Reinstate Medi-Cal Asset Limit (Proposed Trailer Bill Amendments)
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Proposed amendments to reinstate or set resource limits for non‑MAGI Medi‑Cal eligibility, require federal approvals and systems readiness before implementation, mandate quarterly reporting on eligibility losses due to asset limits, and expand state payment of Medicare premiums/deductibles/coinsurance including pursuing a Medicare Part A buy‑in; affects counties, DHCS systems, and non‑MAGI beneficiaries.
Department shall seek federal approval to implement a disregard of $130,000 in nonexempt property for a one‑member case and $65,000 for each additional household member (up to 10) with implementation not before Jan 1, 2026, conditioned on systems programming and written notification to Department of Finance.
Alternate language establishes resource limits of $2,000 for one‑member households, $3,000 for two‑member households, and $150 per additional member (up to 10), operative no sooner than Jan 1, 2027 with application at first annual redetermination for current beneficiaries.
Department must publish quarterly data on the number of Medi‑Cal enrollees who lost eligibility due to the asset limit and consult stakeholders on data elements including reasons for termination.
Provisions to pay Medicare premiums, deductibles, and coinsurance for qualified Medicare beneficiaries whose income and resources meet specified limits, and to enter into a Medicare Part A buy‑in agreement, with varying operative and repeal dates in different sections.
Medicare Cost Sharing and Eligibility Coverage Criteria
Coverage and implementation criteria
Coverage and implementation conditions for state payment of Medicare cost sharing and related eligibility thresholds are provided below. Conditions include income/resource limits, spend‑down handling, county enrollment responsibilities, and prerequisites for implementation.
ALL of the following
ONE of
- Income does not exceed the federal poverty level and resources do not exceed the amount specified in subdivision (a) of Section 14005.62 (per one draft)
- Income does not exceed the federal poverty level and resources do not exceed 300% of the SSI standard (plus CPI adjustment) as specified in Section 14005.11 (alternate draft)
ALL of the following
- For beneficiaries enrolled as of the operative date, the income/resource rules shall apply beginning with the beneficiary's first annual redetermination on or after the operative date (per alternate draft)
ALL of the following
- If a Medi‑Cal beneficiary has a spend down of excess income but is ineligible for assistance under the primary provision, or ineligible for any other federally funded assistance for Medicare Part B premiums, the department shall pay the beneficiary's Medicare Part B premium in the month following each month that the beneficiary's spend down has been met
ALL of the following
- Department shall also pay applicable additional premiums, deductibles, and coinsurance for drug coverage extended to qualified beneficiaries; deductible payments may be covered by providing the same drug coverage as offered to categorically needy recipients
ALL of the following
- When a county is informed that an applicant or beneficiary is eligible for Medicare, the county shall determine eligibility for the Qualified Medicare Beneficiary, Specified Low‑Income Medicare Beneficiary, or Qualifying Individual programs and enroll the individual in the appropriate program
ALL of the following
- The department shall enter into a Medicare Part A buy‑in agreement by submitting a state plan amendment to CMS with a proposed effective date
- Implementation of coverage provisions is conditioned on federal approval and is to be carried out only to the extent consistent with federal law and available federal financial participation; operative timing is subject to systems programming readiness and any specified operative/repeal dates in the enacted language
ALL of the following
- Department to publish quarterly data on the number of Medi‑Cal enrollees who lost eligibility due to the asset limit and to consult stakeholders on data elements (reporting requirement tied to asset limit provisions)
ALL of the following
ONE of
- Certain draft language conditions implementation not before Jan 1, 2026 with a repeal date (where specified) and subject to systems programming and written notification to the Department of Finance (per one draft)
- Alternate draft establishes operative date no sooner than Jan 1, 2027 with application beginning at first annual redetermination for current beneficiaries (per alternate draft)
Resource Limit Parameters and Alternate Drafts
County Enrollment Obligations and Medicare Part A Buy-In Actions
County must determine Medicare eligibility category and enroll; Department to pursue Medicare Part A buy‑in
When a county is notified that an applicant or beneficiary is eligible for Medicare, the county must determine whether the individual qualifies for the Qualified Medicare Beneficiary (QMB), Specified Low‑Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI) program and enroll the person in the appropriate program. Separately, the Department will seek to enter into a Medicare Part A buy‑in agreement (subject to federal approvals and availability of federal financial participation) by submitting a state plan amendment with a proposed effective date; implementation timing depends on systems readiness and required federal approvals.
- County responsibility: determine eligibility for QMB, SLMB, or QI and enroll eligible applicants/beneficiaries in the appropriate program (chunks 6 and 11).
- Department responsibility: submit a state plan amendment to enter into a Medicare Part A buy‑in agreement; effective date tied to Jan 1, 2025 or later based on systems programming, and implementation only to the extent federal approvals and FFP are available (chunks 6 and 11).
- Timing/conditions: Medicare Part A buy‑in effectiveness is conditioned on the department communicating systems readiness to the Department of Finance; implementation only if necessary federal approvals and federal financial participation are obtained (chunks 6 and 11).
Key Definitions: Non‑MAGI Populations and Part A Buy‑In
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