Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 2821

Introduced by Assembly Member Chiu

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(Principal coauthor: Assembly Member Atkins)

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February 19, 2016

begin delete An act to amend Section 14000.03 of the Welfare and Institutions Code, relating to Medi-Cal. end delete begin insert An act to add Chapter 6.9 (commencing with Section 50678) to Part 2 of Division 31 of the Health and Safety Code, relating to housing end insert begin insert . end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 2821, as amended, Chiu. begin delete Medi-Cal: cooperative arrangements. end delete begin insert Whole Person Care Housing Program. end insert

Existing law begin insert establishes various housing programs directed by the Department of Housing and Community Development (HCD), including special housing programs to provide housing assistance for persons with developmental and physical disabilities and persons with mental health disorders. end insert begin insert Existing law end insert provides for the Medi-Cal program, which is administered by the State Department of Health Care begin delete Services, end delete begin insert Services (DHCS), end insert under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. begin delete Existing federal law requires the state’s plan for medical assistance under Medi-Cal to provide for entering into cooperative arrangements with the state agencies responsible for administering or supervising the administration of health services and vocational rehabilitation services in the state. Existing law requires, upon additional funds being appropriated and budgeted for the support of services within the scope of work of a cooperative arrangement, that the amount of the encumbrance in the agreement be amended, by operation of law, to reflect the newly appropriated and budgeted funds. end delete

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This bill would make technical, nonsubstantive changes to these provisions.

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This bill would require HCD, in coordination with DHCS, to, on or before July 1, 2017, design and create the Whole Person Care Housing Program, and on or before January 1, 2018, and every year thereafter, subject to appropriation by the Legislature, award grants to eligible counties or regions participating in a Whole Person Care pilot program, a program under the Medi-Cal program that provides specified entities with the option to receive support to integrate care for a particularly vulnerable group of Medi-Cal beneficiaries, including individuals who are experiencing or are at risk of homelessness. The bill would provide that a county or a region is eligible for a grant under the program if the county or region’s lead entity meets specified requirements, including that the lead entity is participating in a Whole Person Care pilot program or has previously participated in a Whole Person Care pilot program, or is a county with Medi-Cal managed care plans participating in the Health Home Program and demonstrates specified collaboration.

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The bill would require a county or region awarded a grant to use the funds for specified purposes, including long-term rental assistance and interim housing. The bill would provide that a county resident is eligible to receive assistance pursuant to a grant awarded under the Whole Person Care Housing Program if he or she meets specified requirements, including that the person is homeless and is a Medi-Cal beneficiary. The bill would provide that the program is subject to an initial appropriation by the Legislature, and that thereafter grants under the program are subject to annual appropriations by the Legislature, as specified.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert The Legislature finds and declares all of the
following: end insert

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(a) Homeless beneficiaries incur disproportionate Medi-Cal
costs, particularly people experiencing chronic homelessness and
people who cycle between homelessness, emergency departments,
inpatient care, and nursing home stays. Supportive housing, which
is affordable housing with intensive services, allows people
experiencing significant barriers to housing stability to improve
their health and decrease their Medicaid costs. National studies
comparing formerly homeless Medicaid beneficiaries living in
supportive housing with homeless beneficiaries receiving usual
care demonstrate Medicaid cost savings of almost $9,000 per year
after the costs of services.

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(b) In the proposal to renew California’s Section 1115 Medicaid
Waiver, “Medi-Cal 2020: Key Concepts for Renewal,” the State
Department of Health Care Services (DHCS) stated, “Research
suggests that individuals experiencing homelessness, particularly
those individuals with multiple chronic conditions, often struggle
to receive appropriate health care services and are
disproportionately likely to be high utilizers of the health care
safety net.” DHCS proposed using Medi-Cal to fund the tools
communities need to help homeless beneficiaries gain access to
and maintain housing stability, including the costs of interim
housing, recuperative/respite care, and long-term rental subsidies.

