home when discharged.
      
      

   2. Federal Medicaid law requires states to have a personal needs allowance that is reasonable in amount for clothing and other personal needs of the individual while in the institution, and establishes minimum amounts. For an aged, blind or disabled individual, the amount must be at least $30 and $60 for an institutionalized couple if both spouses are aged, blind, or disabled. For other individuals, the personal needs allowance must a reasonable amount set by the agency, based on a reasonable difference in their personal needs from those of the aged, blind, and disabled. The current California personal needs allowance is $35.
      
      This bill establishes a new transitional personal needs fund, caps the amount in the fund at $7,500, and requires money in the fund to be set aside from the income that otherwise would be applied toward the resident’s Medi-Cal SOC for residing in the facility. While federal law requires the use of an allowance, federal law is silent on the creation of a fund. The bill sponsor indicates the Health Care Financing Administration (the predecessor to CMS) has granted states flexibility in determining what is an exempt resource for Medicaid eligibility purposes. Does federal Medicaid law permit the establishment of a fund, as this bill proposes?

SUPPORT AND OPPOSITION:

Support: Disability Rights California (sponsor)

American Federation of State, County and Municipal Employees

California Advocates for Nursing Home Reform

California Association of Public Authorities for IHSS

California Commission on Aging

California Senior Legislature

Contra Costa Advisory Council on Aging

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1235

Author:(Gipson)

As Amended Ver:June 1, 2015

Majority vote

SUMMARY: Defines a home upkeep allowance (HUA), require an HUA to be available to specified long-term care (LTC) facility recipients, and allow specified LTC facility residents to include the transitional costs of establishing a home in their personal needs allowance, as specified. Specifically, this bill:

1. Defines an HUA as the "allowance of home maintenance" in federal regulation and the amount for the "upkeep and maintenance of the home" described in existing law.

2. Requires the HUA to be available to Medi-Cal beneficiaries who receive LTC.

3. Requires a transitional personal needs fund, as defined by federal regulation, to be available to LTC recipients covered under this bill.

4. Requires an HUA, as defined by federal regulation, to be available to LTC recipients covered under this bill.

5. Requires an HUA to be made available to a LTC facility resident who intends to return to his or her home, as specified.

6. Allows the transitional costs of establishing home to be included in the personal needs allowance for all long-term facility residents who do not have a home but intend to leave a facility and establish a home in the community, as specified.

7. Requires the Department of Health Care Services to perform outreach activities to LTC residents, and to promulgate regulations regarding this bill’s provisions, as specified.

FISCAL EFFECT: This bill, as amended, has not yet been analyzed by a fiscal committee.

COMMENTS:

1. Purpose Of This Bill. The author states the reason why many individuals stay in nursing facilities indefinitely is in part because the current HUA is insufficient to sustain the cost of basic living needs. The author explains that the HUA is underutilized due to the high cost of living in California, as compared to other states, and the lack of affordable housing programs. The author concludes that with the increase in the HUA, this bill will improve the quality of life for Medi-Cal recipients in nursing homes and provide greater opportunities for individuals to transfer back into the community.

2. Background. Maintaining or establishing a home in the community is a major obstacle for Medicaid beneficiaries who want to return home after admission to an institution. Medicaid eligibility rules give states the flexibility to support this goal and allow states to exempt income to maintain a home. The HUA is a Medi-Cal deduction for qualifying Medi-Cal beneficiaries who are living in, or will be living in, a nursing home or other medical facility. The HUA currently allows beneficiaries to keep $209 per month of their monthly income for maintenance and upkeep of their homes while they are temporarily residing in the nursing home other medical facility. The HUA can be allowed for up to a six month period from the date the beneficiary enters the nursing home. To qualify for the HUA, a beneficiary must meet all of the following requirements:

   1. Intend to leave the nursing facility and to return home within six months of the date the individual begins living in the nursing home;

   2. Obtain a written medical statement from the individual’s doctor certifying that he or she will be able to return home within six months;

   3. The spouse or family of the individual must not live in the home; and,

   4. The home must be maintained for the individual's return.

Medically needy Medi-Cal beneficiaries who enter a nursing facility apply all their income above a personal needs allowance to the cost of care. State regulations allow beneficiaries to retain 133% of the in-kind value of housing for one person if the applicant or beneficiary has been living alone in the home.

