WELFARE AND INSTITUTIONS CODE
SECTION 14000-14029.8
14000. The purpose of this chapter is to afford to qualifying
individuals health care and related remedial or preventive services,
including related social services which are necessary for those
receiving health care under this chapter.
The intent of the Legislature is to provide, to the extent
practicable, through the provisions of this chapter, for health care
for those aged and other persons, including family persons who lack
sufficient annual income to meet the costs of health care, and whose
other assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future minimum
self-maintenance and security. It is intended that whenever possible
and feasible:
(a) The means employed shall allow, to the extent practicable,
eligible persons to secure health care in the same manner employed by
the public generally, and without discrimination or segregation
based purely on their economic disability. The means employed shall
include an emphasis on efforts to arrange and encourage access to
health care through enrollment in organized, managed care plans of
the type available to the general public.
(b) The benefits available under this chapter shall not duplicate
those provided under other federal or state laws or under other
contractual or legal entitlements of the person or persons receiving
them.
(c) In the administration of this chapter and in establishing the
means to be used to provide access to health care to persons eligible
under this chapter, the department shall emphasize and take
advantage of both the efficient organization and ready accessibility
and availability of health care facilities and resources through
enrollment in managed health care plans and new and innovative
fee-for-service managed health care plan approaches to the delivery
of health care services.
14000.03. (a) The Legislature finds and declares that Section 1396a
(a)(11)(A) of Title 42 of the United States Code provides that
California's state plan for medical assistance under the Medicaid
program must "provide for entering into cooperative arrangements with
the State agencies responsible for administering or supervising the
administration of health services and vocational rehabilitation
services in the State looking toward maximum utilization of such
services in the provision of medical assistance under the plan."
(b) In furtherance of Section 1396a(a)(11)(A) of Title 42 of the
United States Code and Section 7560 of the Government Code, it is the
intent of the Legislature to maximize the amount of federal and
state funds continually available under agreements identified in
Section 1396a(a)(11)(A) of Title 42 of the United States Code and
entered into by the State Department of Health Services by making
later-appropriated and budgeted funds immediately encumbered and
available for expenditure under agreements by operation of law.
(c) Notwithstanding any other provision of law, upon additional
funds being appropriated and budgeted for the support of the services
identified within the scope of work of an agreement of the type
identified in Section 1396a (a)(11)(A) of Title 42 of the United
States Code and previously entered into by the State Department of
Health Services, the amount of the encumbrance in such an agreement
shall be amended, by operation of law, to reflect the newly
appropriated and budgeted funds.
(d) Notwithstanding any other provision of law, once an agreement
of the type identified in Section 1396a (a)(11)(A) of Title 42 of the
United States Code is entered into by the State Department of Health
Services, the agreement shall continue in effect indefinitely and
need not be amended unless the State Department of Health Services
changes the scope of work to be provided under the agreement.
14000.05. The State Department of Health Services shall consider
the special needs and requirements of rural hospitals in California
that are financially distressed and in danger of closure. The
department may provide technical assistance and other appropriate
assistance and relief on Medi-Cal program policies, reimbursement
issues, and Medi-Cal operational and procedural problems to
financially distressed rural hospitals, when appropriate, in order to
preserve the availability of health care services in rural
California.
14000.1. It is the intent of the Legislature that health care
services available under this chapter shall be at least equivalent to
the level provided in 1970-71.
14000.2. During the time this chapter is effective and
notwithstanding other provisions of the Welfare and Institutions Code
and Health and Safety Code, the board of supervisors of each county
may prescribe rules which authorize the county hospital to integrate
its services with those of other hospitals into a system of community
service which offers free choice of hospitals to those requiring
hospital care. The intent of this section is to eliminate
discrimination or segregation based on economic disability so that
the county hospital and other hospitals in the community share in
providing services to paying patients and to those who qualify for
care in public medical care programs. In prescribing rules under
which the county hospital may provide community hospital services
described in this section, the board of supervisors shall provide a
basis under which patients may be attended by their own personal
physicians who are professionally qualified for staff membership in
the county hospital.
Notwithstanding any other provisions of law or provisions
contained in a county charter, the board of supervisors of any county
may transfer the maintenance, operation and management or ownership
of the county hospital to the University of California or any other
public agency or community nonprofit corporation empowered to operate
a hospital facility upon a finding that the community services
provided by the hospital could be more efficiently, effectively or
economically provided by the transferee than the county. If such
transfer be made to the University of California or to any other
public agency empowered to operate a hospital facility the transfer
of control or ownership may be made with or without the payment of a
purchase price by the transferee and otherwise upon such terms and
conditions as the parties may mutually agree, but if the transfer be
to a community nonprofit corporation, the board of supervisors shall
comply with all other provisions of law relating to the sale, lease,
or transfer of public property by a county; and provided that in any
event the transaction shall include such terms and conditions as the
board of supervisors find necessary to insure that the transfer will
constitute an ongoing material benefit to the county and its
residents.
The intent of this section is to permit the implementation of
programs for the consolidation of public hospital services in order
to permit the more effective use of existing hospital facilities and
retard the spiraling costs of medical care.
14000.3. To the extent permitted by federal law, the director may
enter into contracts with the Secretary of Health, Education, and
Welfare to obtain or provide fiscal intermediary services for all
persons who are receiving benefits under this chapter, who are also
recipients of benefits under Title XVIII of the Social Security Act.
14000.4. This chapter shall be known and may be cited as the
"Medi-Cal Act."
14000.5. On a regional pilot project basis, to the extent
authorized by law, the director may enter into contracts with one or
more nonprofit organizations to perform the functions of the
department's Office of the Ombudsman. These activities may include
outreach, community education and training about health care consumer
rights and responsibilities, including the production and
distribution of consumer-oriented material, individual consumer
assistance, including counseling, advice, assistance, education,
advocacy, and referral as appropriate, establishing and operating a
database to analyze the nature of the inquiries and requests for
assistance, and training of department or county staff. These
services may be made available to any person who may be eligible for
or is receiving benefits under this chapter. Funds appropriated in
the annual Budget Act for the support of the Office of the Ombudsman
may be allocated for this purpose.
14001. Health care as administered under this chapter shall be
considered a component of public social services.
14001.1. It is the intention of the Legislature, whenever feasible,
that the needs of categorically needy persons for health care and
related remedial or preventive services be met under the provisions
of this chapter.
14001.11. (a) The department shall implement the federal
requirements described in Section 1396u-5 of Title 42 of the United
States Code.
(b) In each of the several counties of the state, the eligibility
and enrollment functions required under Section 1396u-5(a)(2) and (3)
of Title 42 of the United States Code, which may include, but are
not limited to, determining eligibility and offering enrollment for
premium and cost sharing subsidies made available under and in
accordance with Section 1395w-114 of Title 42 of the United States
Code, shall be a county function and responsibility, subject to the
direction, authority, and regulations of the department. The
department shall request input from the counties as to the potential
cost of implementing these provisions, and shall consider that input
in developing the budget.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, or make specific this section by
means of all county letters, provider bulletins, or similar
instructions, with input from the counties. Thereafter, the
department may adopt regulations in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of the
Government Code.
(d) The department shall seek approval of any amendments to the
state plan, necessary to implement this section, for purposes of
federal financial participation under Title XIX of the Social
Security Act (42 U.S.C. Sec. 1396 et seq.). Notwithstanding any other
law and only when all necessary federal approvals have been
obtained, this section, with the exception of the Phased-Down State
Contribution, as described in subparagraphs (A) to (C), inclusive, of
paragraph (1) of subdivision (c) of Section 1396u-5 of Title 42 of
the United States Code, shall be implemented only to the extent
federal financial participation is available.
14002. Health care granted under the provisions of this chapter is
held subject to the provisions of any law hereafter enacted amending,
repealing, or supplementing in whole or in part the provisions of
this chapter, and subject to the rules and regulations of the
department. No recipient of health care under this chapter shall have
any claim for compensation or otherwise because his service is
affected in any way by any such amending, repealing, or supplemental
act, or by any such rule or regulation or by any addition, amendment,
or repeal of such rules or regulations.
14002.5. For the purposes of this article, the following
definitions shall apply:
(a) "Annuity" means a contract that names an annuitant and gives a
person or entity the right to receive periodic payments of a fixed
or variable sum for a described period of time, which may include a
lump-sum payment or periodic payments upon the death of the
annuitant.
(b) "Community spouse" means the spouse of an institutionalized
spouse.
(c) "Home and facility care" means the following services that are
subject to Medi-Cal reimbursement:
(1) Nursing facility care services.
(2) A level of care in any institution equivalent to that of
nursing facility care services.
(3) Home- or community-based care services furnished under a
waiver granted pursuant to subsection (c) or (d) of Section 1396n of
Title 42 of the United States Code.
(d) "Institutionalized spouse" means any individual to whom all of
the following apply:
(1) The individual is in a medical institution or nursing facility
or is a person who is receiving institutional or noninstitutional
services from an organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590), and is likely to meet that requirement for at least 30
consecutive days.
(2) The individual is married to a spouse who is not in a medical
institution or nursing facility, or to a spouse who is not receiving
services from any organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590).
(3) Except for purposes of Sections 14005.7, 14005.12, 14005.16,
and 14005.17, an individual who is admitted to a medical institution
or nursing facility on or after September 30, 1989, and who applies
for Medi-Cal benefits on or after January 1, 1990, or a Medi-Cal
recipient who is admitted to a medical institution or nursing
facility on or after January 1, 1990.
(e) "Medical institution" has the same meaning as defined in
Section 435.1010 of Title 42 of the Code of Federal Regulations.
(f) "Nursing facility" has the same meaning as defined in Section
1250 of the Health and Safety Code.
14003. The Governor may enter into and execute in behalf of the
state all necessary agreements in connection with this chapter as may
be required by the United States government.
14004. If any individual in good faith adheres to the teachings of
any bona fide church, sect, denomination, or organization, and in
accordance with its principles depends for healing entirely upon
prayer or spiritual means, no medical examination shall be required
to receive health care authorized by this chapter, but in lieu
thereof the certificate of a practitioner of such bona fide sect,
denomination, or organization approved and authorized by the
department, shall be accepted as to the need of such individual for
service. No rule or regulation shall be adopted or continued in force
which discriminates against such an individual.
14005. (a) The health care benefits and services specified in this
chapter, to the extent that such services are neither provided under
any other federal or state law nor provided nor available under other
contractual or legal entitlements of the person, shall be provided
under this chapter to any person who is a resident of this state and
is made eligible by the provisions of this article. It is the intent
of the Legislature that a provider shall look to such other
contractual or legal entitlements for payment before submitting a
bill for payment under this chapter.
(b) Any applicant for, or recipient of, Medi-Cal benefits who
requests medical assistance for home and facility care shall meet the
specific eligibility requirements for the receipt of medical
assistance for home and facility care set forth in this chapter.
(c) This section shall be implemented pursuant to the requirements
of Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.), and any regulations adopted pursuant to that act, and only
to the extent that federal financial participation is available.
(d) To the extent that regulations are necessary to implement this
section, the department shall promulgate regulations using the
nonemergency regulatory process described in Article 5 (commencing
with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of the
Government Code.
(e) It is the intent of the Legislature that the provisions of
this section shall apply prospectively to any individual to whom the
act applies commencing from the date regulations adopted pursuant to
this act are filed with the Secretary of State.
14005.1. Except for adults receiving aid pursuant to Chapter 2
(commencing with Section 11200) and for whom federal financial
participation would not be obtainable for their medical costs under
Title XIX of the federal Social Security Act, categorically needy
persons are eligible for health care services under Section 14005.
Eligibility for health care services under Section 14005 shall
continue for four calendar months beginning with the month in which a
family becomes ineligible for benefits under the Aid to Families
with Dependent Children program, if all of the following apply:
(a) The ineligibility is due wholly or partly to the collection or
increased collection of child or spousal support pursuant to Article
7 (commencing with Section 11475) of Chapter 2.
(b) The family has received benefits under the Aid to Families
with Dependent Children program in at least three of the six months
immediately preceding the month in which ineligibility begins.
(c) Ineligibility occurred after October 1, 1984, and before
October 1, 1988.
14005.2. Unless otherwise specified in this chapter, the
eligibility of a person eligible under the Cuban-Haitian Entrant
Program or the Refugee Resettlement Program for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person, except for those criteria that establish categorical
relatedness, and only as long as federal funds are available. Victims
of trafficking, domestic violence, and other serious crimes, as
defined in subdivision (b) of Section 18945, shall be eligible for
these services to the same extent as individuals who are admitted to
the United States as a refugee under Section 1157 of Title 8 of the
United States Code. Services under this subdivision shall be paid
from state funds to the extent federal funding is unavailable.
14005.3. (a) Notwithstanding any other provision of this chapter,
any person who:
(1) Was once determined to be disabled in accordance with
Section 1614 of Part A of Title XVI of the Social Security Act
(Section 1382c, Title 42, United States Code), and
(2) Became ineligible for benefits pursuant to Section 1614 of
Part A of Title XVI of the Social Security Act (Section 1382c, Title
42, United States Code) because the person engaged in substantial
gainful activity, and
(3) Continues to suffer from the physical or mental impairments
which were the basis of the disability determination required under
paragraph (1),
shall be considered to be disabled, for the purposes of this
chapter, even though such person is engaged in substantial gainful
activity. Regardless of whether such person has excess income
pursuant to Sections 14005.12 and 14005.13, such person shall be
eligible to receive health care benefits and services under this
chapter if his or her income does not exceed the maximum income
eligibility limits for benefits under Part A of Title XVI of the
Social Security Act. Any such person whose income exceeds the maximum
income eligibility limits for benefits under Part A of Title XVI of
the Social Security Act shall be eligible under Sections 14005.4 and
14052 for health care benefits and services under this chapter,
provided, that the income levels for maintenance in Section 14005.12
for such person shall be the maximum income eligibility limits for
benefits under Part A of Title XVI of the Social Security Act and
provided, that his or her nonexempt income in excess of that maximum
is used to pay his or her share of costs.
(b) For purposes of this section, "substantial gainful activity"
means work activity considered to be substantial gainful activity
under applicable federal regulations adopted pursuant to Section 1614
of Part A of Title XVI of the Social Security Act.
(c) The determination of continued impairments and the need for
health care benefits and services shall be supported by medical
reports when requested. Such reports shall be provided at the expense
of the department.
14005.4. Unless otherwise specified in this chapter, the
eligibility of a state-only Medi-Cal person for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person except for those criteria that establish categorical
relatedness.
14005.5. (a) In determining eligibility pursuant to Section 14005.4
or 14005.7, reparation or restitution payments received by victims
of the Nazi persecution from the Federal Republic of Germany pursuant
to the Federal Law on the Compensation of Victims of the National
Socialist Persecution (Federal Compensation Law), as enacted by that
government on June 29, 1956, shall not be deemed as available income,
nor shall any accumulation of those payments be considered an
available resource, to the extent that the funds are not spent and
are kept identifiable.
