#033-2007  March 2, 2007 Friday morning
Edited/Written By: MARTY OMOTO, Director/Organizer 
To Respond to THIS report reply to: martyomoto@rcip.com   CDCAN website: www.cdcan.us

California Legislature
* Deficit Reduction Act Related Medicaid Eligibility Bill
* SB 483 by Kuehl Sets Home Equity Limit At $750,000
* Major Potential Impact to Seniors, People with Disabilities & Families
* AB 1113 To Make Permanent Medi-Cal 250% Working Disabled Program

SACRAMENTO -   Legislation to implement an important change to the Medicaid program in California as required by the  federal "Deficit Reduction Act of 2005"  was referred to the State Senate Health Committee for further action, though no hearing date has been set.  The bill, SB 483 by State Sen. Sheila Kuehl (Democrat - Santa Monica, 23rd District) would, for the first time, put in place a limit of $750,000 on a person's equity in their home as one of the conditions to be eligible for the  Medicaid program (called Medi-Cal in California).  There are specific exceptions (hardship waivers)  to this requirement for spouses and for children with disabilities who remain in the home.  

Two other bills, not directly connected to the Deficit Reduction Act of 2005, but dealing with eligibility are included in this report - including AB 1113 by Assemblymember Julia Brownley (Democrat - Santa Monica, 41st District), that would make permanent, contingent on federal funding, the little known Medi-Cal 250% Working Disabled Program, which allows Californians with disabilities, HIV and AIDS, mental health needs to work and  to receive Medi-Cal benefits.  See below for more details. 

A more detailed CDCAN report on this and - other Medi-Cal related bills introduced in the State Legislature will be issued later today and a CDCAN "Advocacy Without Borders" Townhall Telemeeting will soon be scheduled to focus on updates on implementation of the Deficit Reduction Act - and other Medi-Cal issues. 

Previous Federal & Current State Law Exempts Home
* Under previous federal law and current State law, the home is exempt and the change, combined with other new requirements under the federal Deficit Reduction Act,  will  have potentially major and different impact on people with disabilities, mental health needs, seniors, people with MS and other disorders, people with traumatic brain and other injuries, who may need Medi-Cal services but have not yet applied, and for those people on Medi-Cal now, and whose eligibility comes up for review.
* For some, depending on their specific circumstances and how the new requirements are actually implemented by both state and local government entities, the impact could mean denial or delays in months or even years in becoming eligible to receive benefits .
* Advocates say that outreach by the State and local government agencies on specifics - will be important to avoid problems, unnecessary delays or denial of eligibility and needed services and supports. 

Federal Law Now Requires States To Impose Requirement
* The federal "Deficit Reduction Act of 2005", passed by the then Republican controlled US Congress in late January 2006 and signed by President Bush in early February 2006 increased penalties on persons applying for Medicaid (Medi-Cal) who transfer assets for less than the fair market value (to qualify, by moving the start of the penalty period from the date of the asset transfer to the date of application for Medicaid and by increasing the period looking book when the asset  transfers took place from 3 to 5 years.  [Note: Congress  was not able to muster the necessary votes for passage of the Deficit Reduction Act until January 2006. ] 
* The Deficit Reduction Act also required states to either set the home equity limit at $500,000 or at the higher limit of $750,000 to determine eligibility for Medicaid (Medi-Cal in California).  SB 483 is seeking to impose the higher limit. but because it is federal law, cannot change the requirements.
* The "Deficit Reduction Act" does allow for "hardship waivers" (exceptions) for individuals for some requirements in certain instances, including if the person applying for Medi-Cal benefits has a spouse or child with disabilities who is and will continue to live in the home.
* Previous federal law required that persons applying for Medicaid (with some exceptions) could only have a minimum level of assets before becoming eligible, but excluded some assets - including the home.

Citizenship Requirements Also Part of Deficit Reduction Act
* Last summer, as part of the package of bills passed with the State Budget 2006-2007, the Legislature approved legislation that laid out the broad outlines of how the State is supposed to move forward on implementing the citizenship identification requirements for Medi-Cal required by the Deficit Reduction Act. 
* The Department of Health Care Services issued a final draft instructions that will go to all of the State's county welfare director (who head the county agencies that determine Medi-Cal eligibility) and held a public meeting in late February to hear final comments and feedback from advocates and other stakeholders. 
* The Department of Health Care Services will issue a final version - and other related materials in the coming months (no specific date was set). 
* This part of the Deficit Reduction Act of 2005 requirement has also raised concerns from advocates on how it will be implemented - though many advocates have praised the Department of Health Care Services and the Legislature for its careful approach and openness on the issue. 
* Persons currently receiving Supplemental Security Income (SSI) or Medicare are exempt from the citizenship identification requirements - though persons with disabilities or seniors who are currently not eligible or not receiving either benefit would be required. 
* For more information visit the Department of Health Care Services website covering this specific issue at http://www.dhs.ca.gov/mcs/DRA/default.htm or go to the CDCAN website for documents and also a audio recording of two townhall telemeetings with the head of California's Medi-Cal program talking and answering questions regarding this and other related Medi-Cal issues. 