3. Support. On the previous version of the bill, Disability Rights California, the sponsor of the bill, states the current allowance given to LTC facility residents for the maintenance of their homes is insufficient and highlights the rate has not been updated since the 1970's. The sponsor states the allowance is too restrictive and does not meet the needs of LTC residents.

4. Opposition. With the proposed amendments to this bill, there is no known opposition to this bill.

5. Policy Comments.

   1. The proposed amendments define the HUA as the "allowance for home maintenance" under federal regulation and the amount for the "upkeep and maintenance of the home" described in existing law. The proposed amendments do not specify how the HUA will be determined between these two amounts; the author may wish to consider clarifying changes in a future committee. In addition, the proposed amendments do not specify which code section the "upkeep and maintenance of home" amount refers to; the author may wish to make a technical change to refer to the specific code section in California statute for this amount.

   2. The proposed amendments to this bill reference current federal regulations. All regulations are subject to change by the respective federal or state agencies and departments; if the regulations referenced in the proposed amendments are modified, those changes would have a direct impact on this bill’s provisions. The author may wish to amend the bill such that there are no direct references to federal or state regulations.

   3. The proposed amendments to this bill require an HUA to be provided to all LTC facility residents who intend to leave a facility and either return to his or her existing home, or establish a new home in the community. However the proposed language does not specify which entity would be responsible for determining if a LTC facility resident does in fact intend to leave the facility, and what factors would be considered in that determination. The author may wish to amend the bill to specify these considerations.

   4. The proposed amendments require the transitional costs of establishing a home to be included in the personal needs allowance for a LTC facility resident, and allow the resident to establish a transitional personal needs fund for this purpose. Allowing the resident to maintain and establish his or her own fund may lead to potential conflicts of interest or other logistical challenges; the author may wish to consider if another entity would be more appropriate to maintain this fund.

Analysis Prepared by: An-Chi Tsou / HEALTH / (916) 319-2097 FN: 0000831

ASSEMBLY THIRD READING

ATR Bill Id:AB 1235

Author:(Gipson)

As Amended Ver:April 23, 2015

Majority vote

SUMMARY: Establishes the home upkeep allowance (HUA) for certain Medi-Cal eligible long-term care facility residents, and sets requirements for the allowance, as specified. Specifically, this bill:

1. Requires a HUA to be available to certain long-term care facility residents to use for the maintenance or establishment of a residence following their departure from a facility.

2. Requires a physician to determine the likelihood of a resident's ability to return to the community.

3. Establishes eligibility requirements for individuals to receive the HUA, and specifies maximum values and eligible uses of the HUA.

4. Requires the Department of Health Care Services (DHCS) to perform specified outreach with respect to the HUA.

FISCAL EFFECT: According to the Assembly Appropriations Committee, any additional money the state allows individuals to keep as a HUA results in a commensurate increase in Medi-Cal costs. The HUA would be available only to a portion of the over 200,000 skilled nursing facility discharges every year that, according to analysis of data published by the Office of State Health Planning and Development, have Medi-Cal as a primary payer. Federal law restricts the HUA to situations there is not a spouse or family member living in the individual's home.

1. For every 1,000 Medi-Cal enrollees in long-term care (LTC) facilities that make use of the expanded HUA, and assuming the additional HUA amount is $3,000 on average, the increased state cost will be $1.5 million (50% General Fund (GF), 50% federal funds). The actual cost could be more, or less, depending on utilization. Data is not readily available on what percentage of Medi-Cal enrollees would be both eligible to use and would use the HUA, but it would likely be a small portion of total discharges.

2. Unknown, significant increased costs associated with increased information and outreach related to the availability of the HUA, potentially in the hundreds of thousands or, if considered in tandem with the higher HUA amounts, millions of dollars (GF/federal funds). According to organizations familiar with advocacy for long-term care residents, utilization and knowledge of the current program is quite low.

3. Unknown, significant offsetting cost savings, to the extent this higher HUA allows individuals, who otherwise would have difficulty maintaining or establishing a home in the community in the absence of this higher HUA, to be discharged from institutional care. Because the HUA is restricted to individuals with no spouse or family, allowing these individuals to maintain a home would likely allow them to be discharged more readily.

