Medi-Cal: eligibility.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is partially governed and funded by federal Medicaid provisions. Existing law, subject to the receipt of federal financial participation, requires the department to adopt a federal option under which any employed individual with a disability who meets specified income and resource requirements, shall be eligible for benefits under the Medi-Cal program, subject to the payment of premiums. This bill would, to the extent that federal financial participation is available, authorize an individual who is otherwise eligible under this program but who is temporarily unemployed to elect to remain on Medi-Cal pursuant to these provisions for a period up to 26 weeks, as provided. This bill would also provide additional resource exemptions in determining Medi-Cal eligibility under these provisions. The bill would extend specified resource exemptions to apply for the beneficiary under any other Medi-Cal program under which the beneficiary later becomes eligible for medical assistance where that eligibility is based on age, blindness, or disability. This bill would make its provisions operative 30 days after the date that the increase in the state's federal medical assistance percentage (FMAP) pursuant to the federal American Recovery and Reinvestment Act of 2009 (ARRA) is no longer available. Existing law requires individuals who are eligible for Medi-Cal benefits pursuant to these provisions to be subject to premiums that are determined by a sliding scale that is based on countable income, as provided. This bill, not later than 90 days after the operative date specified above, would instead require each individual to pay a monthly premium that is equal to 5% of his or her individual or spousal countable income, as described, except that the premium cannot fall below or exceed a specified minimum and maximum premium payment, as provided. The bill would require the above-described provisions to be implemented only to the extent that federal financial participation is available, and only to the extent that the department seeks and obtains approval of all necessary state plan amendments. Because counties are required to make Medi-Cal eligibility determinations and this bill would extend the expansion of Medi-Cal eligibility, the 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.