(b) The director shall seek federal waivers from the Secretary of
the United States Department of Health and Human Services, in order
to ensure federal financial participation. In the event of an initial
determination by the Secretary of the United States Department of
Health and Human Services that any provision of this section is in
conflict with any federal statute or regulation, the department shall
take all available and necessary steps to obtain a final
determination reversing that decision. In the event that a final
determination is made which finds a conflict with federal law, the
director shall immediately request the Attorney General to seek
judicial review of the determination, and the director shall notify
the appropriate policy and fiscal committees of both houses of the
Legislature of its request. Notwithstanding the outcome of the
director's efforts to obtain waivers under this subdivision, or a
final judicial decision holding that any provision of this section is
in conflict with federal law, subdivision (a) shall be implemented
on July 1, 1985, or the date upon which waivers are obtained under
this subdivision, whichever is earlier. Failure to obtain waivers
pursuant to this subdivision shall not affect implementation of
subdivision (a).
14005.6. (a) The Legislature finds and declares as follows:
(1) Under federal law, minors living at home with their families
may not be eligible for the SSI and Medicaid programs.
(2) Under the Federal Budget Reconciliation Act of 1981, however,
states may apply for a Section 1915(c) waiver to allow a person to be
eligible for SSI and Medicaid when medical and social services
provided in the home can be shown to be less costly than services
provided in an institution.
(3) Whenever possible, medical and social services should be
provided in the least restrictive setting and at the lowest cost to
the programs involved.
(4) The State Department of Health Services has already
successfully applied for the Section 1915(c) waiver as applied to
certain defined populations of developmentally disabled, elderly, and
medically acute clients.
(b) The State Director of Health Services shall apply for
additional waivers when appropriate to expand the number and types of
persons who will be eligible for in-home services.
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, 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), 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).
(ii) If the deduction specified in paragraph (1) is applicable to
the individual, an amount, not to exceed the amount by which the SSI
recipient retention amount exceeds twenty dollars ($20), nor to be
less than zero, by which the sum of the amount which the individual
pays to his or her 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).
(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).
14005.75. A person who is otherwise eligible for Medi-Cal benefits
under either Section 14005.4 or 14005.7, except for income and
resource eligibility, and who is receiving Medi-Cal services for the
treatment of multiple sclerosis, shall continue to be eligible to
receive benefits only for these services under Medi-Cal, provided
that all other conditions of eligibility for the Medi-Cal program are
met. These restricted benefits shall continue until such time as the
person is eligible for, and receives, third party coverage for these
treatments. However, restricted benefits under this section shall
not continue for more than two years.
14005.75. (a) The Legislature finds and declares all of the
following:
(1) As a result of federal welfare reform, unprecedented numbers
of welfare recipients will be leaving welfare for work, and will face
time limits on the receipt of aid.
(2) It is in the interest of the state both to encourage welfare
recipients to seek employment and to ensure the continuity of health
coverage for these recipients as they move from welfare to work.
(3) California's transitional Medi-Cal program is intended to
encourage welfare recipients to seek employment and to ensure
continuity of health coverage, but various procedural restrictions
limit its effectiveness in achieving those goals.
(b) It is, therefore, the intent of the Legislature to streamline
the transitional Medi-Cal program in order to maximize its
effectiveness in assisting persons leaving welfare for work.
14005.76. (a) The department shall provide a Medi-Cal beneficiary
whose Medi-Cal eligibility is established pursuant to Section 1930 of
the federal Social Security Act (42 U.S.C. Sec. 1396u-1) with simple
and clear written notice of the availability of the transitional
Medi-Cal program and the requirements for that program. This notice
shall be provided at the time that Medi-Cal eligibility is conferred
to the beneficiary and at least once every six months thereafter.
(b) When a beneficiary loses Medi-Cal eligibility established
pursuant to Section 1930 of the federal Social Security Act (42
U.S.C. Sec. 1396u-1) for failure to meet reporting requirements, the
department shall provide the beneficiary with the notice described in
subdivision (a), and a form with simple and clear instructions on
how to complete and return the form to the county. The form shall be
used to determine whether the beneficiary is eligible for the
transitional Medi-Cal program.
(c) The notice and form described in subdivisions (a) and (b)
shall be prepared by the department. The department shall seek input
on the notice and form from beneficiaries of aid, beneficiary
representatives, and counties.
(d) The department shall review, and if necessary for simplicity
and clarity, revise the notice required by subdivision (b) of Section
14005.8 and Section 14005.81. The department shall seek input from
beneficiaries, beneficiary representatives, and counties.
(e) Notwithstanding any other provision of law, this section shall
become operative nine months after the effective date of this
section.
(f) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.8. (a) (1) To the extent required by Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the United
States Code and regulations adopted pursuant thereto, a family who
was receiving aid pursuant to a state plan approved under Part A of
Subchapter IV (commencing with Section 601) of Title 42 of the United
States Code in at least three of the six months immediately
preceding the month in which that family became ineligible for that
assistance due to increased hours of employment, income from
employment, or the loss of earned income disregards, shall remain
eligible for health care services as provided in this chapter during
the immediately succeeding six-month period.
(2) The department shall terminate extensions of health care
services authorized by paragraph (1) as required under federal law.
(b) The department shall notify persons eligible under subdivision
(a) of their right to continued health care services for each
six-month period and a description of their reporting requirement,
and the circumstances under which the extension may be terminated.
The notice shall also include a Medi-Cal card or other evidence of
entitlement to those services.
(c) Notwithstanding any other provision of this section, the
department, in conformance with federal law, shall offer
beneficiaries covered under subdivision (a) the option of remaining
eligible for health care services provided in this chapter for an
additional extension period of six months. Health services shall be
continued in as automatic a manner as permitted by federal law, and
without any unnecessary paperwork.
(d) During the initial extension period and any additional
six-month extension period, the department, consistent with federal
law, may, whenever the department determines it to be cost-effective,
elect to pay a family's expenses for premiums, deductibles,
coinsurance, or similar costs for health insurance or other health
coverage offered by an employer of the caretaker relative or by an
employer of the absent parent of the dependent child. If, during the
additional six-month extension period, the department elects to pay
health premiums and this coverage exists, the beneficiary may be
given the opportunity to express his or her preference between
continuing the Medi-Cal coverage or obtaining health insurance.
(e) During the additional six-month extension period, the
department may impose a premium for the health insurance or other
health coverage consistent with Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) if the department
determines that the imposition of a premium is cost-effective.
(f) The department shall adopt emergency regulations in order to
comply with mandatory provisions of Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) for extension of medical
assistance. These regulations shall become effective immediately upon
filing with the Secretary of State.
(g) This section shall become operative April 1, 1990.
14005.84. (a) The department shall develop and conduct a community
outreach and education campaign to assist persons whose Medi-Cal
eligibility is established pursuant to Section 1931 of the federal
Social Security Act (42 U.S.C. Sec. 1396u-1), to learn about the
availability of the transitional Medi-Cal program.
(b) Any managed care plan, local initiative, or county organized
health system contracting with the department to provide services to
Medi-Cal enrollees shall include in its evidence of coverage and
marketing materials information about the transitional Medi-Cal
program and how to apply for program benefits.
(c) To implement this section, the department may develop and
execute a contract or may amend any existing or future outreach
campaign contract that it has executed. Notwithstanding any other
provision of law, any such contract developed and executed, or
amended, as required to implement this section shall be exempt from
the approval of the Director of General Services and from the Public
Contract Code.
(d) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.85. (a) Families who, because of marriage or because
separated spouses reunite, lose AFDC eligibility under the chapter
because the family no longer meets the need requirement specified in
Section 11250 or has increased assets or income, or both, shall be
eligible for extended medical benefits as specified under this
article for a period not to exceed 12 months.
(b) The department shall seek all federal waivers necessary to
implement this section.
(c) This section shall not be implemented until the director has
executed a declaration, that shall be retained by the director, that
any necessary waivers and federal financial participation have been
obtained.
14005.88. (a) The department shall contract for an independent
evaluation, to be completed no later than January 1, 2001, in order
to determine the effect of changes made in the transitional Medi-Cal
program by the enactment of Sections 14005.76, 14005.82, 14005.83,
14005.84, 14005.87, 14005.89, and the amendment to Section 14005.85
enacted during the first year of the 1997-98 Regular Session of the
Legislature, on the employment of welfare recipients and the
continuity of their health coverage.
(b) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.89. (a) The department shall monitor participation rates for
transitional Medi-Cal and seek input from beneficiaries, beneficiary
representatives, and counties, on a regular basis throughout each
year to consider changes in transitional Medi-Cal procedures as may
be necessary to ensure that participation rates are at levels that
would reasonably be expected, given aid caseload developments. Before
any such changes are made, the department shall seek any federal
waivers, or obtain other federal approval, that may be necessary to
implement the changes.
(b) The department shall make the participation rate monitoring
data described in subdivision (a) available upon request.
14005.9. (a) Share of cost shall be determined on a monthly basis.
No person or family shall be required to incur more than one month's
share of cost prior to being certified as specified in Section 14018.
(b) For persons in long-term care, any income exempted under
Sections 14005.4 and 14005.7 shall be considered in the share-of-cost
determination to the extent required by federal law or regulations.
(c) Once the beneficiary has incurred expenses for Medicare and
other health insurance deductibles or coinsurance charges and
necessary medical and remedial services that are not subject to
payment by a third party and which equal or exceed his or her share
of cost, the individual is entitled to receive health care services
pursuant to Section 14005 if all other applicable conditions of
eligibility under this chapter are met.
14005.10. For purposes of facilitating arrangements for health care
through prepaid health plans, the department may set standards for
determining monthly income, for purposes of eligibility, on the
person's average pattern of income and earnings, subject to
subsequent adjustment if actual experience deviates substantially
from the amount determined by such method.
14005.11. (a) To the extent required by federal law for qualified
Medicare beneficiaries, the department shall pay the premiums,
deductibles, and coinsurance for elderly and disabled persons
entitled to benefits under Title XVIII of the federal Social Security
Act, whose income does not exceed the federal poverty level and
whose resources do not exceed 200 percent of the Supplemental
Security Income program standard.
(b) The department shall, in addition to subdivision (a), pay
applicable additional premiums, deductibles, and coinsurance for drug
coverage extended to qualified Medicare beneficiaries.
(c) The deductible payments required by subdivision (b) may be
covered by providing the same drug coverage as offered to
categorically needy recipients, as defined in Section 14050.1.
(d) As specified in this section, it is the intent of the
Legislature to assist in the payment of Medicare Part B premiums for
qualified low-income Medi-Cal beneficiaries who are ineligible for
federal sharing or federal contribution for the payment of those
premiums.
(e) For a Medi-Cal beneficiary who has a share of cost but who is
ineligible for the assistance provided pursuant to subdivision (a),
or who is ineligible for any other federally funded assistance for
the payment of the beneficiary's Medicare Part B premium, the
department shall pay for the beneficiary's Medicare Part B premium in
the month following each month that the beneficiary's share of cost
has been met.
(f) When a county is informed that an applicant or beneficiary is
eligible for Medicare benefits, the county shall determine whether
that individual is eligible under the Qualified Medicare Beneficiary
(QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB)
program, or the Qualifying Individual program and enroll the
applicant or beneficiary in the appropriate program.
14005.12. (a) For the purposes of Sections 14005.4 and 14005.7, the
department shall 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. It is the intent of the
Legislature that the income levels for maintenance need for medically
needy aged, blind, and disabled adults, in particular, shall be
based upon amounts that adequately reflect their needs.
(1) Subject to paragraph (2), reductions in the maximum aid
payment levels set forth in subdivision (a) of Section 11450 in the
1991-92 fiscal year, and thereafter, shall not result in a reduction
in the income levels for maintenance under this section.
(2) (A) The department shall seek any necessary federal
authorization for maintaining the income levels for maintenance at
the levels in effect June 30, 1991.
(B) If federal authorization is not obtained, medically needy
persons shall not be required to pay the difference between the share
of cost as determined based on the payment levels in effect on June
30, 1991, under Section 11450, and the share of cost as determined
based on the payment levels in effect on July 1, 1991, and
thereafter.
(3) Any medically needy person who was eligible for benefits under
this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families with
Dependent Children program as set forth in Section 11452.018 made in
the 1995-96 Regular Session of the Legislature shall not be
responsible for paying his or her share of cost if all of the
following apply:
(A) He or she had eligibility as categorically needy terminated by
the reductions in the minimum basic standards of adequate care.
(B) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.
(C) He or she is not eligible to receive benefits without a share
of cost as a medically needy person pursuant to paragraph (1) or (2).
(b) In the case of a single individual, the amount of the income
level for maintenance per month shall be 80 percent of the highest
amount that would ordinarily be paid to a family of two persons,
without any income or resources, under subdivision (a) of Section
11450, multiplied by the federal financial participation rate.
(c) In the case of a family of two adults, the income level for
maintenance per month shall be the highest amount that would
ordinarily be paid to a family of three persons without income or
resources under subdivision (a) of Section 11450, multiplied by the
federal financial participation rate.
(d) For the purposes of Sections 14005.4 and 14005.7, for a person
in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from an
organization with a frail elderly demonstration project waiver
pursuant to Chapter 8.75 (commencing with Section 14590), the amount
considered as required for maintenance per month shall be computed in
accordance with, and for those purposes required by, Title XIX of
the federal Social Security Act, and regulations adopted pursuant
thereto. Those amounts shall be computed pursuant to regulations
which include providing for the following purposes:
(1) Personal and incidental needs in the amount of not less than
thirty-five dollars ($35) per month while a patient. The department
may, by regulation, increase this amount as necessitated by
increasing costs of personal and incidental needs. A long-term health
care facility shall not charge an individual for the laundry
services or periodic hair care specified in Section 14110.4.
(2) The upkeep and maintenance of the home.
(3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.
(4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent children,
dependent parents, or dependent siblings of either spouse, provided
the individuals are residing with the community spouse.
(5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396r-5(d)(1)(B)).
(6) The family allowance for each family member residing with the
community spouse shall be computed in accordance with the formula
established in Section 1924(d)(1)(C) of Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).
(e) For the purposes of Sections 14005.4 and 14005.7, with regard
to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be computed
pursuant to regulations adopted by the department which provide for
the support and care of his or her spouse, minor children, or any
disabled relative for whose support he or she has contributed
regularly.
(f) The income levels for maintenance per month, except as
specified in subdivisions (b) to (d), inclusive, shall be equal to
the highest amounts that would ordinarily be paid to a family of the
same size without any income or resources under subdivision (a) of
Section 11450, multiplied by the federal financial participation
rate.
(g) The "federal financial participation rate," as used in this
section, shall mean 133 1/3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396
(b)), or its successor provisions.
(h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.
(i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for each
household in accordance with subdivisions (b) to (h), inclusive. The
total of these levels shall be the level for the single eligibility
unit.
(j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.