COMMENTS: According to the Assembly Health Committee, this bill establishes standards for a home upkeep allowance to be available for certain long-term care facility residents. The Committee may suggest a number of amendments to clarify the bill language in a future committee, as follows:

1. This bill establishes the HUA in statute and requirements for the allowance. However, state regulations already define requirements for home maintenance income for long-term residents. The current language of the bill appears to create an allowance that would be supplemental to the existing home maintenance income; however the author has indicated the intent of this bill appears to be to supplant existing requirements with new regulations for this income. The Committee may suggest amending the language to clarify the intent and providing defined guidance to DHCS for the interaction of these two allowances.

2. This bill specifies the HUA will apply to certain long-term care facility residents. The Committee may suggest specifying which types of long-term care facility residents the HUA will apply to, and the associated criteria for eligibility.

3. This bill requires DHCS to perform outreach regarding the HUA. The language of the bill is currently confusing with regard to the requirements on the adoption of regulations for this outreach and related standards. The Committee may suggest amending this bill to clarify these standards in statute.

This bill requires DHCS to adopt or revise regulations as necessary to reflect the requirements of this section; however the bill provision appears to be incorrectly placed within the language. The Committee may suggest amending this bill to ensure this requirement applies to the entirety of the bill language.

The author states the reason why many individuals stay in nursing facilities indefinitely is in part because the current HUA is insufficient to sustain the cost of basic living needs. The author explains that the HUA is underutilized due to the high cost of living in California, as compared to other states, and the lack of affordable housing programs. The author concludes that with the increase in the HUA, this bill will improve the quality of life for Medi-Cal recipients in nursing homes and provide greater opportunities for individuals to transfer back into the community.

Disability Rights California, the sponsor of the bill, states the current allowance given to long-term care facility residents for the maintenance of their homes is insufficient and highlights the rate has not been updated since the 1970's. The sponsor states the allowance is too restrictive and does not meet the needs of long-term care residents. Supporters of the bill state the provisions will allow people to better preserve their residences and will result in cost savings to the state.

There is no opposition to this bill.

Analysis Prepared by: An-Chi Tsou / HEALTH / (916) 319-2097 FN: 0000768

Date of Hearing: May 13, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 1235

Author:(Gipson) – As Amended Ver:April 23, 2015

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill establishes the home upkeep allowance (HUA) for certain Medi-Cal eligible long-term care facility residents, and sets requirements for the allowance, as specified. Specifically, this bill:

1. Requires a HUA to be available to certain long-term care facility residents to use for the maintenance or establishment of a residence following their departure from a facility.
   
   

2. Requires a physician to determine the likelihood of a resident’s ability to return to the community.
   
   

3. Establishes eligibility requirements for individuals to receive the HUA, and specifies maximum value of $7,500 and eligible uses of the HUA.

4. Requires the Department of Health Care Services (DHCS) to perform specified outreach with respect to the HUA.

FISCAL EFFECT:

Any additional money the state allows individuals to keep as a HUA results in a commensurate increase in Medi-Cal costs. The HUA would be available only to a portion of the over 200,000 skilled nursing facility discharges every year that, according to analysis of data published by the Office of State Health Planning and Development, have Medi-Cal as a primary payer. Federal law restricts the HUA to situations there is not a spouse or family member living in the individual's home.

1. For every 1,000 Medi-Cal enrollees in long-term care (LTC) facilities that make use of the expanded HUA, and assuming the additional HUA amount is $3,000 on average, the increased state cost will be $1.5 million (50% GF, 50% federal). The actual cost could be more, or less, depending on utilization. Data is not readily available on what percentage of Medi-Cal enrollees would be both eligible to use and would use the HUA, but it would likely be a small portion of total discharges.

2. Unknown, significant increased costs associated with increased information and outreach related to the availability of the HUA, potentially in the hundreds of thousands or, if considered in tandem with the higher HUA amounts, millions of dollars (GF/federal). According to organizations familiar with advocacy for long-term care residents, utilization and knowledge of the current program is quite low.

3. Unknown, significant offsetting cost savings, to the extent this higher HUA allows individuals, who otherwise would have difficulty maintaining or establishing a home in the community in the absence of this higher HUA, to be discharged from institutional care. Because the HUA is restricted to individuals with no spouse or family, allowing these individuals to maintain a home would likely allow them to be discharged more readily.

COMMENTS:

1. Purpose. The author states many individuals stay in nursing facilities indefinitely in part because the current HUA is insufficient to sustain the cost of basic living needs. The author explains that the HUA is underutilized due to the high cost of living in California, as compared to other states, and the lack of affordable housing programs. The author concludes that with the increase in the HUA, this bill will improve the quality of life for Medi-Cal recipients in nursing homes and provide greater opportunities for individuals to transfer back into the community.