Brownley Bill Introduced To Make Permanent Medi-Cal 250% Working Disabled Program
Another bill dealing with Medi-Cal eligibility, AB 1113 by Assemblymember Julia Brownley (Democrat -Santa Monica, 41st District)  was introduced February 23,  to remove the sunset provision  of 2008 (expiration date) from Medi-Cal’s 250% Working Disabled Program, which will make the program permanent.
* The Medi-Cal 250% Working Disabled program allows Californians with a disability, HIV and AIDS or a mental health need to work and keep their Medi-Cal benefits.  The term "250%" refers to the person employed with a net income (that is countable for eligibility) that does not exceed 250% of the federal poverty level seeking Medi-Cal benefits, and the person is deemed eligible also if meeting the requirements to determine disability under the federal Supplemental Security Income (SSI) program.  The program has other requirements. 
* Senator Carole Migden (Democrat -San Francisco, 2nd District) authored the original legislation in 1999, AB 155.
* For more information about the program go to the World Institute on Disability website at:  http://www.disabilitybenefits101.org/ca/programs/health_coverage/medi_cal/250/program.htm

SUMMARY OF 3 MEDI-CAL ELIGIBILITY RELATED BILLS

SB 483 - MEDI-CAL ELIGIBILITY: HOME EQUITY
AUTHOR: State Sen. Sheila Kuehl (Democrat - Santa Monica, 23rd District)
LATEST ACTION 02/28/07: Referred to Senate Health Committee (introduced in State Senate 2/22/07)
CDCAN SUMMARY:
Would, as allowed under federal law (Deficit Reduction Act of 2005), have California  choose the option that allows Medi-Cal eligibility for nursing facilities or other long-term care services for individuals with an equity interest in their home of $750,000 or less.
http://www.leginfo.ca.gov/pub/07-08/bill/sen/sb_0451-0500/sb_483_bill_20070222_introduced.html
BACKGROUND:
* The bill can be heard after March 25th in the Senate Health Committee (all bills, except "urgency" or emergency bills - have to wait for 30 calendar days from the date of introduction before it can be heard in a committee.  The committee is chaired by Kuehl. 
* The Department of Health Care Services (formerly Department of Health Services) said earlier in November and January that a bill would be introduced to implement the new federal  requirement (Section 6014 of the Federal Deficit Reduction Act of 2005 (Public Law 109-171) regarding a person's equity in their home to determine eligibility for Medicaid (Medi-Cal in California)., set at $500,000 - though states can choose a higher amount of $750,000.
* This bill is currently not an urgency (or emergency bill) and requires only a simple majority vote.  An "urgency" bill takes effect immediately (after passage of the Legislature and approval of the Governor), while all other bills take effect the following January 1.)
* The requirement has potential major impact for people currently not receiving Medi-Cal services - including people with disabilities and seniors who may own homes, but also those on Medi-Cal whose eligibility comes up for review (redetermination) and impacts Medi-Cal related services and supports including In-Home Supportive Services (IHSS)
PRIORITY: VERY HIGH

AB 1113 - MEDI-CAL ELIGIBILITY: 250% WORKING DISABLED PROGRAM
AUTHOR: Assemblymember Julia Brownley (Democrat - Santa Monica, 41st District)
LATEST ACTION 02/26/07:  Read first time on the Assembly Floor (introduced in Assembly 2/23/07)
CDCAN SUMMARY:
Would delete the inoperative and repeal dates of the existing Medi-Cal 250% Working Disabled Program and make the program operate indefinitely (contingent on federal funding)
http://www.leginfo.ca.gov/pub/07-08/bill/asm/ab_1101-1150/ab_1113_bill_20070223_introduced.html
BACKGROUND:
* The bill can be heard after March 27th but has not yet been referred to any committee - though almost certainly the Assembly Health Committee, chaired by Assemblymember Mervyn Dymally. 
* More detail will be amended into the bill.
PRIORITY:VERY HIGH
                                              
AB 1328 - MEDI-CAL ELIGIBILITY
AUTHOR: Assemblymember Mary Hayashi (Democrat - Hayward, 18th District)
LATEST ACTION 02/26/07:  Read first time on the Assembly Floor (introduced in Assembly 2/23/07)
CDCAN SUMMARY:
The introduced version of the bill would require the Department of Health Care Services, as part of existing ongoing training regarding the treatment of separate and community income and resources in determining eligibility to also include information about  it. 
http://www.leginfo.ca.gov/pub/07-08/bill/asm/ab_1301-1350/ab_1328_bill_20070223_introduced.html
BACKGROUND:
* The bill can be heard after March 27th but has not yet been referred to any committee - though likely Assembly Health Committee chaired by Assemblymember Mervyn Dymally. 
* This is likely a "spot bill" - to hold the spot or bill number for more detailed future amendments. 
PRIORITY: Potentially high  (depending on the specifics)