14005.13. (a) Notwithstanding Section 14005.12, when an individual
residing in a long-term care facility would incur a share of cost for
services under this chapter due to income which exceeds that allowed
for the incidental and personal needs of the individual, a specified
portion of the individual's earned income from therapeutic wages
shall be exempt. Therapeutic wages are wages earned by the individual
under all of the following conditions:
(1) A physician who does not have a financial interest in the
long-term care facility in which the individual resides, and who is
in charge of the individual's case prescribes work as therapy for the
individual.
(2) The individual must be employed within the same long-term care
facility where he or she resides.
(3) The individual's employment does not displace any existing
employees.
(4) The individual has resided in a long-term care facility for a
continuous period commencing at least five years prior to the date of
the addition of this section as originally adopted during the
1983-84 Regular Session.
(b) The amount of earned income from therapeutic wages which shall
be exempt shall be the lesser of 70 percent of the gross therapeutic
wages or 70 percent of the maintenance level for a
noninstitutionalized person or family of corresponding size as
described in subdivision (b), (c), or (e) of Section 14005.12.
(c) The provisions of this section shall be given retroactive
effect for the period commencing June 1, 1983.
(d) This section shall not become operative unless and until the
necessary waivers are obtained from the United States Department of
Health and Human Services.
(e) The director shall adopt regulations implementing this section
as emergency regulations in accordance with Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code. For the purposes of the Administrative Procedure
Act, the adoption of the regulations shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare. Notwithstanding Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, emergency regulations adopted by the
department in order to implement this section shall not be subject to
the review and approval of the Office of Administrative Law. These
regulations shall become effective immediately upon filing with the
Secretary of State.
14005.14. (a) In addition to the income exemptions specified in
subdivision (a) of Section 14005.7, an income exemption shall be
allowed each month for the amount actually paid toward the cost of
in-home supportive services needed as determined under standards and
procedures established by the Director of Social Services, by a
person who is eligible for Medi-Cal in accordance with Section 14005.
3 or 14005.7. For the purpose of this section, "in-home supportive
services" means those services that are available to recipients of
the In-Home Supportive Services Program as defined by the Director of
Social Services in regulations adopted pursuant to Article 7
(commencing with Section 12300) of Chapter 3 of Part 3 of Division 9.
(b) The income exemption provided by this section for those
persons eligible for Medi-Cal in accordance with Section 14005.7
shall be restricted to those persons who, without in-home supportive
services, would require 24-hour-a-day care in a health facility, as
defined in Section 1250 of the Health and Safety Code, or a community
care facility, as defined under Section 1502 of the Health and
Safety Code.
(c) The State Department of Health Services shall seek all federal
waivers necessary to allow for federal financial participation. The
income exemption authorized by subdivision (b) shall remain in effect
during the time period that the federal waivers are pending. If the
necessary federal waivers cannot be obtained, the income exemption
authorized by subdivision (b) shall continue to be implemented by the
department.
14005.15. Notwithstanding the provisions of Section 14005, Medi-Cal
beneficiaries shall obtain family planning services through the
Medi-Cal program to the extent they are available through such
program.
14005.16. (a) In determining the eligibility of a married
individual pursuant to Section 14005.4 or 14005.7, who resides in a
nursing facility, and who is in a Medi-Cal family budget unit
separate from that of his or her spouse, the community property
interest of the noninstitutionalized spouse in the income of the
married individual shall not be considered income available to that
individual.
(b) For purposes of this section, there shall be a presumption,
rebuttable by either spouse, that each spouse has a community
property interest in one-half of the total monthly income of both
spouses.
(c) (1) This section shall not become operative unless Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
laws in determining eligibility or the federal government authorizes
the state to apply community property laws in that determination.
(2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or the receipt of federal approval, as specified in paragraph (1).
14005.17. (a) In determining the eligibility of an
institutionalized spouse pursuant to Section 14005.4 or 14005.7, who
resides in a medical institution or nursing facility, and who is in a
Medi-Cal family budget unit separate from that of his or her spouse,
the community property interest of either spouse in the income of
the other spouse shall not be considered when determining eligibility
for Medi-Cal benefits.
(b) In the case of an institutionalized spouse, income shall be
determined in accordance with subsections (b) and (d) of Section 1924
of the federal Social Security Act and regulations adopted pursuant
thereto.
(c) (1) This section shall remain operative only until Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
law in determining eligibility under this chapter, or the federal
government authorizes the consideration of state community property
in that determination.
(2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or receipt of federal authorization as specified in paragraph (1).
14005.18. A woman is eligible, to the extent required by federal
law, as though she were pregnant, for all pregnancy-related and
postpartum services for a 60-day period beginning on the last day of
pregnancy.
For purposes of this section, "postpartum services" means those
services provided after childbirth, child delivery, or miscarriage.
14005.19. The receipt of respite care, as defined in Section 1418.1
of the Health and Safety Code, shall not affect the eligibility of
any individual with respect to benefits under this chapter, except as
subject to the limitations of subdivision (b) of Section 14124.7.
14005.20. (a) The State Department of Health Services shall adopt
the option made available under Section 13603 of the federal Omnibus
Budget Reconciliation Act of 1993 (Public Law 103-66) to pay
allowable tuberculosis related services for persons infected with
tuberculosis.
(b) The income and resources of these persons may not exceed the
maximum amount for a disabled person as described in Section 1902(a)
(10)(A)(i) of Title XIX of the federal Social Security Act (42 U.S.C.
Sec. 1396a(a)(10)(A)(i)).
14005.21. (a) Any medically needy aged, blind, or disabled person
who was categorically needy under this chapter on the basis of
eligibility under Chapter 3 (commencing with Section 12000) or
Subchapter 16 (commencing with Section 1381) of Chapter 7 of Title 42
of the United States Code for the month of August 1993, and was
discontinued as of September 1, 1993, and who, but for the addition
of Section 12200.015, would be eligible to receive benefits without a
share of cost in September 1993 under this chapter, shall remain
eligible to receive benefits without a share of cost under this
chapter as if that person were categorically needy as long as he or
she meets other applicable requirements.
(b) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy or
medically needy under subdivision (a) for the month of August 1994,
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the addition of Section 12200.017, and
if he or she, but for Section 12200.017, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(c) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivision (a) or (b), for the calendar
month immediately preceding the date that the reductions in maximum
aid payments for the state supplementary program established in
Chapter 3 (commencing with Section 12000) of Part 3 of Division 9
made in the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(d) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivisions (a), (b), or (c) for the
calendar month immediately preceding the date that the reductions in
maximum aid payments for the state supplementary program established
in Chapter 3 (commencing with Section 12000) made in the 1996 portion
of the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for these reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(e) The department shall implement this section regardless of the
availability of federal financial participation for the share of cost
paid from state funds pursuant to subdivisions (a), (b), (c), and
(d).
14005.23. To the extent federal financial participation is
available, the department shall, when determining eligibility for
children under Section 1396a(l)(1)(D) of Title 42 of the United
States Code, designate a birth date by which all children who have
not attained the age of 19 years will meet the age requirement of
Section 1396a(l)(1)(D) of Title 42 of the United States Code.
14005.24. The department shall instruct counties, by means of an
all county letter or similar instruction, as to the process that is
to be used to ensure that each child, physical custody of whom has
been voluntarily surrendered pursuant to Section 1255.7 of the Health
and Safety Code, shall be determined eligible for benefits under
this chapter for, at a minimum, a period of time commencing on the
date physical custody is surrendered and ending on the earliest of
the following dates:
(a) The last day of the month following the month in which the
child was voluntarily surrendered under Section 1255.7 of the Health
and Safety Code.
(b) The date the child is reclaimed under Section 1255.7 of the
Health and Safety Code.
(c) The date the child ceases to reside in California.
14005.25. (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger. A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
(1) The end of a 12-month period following the eligibility
determination.
(2) The date the individual exceeds the age of 19 years.
(b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
14005.28. (a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall exercise its option under Section 1902(a)(10)(A)(XV)
of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)
(XV)) to extend Medi-Cal benefits to independent foster care
adolescents, as defined in Section 1905(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396d(v)(1)).
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, and if the
state plan amendment described in subdivision (a) is approved by the
federal Health Care Financing Administration, the department may
implement subdivision (a) without taking any regulatory action and by
means of all-county letters or similar instructions. Thereafter, the
department shall adopt regulations in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
(c) The department shall implement subdivision (a) on October 1,
2000, but only if, and to the extent that, the department has
obtained all necessary federal approvals.
14005.29. To the extent that federal matching funds are available,
disabled persons who are otherwise eligible for benefits under this
chapter, except for income due to employment, shall continue to be
eligible to receive benefits for conditions excluded from coverage by
a private insurer, provided those persons' incomes do not exceed 200
percent of the income level for maintenance established pursuant to
Section 14005.12.
14005.30. (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) made available to and exercised by the
state.
(2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
(3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u-1(b)(2)
(C) of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012. The department shall
implement this paragraph only if, and to the extent that the State
Child Health Insurance Program waiver described in Section 12693.755
of the Insurance Code extending Healthy Families Program eligibility
to parents and certain other adults is approved and implemented.
(b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to expand eligibility for Medi-Cal under subdivision (a) by
establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).
(c) To the extent federal financial participation is available,
the department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1) and the amount
equal to 100 percent of the federal poverty level applicable to the
size of the family. A recipient shall be entitled to the same
disr
WELFARE AND INSTITUTIONS CODE
SECTION 14000-14029.8
14000. The purpose of this chapter is to afford to qualifying
individuals health care and related remedial or preventive services,
including related social services which are necessary for those
receiving health care under this chapter.
The intent of the Legislature is to provide, to the extent
practicable, through the provisions of this chapter, for health care
for those aged and other persons, including family persons who lack
sufficient annual income to meet the costs of health care, and whose
other assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future minimum
self-maintenance and security. It is intended that whenever possible
and feasible:
(a) The means employed shall allow, to the extent practicable,
eligible persons to secure health care in the same manner employed by
the public generally, and without discrimination or segregation
based purely on their economic disability. The means employed shall
include an emphasis on efforts to arrange and encourage access to
health care through enrollment in organized, managed care plans of
the type available to the general public.
(b) The benefits available under this chapter shall not duplicate
those provided under other federal or state laws or under other
contractual or legal entitlements of the person or persons receiving
them.
(c) In the administration of this chapter and in establishing the
means to be used to provide access to health care to persons eligible
under this chapter, the department shall emphasize and take
advantage of both the efficient organization and ready accessibility
and availability of health care facilities and resources through
enrollment in managed health care plans and new and innovative
fee-for-service managed health care plan approaches to the delivery
of health care services.
14000.03. (a) The Legislature finds and declares that Section 1396a
(a)(11)(A) of Title 42 of the United States Code provides that
California's state plan for medical assistance under the Medicaid
program must "provide for entering into cooperative arrangements with
the State agencies responsible for administering or supervising the
administration of health services and vocational rehabilitation
services in the State looking toward maximum utilization of such
services in the provision of medical assistance under the plan."
(b) In furtherance of Section 1396a(a)(11)(A) of Title 42 of the
United States Code and Section 7560 of the Government Code, it is the
intent of the Legislature to maximize the amount of federal and
state funds continually available under agreements identified in
Section 1396a(a)(11)(A) of Title 42 of the United States Code and
entered into by the State Department of Health Services by making
later-appropriated and budgeted funds immediately encumbered and
available for expenditure under agreements by operation of law.
(c) Notwithstanding any other provision of law, upon additional
funds being appropriated and budgeted for the support of the services
identified within the scope of work of an agreement of the type
identified in Section 1396a (a)(11)(A) of Title 42 of the United
States Code and previously entered into by the State Department of
Health Services, the amount of the encumbrance in such an agreement
shall be amended, by operation of law, to reflect the newly
appropriated and budgeted funds.
(d) Notwithstanding any other provision of law, once an agreement
of the type identified in Section 1396a (a)(11)(A) of Title 42 of the
United States Code is entered into by the State Department of Health
Services, the agreement shall continue in effect indefinitely and
need not be amended unless the State Department of Health Services
changes the scope of work to be provided under the agreement.
14000.05. The State Department of Health Services shall consider
the special needs and requirements of rural hospitals in California
that are financially distressed and in danger of closure. The
department may provide technical assistance and other appropriate
assistance and relief on Medi-Cal program policies, reimbursement
issues, and Medi-Cal operational and procedural problems to
financially distressed rural hospitals, when appropriate, in order to
preserve the availability of health care services in rural
California.
14000.1. It is the intent of the Legislature that health care
services available under this chapter shall be at least equivalent to
the level provided in 1970-71.
14000.2. During the time this chapter is effective and
notwithstanding other provisions of the Welfare and Institutions Code
and Health and Safety Code, the board of supervisors of each county
may prescribe rules which authorize the county hospital to integrate
its services with those of other hospitals into a system of community
service which offers free choice of hospitals to those requiring
hospital care. The intent of this section is to eliminate
discrimination or segregation based on economic disability so that
the county hospital and other hospitals in the community share in
providing services to paying patients and to those who qualify for
care in public medical care programs. In prescribing rules under
which the county hospital may provide community hospital services
described in this section, the board of supervisors shall provide a
basis under which patients may be attended by their own personal
physicians who are professionally qualified for staff membership in
the county hospital.
Notwithstanding any other provisions of law or provisions
contained in a county charter, the board of supervisors of any county
may transfer the maintenance, operation and management or ownership
of the county hospital to the University of California or any other
public agency or community nonprofit corporation empowered to operate
a hospital facility upon a finding that the community services
provided by the hospital could be more efficiently, effectively or
economically provided by the transferee than the county. If such
transfer be made to the University of California or to any other
public agency empowered to operate a hospital facility the transfer
of control or ownership may be made with or without the payment of a
purchase price by the transferee and otherwise upon such terms and
conditions as the parties may mutually agree, but if the transfer be
to a community nonprofit corporation, the board of supervisors shall
comply with all other provisions of law relating to the sale, lease,
or transfer of public property by a county; and provided that in any
event the transaction shall include such terms and conditions as the
board of supervisors find necessary to insure that the transfer will
constitute an ongoing material benefit to the county and its
residents.
The intent of this section is to permit the implementation of
programs for the consolidation of public hospital services in order
to permit the more effective use of existing hospital facilities and
retard the spiraling costs of medical care.
14000.3. To the extent permitted by federal law, the director may
enter into contracts with the Secretary of Health, Education, and
Welfare to obtain or provide fiscal intermediary services for all
persons who are receiving benefits under this chapter, who are also
recipients of benefits under Title XVIII of the Social Security Act.
14000.4. This chapter shall be known and may be cited as the
"Medi-Cal Act."
14000.5. On a regional pilot project basis, to the extent
authorized by law, the director may enter into contracts with one or
more nonprofit organizations to perform the functions of the
department's Office of the Ombudsman. These activities may include
outreach, community education and training about health care consumer
rights and responsibilities, including the production and
distribution of consumer-oriented material, individual consumer
assistance, including counseling, advice, assistance, education,
advocacy, and referral as appropriate, establishing and operating a
database to analyze the nature of the inquiries and requests for
assistance, and training of department or county staff. These
services may be made available to any person who may be eligible for
or is receiving benefits under this chapter. Funds appropriated in
the annual Budget Act for the support of the Office of the Ombudsman
may be allocated for this purpose.