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(c) The final Medi-Cal 2020 Waiver allows participating entities,
including counties, to create Whole Person Care pilots to address
the health, behavioral health. and social services needs of high
users of multiple systems. Participating entities will be able to use
Whole Person Care pilots to target homeless residents, form
collaborations between local agencies and health plans to address
services needs of homeless beneficiaries, pool waiver and other
sources of financing to pay for services promoting housing stability,
and collect data on residents’ outcomes.

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(d) Though the federal Centers for Medicare and Medicaid
Services disallowed federal financial participation in the costs of
housing interventions, the final Section 1115 Medicaid Waiver
special terms and conditions, referred to as the “Medi-Cal 2020
Waiver,” allow for state contributions to Whole Person Care
“county housing pools” to fund long-term costs of housing in order
to achieve the goals of the Waiver proposal.

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(e) In most communities in California, a lack of housing
affordable to people experiencing homelessness is one of the
greatest barriers to exiting homelessness. Housing resources would
allow Whole Person Care counties choosing to target homeless
people with the resources to achieve the goals of the Whole Person
Care Waiver provisions, during the course of the pilot and after
the pilot ends.

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begin insert SEC. 2. end insert   

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begin insert Chapter 6.9 (commencing with Section 50678) is added
to Part 2 of Division 31 of the end insert begin insert Health and Safety Code end insert begin insert , to read: end insert

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Chapter   begin insert 6.9. end insert Whole Person Care Housing Program

 

begin insert 50678. end insert   

For purposes of this chapter, all of the following
definitions shall apply:

(a) “Homeless” has the same meaning as Section 578.3 of Title
24 of the Code of Federal Regulations.

(b) “Interim housing” means a safe place for a participant to
live temporarily while the participant is waiting to move into an
apartment affordable to the participant. “Interim housing” may
include recuperative or respite care and shall not be funded for
longer than a period of nine months.

(c) “Long-term rental assistance” means a rental subsidy
provided to a housing provider to assist a tenant to pay the
difference between 30 percent of the tenant’s income and the costs
of operating the assisted apartment.

(d) “Supportive housing” has the same meaning as Section
50675.14.

(e) “Whole Person Care pilot program” has the same meaning
as described in Sections 110-126 of the Medi-Cal 2020 Waiver
Special Terms and Conditions, finalized on December 30, 2015.

begin insert 50678.1. end insert   

The Department of Housing and Community
Development (HCD), in coordination with the State Department
of Health Care Services (DHCS), shall do all of the following:

(a) On or before July 1, 2017, design and create the Whole
Person Care Housing Program.

(b) On or before July 1, 2017, draft guidelines for stakeholder
comment to fund grants to pay for long-term housing costs under
the Whole Person Care Housing Program.

(c) On or before January 1, 2018, and every year thereafter,
subject to appropriation by the Legislature, award grants to
eligible counties and regions participating in a Whole Person Care
pilot program.

(d) Collect data midyear and annually from counties and regions
receiving grants awarded pursuant to this chapter.

(e) (1) By March 31, 2019, and by every year thereafter in
which the Whole Person Care Housing Program receives funding,
report data collected to the Assembly Committee on Budget, the
Senate Committee on Budget and Fiscal Review, the Assembly
Committee on Housing and Community Development, and the
Senate Committee on Transportation and Housing.

(2) A report to be submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government
Code.

begin insert 50678.2. end insert   

A county or a region that includes more than one
county shall be eligible for a Whole Person Care Housing Program
grant if the county or region’s lead entity meets all of the following
requirements:

(a) Meets one of the following descriptions:

(1) Is a lead entity participating in a Whole Person Care pilot
program under the Medi-Cal 2020 Waiver.

(2)  Is a lead entity that had previously participated in a Whole
Person Care pilot program that has expired.

(3) Is a county with Medi-Cal managed care plans participating
in the Health Home Program and demonstrates collaboration
required in subdivision (b).

(b) Has formed collaborative relationships with at least one
health plan, county health and behavioral health agencies, at least
one housing authority, and established relevant continuums of
care, as described in Section 115 of the Medi-Cal 2020 Waiver
Special Terms and Conditions, along with nonprofit housing and
homeless service providers, to enable the county or region to carry
out the provisions of this program.

