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 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 beforebegin delete January 1, 2018,end deletebegin insert
September 1, 2017,end insert and every year thereafter, subject to appropriation by the Legislature, award grantsbegin insert on a competitive basisend insert to eligible countiesbegin delete orend deletebegin insert andend insert 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 ofbegin delete homelessness.end deletebegin insert homelessness, or counties and regions with
Medi-Cal managed care plans administering the Health Home Program.end insert The bill would provide that a county or a region is eligible for a grant under the program if the county or region’s leadbegin delete entityend deletebegin insert agencyend insert meets specified requirements, including that the leadbegin delete entityend deletebegin insert agencyend insert is participating in a Whole Person Care pilotbegin delete programend delete
or has previously participated in a Whole Person Carebegin delete pilot program,end deletebegin insert pilot,end insert or is a county with Medi-Cal managed carebegin insert plan orend insert plans participating in the Health Homebegin delete Program and demonstrates specified collaboration.end deletebegin insert Program.end insert
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 isbegin delete homeless andend deletebegin insert homeless,end insert is a Medi-Calbegin delete beneficiary.end deletebegin insert
beneficiary, and is eligible for Supplemental Security Income, and is eligible to receive services under the Whole Person Care pilot or the Health Home Program.end insert 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:
The Legislature finds and declares all of the
2following:
3(a) Homeless beneficiaries incur disproportionate Medi-Cal
4costs, particularly people experiencing chronic homelessness and
5people who cycle between homelessness, emergency departments,
6inpatient care, and nursing home stays. Supportive housing, which
7is affordable housing with intensive services, allows people
8experiencing significant barriers to housing stability to improve
9their health and decrease their Medicaid costs. National studies
P3 1comparing formerly homeless Medicaid beneficiaries living in
2supportive housing with homeless beneficiaries receiving usual
3care demonstrate
Medicaid cost savings of almost $9,000 per year
4after the costs of services.
5(b) In the proposal to renew California’s Section 1115 Medicaid
6Waiver, “Medi-Cal 2020: Key Concepts for Renewal,” the State
7Department of Health Care Services (DHCS) stated, “Research
8suggests that individuals experiencing homelessness, particularly
9those individuals with multiple chronic conditions, often struggle
10to receive appropriate health care services and are
11disproportionately likely to be high utilizers of the health care
12safety net.” DHCS proposed using Medi-Cal to fund the tools
13communities need to help homeless beneficiaries gain access to
14and maintain housing stability, including the costs of interim
15housing, recuperative/respite care, and long-term rental subsidies.
16(c) The final Medi-Cal
2020 Waiver allows participating entities,
17including counties, to create Whole Person Care pilots to address
18the health, behavioral health, and social services needs of high
19users of multiple systems. Participating entities will be able to use
20Whole Person Care pilots tobegin delete targetend deletebegin insert offer housing-related services
21toend insert homeless residents, form collaborations between local agencies
22and health plans to address service needs of homeless beneficiaries,
23pool waiver and other sources of financing to pay for services
24promoting housing stability, and collect data on residents’
25outcomes.
26(d) Though the federal Centers for Medicare and Medicaid
27Services disallowed federal financial participation
in the costs of
28housing interventions, the final Section 1115 Medicaid Waiver
29special terms and conditions, referred to as the “Medi-Cal 2020
30Waiver,” allow for state contributions to Whole Person Care
31
“county housing pools” to fund long-term costs of housingbegin delete in orderend delete
32 to achieve the goals of the Waiver proposal.begin insert The final Waiver
33special terms and conditions also permit tracking costs saved by
34moving beneficiaries from homelessness to housing and then using
35these costs savings to pay for some costs of housing and providing
36services to additional participants.end insert
37(e) In most communities in California, a lack of housing
38affordable to people experiencing homelessness is one of the
39greatest barriers to exiting homelessness. Housing resources would
40begin delete allowend deletebegin insert
equipend insert Whole Person Care counties choosing to target
P4 1homeless people with the resources to achieve the goals of the
2Whole Person Care Waiver provisions, during the course of the
3pilot and after the pilot ends.
Chapter 6.9 (commencing with Section 50678) is added
5to Part 2 of Division 31 of the Health and Safety Code, to read:
6
For purposes of this chapter, all of the following
10definitions shall apply:
11(a) “Homeless” has the same meaning as in Section 578.3 of
12Title 24 of the Code of Federal Regulations.
13(b) “Interim housing” means a safe place for a participant to
14live temporarily while the participant is waiting to move intobegin delete anend delete
15begin insert a permanentend insert apartment affordable to thebegin delete participant.end deletebegin insert
participant
16with rental assistance, and where the participant is not required
17to pay more than 30 percent of his or her income toward the cost
18of the interim housing.end insert “Interim housing” may include recuperative
19or respite care and shall not be funded for longer than a period of
20nine months.
21(c) “Long-term rental assistance” means a rental subsidy
22provided to a housingbegin delete providerend deletebegin insert provider, including a landlord
23renting in the private market or developers or a developer creating
24affordable housing,end insert to assist a tenant to pay the difference between
2530 percent of the tenant’s income and the costs of operating the
26assisted apartment.