14001. Health care as administered under this chapter shall be
considered a component of public social services.
14001.1. It is the intention of the Legislature, whenever feasible,
that the needs of categorically needy persons for health care and
related remedial or preventive services be met under the provisions
of this chapter.
14001.11. (a) The department shall implement the federal
requirements described in Section 1396u-5 of Title 42 of the United
States Code.
(b) In each of the several counties of the state, the eligibility
and enrollment functions required under Section 1396u-5(a)(2) and (3)
of Title 42 of the United States Code, which may include, but are
not limited to, determining eligibility and offering enrollment for
premium and cost sharing subsidies made available under and in
accordance with Section 1395w-114 of Title 42 of the United States
Code, shall be a county function and responsibility, subject to the
direction, authority, and regulations of the department. The
department shall request input from the counties as to the potential
cost of implementing these provisions, and shall consider that input
in developing the budget.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, or make specific this section by
means of all county letters, provider bulletins, or similar
instructions, with input from the counties. Thereafter, the
department may adopt regulations in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of the
Government Code.
(d) The department shall seek approval of any amendments to the
state plan, necessary to implement this section, for purposes of
federal financial participation under Title XIX of the Social
Security Act (42 U.S.C. Sec. 1396 et seq.). Notwithstanding any other
law and only when all necessary federal approvals have been
obtained, this section, with the exception of the Phased-Down State
Contribution, as described in subparagraphs (A) to (C), inclusive, of
paragraph (1) of subdivision (c) of Section 1396u-5 of Title 42 of
the United States Code, shall be implemented only to the extent
federal financial participation is available.
14002. Health care granted under the provisions of this chapter is
held subject to the provisions of any law hereafter enacted amending,
repealing, or supplementing in whole or in part the provisions of
this chapter, and subject to the rules and regulations of the
department. No recipient of health care under this chapter shall have
any claim for compensation or otherwise because his service is
affected in any way by any such amending, repealing, or supplemental
act, or by any such rule or regulation or by any addition, amendment,
or repeal of such rules or regulations.
14002.5. For the purposes of this article, the following
definitions shall apply:
(a) "Annuity" means a contract that names an annuitant and gives a
person or entity the right to receive periodic payments of a fixed
or variable sum for a described period of time, which may include a
lump-sum payment or periodic payments upon the death of the
annuitant.
(b) "Community spouse" means the spouse of an institutionalized
spouse.
(c) "Home and facility care" means the following services that are
subject to Medi-Cal reimbursement:
(1) Nursing facility care services.
(2) A level of care in any institution equivalent to that of
nursing facility care services.
(3) Home- or community-based care services furnished under a
waiver granted pursuant to subsection (c) or (d) of Section 1396n of
Title 42 of the United States Code.
(d) "Institutionalized spouse" means any individual to whom all of
the following apply:
(1) The individual is in a medical institution or nursing facility
or is a person who is receiving institutional or noninstitutional
services from an organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590), and is likely to meet that requirement for at least 30
consecutive days.
(2) The individual is married to a spouse who is not in a medical
institution or nursing facility, or to a spouse who is not receiving
services from any organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590).
(3) Except for purposes of Sections 14005.7, 14005.12, 14005.16,
and 14005.17, an individual who is admitted to a medical institution
or nursing facility on or after September 30, 1989, and who applies
for Medi-Cal benefits on or after January 1, 1990, or a Medi-Cal
recipient who is admitted to a medical institution or nursing
facility on or after January 1, 1990.
(e) "Medical institution" has the same meaning as defined in
Section 435.1010 of Title 42 of the Code of Federal Regulations.
(f) "Nursing facility" has the same meaning as defined in Section
1250 of the Health and Safety Code.
14003. The Governor may enter into and execute in behalf of the
state all necessary agreements in connection with this chapter as may
be required by the United States government.
14004. If any individual in good faith adheres to the teachings of
any bona fide church, sect, denomination, or organization, and in
accordance with its principles depends for healing entirely upon
prayer or spiritual means, no medical examination shall be required
to receive health care authorized by this chapter, but in lieu
thereof the certificate of a practitioner of such bona fide sect,
denomination, or organization approved and authorized by the
department, shall be accepted as to the need of such individual for
service. No rule or regulation shall be adopted or continued in force
which discriminates against such an individual.
14005. (a) The health care benefits and services specified in this
chapter, to the extent that such services are neither provided under
any other federal or state law nor provided nor available under other
contractual or legal entitlements of the person, shall be provided
under this chapter to any person who is a resident of this state and
is made eligible by the provisions of this article. It is the intent
of the Legislature that a provider shall look to such other
contractual or legal entitlements for payment before submitting a
bill for payment under this chapter.
(b) Any applicant for, or recipient of, Medi-Cal benefits who
requests medical assistance for home and facility care shall meet the
specific eligibility requirements for the receipt of medical
assistance for home and facility care set forth in this chapter.
(c) This section shall be implemented pursuant to the requirements
of Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.), and any regulations adopted pursuant to that act, and only
to the extent that federal financial participation is available.
(d) To the extent that regulations are necessary to implement this
section, the department shall promulgate regulations using the
nonemergency regulatory process described in Article 5 (commencing
with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of the
Government Code.
(e) It is the intent of the Legislature that the provisions of
this section shall apply prospectively to any individual to whom the
act applies commencing from the date regulations adopted pursuant to
this act are filed with the Secretary of State.
14005.1. Except for adults receiving aid pursuant to Chapter 2
(commencing with Section 11200) and for whom federal financial
participation would not be obtainable for their medical costs under
Title XIX of the federal Social Security Act, categorically needy
persons are eligible for health care services under Section 14005.
Eligibility for health care services under Section 14005 shall
continue for four calendar months beginning with the month in which a
family becomes ineligible for benefits under the Aid to Families
with Dependent Children program, if all of the following apply:
(a) The ineligibility is due wholly or partly to the collection or
increased collection of child or spousal support pursuant to Article
7 (commencing with Section 11475) of Chapter 2.
(b) The family has received benefits under the Aid to Families
with Dependent Children program in at least three of the six months
immediately preceding the month in which ineligibility begins.
(c) Ineligibility occurred after October 1, 1984, and before
October 1, 1988.
14005.2. Unless otherwise specified in this chapter, the
eligibility of a person eligible under the Cuban-Haitian Entrant
Program or the Refugee Resettlement Program for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person, except for those criteria that establish categorical
relatedness, and only as long as federal funds are available. Victims
of trafficking, domestic violence, and other serious crimes, as
defined in subdivision (b) of Section 18945, shall be eligible for
these services to the same extent as individuals who are admitted to
the United States as a refugee under Section 1157 of Title 8 of the
United States Code. Services under this subdivision shall be paid
from state funds to the extent federal funding is unavailable.
14005.3. (a) Notwithstanding any other provision of this chapter,
any person who:
(1) Was once determined to be disabled in accordance with
Section 1614 of Part A of Title XVI of the Social Security Act
(Section 1382c, Title 42, United States Code), and
(2) Became ineligible for benefits pursuant to Section 1614 of
Part A of Title XVI of the Social Security Act (Section 1382c, Title
42, United States Code) because the person engaged in substantial
gainful activity, and
(3) Continues to suffer from the physical or mental impairments
which were the basis of the disability determination required under
paragraph (1),
shall be considered to be disabled, for the purposes of this
chapter, even though such person is engaged in substantial gainful
activity. Regardless of whether such person has excess income
pursuant to Sections 14005.12 and 14005.13, such person shall be
eligible to receive health care benefits and services under this
chapter if his or her income does not exceed the maximum income
eligibility limits for benefits under Part A of Title XVI of the
Social Security Act. Any such person whose income exceeds the maximum
income eligibility limits for benefits under Part A of Title XVI of
the Social Security Act shall be eligible under Sections 14005.4 and
14052 for health care benefits and services under this chapter,
provided, that the income levels for maintenance in Section 14005.12
for such person shall be the maximum income eligibility limits for
benefits under Part A of Title XVI of the Social Security Act and
provided, that his or her nonexempt income in excess of that maximum
is used to pay his or her share of costs.
(b) For purposes of this section, "substantial gainful activity"
means work activity considered to be substantial gainful activity
under applicable federal regulations adopted pursuant to Section 1614
of Part A of Title XVI of the Social Security Act.
(c) The determination of continued impairments and the need for
health care benefits and services shall be supported by medical
reports when requested. Such reports shall be provided at the expense
of the department.
14005.4. Unless otherwise specified in this chapter, the
eligibility of a state-only Medi-Cal person for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person except for those criteria that establish categorical
relatedness.
14005.5. (a) In determining eligibility pursuant to Section 14005.4
or 14005.7, reparation or restitution payments received by victims
of the Nazi persecution from the Federal Republic of Germany pursuant
to the Federal Law on the Compensation of Victims of the National
Socialist Persecution (Federal Compensation Law), as enacted by that
government on June 29, 1956, shall not be deemed as available income,
nor shall any accumulation of those payments be considered an
available resource, to the extent that the funds are not spent and
are kept identifiable.
(b) The director shall seek federal waivers from the Secretary of
the United States Department of Health and Human Services, in order
to ensure federal financial participation. In the event of an initial
determination by the Secretary of the United States Department of
Health and Human Services that any provision of this section is in
conflict with any federal statute or regulation, the department shall
take all available and necessary steps to obtain a final
determination reversing that decision. In the event that a final
determination is made which finds a conflict with federal law, the
director shall immediately request the Attorney General to seek
judicial review of the determination, and the director shall notify
the appropriate policy and fiscal committees of both houses of the
Legislature of its request. Notwithstanding the outcome of the
director's efforts to obtain waivers under this subdivision, or a
final judicial decision holding that any provision of this section is
in conflict with federal law, subdivision (a) shall be implemented
on July 1, 1985, or the date upon which waivers are obtained under
this subdivision, whichever is earlier. Failure to obtain waivers
pursuant to this subdivision shall not affect implementation of
subdivision (a).
14005.6. (a) The Legislature finds and declares as follows:
(1) Under federal law, minors living at home with their families
may not be eligible for the SSI and Medicaid programs.
(2) Under the Federal Budget Reconciliation Act of 1981, however,
states may apply for a Section 1915(c) waiver to allow a person to be
eligible for SSI and Medicaid when medical and social services
provided in the home can be shown to be less costly than services
provided in an institution.
(3) Whenever possible, medical and social services should be
provided in the least restrictive setting and at the lowest cost to
the programs involved.
(4) The State Department of Health Services has already
successfully applied for the Section 1915(c) waiver as applied to
certain defined populations of developmentally disabled, elderly, and
medically acute clients.
(b) The State Director of Health Services shall apply for
additional waivers when appropriate to expand the number and types of
persons who will be eligible for in-home services.
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, 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), 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).
(ii) If the deduction specified in paragraph (1) is applicable to
the individual, an amount, not to exceed the amount by which the SSI
recipient retention amount exceeds twenty dollars ($20), nor to be
less than zero, by which the sum of the amount which the individual
pays to his or her 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).
(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).
14005.75. A person who is otherwise eligible for Medi-Cal benefits
under either Section 14005.4 or 14005.7, except for income and
resource eligibility, and who is receiving Medi-Cal services for the
treatment of multiple sclerosis, shall continue to be eligible to
receive benefits only for these services under Medi-Cal, provided
that all other conditions of eligibility for the Medi-Cal program are
met. These restricted benefits shall continue until such time as the
person is eligible for, and receives, third party coverage for these
treatments. However, restricted benefits under this section shall
not continue for more than two years.
14005.75. (a) The Legislature finds and declares all of the
following:
(1) As a result of federal welfare reform, unprecedented numbers
of welfare recipients will be leaving welfare for work, and will face
time limits on the receipt of aid.
(2) It is in the interest of the state both to encourage welfare
recipients to seek employment and to ensure the continuity of health
coverage for these recipients as they move from welfare to work.
(3) California's transitional Medi-Cal program is intended to
encourage welfare recipients to seek employment and to ensure
continuity of health coverage, but various procedural restrictions
limit its effectiveness in achieving those goals.
(b) It is, therefore, the intent of the Legislature to streamline
the transitional Medi-Cal program in order to maximize its
effectiveness in assisting persons leaving welfare for work.
14005.76. (a) The department shall provide a Medi-Cal beneficiary
whose Medi-Cal eligibility is established pursuant to Section 1930 of
the federal Social Security Act (42 U.S.C. Sec. 1396u-1) with simple
and clear written notice of the availability of the transitional
Medi-Cal program and the requirements for that program. This notice
shall be provided at the time that Medi-Cal eligibility is conferred
to the beneficiary and at least once every six months thereafter.
(b) When a beneficiary loses Medi-Cal eligibility established
pursuant to Section 1930 of the federal Social Security Act (42
U.S.C. Sec. 1396u-1) for failure to meet reporting requirements, the
department shall provide the beneficiary with the notice described in
subdivision (a), and a form with simple and clear instructions on
how to complete and return the form to the county. The form shall be
used to determine whether the beneficiary is eligible for the
transitional Medi-Cal program.
(c) The notice and form described in subdivisions (a) and (b)
shall be prepared by the department. The department shall seek input
on the notice and form from beneficiaries of aid, beneficiary
representatives, and counties.
(d) The department shall review, and if necessary for simplicity
and clarity, revise the notice required by subdivision (b) of Section
14005.8 and Section 14005.81. The department shall seek input from
beneficiaries, beneficiary representatives, and counties.
(e) Notwithstanding any other provision of law, this section shall
become operative nine months after the effective date of this
section.
(f) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.8. (a) (1) To the extent required by Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the United
States Code and regulations adopted pursuant thereto, a family who
was receiving aid pursuant to a state plan approved under Part A of
Subchapter IV (commencing with Section 601) of Title 42 of the United
States Code in at least three of the six months immediately
preceding the month in which that family became ineligible for that
assistance due to increased hours of employment, income from
employment, or the loss of earned income disregards, shall remain
eligible for health care services as provided in this chapter during
the immediately succeeding six-month period.
(2) The department shall terminate extensions of health care
services authorized by paragraph (1) as required under federal law.
(b) The department shall notify persons eligible under subdivision
(a) of their right to continued health care services for each
six-month period and a description of their reporting requirement,
and the circumstances under which the extension may be terminated.
The notice shall also include a Medi-Cal card or other evidence of
entitlement to those services.
(c) Notwithstanding any other provision of this section, the
department, in conformance with federal law, shall offer
beneficiaries covered under subdivision (a) the option of remaining
eligible for health care services provided in this chapter for an
additional extension period of six months. Health services shall be
continued in as automatic a manner as permitted by federal law, and
without any unnecessary paperwork.
