BILL NUMBER: AB 2821 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 13, 2016
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
establish the Medi-Cal Housing Program and on or before
September December 1, 2017, and every
year thereafter, subject to appropriation by the Legislature, award
grants on a competitive basis to eligible
counties and regions grant applicants
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, that includes
eligibility based on 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 an applicant is eligible for a grant
under the program if the county or region's lead agency
applicant meets specified requirements,
including that the lead agency is participating in a Whole Person
Care pilot or has previously participated in a Whole Person Care
pilot, pilot designed to provide services to
people experiencing homelessness or is located in a
county with Medi-Cal managed care plan or plans participating in the
Health Home 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, is a
Medi-Cal 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. The
bill would also authorize HCD and DHCS, for purposes of implementing
these provisions, to enter into exclusive or nonexclusive contracts
on a bid or negotiated basis, exempt from specified small
business procurement, personal service, and public contracting
provisions, and exempt from the review or approval of any division of
the Department of General Services. The bill would also prohibit HCD
and DHCS from implementing provisions developed pursuant to these
provisions until necessary federal approvals have been obtained and
other federal financial participation is not jeopardized.
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 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 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. leveraging local resources to increase
access to subsidized housing units. They may also incorporate a
financing component to reallocate or reinvest a portion of the
savings from the reduced utilization of health care services into the
housing pool.
(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 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) "DHCS" means the Department of Health Care Services.
(b) "HCD" means the Department of Housing and Community
Development.
(a)
(c) "Homeless" has the same meaning as in Section 578.3
of Title 24 of the Code of Federal Regulations. "Homeless" also
includes a person who would become homeless upon exiting a
publicly-funded institution or system of care, including a hospital,
skilled nursing facility, mental health facility, or incarceration.
"Homeless" also includes Whole Person Care pilot program homeless
populations, as approved by DHCS in the Whole Person Care pilot
program application and Medi-Cal beneficiaries served under
California's Health Home Program under Section 2703 of the
federal Patient Protection and Affordable Care Act (Public Law
111-148).
(b)
(d) "Interim housing" means a safe place for a
participant to live temporarily while the participant is waiting to
move into a permanent apartment affordable to the 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)
(e) "Long-term rental assistance" means a rental
subsidy provided to a housing provider, including a landlord renting
in the private market or developers or a developer
creating leasing 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. a housing unit.
(d)
(f) "Permanent housing" means an apartment
a housing unit where the landlord does not limit
length of stay in the apartment, housing
unit, 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.
(e)
(g) "Supportive housing" has the same meaning as in
Section 50675.14.
(f)
(h) "Whole Person Care pilot" has the same meaning as
described in Sections 110-126 of the Medi-Cal 2020
Waiver Special Terms and Conditions, finalized
Conditions (STCs), Sections 110-126, as approved by the federal
Centers for Medicare and Medicaid Services, on December 30,
2015. 2015, or in any subsequent amendment to
the STCs.
50678.1. The Department of Housing and Community
Development (HCD), HCD in coordination with
the State Department of Health Care Services (DHCS),
DHCS, shall do all of the following:
(a) On or before July 1, 2017, design and create
establish 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
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) Need, which includes consideration of the number of
individuals experiencing homelessness and the impact of the housing
costs in the applicant's geographic area.
(1) Capacity
(2) Ability of the applicant to
administer a program offering interim and long-term rental
assistance. assistance to people
experiencing homelessness.
(2) Identified
(3) The applicant's documented
identified partnerships with affordable and supportive housing
providers. providers in the applicant's
geographic area.
(3) Partnerships
(4) The applicant's partnerships
with Medi-Cal managed care plans in the applicant's geographic
area and the percentage of county Medi-Cal
beneficiaries that assigned to those
partnering Medi-Cal managed health plans cover.
plans.
(4) Comprehensive plans that connect housing
(5) A comprehensive plan to connect
interim housing, long-term rental assistance, and project-based
supportive housing resources made available under the
program Medi-Cal Housing Program with services
made available through the Whole Person Care pilot or
and the Health Home Program.
(5) Quality of services provided through the Whole Person Care
pilot or the Health Home Program in the applying county.
(6) Coordination with community-based housing and homeless service
providers, behavioral health providers, and safety net providers,
including community health centers.
