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SB 1124 - California’s Medi-Cal Recovery System

SB 1124 (Hernandez) will be heard in the Senate Appropriations Committee on April 28, 2014. SB 1124 includes the most important Medi-Cal Recovery changes since 1993, when the current law was passed via Governor Wilson’s budget proposal.

Responding to consumer concerns and consumer outrage at being forced to apply for Medi-Cal Expansion if their income is too low for Covered California; being forced to obtain coverage via a Medi-Cal managed care program; being denied information as to what the monthly capitated managed care rate might be; and then having their estates subject to Medi-Cal recovery because they are aged 55 or older, regardless of what health care services they use – SB 1124 addresses many of these concerns.

SB 1124 would eliminate most of the optional recovery provisions and allow thousands of older, low-income Medi-Cal beneficiaries to be relieved of the worry about losing their family homes. 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 – eliminates optional recovery.

  • 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 Appropriations hearing on SB 1124 is set for April 28 in the Senate Appropriations Committee – send letters of support to Senator Kevin de Leon, Chair, Senate Appropriations Committee via FAX: (916) 327-8817.

(The following information was reprinted with the permission of California Advocates of Nursing Home Reform, a co-sponsor of the bill).

Update - This Bill was vetoed by Governor Brown.

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