(d) During the initial extension period and any additional
six-month extension period, the department, consistent with federal
law, may, whenever the department determines it to be cost-effective,
elect to pay a family's expenses for premiums, deductibles,
coinsurance, or similar costs for health insurance or other health
coverage offered by an employer of the caretaker relative or by an
employer of the absent parent of the dependent child. If, during the
additional six-month extension period, the department elects to pay
health premiums and this coverage exists, the beneficiary may be
given the opportunity to express his or her preference between
continuing the Medi-Cal coverage or obtaining health insurance.
(e) During the additional six-month extension period, the
department may impose a premium for the health insurance or other
health coverage consistent with Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) if the department
determines that the imposition of a premium is cost-effective.
(f) The department shall adopt emergency regulations in order to
comply with mandatory provisions of Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) for extension of medical
assistance. These regulations shall become effective immediately upon
filing with the Secretary of State.
(g) This section shall become operative April 1, 1990.
14005.84. (a) The department shall develop and conduct a community
outreach and education campaign to assist persons whose Medi-Cal
eligibility is established pursuant to Section 1931 of the federal
Social Security Act (42 U.S.C. Sec. 1396u-1), to learn about the
availability of the transitional Medi-Cal program.
(b) Any managed care plan, local initiative, or county organized
health system contracting with the department to provide services to
Medi-Cal enrollees shall include in its evidence of coverage and
marketing materials information about the transitional Medi-Cal
program and how to apply for program benefits.
(c) To implement this section, the department may develop and
execute a contract or may amend any existing or future outreach
campaign contract that it has executed. Notwithstanding any other
provision of law, any such contract developed and executed, or
amended, as required to implement this section shall be exempt from
the approval of the Director of General Services and from the Public
Contract Code.
(d) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.85. (a) Families who, because of marriage or because
separated spouses reunite, lose AFDC eligibility under the chapter
because the family no longer meets the need requirement specified in
Section 11250 or has increased assets or income, or both, shall be
eligible for extended medical benefits as specified under this
article for a period not to exceed 12 months.
(b) The department shall seek all federal waivers necessary to
implement this section.
(c) This section shall not be implemented until the director has
executed a declaration, that shall be retained by the director, that
any necessary waivers and federal financial participation have been
obtained.
14005.88. (a) The department shall contract for an independent
evaluation, to be completed no later than January 1, 2001, in order
to determine the effect of changes made in the transitional Medi-Cal
program by the enactment of Sections 14005.76, 14005.82, 14005.83,
14005.84, 14005.87, 14005.89, and the amendment to Section 14005.85
enacted during the first year of the 1997-98 Regular Session of the
Legislature, on the employment of welfare recipients and the
continuity of their health coverage.
(b) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.89. (a) The department shall monitor participation rates for
transitional Medi-Cal and seek input from beneficiaries, beneficiary
representatives, and counties, on a regular basis throughout each
year to consider changes in transitional Medi-Cal procedures as may
be necessary to ensure that participation rates are at levels that
would reasonably be expected, given aid caseload developments. Before
any such changes are made, the department shall seek any federal
waivers, or obtain other federal approval, that may be necessary to
implement the changes.
(b) The department shall make the participation rate monitoring
data described in subdivision (a) available upon request.
14005.9. (a) Share of cost shall be determined on a monthly basis.
No person or family shall be required to incur more than one month's
share of cost prior to being certified as specified in Section 14018.
(b) For persons in long-term care, any income exempted under
Sections 14005.4 and 14005.7 shall be considered in the share-of-cost
determination to the extent required by federal law or regulations.
(c) Once the beneficiary has incurred expenses for Medicare and
other health insurance deductibles or coinsurance charges and
necessary medical and remedial services that are not subject to
payment by a third party and which equal or exceed his or her share
of cost, the individual is entitled to receive health care services
pursuant to Section 14005 if all other applicable conditions of
eligibility under this chapter are met.
14005.10. For purposes of facilitating arrangements for health care
through prepaid health plans, the department may set standards for
determining monthly income, for purposes of eligibility, on the
person's average pattern of income and earnings, subject to
subsequent adjustment if actual experience deviates substantially
from the amount determined by such method.
14005.11. (a) To the extent required by federal law for qualified
Medicare beneficiaries, the department shall pay the premiums,
deductibles, and coinsurance for elderly and disabled persons
entitled to benefits under Title XVIII of the federal Social Security
Act, whose income does not exceed the federal poverty level and
whose resources do not exceed 200 percent of the Supplemental
Security Income program standard.
(b) The department shall, in addition to subdivision (a), pay
applicable additional premiums, deductibles, and coinsurance for drug
coverage extended to qualified Medicare beneficiaries.
(c) The deductible payments required by subdivision (b) may be
covered by providing the same drug coverage as offered to
categorically needy recipients, as defined in Section 14050.1.
(d) As specified in this section, it is the intent of the
Legislature to assist in the payment of Medicare Part B premiums for
qualified low-income Medi-Cal beneficiaries who are ineligible for
federal sharing or federal contribution for the payment of those
premiums.
(e) For a Medi-Cal beneficiary who has a share of cost but who is
ineligible for the assistance provided pursuant to subdivision (a),
or who is ineligible for any other federally funded assistance for
the payment of the beneficiary's Medicare Part B premium, the
department shall pay for the beneficiary's Medicare Part B premium in
the month following each month that the beneficiary's share of cost
has been met.
(f) When a county is informed that an applicant or beneficiary is
eligible for Medicare benefits, the county shall determine whether
that individual is eligible under the Qualified Medicare Beneficiary
(QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB)
program, or the Qualifying Individual program and enroll the
applicant or beneficiary in the appropriate program.
14005.12. (a) For the purposes of Sections 14005.4 and 14005.7, the
department shall 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. It is the intent of the
Legislature that the income levels for maintenance need for medically
needy aged, blind, and disabled adults, in particular, shall be
based upon amounts that adequately reflect their needs.
(1) Subject to paragraph (2), reductions in the maximum aid
payment levels set forth in subdivision (a) of Section 11450 in the
1991-92 fiscal year, and thereafter, shall not result in a reduction
in the income levels for maintenance under this section.
(2) (A) The department shall seek any necessary federal
authorization for maintaining the income levels for maintenance at
the levels in effect June 30, 1991.
(B) If federal authorization is not obtained, medically needy
persons shall not be required to pay the difference between the share
of cost as determined based on the payment levels in effect on June
30, 1991, under Section 11450, and the share of cost as determined
based on the payment levels in effect on July 1, 1991, and
thereafter.
(3) Any medically needy person who was eligible for benefits under
this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families with
Dependent Children program as set forth in Section 11452.018 made in
the 1995-96 Regular Session of the Legislature shall not be
responsible for paying his or her share of cost if all of the
following apply:
(A) He or she had eligibility as categorically needy terminated by
the reductions in the minimum basic standards of adequate care.
(B) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.
(C) He or she is not eligible to receive benefits without a share
of cost as a medically needy person pursuant to paragraph (1) or (2).
(b) In the case of a single individual, the amount of the income
level for maintenance per month shall be 80 percent of the highest
amount that would ordinarily be paid to a family of two persons,
without any income or resources, under subdivision (a) of Section
11450, multiplied by the federal financial participation rate.
(c) In the case of a family of two adults, the income level for
maintenance per month shall be the highest amount that would
ordinarily be paid to a family of three persons without income or
resources under subdivision (a) of Section 11450, multiplied by the
federal financial participation rate.
(d) For the purposes of Sections 14005.4 and 14005.7, for a person
in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from an
organization with a frail elderly demonstration project waiver
pursuant to Chapter 8.75 (commencing with Section 14590), the amount
considered as required for maintenance per month shall be computed in
accordance with, and for those purposes required by, Title XIX of
the federal Social Security Act, and regulations adopted pursuant
thereto. Those amounts shall be computed pursuant to regulations
which include providing for the following purposes:
(1) Personal and incidental needs in the amount of not less than
thirty-five dollars ($35) per month while a patient. The department
may, by regulation, increase this amount as necessitated by
increasing costs of personal and incidental needs. A long-term health
care facility shall not charge an individual for the laundry
services or periodic hair care specified in Section 14110.4.
(2) The upkeep and maintenance of the home.
(3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.
(4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent children,
dependent parents, or dependent siblings of either spouse, provided
the individuals are residing with the community spouse.
(5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396r-5(d)(1)(B)).
(6) The family allowance for each family member residing with the
community spouse shall be computed in accordance with the formula
established in Section 1924(d)(1)(C) of Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).
(e) For the purposes of Sections 14005.4 and 14005.7, with regard
to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be computed
pursuant to regulations adopted by the department which provide for
the support and care of his or her spouse, minor children, or any
disabled relative for whose support he or she has contributed
regularly.
(f) The income levels for maintenance per month, except as
specified in subdivisions (b) to (d), inclusive, shall be equal to
the highest amounts that would ordinarily be paid to a family of the
same size without any income or resources under subdivision (a) of
Section 11450, multiplied by the federal financial participation
rate.
(g) The "federal financial participation rate," as used in this
section, shall mean 133 1/3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396
(b)), or its successor provisions.
(h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.
(i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for each
household in accordance with subdivisions (b) to (h), inclusive. The
total of these levels shall be the level for the single eligibility
unit.
(j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.
14005.13. (a) Notwithstanding Section 14005.12, when an individual
residing in a long-term care facility would incur a share of cost for
services under this chapter due to income which exceeds that allowed
for the incidental and personal needs of the individual, a specified
portion of the individual's earned income from therapeutic wages
shall be exempt. Therapeutic wages are wages earned by the individual
under all of the following conditions:
(1) A physician who does not have a financial interest in the
long-term care facility in which the individual resides, and who is
in charge of the individual's case prescribes work as therapy for the
individual.
(2) The individual must be employed within the same long-term care
facility where he or she resides.
(3) The individual's employment does not displace any existing
employees.
(4) The individual has resided in a long-term care facility for a
continuous period commencing at least five years prior to the date of
the addition of this section as originally adopted during the
1983-84 Regular Session.
(b) The amount of earned income from therapeutic wages which shall
be exempt shall be the lesser of 70 percent of the gross therapeutic
wages or 70 percent of the maintenance level for a
noninstitutionalized person or family of corresponding size as
described in subdivision (b), (c), or (e) of Section 14005.12.
(c) The provisions of this section shall be given retroactive
effect for the period commencing June 1, 1983.
(d) This section shall not become operative unless and until the
necessary waivers are obtained from the United States Department of
Health and Human Services.
(e) The director shall adopt regulations implementing this section
as emergency regulations in accordance with Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code. For the purposes of the Administrative Procedure
Act, the adoption of the regulations shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare. Notwithstanding Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, emergency regulations adopted by the
department in order to implement this section shall not be subject to
the review and approval of the Office of Administrative Law. These
regulations shall become effective immediately upon filing with the
Secretary of State.
14005.14. (a) In addition to the income exemptions specified in
subdivision (a) of Section 14005.7, an income exemption shall be
allowed each month for the amount actually paid toward the cost of
in-home supportive services needed as determined under standards and
procedures established by the Director of Social Services, by a
person who is eligible for Medi-Cal in accordance with Section 14005.
3 or 14005.7. For the purpose of this section, "in-home supportive
services" means those services that are available to recipients of
the In-Home Supportive Services Program as defined by the Director of
Social Services in regulations adopted pursuant to Article 7
(commencing with Section 12300) of Chapter 3 of Part 3 of Division 9.
(b) The income exemption provided by this section for those
persons eligible for Medi-Cal in accordance with Section 14005.7
shall be restricted to those persons who, without in-home supportive
services, would require 24-hour-a-day care in a health facility, as
defined in Section 1250 of the Health and Safety Code, or a community
care facility, as defined under Section 1502 of the Health and
Safety Code.
(c) The State Department of Health Services shall seek all federal
waivers necessary to allow for federal financial participation. The
income exemption authorized by subdivision (b) shall remain in effect
during the time period that the federal waivers are pending. If the
necessary federal waivers cannot be obtained, the income exemption
authorized by subdivision (b) shall continue to be implemented by the
department.
14005.15. Notwithstanding the provisions of Section 14005, Medi-Cal
beneficiaries shall obtain family planning services through the
Medi-Cal program to the extent they are available through such
program.
14005.16. (a) In determining the eligibility of a married
individual pursuant to Section 14005.4 or 14005.7, who resides in a
nursing facility, and who is in a Medi-Cal family budget unit
separate from that of his or her spouse, the community property
interest of the noninstitutionalized spouse in the income of the
married individual shall not be considered income available to that
individual.
(b) For purposes of this section, there shall be a presumption,
rebuttable by either spouse, that each spouse has a community
property interest in one-half of the total monthly income of both
spouses.
(c) (1) This section shall not become operative unless Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
laws in determining eligibility or the federal government authorizes
the state to apply community property laws in that determination.
(2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or the receipt of federal approval, as specified in paragraph (1).
14005.17. (a) In determining the eligibility of an
institutionalized spouse pursuant to Section 14005.4 or 14005.7, who
resides in a medical institution or nursing facility, and who is in a
Medi-Cal family budget unit separate from that of his or her spouse,
the community property interest of either spouse in the income of
the other spouse shall not be considered when determining eligibility
for Medi-Cal benefits.
(b) In the case of an institutionalized spouse, income shall be
determined in accordance with subsections (b) and (d) of Section 1924
of the federal Social Security Act and regulations adopted pursuant
thereto.
(c) (1) This section shall remain operative only until Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
law in determining eligibility under this chapter, or the federal
government authorizes the consideration of state community property
in that determination.
(2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or receipt of federal authorization as specified in paragraph (1).
14005.18. A woman is eligible, to the extent required by federal
law, as though she were pregnant, for all pregnancy-related and
postpartum services for a 60-day period beginning on the last day of
pregnancy.
For purposes of this section, "postpartum services" means those
services provided after childbirth, child delivery, or miscarriage.
14005.19. The receipt of respite care, as defined in Section 1418.1
of the Health and Safety Code, shall not affect the eligibility of
any individual with respect to benefits under this chapter, except as
subject to the limitations of subdivision (b) of Section 14124.7.
14005.20. (a) The State Department of Health Services shall adopt
the option made available under Section 13603 of the federal Omnibus
Budget Reconciliation Act of 1993 (Public Law 103-66) to pay
allowable tuberculosis related services for persons infected with
tuberculosis.
(b) The income and resources of these persons may not exceed the
maximum amount for a disabled person as described in Section 1902(a)
(10)(A)(i) of Title XIX of the federal Social Security Act (42 U.S.C.
Sec. 1396a(a)(10)(A)(i)).
14005.21. (a) Any medically needy aged, blind, or disabled person
who was categorically needy under this chapter on the basis of
eligibility under Chapter 3 (commencing with Section 12000) or
Subchapter 16 (commencing with Section 1381) of Chapter 7 of Title 42
of the United States Code for the month of August 1993, and was
discontinued as of September 1, 1993, and who, but for the addition
of Section 12200.015, would be eligible to receive benefits without a
share of cost in September 1993 under this chapter, shall remain
eligible to receive benefits without a share of cost under this
chapter as if that person were categorically needy as long as he or
she meets other applicable requirements.