2. Background. The HUA is a Medi-Cal deduction for qualifying Medi-Cal beneficiaries who are living in, or will be living in, a nursing home or other medical facility. The HUA currently allows beneficiaries to keep $209 per month of their monthly income for maintenance and upkeep of their homes while they are temporarily residing in the nursing home or other medical facility. The HUA can be allowed for up to a six-month period from the date the beneficiary enters the nursing home. Because the HUA is not a payment from the state, but instead reduces the share-of-cost an individual would otherwise have to incur before Medi-Cal pays on the individual's behalf, the HUA only applies to individuals with incomes that are high enough to allow for exclusion of a portion of the income for an HUA. For example, individuals solely reliant on Supplemental Security Income (SSI) have income too low to qualify for the HUA. To qualify for the HUA, a beneficiary must also meet all of the following requirements:
   
   

1. Intend to leave the nursing facility and to return home within six months of the date the individual begins living in the nursing home.
   
   

2. Obtain a written medical statement from the individual’s doctor certifying that he or she will be able to return home within six months.
   
   

3. The spouse or family of the individual must not live in the home.
   
   

4. The home must be maintained for the individual’s return.

3. Related Legislation. AB 1319 (Dababneh), pending in this committee, raises the current $20 per month incidental needs deduction to $50 for Medi-Cal beneficiaries who qualify for personal and incidental needs deductions and are residing in a community care facility, provided all necessary federal approvals can be obtained. 

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 28, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

ABPCA Bill Id:AB 1235

Author:Gipson – As Amended Ver:April 23, 2015

SUBJECT: Medi-Cal: beneficiary maintenance needs: home upkeep allowance.

SUMMARY: Establishes the home upkeep allowance (HUA) for certain Medi-Cal eligible long-term care facility residents, and sets requirements for the allowance, as specified. Specifically, this bill:

1. Requires a HUA to be available to certain long-term care facility residents to use for the maintenance or establishment of a residence following their departure from a facility.
   
   

2. Requires a physician to determine the likelihood of a resident’s ability to return to the community.
   
   

3. Establishes eligibility requirements for individuals to receive the HUA, and specifies maximum values and eligible uses of the HUA.
   
   

4. Requires the Department of Health Care Services (DHCS) to perform specified outreach with respect to the HUA.
   
   

EXISTING LAW:

1. Establishes the Medi-Cal program to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria.
   
   

2. Requires DHCS to establish the income levels for maintenance need at the lowest levels that reasonably permit medically needy persons to meet their basic needs for food, clothing, and shelter, and for which federal financial participation will still be provided under Title XIX of the federal Social Security Act.
   
   

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. The author states the reason why many individuals stay in nursing facilities indefinitely is in part because the current HUA is insufficient to sustain the cost of basic living needs. The author explains that the HUA is underutilized due to the high cost of living in California, as compared to other states, and the lack of affordable housing programs. The author concludes that with the increase in the HUA, this bill will improve the quality of life for Medi-Cal recipients in nursing homes and provide greater opportunities for individuals to transfer back into the community.
   
   
   

2. BACKGROUND.
   
   

   1. Long-term care in California. In 2007, California was home to 4 million persons age 65 and older or representing 11% of the state’s population. In 2010, the number of Californians age 65 and older is projected to increase to 4.4 million or 14.7%, and is projected to increase to 8.3 million or 17.8% of all Californians in 2030. Approximately 2.4 million persons in California report having two or more disabilities and an estimated 400,000 plus have intellectual or developmental disabilities.
      
      

Long-term care services generally address an individual’s health, social, and personal needs, and are provided in institutional care settings (for example, skilled nursing facilities) and through community-based providers ranging from nonmedical residential care facilities to services such as transportation and meals to help individuals remain in their homes instead of being placed in an facility. Long-term care services are provided not only to the elderly (age 65 and older), but also to younger persons with developmental, mental, and/or physical disabilities. Many of the persons eligible for long-term care services use multiple services provided by a variety of programs operated by many state departments. Within California, DHCS and the Departments of Aging, Health Care Services, Social Services, Developmental Services, Mental Health, Rehabilitation, and Veterans Affairs directly administer long-term care programs.

