AB 414

This bill makes various changes to the Medical Assistance purchase plan

(MAPP) and requires the Department of Health Services (DHS) to exclude certain

types of assets when determining eligibility and cost-sharing requirements for

certain Medical Assistance (MA) and long-term care programs.

Under current law, an individual who would be eligible for MA based on

eligibility for supplemental security income (SSI), but who is not eligible for SSI

because he or she is employed and has too much earned and unearned income to be

eligible, may pay premiums for coverage under MA if his or her family's net income

is less than 250 percent of the poverty line and his or her assets do not exceed $15,000,

excluding certain assets. This program is known as MAPP. When determining the

value of the individual's assets for continued eligibility under MAPP, DHS excludes

amounts in a DHS-approved account that consists solely of savings from the

individual's employment after the individual's coverage under MAPP began. These

accounts are known as "independence accounts."

This bill makes changes to the eligibility and premium requirements under

MAPP. Under current law, when determining whether an individual's net income is

less than 250 percent of the poverty line, certain disregards are deducted from the

individual's and his or her spouse's total earned income, then the individual's and his

or her spouse's total unearned income is added, and then another general disregard

is deducted. Under the bill, an individual's net income is determined by subtracting

the same disregards as under current law from the individual's total earned and

unearned income alone, then the individual's out-of-pocket medical and remedial

expenses and long-term care costs, if any, are deducted. In addition, the bill provides

that, if an individual whose income is equal to or greater than 250 percent of the

poverty line satisfies all of the other eligibility requirements, he or she is eligible for

MAPP if DHS determines that his or her earnings are insufficient to replace all of

the publicly funded benefits that he or she would be eligible to receive in the absence

of those earnings. The bill also requires DHS, when determining eligibility for

MAPP, to exclude from assets, to the extent approved by the federal government,

income or assets from retirement benefits that accumulated or were earned from

employment income or employer contributions while the individual was employed

and receiving MA coverage under MAPP.

Premiums for MA coverage under MAPP currently are calculated for an

individual by adding together all of the individual's unearned income, after certain

specified amounts are deducted, and then adding, in practice, 3 percent of the

individual's earned income, although the statutes provide that 3.5 percent of the

individual's earned income is to be added. DHS may waive any premiums that are

calculated to be below $10 per month, although, in practice, DHS waives any

premiums below $25 per month. In addition, the statutes prohibit DHS from

assessing a premium to an individual whose earned and unearned income is below