27
(d) “Permanent housing” means an apartment where the
28landlord does not limit length of stay in the apartment, the landlord
29does not restrict the movements of the tenant, and the tenant has
30a lease and is subject to the rights and responsibilities of tenancy,
31pursuant to Chapter 2 (commencing with Section 1940) of Title 5
32of Part 4 of Division 3 of the Civil Code.
33(d)
end delete
34begin insert(e)end insert “Supportive housing” has the same meaning as in Section
3550675.14.
36(e)
end delete
37begin insert(f)end insert “Whole Person Care pilotbegin delete programend delete” has the same meaning
38as described in Sections 110-126 of the Medi-Cal 2020 Waiver
39Special Terms and Conditions, finalized on December 30, 2015.
The Department of Housing and Community
2Development (HCD), in coordination with the State Department
3of Health Care Services (DHCS), shall do all of the following:
4(a) On or before July 1, 2017, design and create the Medi-Cal
5Housing Program.
6(b) On or before July 1, 2017, draft guidelines for stakeholder
7comment to fundbegin insert competitiveend insert grants to pay forbegin insert interim andend insert
8 long-termbegin delete housing costsend deletebegin insert
rental assistanceend insert under the Medi-Cal
9Housing Program.begin insert The guidelines shall detail competitive scoring
10criteria that includes, but is not limited to, scoring that awards
11points based upon all of the following:end insert
12
(1) Capacity to administer interim and long-term rental
13assistance.
14
(2) Identified partnerships with affordable and supportive
15housing providers.
16
(3) Partnerships with Medi-Cal managed care plans and the
17percentage of county Medi-Cal beneficiaries that those partnering
18health plans cover.
19
(4) Comprehensive plans that connect housing resources made
20available under the program with services made available through
21the Whole Person Care pilot or the Health Home Program.
22
(5) Quality of services provided through the Whole Person Care
23pilot or the Health Home Program in the applying county.
24(c) On or beforebegin delete January 1, 2018,end deletebegin insert
September 1, 2017,end insert and every
25year thereafter, subject to appropriation by the Legislature, award
26grantsbegin insert
on a competitive basisend insert to eligible counties and regions
27participating in a Whole Person Care pilotbegin delete program.end deletebegin insert or counties
28and regions with Medi-Cal managed care plans administering the
29Health Home Program under Section 2703 of the federal Patient
30Protection and Affordable Care Act.end insert
31(d) Collect data midyear and annually frombegin insert the Medi-Cal
32managed care plan partnering with participatingend insert counties and
33regions receiving grants awarded pursuant to this chapter.
34
(e) No later than July 1, 2017, contract with an independent
35evaluator to analyze data collected pursuant to Section 50678.4
36to determine potential costs avoided or saved due to the Medi-Cal
37Housing Program.
38(e)
end delete
39begin insert(f)end insert (1) By March 31, 2019, and every year thereafter in which
40the Medi-Cal Housing Program receives funding, report data
P6 1collected to the Assembly Committee on Budget, the Senate
2Committee on Budget and Fiscal Review, the Assembly and Senate
3committees on health, the Assembly Committee on Housing and
4Community
Development, and the Senate Committee on
5Transportation and Housing.
6(2) A report to be submitted pursuant to paragraph (1) shall be
7submitted in compliance with Section 9795 of the Government
8Code.
A county or a region that includes more than one
10county shall be eligible for a Medi-Cal Housing Program grant if
11thebegin delete county or region’s lead entity meetsend deletebegin insert county or regional agency
12applying for grant funds meets the requirements of this section.
13Eligibility does not create an entitlement to grant funds and is
14subject to availability of funds. The county or regional agency
15applying shall meetend insert all of the following requirements:
16(a) begin deleteMeets end deletebegin insertThe
agency satisfies end insertone of thebegin delete following descriptions:end delete
17
begin insert following:end insert
18(1) Is a leadbegin delete entityend deletebegin insert agencyend insert participating in a Whole Person Care
19
begin delete pilot program under the Medi-Cal 2020 Waiver.end deletebegin insert pilot.end insert
20(2) Is a leadbegin delete entityend deletebegin insert
agencyend insert
that had previously participated in
21a Whole Person Care pilotbegin delete programend delete that has expired.
