BILL NUMBER: AB 2821 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 31, 2016
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 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, September
1, 2017, and every year thereafter, subject to appropriation by
the Legislature, award grants on a competitive basis to
eligible counties or and 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.
homelessness, or counties and regions with Medi-Cal
managed care plans administering the Health Home Program. 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
agency meets specified requirements, including
that the lead entity agency is
participating in a Whole Person Care pilot program
or has previously participated in a Whole Person Care pilot
program, pilot, or is a county with Medi-Cal
managed care plan or plans participating in the Health Home
Program and demonstrates specified collaboration.
Program.
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 homeless, is a Medi-Cal
beneficiary. 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.
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, and social services needs of high users
of multiple systems. Participating entities will be able to use Whole
Person Care pilots to target offer
housing-related services to homeless residents, form
collaborations between local agencies and health plans to address
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. The final Waiver
special terms and conditions also permit tracking costs saved by
moving beneficiaries from homelessness to housing and then using
these costs savings to pay for some costs of housing and providing
services to additional participants.
(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 equip 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 a permanent apartment affordable to the
participant. participant with rental
assistance, and where the participant is not required to pay more
than 30 percent of his or her income toward the cost of the interim
housing. "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 provider, including a
landlord renting in the private market or developers or a developer
creating affordable housing, 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) "Permanent housing" means an apartment where the landlord does
not limit length of stay in the apartment, the landlord does not
restrict the movements of the tenant, and the tenant has a lease and
is subject to the rights and responsibilities of tenancy, pursuant to
Chapter 2 (commencing with Section 1940) of Title 5 of Part 4 of
Division 3 of the Civil Code.
(d)
(e) "Supportive housing" has the same meaning as in
Section 50675.14.
(e)
(f) "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 competitive grants to pay for interim
and long-term housing costs rental
assistance under the Medi-Cal Housing Program. The
guidelines shall detail competitive scoring criteria that includes,
but is not limited to, scoring that awards points based upon all of
the following:
(1) Capacity to administer interim and long-term rental
assistance.
(2) Identified partnerships with affordable and supportive housing
providers.
(3) Partnerships with Medi-Cal managed care plans and the
percentage of county Medi-Cal beneficiaries that those partnering
health plans cover.
(4) Comprehensive plans that connect housing resources made
available under the program with services made available through the
Whole Person Care pilot or the Health Home Program.
(5) Quality of services provided through the Whole Person Care
pilot or the Health Home Program in the applying county.
(c) On or before January 1, 2018,
September 1, 2017, and every year thereafter, subject to
appropriation by the Legislature, award grants on a competitive
basis to eligible counties and regions participating in a Whole
Person Care pilot program. or counties and
regions with Medi-Cal managed care plans administering the Health
Home Program under Section 2703 of the federal Patient Protection and
Affordable Care Act.
(d) Collect data midyear and annually from the Medi-Cal
managed care plan partnering with participating counties and
regions receiving grants awarded pursuant to this chapter.
(e) No later than July 1, 2017, contract with an independent
evaluator to analyze data collected pursuant to Section 50678.4 to
determine potential costs avoided or saved due to the Medi-Cal
Housing Program.
(e)
(f) (1) By March 31, 2019, and 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 county
or regional agency applying for grant funds meets the requirements of
this section. Eligibility does not create an entitlement to grant
funds and is subject to availability of funds. The county or regional
agency applying shall meet all of the following requirements:
(a) Meets The agency satisfies
one of the following descriptions:
following:
(1) Is a lead entity agency
participating in a Whole Person Care pilot program under the
Medi-Cal 2020 Waiver. pilot.
(2) Is a lead entity agency that
had previously participated in a Whole Person Care pilot
program that has expired.
(3) Is a county with Medi-Cal managed care plan or plans
participating in the Health Home Program and demonstrates
collaboration required in subdivision (b). Program.
(b) Has As described under Section 115 of
the Medi-Cal 2020 Special Waiver Terms and Conditions, the agency has
formed collaborative relationships with at least one health
plan, plan whose members will participate in
the program, 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.
care.
(c) For residents participating in the Medi-Cal Housing Program,
has identified a source of funding for care management and
other services Housing Transition Services and Tenancy
Sustaining Services, as identified in the Centers for Medicare
and Medicaid Services 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. 26, 2015. Funding for these
services 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) Agrees to contribute funding for interim and long-term rental
assistance through one or more of the following sources:
(1) County general funds.
(2) Housing pools created through a Whole Person Care pilot.
(3) A county or parternering housing authority's set-aside of at
least 15 percent turn-over federal Housing Choice Vouchers to
residents experiencing homelessness and who are eligible to receive
Whole Person Care pilot or Health Home Program services.
(d)
(e) Has designated a process for administering grant
funds through agencies administering housing programs.
(e)
(f) 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 partnering health plans
to collect Medi-Cal data regarding members' overall health
costs. medical costs, to the extent that information
is available, up to 12 months prior to each participant's move into
permanent housing, as well as medical costs after each participant's
move in, pursuant to the reporting requirements of this section.
(b) A county or region awarded grant funds or the county's or
region's partnering Medi-Cal managed care plan 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
medical costs of participants receiving
long-term rental assistance under the Medi-Cal Housing Program to
health care costs of homeless residents not receiving
long-term rental assistance. medical costs of the same
participants 12 months prior to move in to permanent housing, or for
participants with less than 12 months of available data prior to
move in, any data available prior to move in.
(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. permanent
housing.
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:
Whole Person Care pilot:
(a) Long-term rental assistance for periods up to five
years, as determined by the eligible county. years.
(b) A capitalized operating reserve for up to 15 years to pay for
operating costs of an apartment or apartments within a development
receiving public funding to provide supportive housing to people
experiencing homelessness.
(b)
(c) Interim housing.
(c)
(d) A county's administrative costs for up to
5 3 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 Supplemental Security Income.
(c)
(d) Is eligible for the services program
identified by participating counties or regions .
to receive services under either the Whole Person Care
pilot or the Health Home Program, whichever is operative in the
participating county or region.
(e) Is assessed to be likely to improve his or her health
conditions with supportive housing.
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,
identified in the evaluation described in Section 50678.1, of
moving eligible participants into supportive housing.
50678.7. HCD shall reimburse DHCS for the costs of
collecting data and collaborating in the design of the program. HDC
shall use no more than 5 percent of the funds appropriated for
the Medi-Cal Housing Program for purposes of administering the
program.