(b) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy or
medically needy under subdivision (a) for the month of August 1994,
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the addition of Section 12200.017, and
if he or she, but for Section 12200.017, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(c) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivision (a) or (b), for the calendar
month immediately preceding the date that the reductions in maximum
aid payments for the state supplementary program established in
Chapter 3 (commencing with Section 12000) of Part 3 of Division 9
made in the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(d) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivisions (a), (b), or (c) for the
calendar month immediately preceding the date that the reductions in
maximum aid payments for the state supplementary program established
in Chapter 3 (commencing with Section 12000) made in the 1996 portion
of the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for these reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(e) The department shall implement this section regardless of the
availability of federal financial participation for the share of cost
paid from state funds pursuant to subdivisions (a), (b), (c), and
(d).
14005.23. To the extent federal financial participation is
available, the department shall, when determining eligibility for
children under Section 1396a(l)(1)(D) of Title 42 of the United
States Code, designate a birth date by which all children who have
not attained the age of 19 years will meet the age requirement of
Section 1396a(l)(1)(D) of Title 42 of the United States Code.
14005.24. The department shall instruct counties, by means of an
all county letter or similar instruction, as to the process that is
to be used to ensure that each child, physical custody of whom has
been voluntarily surrendered pursuant to Section 1255.7 of the Health
and Safety Code, shall be determined eligible for benefits under
this chapter for, at a minimum, a period of time commencing on the
date physical custody is surrendered and ending on the earliest of
the following dates:
(a) The last day of the month following the month in which the
child was voluntarily surrendered under Section 1255.7 of the Health
and Safety Code.
(b) The date the child is reclaimed under Section 1255.7 of the
Health and Safety Code.
(c) The date the child ceases to reside in California.
14005.25. (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger. A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
(1) The end of a 12-month period following the eligibility
determination.
(2) The date the individual exceeds the age of 19 years.
(b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
14005.28. (a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall exercise its option under Section 1902(a)(10)(A)(XV)
of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)
(XV)) to extend Medi-Cal benefits to independent foster care
adolescents, as defined in Section 1905(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396d(v)(1)).
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, and if the
state plan amendment described in subdivision (a) is approved by the
federal Health Care Financing Administration, the department may
implement subdivision (a) without taking any regulatory action and by
means of all-county letters or similar instructions. Thereafter, the
department shall adopt regulations in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
(c) The department shall implement subdivision (a) on October 1,
2000, but only if, and to the extent that, the department has
obtained all necessary federal approvals.
14005.29. To the extent that federal matching funds are available,
disabled persons who are otherwise eligible for benefits under this
chapter, except for income due to employment, shall continue to be
eligible to receive benefits for conditions excluded from coverage by
a private insurer, provided those persons' incomes do not exceed 200
percent of the income level for maintenance established pursuant to
Section 14005.12.
14005.30. (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) made available to and exercised by the
state.
(2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
(3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u-1(b)(2)
(C) of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012. The department shall
implement this paragraph only if, and to the extent that the State
Child Health Insurance Program waiver described in Section 12693.755
of the Insurance Code extending Healthy Families Program eligibility
to parents and certain other adults is approved and implemented.
(b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to expand eligibility for Medi-Cal under subdivision (a) by
establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).
(c) To the extent federal financial participation is available,
the department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1) and the amount
equal to 100 percent of the federal poverty level applicable to the
size of the family. A recipient shall be entitled to the same
disr
WELFARE AND INSTITUTIONS CODE
SECTION 14000-14029.8
14000. The purpose of this chapter is to afford to qualifying
individuals health care and related remedial or preventive services,
including related social services which are necessary for those
receiving health care under this chapter.
The intent of the Legislature is to provide, to the extent
practicable, through the provisions of this chapter, for health care
for those aged and other persons, including family persons who lack
sufficient annual income to meet the costs of health care, and whose
other assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future minimum
self-maintenance and security. It is intended that whenever possible
and feasible:
(a) The means employed shall allow, to the extent practicable,
eligible persons to secure health care in the same manner employed by
the public generally, and without discrimination or segregation
based purely on their economic disability. The means employed shall
include an emphasis on efforts to arrange and encourage access to
health care through enrollment in organized, managed care plans of
the type available to the general public.
(b) The benefits available under this chapter shall not duplicate
those provided under other federal or state laws or under other
contractual or legal entitlements of the person or persons receiving
them.
(c) In the administration of this chapter and in establishing the
means to be used to provide access to health care to persons eligible
under this chapter, the department shall emphasize and take
advantage of both the efficient organization and ready accessibility
and availability of health care facilities and resources through
enrollment in managed health care plans and new and innovative
fee-for-service managed health care plan approaches to the delivery
of health care services.
14000.03. (a) The Legislature finds and declares that Section 1396a
(a)(11)(A) of Title 42 of the United States Code provides that
California's state plan for medical assistance under the Medicaid
program must "provide for entering into cooperative arrangements with
the State agencies responsible for administering or supervising the
administration of health services and vocational rehabilitation
services in the State looking toward maximum utilization of such
services in the provision of medical assistance under the plan."
(b) In furtherance of Section 1396a(a)(11)(A) of Title 42 of the
United States Code and Section 7560 of the Government Code, it is the
intent of the Legislature to maximize the amount of federal and
state funds continually available under agreements identified in
Section 1396a(a)(11)(A) of Title 42 of the United States Code and
entered into by the State Department of Health Services by making
later-appropriated and budgeted funds immediately encumbered and
available for expenditure under agreements by operation of law.
(c) Notwithstanding any other provision of law, upon additional
funds being appropriated and budgeted for the support of the services
identified within the scope of work of an agreement of the type
identified in Section 1396a (a)(11)(A) of Title 42 of the United
States Code and previously entered into by the State Department of
Health Services, the amount of the encumbrance in such an agreement
shall be amended, by operation of law, to reflect the newly
appropriated and budgeted funds.
(d) Notwithstanding any other provision of law, once an agreement
of the type identified in Section 1396a (a)(11)(A) of Title 42 of the
United States Code is entered into by the State Department of Health
Services, the agreement shall continue in effect indefinitely and
need not be amended unless the State Department of Health Services
changes the scope of work to be provided under the agreement.
14000.05. The State Department of Health Services shall consider
the special needs and requirements of rural hospitals in California
that are financially distressed and in danger of closure. The
department may provide technical assistance and other appropriate
assistance and relief on Medi-Cal program policies, reimbursement
issues, and Medi-Cal operational and procedural problems to
financially distressed rural hospitals, when appropriate, in order to
preserve the availability of health care services in rural
California.
14000.1. It is the intent of the Legislature that health care
services available under this chapter shall be at least equivalent to
the level provided in 1970-71.
14000.2. During the time this chapter is effective and
notwithstanding other provisions of the Welfare and Institutions Code
and Health and Safety Code, the board of supervisors of each county
may prescribe rules which authorize the county hospital to integrate
its services with those of other hospitals into a system of community
service which offers free choice of hospitals to those requiring
hospital care. The intent of this section is to eliminate
discrimination or segregation based on economic disability so that
the county hospital and other hospitals in the community share in
providing services to paying patients and to those who qualify for
care in public medical care programs. In prescribing rules under
which the county hospital may provide community hospital services
described in this section, the board of supervisors shall provide a
basis under which patients may be attended by their own personal
physicians who are professionally qualified for staff membership in
the county hospital.
Notwithstanding any other provisions of law or provisions
contained in a county charter, the board of supervisors of any county
may transfer the maintenance, operation and management or ownership
of the county hospital to the University of California or any other
public agency or community nonprofit corporation empowered to operate
a hospital facility upon a finding that the community services
provided by the hospital could be more efficiently, effectively or
economically provided by the transferee than the county. If such
transfer be made to the University of California or to any other
public agency empowered to operate a hospital facility the transfer
of control or ownership may be made with or without the payment of a
purchase price by the transferee and otherwise upon such terms and
conditions as the parties may mutually agree, but if the transfer be
to a community nonprofit corporation, the board of supervisors shall
comply with all other provisions of law relating to the sale, lease,
or transfer of public property by a county; and provided that in any
event the transaction shall include such terms and conditions as the
board of supervisors find necessary to insure that the transfer will
constitute an ongoing material benefit to the county and its
residents.
The intent of this section is to permit the implementation of
programs for the consolidation of public hospital services in order
to permit the more effective use of existing hospital facilities and
retard the spiraling costs of medical care.
14000.3. To the extent permitted by federal law, the director may
enter into contracts with the Secretary of Health, Education, and
Welfare to obtain or provide fiscal intermediary services for all
persons who are receiving benefits under this chapter, who are also
recipients of benefits under Title XVIII of the Social Security Act.
14000.4. This chapter shall be known and may be cited as the
"Medi-Cal Act."
14000.5. On a regional pilot project basis, to the extent
authorized by law, the director may enter into contracts with one or
more nonprofit organizations to perform the functions of the
department's Office of the Ombudsman. These activities may include
outreach, community education and training about health care consumer
rights and responsibilities, including the production and
distribution of consumer-oriented material, individual consumer
assistance, including counseling, advice, assistance, education,
advocacy, and referral as appropriate, establishing and operating a
database to analyze the nature of the inquiries and requests for
assistance, and training of department or county staff. These
services may be made available to any person who may be eligible for
or is receiving benefits under this chapter. Funds appropriated in
the annual Budget Act for the support of the Office of the Ombudsman
may be allocated for this purpose.
14001. Health care as administered under this chapter shall be
considered a component of public social services.
14001.1. It is the intention of the Legislature, whenever feasible,
that the needs of categorically needy persons for health care and
related remedial or preventive services be met under the provisions
of this chapter.
14001.11. (a) The department shall implement the federal
requirements described in Section 1396u-5 of Title 42 of the United
States Code.
(b) In each of the several counties of the state, the eligibility
and enrollment functions required under Section 1396u-5(a)(2) and (3)
of Title 42 of the United States Code, which may include, but are
not limited to, determining eligibility and offering enrollment for
premium and cost sharing subsidies made available under and in
accordance with Section 1395w-114 of Title 42 of the United States
Code, shall be a county function and responsibility, subject to the
direction, authority, and regulations of the department. The
department shall request input from the counties as to the potential
cost of implementing these provisions, and shall consider that input
in developing the budget.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, or make specific this section by
means of all county letters, provider bulletins, or similar
instructions, with input from the counties. Thereafter, the
department may adopt regulations in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of the
Government Code.
(d) The department shall seek approval of any amendments to the
state plan, necessary to implement this section, for purposes of
federal financial participation under Title XIX of the Social
Security Act (42 U.S.C. Sec. 1396 et seq.). Notwithstanding any other
law and only when all necessary federal approvals have been
obtained, this section, with the exception of the Phased-Down State
Contribution, as described in subparagraphs (A) to (C), inclusive, of
paragraph (1) of subdivision (c) of Section 1396u-5 of Title 42 of
the United States Code, shall be implemented only to the extent
federal financial participation is available.
14002. Health care granted under the provisions of this chapter is
held subject to the provisions of any law hereafter enacted amending,
repealing, or supplementing in whole or in part the provisions of
this chapter, and subject to the rules and regulations of the
department. No recipient of health care under this chapter shall have
any claim for compensation or otherwise because his service is
affected in any way by any such amending, repealing, or supplemental
act, or by any such rule or regulation or by any addition, amendment,
or repeal of such rules or regulations.
14002.5. For the purposes of this article, the following
definitions shall apply:
(a) "Annuity" means a contract that names an annuitant and gives a
person or entity the right to receive periodic payments of a fixed
or variable sum for a described period of time, which may include a
lump-sum payment or periodic payments upon the death of the
annuitant.
(b) "Community spouse" means the spouse of an institutionalized
spouse.
(c) "Home and facility care" means the following services that are
subject to Medi-Cal reimbursement:
(1) Nursing facility care services.
(2) A level of care in any institution equivalent to that of
nursing facility care services.
(3) Home- or community-based care services furnished under a
waiver granted pursuant to subsection (c) or (d) of Section 1396n of
Title 42 of the United States Code.
(d) "Institutionalized spouse" means any individual to whom all of
the following apply:
(1) The individual is in a medical institution or nursing facility
or is a person who is receiving institutional or noninstitutional
services from an organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590), and is likely to meet that requirement for at least 30
consecutive days.
(2) The individual is married to a spouse who is not in a medical
institution or nursing facility, or to a spouse who is not receiving
services from any organization with a frail elderly demonstration
project waiver pursuant to Chapter 8.75 (commencing with Section
14590).
(3) Except for purposes of Sections 14005.7, 14005.12, 14005.16,
and 14005.17, an individual who is admitted to a medical institution
or nursing facility on or after September 30, 1989, and who applies
for Medi-Cal benefits on or after January 1, 1990, or a Medi-Cal
recipient who is admitted to a medical institution or nursing
facility on or after January 1, 1990.
(e) "Medical institution" has the same meaning as defined in
Section 435.1010 of Title 42 of the Code of Federal Regulations.
(f) "Nursing facility" has the same meaning as defined in Section
1250 of the Health and Safety Code.
14003. The Governor may enter into and execute in behalf of the
state all necessary agreements in connection with this chapter as may
be required by the United States government.
14004. If any individual in good faith adheres to the teachings of
any bona fide church, sect, denomination, or organization, and in
accordance with its principles depends for healing entirely upon
prayer or spiritual means, no medical examination shall be required
to receive health care authorized by this chapter, but in lieu
thereof the certificate of a practitioner of such bona fide sect,
denomination, or organization approved and authorized by the
department, shall be accepted as to the need of such individual for
service. No rule or regulation shall be adopted or continued in force
which discriminates against such an individual.
14005. (a) The health care benefits and services specified in this
chapter, to the extent that such services are neither provided under
any other federal or state law nor provided nor available under other
contractual or legal entitlements of the person, shall be provided
under this chapter to any person who is a resident of this state and
is made eligible by the provisions of this article. It is the intent
of the Legislature that a provider shall look to such other
contractual or legal entitlements for payment before submitting a
bill for payment under this chapter.
(b) Any applicant for, or recipient of, Medi-Cal benefits who
requests medical assistance for home and facility care shall meet the
specific eligibility requirements for the receipt of medical
assistance for home and facility care set forth in this chapter.
(c) This section shall be implemented pursuant to the requirements
of Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.), and any regulations adopted pursuant to that act, and only
to the extent that federal financial participation is available.
(d) To the extent that regulations are necessary to implement this
section, the department shall promulgate regulations using the
nonemergency regulatory process described in Article 5 (commencing
with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of the
Government Code.
(e) It is the intent of the Legislature that the provisions of
this section shall apply prospectively to any individual to whom the
act applies commencing from the date regulations adopted pursuant to
this act are filed with the Secretary of State.
14005.1. Except for adults receiving aid pursuant to Chapter 2
(commencing with Section 11200) and for whom federal financial
participation would not be obtainable for their medical costs under
Title XIX of the federal Social Security Act, categorically needy
persons are eligible for health care services under Section 14005.