22(3) Is a county with Medi-Cal managed carebegin insert plan orend insert plans
23participating in the Health Homebegin delete Program and demonstrates begin insert
Program.end insert
24collaboration required in subdivision (b).end delete
25(b) begin deleteHas end deletebegin insertAs described under Section 115 of the Medi-Cal 2020
26Special Waiver Terms and Conditions, the agency has end insertformed
27collaborative relationships with at least one healthbegin delete plan,end deletebegin insert plan whose
28members will participate in the program,end insert county health and
29behavioral health agencies, at least one housing authority, and
30begin delete establishedend delete relevant continuums of begin deletecare, as described in Section begin insert
care.end insert
31115 of the Medi-Cal 2020 Waiver Special Terms and Conditions,
32along with nonprofit housing and homeless service providers, to
33enable the county or region to carry out the provisions of this
34program.end delete
35(c) For residents participating in the Medi-Cal Housing Program,
36has identified a source of funding forbegin delete care management and other begin insert Housing Transition Services and Tenancy Sustaining
37servicesend delete
38Services, asend insert identified in the Centers for Medicare and Medicaid
39begin delete Servicesend deletebegin insert Servicesend insertbegin insert’end insert Informational Bulletin regarding
40Housing-Related Activities and Services for People with
P7 1
Disabilities, issued Junebegin delete 2015, and identified in the Medi-Cal begin insert 26, 2015.end insert Funding
2Waiver 2020 Special Terms and Conditions.end delete
3begin insert
for these servicesend insert shall include one or more of the following:
4(1) County general funds.
5(2) Whole Person Care pilot housing pool and care management
6programs.
7(3) The Health Home Program.
begin insert
8
(d) Agrees to contribute funding for interim and long-term rental
9assistance through one or more of the following sources:
10
(1) County general funds.
11
(2) Housing pools created through a Whole Person Care pilot.
12
(3) A county or parternering housing authority’s set-aside of
13at least 15 percent turn-over federal Housing Choice Vouchers to
14residents experiencing homelessness and who are eligible to
15receive Whole Person Care pilot or Health Home Program
16services.
30 17(d)
end delete
18begin insert(e)end insert Has designated a process for administering grant funds
19through agencies
administering housing programs.
32 20(e)
end delete
21begin insert(f)end insert Agrees to collect and report data, as described in Section
2250678.3, to the Department of Housing and Community
23Development and the State Department of Health Care Services.
(a) A county or region awarded grant funds under
25this chapter shall form agreements withbegin insert partneringend insert health plans
26to collect Medi-Cal data regarding members’begin delete overall health costs.end delete
27
begin insert medical costs, to the extent that information is available, up to 12
28months prior to each participant’s move into permanent housing,
29as well as medical costs after each participant’s move in, pursuant
30to the reporting requirements of this section.end insert
31(b) A
county or region awarded grant fundsbegin insert or the county’s or
32region’s partnering Medi-Cal managed care planend insert
shall, at annual
33and midyear intervals, report all of the following data to HCD and
34DHCS:
35(1) A comparison ofbegin delete health care costs of residentsend deletebegin insert medical costs
36of participantsend insert receiving long-term rental assistance under the
37Medi-Cal Housing Program tobegin delete health care costs of homeless begin insert medical costs
38residents not receiving long-term rental assistance.end delete
39of the same participants 12 months prior to move in to permanent
P8 1housing, or for participants with less than 12 months of available
2data prior to move in, any data available
prior to move in.end insert
3(2) The number of participants and the type of interventions
4offered through grant funds.
5(3) The number of participantsbegin delete receiving long-term rental living in supportive housing or other
6assistanceend deletebegin delete housing that does begin insert permanent housing.end insert
7not limit length of stay.end delete
A county or region shall use grants awarded pursuant
9to this chapter for one or more of the following, which may be
10administered through a housing pool, as defined in thebegin delete Medi-Cal begin insert Whole Person Care
112020 Waiver Special Terms and Conditions:end delete
12pilot:end insert
13(a) Long-term rental assistance for periods up to fivebegin delete years, as begin insert years.end insert
14determined by the eligible county.end delete
15
(b) A capitalized operating reserve for up to 15 years to pay for
16operating costs of an apartment or apartments within a
17development receiving public funding to provide supportive
18housing to people experiencing homelessness.
16 19(b)
end delete20begin insert(c)end insert Interim housing.
17 21(c)
end delete
22begin insert(d)end insert A county’s administrative costs for up tobegin delete 5end deletebegin insert 3end insert percent of the
23total grant awarded.
A county resident is eligible to receive assistance
25pursuant to a grant awarded under the Medi-Cal Housing Program
26if he or she meets all of the following requirements:
27(a) Is homeless upon initial eligibility.
28(b) Is a Medi-Cal beneficiary.
begin insert
29
(c) Is eligible for Supplemental Security Income.
30(c)
end delete
31begin insert(d)end insert Is eligiblebegin delete for the services program identified by participating
32counties or regionsend deletebegin delete.end deletebegin insert
to receive services under either the Whole
33Person Care pilot or the Health Home Program, whichever is
34operative in the participating county or region.end insert
35
(e) Is assessed to be likely to improve his or her health
36conditions with supportive housing.
The Medi-Cal Housing Program is subject to an initial
38appropriation by the Legislature. After the initial appropriation,
39the funding of grants under the program is subject to annual
40appropriations by the Legislature based on decreased costs of care,
P9 1asbegin delete reported by participating counties,end deletebegin insert identified in the evaluation
2described in Section 50678.1,end insert of moving eligible participants into
3supportive housing.
HCD shallbegin insert reimburse DHCS for the costs of collecting
5data and collaborating in the design of the program. HDC shallend insert
6 use no more than 5 percent of the funds appropriated for the
7Medi-Cal Housing Program for purposes of administering the
8program.
O
95