An act to amend Section 14005.7 of the Welfare and Institutions Code, relating to Medi-Cal.

The people of the State of California do enact as follows:


SECTION 1.
Section 14005.7 of the Welfare and Institutions Code is amended to read:
14005.7.
(a) Medically needy persons and medically needy family persons are entitled to health care services under Section 14005 providing all eligibility criteria established pursuant to this chapter are met.
(b) Except as otherwise provided in this chapter or in Title XIX of the federal Social Security Act, no medically needy family person, medically needy person or state-only Medi-Cal persons shall be entitled to receive health care services pursuant to Section 14005 during any month in which his or her share of cost has not been met.
(c) In the case of a medically needy person, monthly income, as determined, defined, counted, and valued, in accordance with Title XIX of the federal Social Security Act, in excess of the amount required for maintenance established pursuant to Section 14005.12, exclusive of any amounts considered exempt as income under Chapter 3 (commencing with Section 12000), less amounts paid for Medicare and other health insurance premiums shall be the share of cost to be met under Section 14005.9.
(d) In the case of a medically needy family person or state-only Medi-Cal person, monthly income, as determined, defined, counted, and valued, in accordance with Title XIX of the federal Social Security Act, in excess of the amount required for maintenance established pursuant to Section 14005.12, exclusive of any amounts considered exempt as income under Chapter 2 (commencing with Section 11200), less amounts paid for Medicare and other health insurance premiums shall be the share of cost to be met under Section 14005.9.
(e) In determining the income of a medically needy person residing in a licensed community care facility, income shall be determined, defined, counted, and valued, in accordance with Title XIX of the federal Social Security Act, any amount paid to the facility for residential care and support that exceeds the amount needed for maintenance shall be deemed unavailable for the purposes of this chapter.
(f) (1) For purposes of this section the following definitions apply:
(A) “SSI” means the federal Supplemental Security Income program established under Title XVI of the federal Social Security Act.
(B) “MNL” means the income standard of the Medi-Cal medically needy program defined in Section 14005.12.
(C) Board and care “personal care services” or “PCS” deduction means the income disregard that is applied to a resident in a licensed community care facility, in lieu of the board and care deduction specified in subdivision
(e) of Section 14005.7,
(e),
when the PCS deduction is greater than the board and care deduction.
(2) (A) For purposes of this section, the SSI recipient retention amount is the amount by which the SSI maximum payment amount to an individual residing in a licensed community care facility exceeds the maximum amount that the state allows community care facilities to charge a resident who is an SSI recipient.
(B) For purposes of this section, the personal and incidental needs deduction for an individual residing in a licensed community care facility is either of the following:
(i) If the deduction specified in subdivision (e) is applicable to the individual, the amount, not to exceed the amount by which the SSI recipient retention amount exceeds
twenty dollars ($20),
fifty dollars ($50),
nor to be less than zero, by which the sum of the amount that the individual pays to his or her licensed community care facility and the SSI recipient retention amount exceed the sum of the individual’s MNL, the individual’s board and care deduction, and
twenty dollars ($20).
fifty dollars ($50).
(ii) If the deduction specified in paragraph (1) is applicable to the individual,
an
the
amount, not to exceed the amount by which the SSI recipient retention amount exceeds
twenty dollars ($20),
fifty dollars ($50),
nor to be less than zero, by which the sum of the amount which the individual pays to his or her
licensed
community care facility and the SSI recipient retention amount exceed the sum of the individual’s MNL, the individual’s PCS deduction and
twenty dollars ($20).
fifty dollars ($50).
(3) In determining the countable income of a medically needy individual residing in a licensed community care facility, the individual shall have deducted from his or her income the amount specified in subparagraph (B) of paragraph (2).
(g) No later than one month after the effective date of subparagraph (B) of paragraph (2) of subdivision (f), the department shall submit to the federal medicaid administrator a state plan amendment seeking approval of the income deduction specified in subdivision (f), and of federal financial participation for the costs resulting from that income deduction.
(h) The deduction prescribed by paragraph (3) of subdivision (f) shall be applied no later than the first day of the fourth month after the month in which the department receives approval for the federal financial participation specified in subdivision (g). Until approval for federal financial participation is received by the department, there shall be no deduction under paragraph (3) of subdivision (f).
(i) The amendments to clauses (i) and (ii) of subparagraph (B) of paragraph (2) of subdivision (f) made by the act that added this subdivision during the 2015–16 Regular Session of the Legislature shall be implemented only to the extent that federal financial participation is available and that the department receives any necessary federal approvals.
SEC. 2.
If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

Summary: 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 Program provisions. Under existing law, certain aged, blind, and disabled Medi-Cal recipients are required to pay a share of cost as a condition of eligibility, with the share of cost determined in accordance with specified requirements. For purposes of determining the share of cost, existing law establishes a formula to calculate the personal and incidental needs deduction for an individual residing in a licensed community care facility. Existing law prohibits that deduction from exceeding the amount by which the Supplemental Security Income recipient retention amount, as defined, exceeds $20.
This bill would revise the formula to determine the personal and incidental needs deduction. By increasing the responsibility of the counties in determining Medi-Cal eligibility, this bill would impose a state-mandated local program. The bill would also require that its provisions be implemented only to the extent that federal financial participation is available and that the department receives any necessary federal approvals.
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.