SB 1248: California Partnership for Long-Term Care Program.

Existing law establishes the California Partnership for Long-Term Care Program, which is administered by the State Department of Health Care Services. The purpose of the program is to link private long-term care insurance and health care service plan contracts that cover long-term care with the In-Home Supportive Services (IHSS) program and the Medi-Cal program, and to provide IHSS and Medi-Cal program benefits to certain individuals who have income and resources above the eligibility levels for receipt of medical assistance, but who have purchased certified private long-term care insurance policies. Existing law prescribes specified criteria for certification of a long-term care insurance policy under the program, including a requirement that the policy provide levels and durations of benefits that meet minimum standards set by the department.

Existing law requires a policy, certificate, or rider in which benefits are limited to the provision of all care settings, except nursing facility care, and that is offered under the California Partnership for Long-Term Care Program to be called a home care and community-based services policy, certificate, or rider. A long-term care policy, certificate, or rider that purports to provide benefits of home and community-based services under the California Partnership for Long-Term Care Program is required to provide specified minimum services, including assisted living facility services and residential care facility services. Existing law includes minimum policy definitions of those facilities. Existing law also requires the department to adopt regulations requiring that a long-term care insurance policy or health care service plan contract that includes long-term care services include, among other specified coverage categories, home care and community-based care coverage only.

This bill would require a policy, certificate, or rider as described above to instead be called a home care, community-based services, and residential care facility only policy, certificate, or rider. The bill would delete assisted living facility services from the list of required minimum services to be provided, clarify that those required minimum services include care in a residential care facility, and delete the policy definitions. The bill also would make conforming name changes.

This bill would authorize the department to certify a policy with a per diem benefit of at least $100 per day for a nursing facility, residential care facility, and home care and community-based services, if the policy provides a lifetime maximum benefit of not less than $73,000. The bill would authorize an insurer to offer a policy with those benefits only if the insurer also offers the applicant policy benefits that provide at least a lifetime maximum benefit that, at the time of purchase, is equivalent in dollars to at least 365 times 70% of the average daily private pay rate for a nursing facility and a nursing facility per diem benefit of no less than 70% of the average daily private pay rate for a nursing facility.

Existing law requires an insurer or producer, at the time of application, to provide to an applicant a graph that illustrates the difference in premium rates and policy benefits payable in accordance with specified inflation protection provisions.

This bill would also require the insurer or producer to provide to the applicant, an illustration of the differences in benefits between the 2 policies described above and a description of the available lower-cost options and the advantages and disadvantages of each option.