Residential care facilities for the elderly: assisted living waiver rental rate protection.

Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services, under which qualified low-income persons are provided with health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law provides for the State Supplementary Program for the Aged, Blind and Disabled (SSP), which requires the State Department of Social Services to contract with the United States Secretary of Health and Human Services to make payments to SSP recipients to supplement Supplemental Security Income (SSI) payments made available pursuant to the federal Social Security Act. Under existing regulation, residential facilities for the elderly are prohibited from charging recipients of SSI payments more than a specific set rate for basic services. Existing law requires an individual under these provisions to satisfy certain financial eligibility requirements to be eligible for Medi-Cal, including, among other things, that the individual's countable income does not exceed an income standard equal to a specified amount, plus an income disregard of specified amounts, subject to certain exceptions.

This bill would prohibit a residential care facility for the elderly that is contracted to receive Medi-Cal reimbursement for services provided to a resident enrolled in Medi-Cal from charging that resident a room and board rate exceeding the difference between their income, as defined, and the personal and incidental needs allowance set by the department for recipients of SSI/SSP in nonmedical out-of-home care. By creating a new crime, this bill would impose a state-mandated local program.

This bill would, for the purposes of determining Medi-Cal eligibility, exclude the difference between the resident's income and the rate charged by a residential care facility for the elderly and retained by the resident from countable income. The bill would state that the exclusion does not apply to the portion of the difference retained by the resident that exceeds the personal and incidental needs allowance set by the department for recipients of SSI/SSP in nonmedical out-of-home care. Because counties are required to make Medi-Cal eligibility determinations, and this bill would alter Medi-Cal eligibility by changing the income disregard amounts and would increase the responsibility of counties in determining Medi-Cal eligibility, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.

With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.