Friday, March 28, 2014


Update: New similar legislation was just passed! See here fore more information. 



For those of you who have been following my posts about Medi-Cal, you know that I put out an alert that going on Medi-Cal under Covered California could lead to the loss of your family home if you are over 55 years old. This is new news to for the many people who have just qualified for Medi-Cal because of the expanded program (Thanks Obama!), but as my post on Medi-Cal recovery explains, it is old news for everyone who has been dealing with the fact that Medi-Cal is a LOAN, not a public service, once you hit 55 (or if you are unlucky enough to fall in any of the other recovery categories).

But California State Senator Hernandez introduced a bill yesterday (SB1124 for you code lovers) that goes a long way to address the fundamental unfairness of forcing very poor people ages 55-65 to pay for their health care with their homes while everyone else, from birth to death, is now eligible for either subsidized health insurance or (for those over 65) medicare.

SB 1124 isn’t perfect, but it would allow thousands of older, low-income Medi-Cal beneficiaries to be relieved of the worry about losing their family homes.

Here is a quick overview of SB 1124:

• Limits recovery for those 55+ to what is required by federal law – e.g. nursing facility, home and community based services and related hospital and prescription drug services. In addition to these required categories, federal law also allows optional recovery, which California currently enjoys.  California collects forALL medical care received for people 55 and older.  Therefore, the state can recover up to the total amount spent for Medi-Cal services including the total capitation paid to a health plan on behalf of the beneficiary –- even if the beneficiary never actually used the care.  So, limiting recovery to only the mandatory categories will effect a large portion of Medi-Cal recipients.   

• Eliminates recovery from the estate of a surviving spouse of a deceased Medi-Cal beneficiary;

• Restricts recovery amount to benefits paid for services actually received or capitated monthly rate, whichever is less;

• Requires DHCS to provide claims detail information free of charge to Medi-Cal beneficiaries or their representatives via phone, internet, mail, in person or other means, and requires the Department to post information on their web site the methods by which a consumer or his/her representative can request claims detail information.

The first hearing on SB 1124 is tentatively set for April 9 in the Senate Health Committee – send letters of support by Wednesday April 2nd, to Senator Ed Hernandez, Chair, Senate Health Committee via FAX: (916) 324-0384.

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