2. Current standards of the HUA. Maintaining or establishing a home in the community is a major obstacle for Medicaid beneficiaries who want to return home after admission to an institution. Medicaid eligibility rules give states the flexibility to support this goal and allow states to exempt income to maintain a home. The HUA is a Medi-Cal deduction for qualifying Medi-Cal beneficiaries who are living in, or will be living in, a nursing home or other medical facility. The HUA currently allows beneficiaries to keep $209 per month of their monthly income for maintenance and upkeep of their homes while they are temporarily residing in the nursing home other medical facility. The HUA can be allowed for up to a six month period from the date the beneficiary enters the nursing home. To qualify for the HUA, a beneficiary must meet all of the following requirements:
   
   

   1. Intend to leave the nursing facility and to return home within six months of the date the individual begins living in the nursing home.
      
      

   2. Obtain a written medical statement from the individual’s doctor certifying that he or she will be able to return home within six months.
      
      

   3. The spouse or family of the individual must not live in the home.
      
      

   4. The home must be maintained for the individual’s return.
      
      

Medically needy Medi-Cal beneficiaries who enter a nursing facility apply all their income above a personal needs allowance to the cost of care. State regulations allow beneficiaries to retain 133% of the in-kind value of housing for one person if the applicant or beneficiary has been living alone in the home.

3. SUPPORT. Disability Rights California, the sponsor of the bill, states the current allowance given to long-term care facility residents for the maintenance of their homes is insufficient and highlights the rate has not been updated since the 1970’s. In addition, the sponsor states individuals are taking full advantage of existing allowances for home maintenance because they are not aware of its existence. Finally, the sponsor states the allowance is too restrictive and does not meet the needs of long-term care residents; for example, it does not allow for residents who lost their homes but want to find a new home to leave the facility. The sponsor states the bill will allow for the HUA to be a useful tool to help patients move into more home- and community-based settings.
   
   

Supporters of the bill state the provisions will allow people to better preserve their residences and will result in significant cost savings to the state. The supporters content that by calculating the HUA using the actual cost of maintaining a patient’s home, the bill will ensure that a greater number of individuals who are eligible to return to their homes will have a home to return to.

4. RELATED LEGISLATION. AB 1319 (Dababneh) raises the current $20 per month incidental needs deduction to $50 for Medi-Cal beneficiaries who qualify for personal and incidental needs deductions and are residing in a community care facility, provided all necessary federal approvals can be obtained.  AB 1319 is set for hearing in this Committee on April 28, 2015.
   
   

5. POLICY COMMENTS. This bill establishes standards for a home upkeep allowance to be available for certain long-term care facility residents. The Committee may suggest a number of amendments to clarify the bill language in a future committee, as follows:
   
   

   1. This bill establishes the HUA in statute and requirements for the allowance. However, state regulations already define requirements for home maintenance income for long-term residents. The current language of the bill appears to create an allowance that would be supplemental to the existing home maintenance income; however the author has indicated the intent of this bill appears to be to supplant existing requirements with new regulations for this income. The Committee may suggest amending the language to clarify the intent and providing defined guidance to DHCS for the interaction of these two allowances.
      
      

   2. This bill specifies the HUA will apply to certain long-term care facility residents. The Committee may suggest specifying which types of long-term care facility residents the HUA will apply to, and the associated criteria for eligibility.
      
      

   3. This bill requires DHCS to perform outreach regarding the HUA. The language of the bill is currently confusing with regard to the requirements on the adoption of regulations for this outreach and related standards. The Committee may suggest amending this bill to clarify these standards in statute.
      
      

   4. This bill requires DHCS to adopt or revise regulations as necessary to reflect the requirements of this section; however the bill provision appears to be incorrectly placed within the language. The Committee may suggest amending this bill to ensure this requirement applies to the entirety of the bill language.
      
      

REGISTERED SUPPORT / OPPOSITION:

Support

Disability Rights California (sponsor)
California Advocates for Nursing Home Reform (prior version)
California Association of Public Authorities for IHSS (prior version)
California Commission on Aging (prior version)

California Long-Term Care Ombudsman Association (prior version)
County Board of San Bernardino (prior version)
United Domestic Workers of America / AFSCME Local 3930 / AFL-CIO (prior version)

Opposition

None on file.

Analysis Prepared by: An-Chi Tsou / HEALTH / (916) 319-2097