BILL NUMBER: AB 2821 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 26, 2016
AMENDED IN ASSEMBLY MARCH 29, 2016
AMENDED IN ASSEMBLY MARCH 18, 2016
INTRODUCED BY Assembly Member Chiu
(Principal coauthor: Assembly Member Atkins)
FEBRUARY 19, 2016
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.
LEGISLATIVE COUNSEL'S DIGEST
AB 2821, as amended, Chiu. Medi-Cal Housing Program.
Existing law 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. Existing law provides for the Medi-Cal program,
which is administered by the State Department of Health Care Services
(DHCS), under which qualified low-income individuals receive health
care services. The Medi-Cal program is, in part, governed and funded
by federal Medicaid Program program
provisions.
This bill would require HCD, in coordination with DHCS, to, on or
before July 1, 2017, design and create the Medi-Cal 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.
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 Medi-Cal 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(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.
(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.
(c) The final Medi-Cal 2020 Waiver allows participating entities,
including counties, to create Whole Person Care pilots to address the
health, behavioral health. 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
service needs of homeless beneficiaries, pool waiver and other
sources of financing to pay for services promoting housing
stability, and collect data on residents' outcomes.
(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.
(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.
SEC. 2. Chapter 6.9 (commencing with Section 50678) is added to
Part 2 of Division 31 of the Health and Safety Code, to read:
CHAPTER 6.9. MEDI-CAL HOUSING PROGRAM
50678. For purposes of this chapter, all of the following
definitions shall apply:
(a) "Homeless" has the same meaning as in 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 in
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.
50678.1. 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 Medi-Cal
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
Medi-Cal 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 Medi-Cal Housing Program receives funding,
report data collected to the Assembly Committee on Budget, the Senate
Committee on Budget and Fiscal Review, the Assembly and Senate
committees on health, 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.
50678.2. A county or a region that includes more than one county
shall be eligible for a Medi-Cal 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 Medi-Cal 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.
50678.3. (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 Medi-Cal 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.
50678.4. 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.
50678.5. A county resident is eligible to receive assistance
pursuant to a grant awarded under the Medi-Cal 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.
50678.6. The Medi-Cal 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.
50678.7. HCD shall use no more than 5 percent of the funds
appropriated for the Medi-Cal Housing Program for purposes of
administering the program.