Amended in Senate August 19, 2016

Amended in Senate August 15, 2016

Amended in Senate June 16, 2016

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

California Legislature—2015–16 Regular Session

Assembly Bill No. 2821

Introduced by Assembly Members Chiu and Santiago

(Principal coauthor: Assembly Member Atkins)

February 19, 2016

An act to add Part begin delete 14 end delete begin insert 14.2 end insert (commencing with Section begin delete 53570) end delete begin insert 53590) end insert to Division 31 of the Health and Safety Code, relating to housing.

LEGISLATIVE COUNSEL’S DIGEST

AB 2821, as amended, Chiu. begin delete Medi-Cal end delete Housing begin insert for a Healthy California end insert 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 begin delete HCD, in coordination with DHCS, end delete begin insert HCD end insert to, on or before begin delete July 1, 2017, end delete begin insert October 1, 2017, end insert establish the begin delete Medi-Cal end delete Housing begin insert for a Healthy California end insert Program and on or before begin delete December 1, 2017, end delete begin insert April 1, 2018, end insert and every year thereafter, subject to appropriation by the Legislature, award grants on a competitive basis to eligible grant begin delete 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 with Medi-Cal managed care plans administering the Health Home Program. end delete begin insert applicants based on guidelines that HCD would draft, as prescribed, and other requirements. end insert The bill would provide that an applicant is eligible for a grant under the program if the applicant meets specified requirements, including that the applicant begin delete is a lead agency participating in a Whole Person Care pilot or has previously participated in a Whole Person Care 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. end delete begin insert identify a source of funding, as specified, agree to contribute funding for interim and long-term rental assistance, and agree to collect and report data, as specified. end insert

The bill would require an applicant 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 begin delete Medi-Cal Housing Program end delete begin insert program end insert if he or she meets specified requirements, including that the person is homeless, is a Medi-Cal beneficiary, is eligible for Supplemental Security Income, begin delete and end delete is eligible to receive begin delete services under the Whole Person Care pilot or the Health Home Program. end delete begin insert certain services, and is likely to improve his or her health with supportive services. end insert The bill would provide that the program shall be funded upon appropriation by the Legislature. The bill would also authorize begin delete HCD and DHCS, end delete begin insert HCD, end insert 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. begin delete The bill would also prohibit HCD and DHCS from implementing provisions developed pursuant to these provisions until necessary federal approvals have been obtained and to the extent that other federal financial participation is not jeopardized. end delete begin insert The bill would exempt the program guidelines created by the department from requirements prescribed for administrative regulations. The bill would require HCD to analyze data collected pursuant to the program, as specified, and by October 1, 2019, and subsequently as the program may be funded, to report program data to certain legislative committees, as specified. end insert The bill would condition implementation of these provisions upon an appropriation provided for this purpose.

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.

begin delete

(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 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)

end delete

begin insert (b) end insert  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. begin insert “Whole Person Care pilot” has the meaning as
described in the Medi-Cal 2020 Waiver Special Terms and
Conditions (STCs), Sections 110-126, as approved by the federal
Centers for Medicare and Medicaid Services on December 30,
2015, or in any subsequent amendment to the STCs. end insert

SEC. 2.  

Part begin delete 14 end delete begin insert 14.2 end insert (commencing with Section begin delete 53570) end delete begin insert 53590) end insert
is added to Division 31 of the Health and Safety Code, to read:

 

PART  begin delete 14. end delete begin insert 14.2. end insert   begin delete Medi-Cal end delete Housing begin insert for a Healthy
California end insert Program

 

begin delete 53570. end delete

begin insert 53590. end insert   

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

begin insert

(a) “Applicant” means a county or a city collaborating with a
county to secure services funding.

end insert begin delete

(a)

end delete

begin insert (b) end insert  “DHCS” means the State Department of Health Care
Services.

begin delete

(b)

end delete

begin insert (c) end insert  “Fair market rent” means the rent, including the cost of
utilities, as established by the United States Department of Housing
and Urban Development pursuant to Parts 888 and 982 of Title 24
of the Code of Federal Regulations, as those parts read on January
1, 2017, for units by number of bedrooms, that must be paid in the
market area to rent privately owned, existing, decent, safe, and
sanitary rental housing of nonluxury nature with suitable amenities.

begin delete

(c)

end delete

begin insert (d) end insert  “HCD” means the Department of Housing and Community
Development.

begin delete

(d)

end delete

begin insert (e) end insert  “Homeless” has the same meaning as in Section 578.3 of
Title 24 of the Code of Federal Regulations, as that section read
on January 1, 2017. begin delete “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). end delete

begin delete

(e)

end delete

begin insert (f) end insert  “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.

begin delete

(f)

end delete

begin insert (g) end insert  “Long-term rental assistance” means a rental subsidy
provided to a housing provider, including a landlord renting in the
private market or a developer leasing affordable housing, to assist
a tenant to pay the difference between 30 percent of the tenant’s
income and fair market begin delete rent. end delete begin insert rent or reasonable market rent as
determined by HCD. end insert

begin delete

(g)

end delete

begin insert (h) end insert  “Permanent housing” means a housing unit where the
landlord does not limit length of stay in the 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.

begin insert

(i) “Program” means the Housing for a Healthy California
Program created by this part.

end insert begin delete

(h)

end delete

begin insert (j) end insert  “Supportive housing” has the same meaning as in Section
50675.14.

begin delete

(i) “Whole Person Care pilot” has the same meaning as described
in the Medi-Cal 2020 Waiver Special Terms and Conditions
(STCs), Sections 110-126, as approved by the federal Centers for
Medicare and Medicaid Services, on December 30, 2015, or in
any subsequent amendment to the STCs.

end delete

begin delete

53571.  