Eligibility for health care services under Section 14005 shall
continue for four calendar months beginning with the month in which a
family becomes ineligible for benefits under the Aid to Families
with Dependent Children program, if all of the following apply:
(a) The ineligibility is due wholly or partly to the collection or
increased collection of child or spousal support pursuant to Article
7 (commencing with Section 11475) of Chapter 2.
(b) The family has received benefits under the Aid to Families
with Dependent Children program in at least three of the six months
immediately preceding the month in which ineligibility begins.
(c) Ineligibility occurred after October 1, 1984, and before
October 1, 1988.
14005.2. Unless otherwise specified in this chapter, the
eligibility of a person eligible under the Cuban-Haitian Entrant
Program or the Refugee Resettlement Program for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person, except for those criteria that establish categorical
relatedness, and only as long as federal funds are available. Victims
of trafficking, domestic violence, and other serious crimes, as
defined in subdivision (b) of Section 18945, shall be eligible for
these services to the same extent as individuals who are admitted to
the United States as a refugee under Section 1157 of Title 8 of the
United States Code. Services under this subdivision shall be paid
from state funds to the extent federal funding is unavailable.
14005.3. (a) Notwithstanding any other provision of this chapter,
any person who:
(1) Was once determined to be disabled in accordance with
Section 1614 of Part A of Title XVI of the Social Security Act
(Section 1382c, Title 42, United States Code), and
(2) Became ineligible for benefits pursuant to Section 1614 of
Part A of Title XVI of the Social Security Act (Section 1382c, Title
42, United States Code) because the person engaged in substantial
gainful activity, and
(3) Continues to suffer from the physical or mental impairments
which were the basis of the disability determination required under
paragraph (1),
shall be considered to be disabled, for the purposes of this
chapter, even though such person is engaged in substantial gainful
activity. Regardless of whether such person has excess income
pursuant to Sections 14005.12 and 14005.13, such person shall be
eligible to receive health care benefits and services under this
chapter if his or her income does not exceed the maximum income
eligibility limits for benefits under Part A of Title XVI of the
Social Security Act. Any such person whose income exceeds the maximum
income eligibility limits for benefits under Part A of Title XVI of
the Social Security Act shall be eligible under Sections 14005.4 and
14052 for health care benefits and services under this chapter,
provided, that the income levels for maintenance in Section 14005.12
for such person shall be the maximum income eligibility limits for
benefits under Part A of Title XVI of the Social Security Act and
provided, that his or her nonexempt income in excess of that maximum
is used to pay his or her share of costs.
(b) For purposes of this section, "substantial gainful activity"
means work activity considered to be substantial gainful activity
under applicable federal regulations adopted pursuant to Section 1614
of Part A of Title XVI of the Social Security Act.
(c) The determination of continued impairments and the need for
health care benefits and services shall be supported by medical
reports when requested. Such reports shall be provided at the expense
of the department.
14005.4. Unless otherwise specified in this chapter, the
eligibility of a state-only Medi-Cal person for health care services
under Section 14005 shall be determined by applying the same income
and resource methodologies and standards and all other eligibility
criteria established pursuant to this chapter that are applied by the
department in determining the eligibility of a medically needy
family person except for those criteria that establish categorical
relatedness.
14005.5. (a) In determining eligibility pursuant to Section 14005.4
or 14005.7, reparation or restitution payments received by victims
of the Nazi persecution from the Federal Republic of Germany pursuant
to the Federal Law on the Compensation of Victims of the National
Socialist Persecution (Federal Compensation Law), as enacted by that
government on June 29, 1956, shall not be deemed as available income,
nor shall any accumulation of those payments be considered an
available resource, to the extent that the funds are not spent and
are kept identifiable.
(b) The director shall seek federal waivers from the Secretary of
the United States Department of Health and Human Services, in order
to ensure federal financial participation. In the event of an initial
determination by the Secretary of the United States Department of
Health and Human Services that any provision of this section is in
conflict with any federal statute or regulation, the department shall
take all available and necessary steps to obtain a final
determination reversing that decision. In the event that a final
determination is made which finds a conflict with federal law, the
director shall immediately request the Attorney General to seek
judicial review of the determination, and the director shall notify
the appropriate policy and fiscal committees of both houses of the
Legislature of its request. Notwithstanding the outcome of the
director's efforts to obtain waivers under this subdivision, or a
final judicial decision holding that any provision of this section is
in conflict with federal law, subdivision (a) shall be implemented
on July 1, 1985, or the date upon which waivers are obtained under
this subdivision, whichever is earlier. Failure to obtain waivers
pursuant to this subdivision shall not affect implementation of
subdivision (a).
14005.6. (a) The Legislature finds and declares as follows:
(1) Under federal law, minors living at home with their families
may not be eligible for the SSI and Medicaid programs.
(2) Under the Federal Budget Reconciliation Act of 1981, however,
states may apply for a Section 1915(c) waiver to allow a person to be
eligible for SSI and Medicaid when medical and social services
provided in the home can be shown to be less costly than services
provided in an institution.
(3) Whenever possible, medical and social services should be
provided in the least restrictive setting and at the lowest cost to
the programs involved.
(4) The State Department of Health Services has already
successfully applied for the Section 1915(c) waiver as applied to
certain defined populations of developmentally disabled, elderly, and
medically acute clients.
(b) The State Director of Health Services shall apply for
additional waivers when appropriate to expand the number and types of
persons who will be eligible for in-home services.
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, 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), 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).
(ii) If the deduction specified in paragraph (1) is applicable to
the individual, an amount, not to exceed the amount by which the SSI
recipient retention amount exceeds twenty dollars ($20), nor to be
less than zero, by which the sum of the amount which the individual
pays to his or her 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).
(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).
14005.75. A person who is otherwise eligible for Medi-Cal benefits
under either Section 14005.4 or 14005.7, except for income and
resource eligibility, and who is receiving Medi-Cal services for the
treatment of multiple sclerosis, shall continue to be eligible to
receive benefits only for these services under Medi-Cal, provided
that all other conditions of eligibility for the Medi-Cal program are
met. These restricted benefits shall continue until such time as the
person is eligible for, and receives, third party coverage for these
treatments. However, restricted benefits under this section shall
not continue for more than two years.
14005.75. (a) The Legislature finds and declares all of the
following:
(1) As a result of federal welfare reform, unprecedented numbers
of welfare recipients will be leaving welfare for work, and will face
time limits on the receipt of aid.
(2) It is in the interest of the state both to encourage welfare
recipients to seek employment and to ensure the continuity of health
coverage for these recipients as they move from welfare to work.
(3) California's transitional Medi-Cal program is intended to
encourage welfare recipients to seek employment and to ensure
continuity of health coverage, but various procedural restrictions
limit its effectiveness in achieving those goals.
(b) It is, therefore, the intent of the Legislature to streamline
the transitional Medi-Cal program in order to maximize its
effectiveness in assisting persons leaving welfare for work.
14005.76. (a) The department shall provide a Medi-Cal beneficiary
whose Medi-Cal eligibility is established pursuant to Section 1930 of
the federal Social Security Act (42 U.S.C. Sec. 1396u-1) with simple
and clear written notice of the availability of the transitional
Medi-Cal program and the requirements for that program. This notice
shall be provided at the time that Medi-Cal eligibility is conferred
to the beneficiary and at least once every six months thereafter.
(b) When a beneficiary loses Medi-Cal eligibility established
pursuant to Section 1930 of the federal Social Security Act (42
U.S.C. Sec. 1396u-1) for failure to meet reporting requirements, the
department shall provide the beneficiary with the notice described in
subdivision (a), and a form with simple and clear instructions on
how to complete and return the form to the county. The form shall be
used to determine whether the beneficiary is eligible for the
transitional Medi-Cal program.
(c) The notice and form described in subdivisions (a) and (b)
shall be prepared by the department. The department shall seek input
on the notice and form from beneficiaries of aid, beneficiary
representatives, and counties.
(d) The department shall review, and if necessary for simplicity
and clarity, revise the notice required by subdivision (b) of Section
14005.8 and Section 14005.81. The department shall seek input from
beneficiaries, beneficiary representatives, and counties.
(e) Notwithstanding any other provision of law, this section shall
become operative nine months after the effective date of this
section.
(f) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.8. (a) (1) To the extent required by Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the United
States Code and regulations adopted pursuant thereto, a family who
was receiving aid pursuant to a state plan approved under Part A of
Subchapter IV (commencing with Section 601) of Title 42 of the United
States Code in at least three of the six months immediately
preceding the month in which that family became ineligible for that
assistance due to increased hours of employment, income from
employment, or the loss of earned income disregards, shall remain
eligible for health care services as provided in this chapter during
the immediately succeeding six-month period.
(2) The department shall terminate extensions of health care
services authorized by paragraph (1) as required under federal law.
(b) The department shall notify persons eligible under subdivision
(a) of their right to continued health care services for each
six-month period and a description of their reporting requirement,
and the circumstances under which the extension may be terminated.
The notice shall also include a Medi-Cal card or other evidence of
entitlement to those services.
(c) Notwithstanding any other provision of this section, the
department, in conformance with federal law, shall offer
beneficiaries covered under subdivision (a) the option of remaining
eligible for health care services provided in this chapter for an
additional extension period of six months. Health services shall be
continued in as automatic a manner as permitted by federal law, and
without any unnecessary paperwork.
(d) During the initial extension period and any additional
six-month extension period, the department, consistent with federal
law, may, whenever the department determines it to be cost-effective,
elect to pay a family's expenses for premiums, deductibles,
coinsurance, or similar costs for health insurance or other health
coverage offered by an employer of the caretaker relative or by an
employer of the absent parent of the dependent child. If, during the
additional six-month extension period, the department elects to pay
health premiums and this coverage exists, the beneficiary may be
given the opportunity to express his or her preference between
continuing the Medi-Cal coverage or obtaining health insurance.
(e) During the additional six-month extension period, the
department may impose a premium for the health insurance or other
health coverage consistent with Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) if the department
determines that the imposition of a premium is cost-effective.
(f) The department shall adopt emergency regulations in order to
comply with mandatory provisions of Title XIX of the federal Social
Security Act (42 U.S.C. Sec. 1396 et seq.) for extension of medical
assistance. These regulations shall become effective immediately upon
filing with the Secretary of State.
(g) This section shall become operative April 1, 1990.
14005.84. (a) The department shall develop and conduct a community
outreach and education campaign to assist persons whose Medi-Cal
eligibility is established pursuant to Section 1931 of the federal
Social Security Act (42 U.S.C. Sec. 1396u-1), to learn about the
availability of the transitional Medi-Cal program.
(b) Any managed care plan, local initiative, or county organized
health system contracting with the department to provide services to
Medi-Cal enrollees shall include in its evidence of coverage and
marketing materials information about the transitional Medi-Cal
program and how to apply for program benefits.
(c) To implement this section, the department may develop and
execute a contract or may amend any existing or future outreach
campaign contract that it has executed. Notwithstanding any other
provision of law, any such contract developed and executed, or
amended, as required to implement this section shall be exempt from
the approval of the Director of General Services and from the Public
Contract Code.
(d) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.85. (a) Families who, because of marriage or because
separated spouses reunite, lose AFDC eligibility under the chapter
because the family no longer meets the need requirement specified in
Section 11250 or has increased assets or income, or both, shall be
eligible for extended medical benefits as specified under this
article for a period not to exceed 12 months.
(b) The department shall seek all federal waivers necessary to
implement this section.
(c) This section shall not be implemented until the director has
executed a declaration, that shall be retained by the director, that
any necessary waivers and federal financial participation have been
obtained.
14005.88. (a) The department shall contract for an independent
evaluation, to be completed no later than January 1, 2001, in order
to determine the effect of changes made in the transitional Medi-Cal
program by the enactment of Sections 14005.76, 14005.82, 14005.83,
14005.84, 14005.87, 14005.89, and the amendment to Section 14005.85
enacted during the first year of the 1997-98 Regular Session of the
Legislature, on the employment of welfare recipients and the
continuity of their health coverage.
(b) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et
seq.), is available.
14005.89. (a) The department shall monitor participation rates for
transitional Medi-Cal and seek input from beneficiaries, beneficiary
representatives, and counties, on a regular basis throughout each
year to consider changes in transitional Medi-Cal procedures as may
be necessary to ensure that participation rates are at levels that
would reasonably be expected, given aid caseload developments. Before
any such changes are made, the department shall seek any federal
waivers, or obtain other federal approval, that may be necessary to
implement the changes.
(b) The department shall make the participation rate monitoring
data described in subdivision (a) available upon request.
14005.9. (a) Share of cost shall be determined on a monthly basis.
No person or family shall be required to incur more than one month's
share of cost prior to being certified as specified in Section 14018.
(b) For persons in long-term care, any income exempted under
Sections 14005.4 and 14005.7 shall be considered in the share-of-cost
determination to the extent required by federal law or regulations.
(c) Once the beneficiary has incurred expenses for Medicare and
other health insurance deductibles or coinsurance charges and
necessary medical and remedial services that are not subject to
payment by a third party and which equal or exceed his or her share
of cost, the individual is entitled to receive health care services
pursuant to Section 14005 if all other applicable conditions of
eligibility under this chapter are met.
14005.10. For purposes of facilitating arrangements for health care
through prepaid health plans, the department may set standards for
determining monthly income, for purposes of eligibility, on the
person's average pattern of income and earnings, subject to
subsequent adjustment if actual experience deviates substantially
from the amount determined by such method.
14005.11. (a) To the extent required by federal law for qualified
Medicare beneficiaries, the department shall pay the premiums,
deductibles, and coinsurance for elderly and disabled persons
entitled to benefits under Title XVIII of the federal Social Security
Act, whose income does not exceed the federal poverty level and
whose resources do not exceed 200 percent of the Supplemental
Security Income program standard.
(b) The department shall, in addition to subdivision (a), pay
applicable additional premiums, deductibles, and coinsurance for drug
coverage extended to qualified Medicare beneficiaries.
(c) The deductible payments required by subdivision (b) may be
covered by providing the same drug coverage as offered to
categorically needy recipients, as defined in Section 14050.1.
(d) As specified in this section, it is the intent of the
Legislature to assist in the payment of Medicare Part B premiums for
qualified low-income Medi-Cal beneficiaries who are ineligible for
federal sharing or federal contribution for the payment of those
premiums.
(e) For a Medi-Cal beneficiary who has a share of cost but who is
ineligible for the assistance provided pursuant to subdivision (a),
or who is ineligible for any other federally funded assistance for
the payment of the beneficiary's Medicare Part B premium, the
department shall pay for the beneficiary's Medicare Part B premium in
the month following each month that the beneficiary's share of cost
has been met.
(f) When a county is informed that an applicant or beneficiary is
eligible for Medicare benefits, the county shall determine whether
that individual is eligible under the Qualified Medicare Beneficiary
(QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB)
program, or the Qualifying Individual program and enroll the
applicant or beneficiary in the appropriate program.