(c) On or before September December
1, 2017, and every year thereafter, subject to appropriation by the
Legislature, award grants on a competitive basis
to eligible counties and regions grant
applicants participating in a Whole Person Care pilot
or counties and regions that includes eligibility
bases on homelessness or a partnership with Medi-Cal managed
care plans administering the Health Home Program under
Section 2703 of the federal Patient Protection and Affordable Care
Act. Program. If appropriations are made available in
future years, counties shall compete for each round of five-year
grants.
(d) Collect data midyear and annually
Midyear and annually, collect data from the Medi-Cal
Housing Program grantees or from the Medi-Cal managed care plan
partnering with participating counties and regions
receiving grants awarded pursuant to this chapter.
applicants and other Medi-Cal data available from grantees or from
DHS, as appropriate.
(e) No later than July 1, 2017, January 1,
2018, contract with an independent evaluator to analyze data
collected pursuant to Section 50678.4 50678.3
to determine potential costs avoided or saved due to
changes in health care costs associated with services
provided under the Medi-Cal Housing Program. HCD shall
provide, on a regular basis as needed, collected data
to the evaluator.
(f) (1) By March 31, 2019, for grants awarded in 2017,
and in subsequent years for every year thereafter in which
the Medi-Cal Housing Program receives is
allocated 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 An applicant shall be eligible for a
Medi-Cal Housing Program grant if the county or regional
agency applying for grant funds applicant 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
applicant shall meet all of the following requirements:
(a) The agency satisfies one of Satisfies
one or more the following:
(1) Is a lead agency participating in a Whole Person Care
pilot. pilot designed to provide services to people
experiencing homelessness.
(2) Is a lead agency that had previously
participated in a Whole Person Care pilot that has expired.
expired and the applicant has decided to continue to
provide services to homeless people under the structures developed in
the Whole Person Care pilot.
(3) Is located in a county with a Medi-Cal
managed care plan or plans participating in the Health Home Program.
(b) 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 whose members will
participate in the program, county health and behavioral health
agencies, at least one housing authority, and relevant continuums of
care.
(c) For residents participating in the Medi-Cal Housing Program,
has
(b) Has identified a source of
funding for Housing Transition Services and Tenancy Sustaining
Services, as identified in the Centers for Medicare and Medicaid
Services' Informational Bulletin regarding Housing-Related Activities
and Services for People with Disabilities, issued June 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. program funds.
(3) The Health Home Program.
(d)
(c) 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 Flexible housing pools
created through a Whole Person Care pilot.
(3) A county or partnering 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.
(e)
(d) Has designated a process for administering grant
funds through agencies administering housing programs.
(f)
(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.
HCD and DHCS.
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' medical costs,
50678.3. (a) HCD shall
coordinate with DHCS to identify a process for collecting and
providing Medi-Cal data regarding changes in health care costs
associated with services provided under the Medi-Cal Housing Program
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 An
applicant 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 medical costs of participants receiving
long-term rental assistance under the Medi-Cal Housing Program to
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.
(1) Data specified by HCD necessary to measure the costs described
in subdivision (a).
(2) The number of participants and the type of interventions
offered through grant funds.
(3) The number of participants living in supportive housing or
other permanent housing.
(c) HCD shall collaborate with DHCS to provide available
fee-for-service data to the evaluator.
50678.4. A county or region An applicant
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 Whole Person Care pilot:
(a) Long-term rental assistance for periods up to five 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.
(c) Interim housing.
(d) A county's administrative costs for up to 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.
(d) Is eligible 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, Legislature. The Legislature shall consider
the impact that housing and supportive services have had in changing
utilization and health care costs, as 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 and
implementation 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.
50678.8. (a) For purposes of implementing this chapter, HCD or
DHCS may enter into exclusive or nonexclusive contracts on a bid or
negotiated basis. Contracts entered into or amended pursuant to this
subdivision shall be exempt from Chapter 6 (commencing with Section
14825) of Part 5.5 of Division 3 of Title 2 of the Government Code,
Section 19130 of the Government Code, and Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code and shall be
exempt from the review or approval of any division of the Department
of General Services.
(b) HDC and DHCS shall implement the provisions developed pursuant
to this chapter only after all necessary federal approvals have been
obtained and other federal financial participation is not
jeopardized.