(c) For residents participating in the Whole Person Care
Housing Program, has identified a source of funding for care
management and other services identified in the Centers for
Medicare and Medicaid Services Informational Bulletin regarding
Housing-Related Activities and Services for People with
Disabilities, issued June 2015, and identified in the Medi-Cal
Waiver 2020 Special Terms and Conditions. Funding shall include
one or more of the following:

(1) County general funds.

(2) Whole Person Care pilot housing pool and care management
programs.

(3) The Health Home Program.

(d) Has designated a process for administering grant funds
through agencies administering housing programs.

(e) Agrees to collect and report data, as described in Section
50678.3, to the Department of Housing and Community
Development and the State Department of Health Care Services.

begin insert 50678.3. end insert   

(a) A county or region awarded grant funds under
this chapter shall form agreements with health plans to collect
Medi-Cal data regarding members’ overall health costs.

(b) A county or region awarded grant funds shall, at annual
and midyear intervals, report all of the following data to HCD
and DHCS:

(1) A comparison of health care costs of residents receiving
long-term rental assistance under the Whole Person Care Housing
Program to health care costs of homeless residents not receiving
long-term rental assistance.

(2) The number of participants and the type of interventions
offered through grant funds.

(3) The number of participants receiving long-term rental
assistance living in supportive housing or other housing that does
not limit length of stay.

begin insert 50678.4. end insert   

A county or region shall use grants awarded pursuant
to this chapter for one or more of the following, which may be
administered through a housing pool, as defined in the Medi-Cal
2020 Waiver Special Terms and Conditions:

(a) Long-term rental assistance for periods up to five years, as
determined by the eligible county.

(b) Interim housing.

(c) A county’s administrative costs for up to 5 percent of the
total grant awarded.

begin insert 50678.5. end insert   

A county resident is eligible to receive assistance
pursuant to a grant awarded under the Whole Person Care
Housing Program if he or she meets all of the following
requirements:

(a) Is homeless upon initial eligibility.

(b) Is a Medi-Cal beneficiary.

(c) Is eligible for the services program identified by participating
counties or regions.

begin insert 50678.6. end insert   

The Whole Person Care Housing Program is subject
to an initial appropriation by the Legislature. After the initial
appropriation, the funding of grants under the program is subject
to annual appropriations by the Legislature based on decreased
costs of care, as reported by participating counties, of moving
eligible participants into supportive housing.

begin insert 50678.7. end insert   

HCD shall use no more than 5 percent of the funds
appropriated for the Whole Person Care Housing Program for
purposes of administering the program.

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SECTION 1.  

Section 14000.03 of the Welfare and Institutions
Code is amended to read:

14000.03.  

(a) The Legislature finds and declares that Section
1396a(a)(11)(A) of Title 42 of the United States Code provides
that California’s state plan for medical assistance under the
Medicaid program shall “provide for entering into cooperative
arrangements with the State agencies responsible for administering
or supervising the administration of health services and vocational
rehabilitation services in the State looking toward maximum
utilization of such services in the provision of medical assistance
under the plan.”

(b) In furtherance of Section 1396a(a)(11)(A) of Title 42 of the
United States Code and Section 7560 of the Government Code, it
is the intent of the Legislature to maximize the amount of federal
and state funds continually available under agreements identified
in Section 1396a(a)(11)(A) of Title 42 of the United States Code
and entered into by the State Department of Health Care Services
by making later-appropriated and budgeted funds immediately
encumbered and available for expenditure under agreements by
operation of law.

(c) Notwithstanding any other provision of law, upon additional
funds being appropriated and budgeted for the support of the
services identified within the scope of work of an agreement of
the type identified in Section 1396a(a)(11)(A) of Title 42 of the
United States Code and previously entered into by the State
Department of Health Care Services, the amount of the
encumbrance in such an agreement shall be amended, by operation
of law, to reflect the newly appropriated and budgeted funds.

(d) Notwithstanding any other provision of law, once an
agreement of the type identified in Section 1396a(a)(11)(A) of
Title 42 of the United States Code is entered into by the State
Department of Health Care Services, the agreement shall continue
in effect indefinitely and need not be amended unless the State
Department of Health Care Services changes the scope of work to
be provided under the agreement.

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