14005.12. (a) For the purposes of Sections 14005.4 and 14005.7, the
department shall 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. It is the intent of the
Legislature that the income levels for maintenance need for medically
needy aged, blind, and disabled adults, in particular, shall be
based upon amounts that adequately reflect their needs.
(1) Subject to paragraph (2), reductions in the maximum aid
payment levels set forth in subdivision (a) of Section 11450 in the
1991-92 fiscal year, and thereafter, shall not result in a reduction
in the income levels for maintenance under this section.
(2) (A) The department shall seek any necessary federal
authorization for maintaining the income levels for maintenance at
the levels in effect June 30, 1991.
(B) If federal authorization is not obtained, medically needy
persons shall not be required to pay the difference between the share
of cost as determined based on the payment levels in effect on June
30, 1991, under Section 11450, and the share of cost as determined
based on the payment levels in effect on July 1, 1991, and
thereafter.
(3) Any medically needy person who was eligible for benefits under
this chapter as categorically needy for the calendar month
immediately preceding the effective date of the reductions in the
minimum basic standards of adequate care for the Aid to Families with
Dependent Children program as set forth in Section 11452.018 made in
the 1995-96 Regular Session of the Legislature shall not be
responsible for paying his or her share of cost if all of the
following apply:
(A) He or she had eligibility as categorically needy terminated by
the reductions in the minimum basic standards of adequate care.
(B) He or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter as categorically
needy.
(C) He or she is not eligible to receive benefits without a share
of cost as a medically needy person pursuant to paragraph (1) or (2).
(b) In the case of a single individual, the amount of the income
level for maintenance per month shall be 80 percent of the highest
amount that would ordinarily be paid to a family of two persons,
without any income or resources, under subdivision (a) of Section
11450, multiplied by the federal financial participation rate.
(c) In the case of a family of two adults, the income level for
maintenance per month shall be the highest amount that would
ordinarily be paid to a family of three persons without income or
resources under subdivision (a) of Section 11450, multiplied by the
federal financial participation rate.
(d) For the purposes of Sections 14005.4 and 14005.7, for a person
in a medical institution or nursing facility, or for a person
receiving institutional or noninstitutional services from an
organization with a frail elderly demonstration project waiver
pursuant to Chapter 8.75 (commencing with Section 14590), the amount
considered as required for maintenance per month shall be computed in
accordance with, and for those purposes required by, Title XIX of
the federal Social Security Act, and regulations adopted pursuant
thereto. Those amounts shall be computed pursuant to regulations
which include providing for the following purposes:
(1) Personal and incidental needs in the amount of not less than
thirty-five dollars ($35) per month while a patient. The department
may, by regulation, increase this amount as necessitated by
increasing costs of personal and incidental needs. A long-term health
care facility shall not charge an individual for the laundry
services or periodic hair care specified in Section 14110.4.
(2) The upkeep and maintenance of the home.
(3) The support and care of his or her minor children, or any
disabled relative for whose support he or she has contributed
regularly, if there is no community spouse.
(4) If the person is an institutionalized spouse, for the support
and care of his or her community spouse, minor or dependent children,
dependent parents, or dependent siblings of either spouse, provided
the individuals are residing with the community spouse.
(5) The community spouse monthly income allowance shall be
established at the maximum amount permitted in accordance with
Section 1924(d)(1)(B) of Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396r-5(d)(1)(B)).
(6) The family allowance for each family member residing with the
community spouse shall be computed in accordance with the formula
established in Section 1924(d)(1)(C) of Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396r-5(d)(1)(C)).
(e) For the purposes of Sections 14005.4 and 14005.7, with regard
to a person in a licensed community care facility, the amount
considered as required for maintenance per month shall be computed
pursuant to regulations adopted by the department which provide for
the support and care of his or her spouse, minor children, or any
disabled relative for whose support he or she has contributed
regularly.
(f) The income levels for maintenance per month, except as
specified in subdivisions (b) to (d), inclusive, shall be equal to
the highest amounts that would ordinarily be paid to a family of the
same size without any income or resources under subdivision (a) of
Section 11450, multiplied by the federal financial participation
rate.
(g) The "federal financial participation rate," as used in this
section, shall mean 133 1/3 percent, or such other rate set forth in
Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396
(b)), or its successor provisions.
(h) The income levels for maintenance per month shall not be
decreased to reflect the presence in the household of persons
receiving forms of aid other than Medi-Cal.
(i) When family members maintain separate residences, but
eligibility is determined as a single unit under Section 14008, the
income levels for maintenance per month shall be established for each
household in accordance with subdivisions (b) to (h), inclusive. The
total of these levels shall be the level for the single eligibility
unit.
(j) The income levels for maintenance per month established
pursuant to subdivisions (b) to (i), inclusive, shall be calculated
on an annual basis, rounded to the next higher multiple of one
hundred dollars ($100), and then prorated.
14005.13. (a) Notwithstanding Section 14005.12, when an individual
residing in a long-term care facility would incur a share of cost for
services under this chapter due to income which exceeds that allowed
for the incidental and personal needs of the individual, a specified
portion of the individual's earned income from therapeutic wages
shall be exempt. Therapeutic wages are wages earned by the individual
under all of the following conditions:
(1) A physician who does not have a financial interest in the
long-term care facility in which the individual resides, and who is
in charge of the individual's case prescribes work as therapy for the
individual.
(2) The individual must be employed within the same long-term care
facility where he or she resides.
(3) The individual's employment does not displace any existing
employees.
(4) The individual has resided in a long-term care facility for a
continuous period commencing at least five years prior to the date of
the addition of this section as originally adopted during the
1983-84 Regular Session.
(b) The amount of earned income from therapeutic wages which shall
be exempt shall be the lesser of 70 percent of the gross therapeutic
wages or 70 percent of the maintenance level for a
noninstitutionalized person or family of corresponding size as
described in subdivision (b), (c), or (e) of Section 14005.12.
(c) The provisions of this section shall be given retroactive
effect for the period commencing June 1, 1983.
(d) This section shall not become operative unless and until the
necessary waivers are obtained from the United States Department of
Health and Human Services.
(e) The director shall adopt regulations implementing this section
as emergency regulations in accordance with Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code. For the purposes of the Administrative Procedure
Act, the adoption of the regulations shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare. Notwithstanding Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, emergency regulations adopted by the
department in order to implement this section shall not be subject to
the review and approval of the Office of Administrative Law. These
regulations shall become effective immediately upon filing with the
Secretary of State.
14005.14. (a) In addition to the income exemptions specified in
subdivision (a) of Section 14005.7, an income exemption shall be
allowed each month for the amount actually paid toward the cost of
in-home supportive services needed as determined under standards and
procedures established by the Director of Social Services, by a
person who is eligible for Medi-Cal in accordance with Section 14005.
3 or 14005.7. For the purpose of this section, "in-home supportive
services" means those services that are available to recipients of
the In-Home Supportive Services Program as defined by the Director of
Social Services in regulations adopted pursuant to Article 7
(commencing with Section 12300) of Chapter 3 of Part 3 of Division 9.
(b) The income exemption provided by this section for those
persons eligible for Medi-Cal in accordance with Section 14005.7
shall be restricted to those persons who, without in-home supportive
services, would require 24-hour-a-day care in a health facility, as
defined in Section 1250 of the Health and Safety Code, or a community
care facility, as defined under Section 1502 of the Health and
Safety Code.
(c) The State Department of Health Services shall seek all federal
waivers necessary to allow for federal financial participation. The
income exemption authorized by subdivision (b) shall remain in effect
during the time period that the federal waivers are pending. If the
necessary federal waivers cannot be obtained, the income exemption
authorized by subdivision (b) shall continue to be implemented by the
department.
14005.15. Notwithstanding the provisions of Section 14005, Medi-Cal
beneficiaries shall obtain family planning services through the
Medi-Cal program to the extent they are available through such
program.
14005.16. (a) In determining the eligibility of a married
individual pursuant to Section 14005.4 or 14005.7, who resides in a
nursing facility, and who is in a Medi-Cal family budget unit
separate from that of his or her spouse, the community property
interest of the noninstitutionalized spouse in the income of the
married individual shall not be considered income available to that
individual.
(b) For purposes of this section, there shall be a presumption,
rebuttable by either spouse, that each spouse has a community
property interest in one-half of the total monthly income of both
spouses.
(c) (1) This section shall not become operative unless Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
laws in determining eligibility or the federal government authorizes
the state to apply community property laws in that determination.
(2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or the receipt of federal approval, as specified in paragraph (1).
14005.17. (a) In determining the eligibility of an
institutionalized spouse pursuant to Section 14005.4 or 14005.7, who
resides in a medical institution or nursing facility, and who is in a
Medi-Cal family budget unit separate from that of his or her spouse,
the community property interest of either spouse in the income of
the other spouse shall not be considered when determining eligibility
for Medi-Cal benefits.
(b) In the case of an institutionalized spouse, income shall be
determined in accordance with subsections (b) and (d) of Section 1924
of the federal Social Security Act and regulations adopted pursuant
thereto.
(c) (1) This section shall remain operative only until Title XIX
of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is
amended to authorize the consideration of state community property
law in determining eligibility under this chapter, or the federal
government authorizes the consideration of state community property
in that determination.
(2) The department shall report to the appropriate committees of
the Legislature upon the occurrence of the amendment of federal law
or receipt of federal authorization as specified in paragraph (1).
14005.18. A woman is eligible, to the extent required by federal
law, as though she were pregnant, for all pregnancy-related and
postpartum services for a 60-day period beginning on the last day of
pregnancy.
For purposes of this section, "postpartum services" means those
services provided after childbirth, child delivery, or miscarriage.
14005.19. The receipt of respite care, as defined in Section 1418.1
of the Health and Safety Code, shall not affect the eligibility of
any individual with respect to benefits under this chapter, except as
subject to the limitations of subdivision (b) of Section 14124.7.
14005.20. (a) The State Department of Health Services shall adopt
the option made available under Section 13603 of the federal Omnibus
Budget Reconciliation Act of 1993 (Public Law 103-66) to pay
allowable tuberculosis related services for persons infected with
tuberculosis.
(b) The income and resources of these persons may not exceed the
maximum amount for a disabled person as described in Section 1902(a)
(10)(A)(i) of Title XIX of the federal Social Security Act (42 U.S.C.
Sec. 1396a(a)(10)(A)(i)).
14005.21. (a) Any medically needy aged, blind, or disabled person
who was categorically needy under this chapter on the basis of
eligibility under Chapter 3 (commencing with Section 12000) or
Subchapter 16 (commencing with Section 1381) of Chapter 7 of Title 42
of the United States Code for the month of August 1993, and was
discontinued as of September 1, 1993, and who, but for the addition
of Section 12200.015, would be eligible to receive benefits without a
share of cost in September 1993 under this chapter, shall remain
eligible to receive benefits without a share of cost under this
chapter as if that person were categorically needy as long as he or
she meets other applicable requirements.
(b) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy or
medically needy under subdivision (a) for the month of August 1994,
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the addition of Section 12200.017, and
if he or she, but for Section 12200.017, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(c) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivision (a) or (b), for the calendar
month immediately preceding the date that the reductions in maximum
aid payments for the state supplementary program established in
Chapter 3 (commencing with Section 12000) of Part 3 of Division 9
made in the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for the reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(d) Any medically needy aged, blind, or disabled person who was
eligible for benefits under this chapter as categorically needy, or
as medically needy under subdivisions (a), (b), or (c) for the
calendar month immediately preceding the date that the reductions in
maximum aid payments for the state supplementary program established
in Chapter 3 (commencing with Section 12000) made in the 1996 portion
of the 1995-96 Regular Session of the Legislature are effective
shall not be responsible for paying his or her share of cost if he or
she had that eligibility for benefits without a share of cost
interrupted or terminated by the reductions in maximum aid payments,
and if he or she, but for these reductions, would be eligible to
continue receiving benefits under this chapter without a share of
cost.
(e) The department shall implement this section regardless of the
availability of federal financial participation for the share of cost
paid from state funds pursuant to subdivisions (a), (b), (c), and
(d).
14005.23. To the extent federal financial participation is
available, the department shall, when determining eligibility for
children under Section 1396a(l)(1)(D) of Title 42 of the United
States Code, designate a birth date by which all children who have
not attained the age of 19 years will meet the age requirement of
Section 1396a(l)(1)(D) of Title 42 of the United States Code.
14005.24. The department shall instruct counties, by means of an
all county letter or similar instruction, as to the process that is
to be used to ensure that each child, physical custody of whom has
been voluntarily surrendered pursuant to Section 1255.7 of the Health
and Safety Code, shall be determined eligible for benefits under
this chapter for, at a minimum, a period of time commencing on the
date physical custody is surrendered and ending on the earliest of
the following dates:
(a) The last day of the month following the month in which the
child was voluntarily surrendered under Section 1255.7 of the Health
and Safety Code.
(b) The date the child is reclaimed under Section 1255.7 of the
Health and Safety Code.
(c) The date the child ceases to reside in California.
14005.25. (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger. A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
(1) The end of a 12-month period following the eligibility
determination.
(2) The date the individual exceeds the age of 19 years.
(b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
14005.28. (a) To the extent federal financial participation is
available pursuant to an approved state plan amendment, the
department shall exercise its option under Section 1902(a)(10)(A)(XV)
of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)
(XV)) to extend Medi-Cal benefits to independent foster care
adolescents, as defined in Section 1905(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396d(v)(1)).
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, and if the
state plan amendment described in subdivision (a) is approved by the
federal Health Care Financing Administration, the department may
implement subdivision (a) without taking any regulatory action and by
means of all-county letters or similar instructions. Thereafter, the
department shall adopt regulations in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
(c) The department shall implement subdivision (a) on October 1,
2000, but only if, and to the extent that, the department has
obtained all necessary federal approvals.
14005.29. To the extent that federal matching funds are available,
disabled persons who are otherwise eligible for benefits under this
chapter, except for income due to employment, shall continue to be
eligible to receive benefits for conditions excluded from coverage by
a private insurer, provided those persons' incomes do not exceed 200
percent of the income level for maintenance established pursuant to
Section 14005.12.
14005.30. (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) made available to and exercised by the
state.
(2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
(3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u-1(b)(2)
(C) of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012. The department shall
implement this paragraph only if, and to the extent that the State
Child Health Insurance Program waiver described in Section 12693.755
of the Insurance Code extending Healthy Families Program eligibility
to parents and certain other adults is approved and implemented.
(b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to expand eligibility for Medi-Cal under subdivision (a) by
establishing the amount of countable resources individuals or
families are allowed to retain at the same amount medically needy
individuals and families are allowed to retain, except that a family
of one shall be allowed to retain countable resources in the amount
of three thousand dollars ($3,000).
(c) To the extent federal financial participation is available,
the department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1) and the amount
equal to 100 percent of the federal poverty level applicable to the
size of the family. A recipient shall be entitled to the same
disr