HCD, in coordination with DHCS,

end delete

begin insert

begin insert 53591. end insert   

end insert

begin insert HCD end insert shall do all of the following:

(a) On or before begin delete July 1, 2017, end delete begin insert October 1, 2017, end insert establish the
begin delete Medi-Cal end delete Housing begin insert for a Healthy California end insert Program.

(b) On or before begin delete July 1, 2017, end delete begin insert October 1, 2017, end insert draft guidelines
for stakeholder comment to fund competitive grants to pay for
interim and long-term rental assistance under the begin delete Medi-Cal Housing
Program. end delete begin insert program. end insert 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 housing
costs in the applicant’s geographic area.

(2) Ability of the applicant to administer a program offering
interim and long-term rental assistance to people experiencing
homelessness.

(3) The applicant’s documented partnerships with affordable
and supportive housing providers in the applicant’s geographic
area.

begin delete

(4) The applicant’s partnerships with Medi-Cal managed care
plans in the applicant’s geographic area and the percentage of
Medi-Cal beneficiaries assigned to those partnering Medi-Cal
managed health plans.

end delete begin delete

(5)

end delete

begin insert (4) end insert  A comprehensive plan to connect interim housing, long-term
rental assistance, and project-based supportive housing begin delete resources
made available under the Medi-Cal Housing Program with services
made available through the Whole Person Care pilot and the Health
Home Program. end delete begin insert resources. end insert

begin delete

(6)

end delete

begin insert (5) end insert  Coordination with (A) community-based housing and
homeless service providers, (B) behavioral health providers, and
(C), safety net providers, including community health centers.

(c) On or before begin delete December 1, 2017, end delete begin insert April 1, 2018, end insert and every
year thereafter, subject to appropriation by the Legislature, award
grants on a competitive basis to eligible grant begin delete applicants
participating in a Whole Person Care pilot that includes eligibility
based on homelessness or a partnership with Medi-Cal managed
care plans administering the Health Home Program. end delete begin insert applicants. end insert
If appropriations are made available in future years, applicants
shall compete for each round of five-year grants.

(d) Midyear and annually, collect data from the begin delete Medi-Cal
Housing Program grantees or from the Medi-Cal managed care
plan partnering with applicants, as well as other Medi-Cal data
available from DHCS, as appropriate. end delete begin insert program grantees. end insert

(e) No later than begin delete January end delete begin insert April end insert 1, 2018, contract with an
independent evaluator begin insert or work with an evaluator who is contracted
with DHCS end insert to analyze data collected pursuant to Section 53573
to determine changes in health care costs associated with services
provided under the begin delete Medi-Cal Housing Program. end delete begin insert program. end insert HCD
shall provide, on a regular basis as needed, collected data to the
evaluator.

(f) (1)  begin delete By March 31, 2019, end delete begin insert On or before October 1, 2019, end insert for
grants awarded in begin delete 2017, end delete begin insert 2018, end insert and in subsequent years thereafter
in which the begin delete Medi-Cal Housing Program end delete begin insert program end insert is allocated
additional funds, 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.

begin insert

(g) HCD is encouraged to consult with DHCS where appropriate
to carry out the intent of this section.

end insert

begin delete 53572. end delete

begin insert 53592. end insert   

An applicant shall be eligible for a begin delete Medi-Cal Housing
Program end delete begin insert program end insert grant if the applicant meets the requirements of
this section. Eligibility does not create an entitlement to grant funds
and is subject to availability of funds. The applicant shall meet all
of the following requirements:

begin delete

(a) Satisfies one or more the following:

(1) Is a lead agency participating in a Whole Person Care pilot
designed to provide services to people experiencing homelessness.

(2) Is a lead agency that previously participated in a Whole
Person Care pilot that has 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) Has identified

end delete

begin insert (a) end insert begin insert   end insert begin insert Identify end insert a source of funding for Housing Transition Services
and Tenancy Sustaining Services, as defined 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 begin delete shall
include end delete begin insert may include, but are not limited to, end insert one or more of the
following:

(1) County general funds.

(2) Whole Person Care pilot program funds.

(3) The Health Home Program.

begin insert

(4) Other county-controlled funding to provide these services
to eligible participants.

end insert begin delete

(c) Agrees

end delete

begin insert (b) end insert begin insert   end insert begin insert Agree end insert to contribute funding for interim and long-term rental
assistance through begin delete one or more of the following sources: end delete begin insert an
identified source. end insert

begin delete

(1) County general funds.

end delete begin delete

(2) Flexible housing pools created through a Whole Person Care
pilot.

end delete begin delete

(3) A county or partnering housing authority’s set-aside of at
least 15 percent Housing Choice Vouchers to residents
experiencing homelessness and who are eligible to receive Whole
Person Care pilot or Health Home Program services.

end delete begin delete

(d)

end delete

begin insert (c) end insert  Has designated a process for administering grant funds
through agencies administering housing programs.

begin delete

(e) Agrees

end delete

begin insert (d) end insert begin insert   end insert begin insert Agree end insert to collect and report data, as described in Section

begin delete 53573, to HCD and DHCS. end delete begin insert 53593, to HCD. end insert

begin delete 53573. end delete

begin insert 53593. end insert   

(a) HCD shall coordinate with DHCS to begin delete identify a
process for collecting and providing end delete begin insert match program participant
data, consistent with state and federal privacy law, to end insert Medi-Cal
data begin delete regarding end delete begin insert to identify outcomes among participants as well as end insert
changes in health care costs associated with begin insert housing and end insert services
provided under the begin delete Medi-Cal Housing Program end delete begin insert program end insert to the
extent that information is available, up to 12 months prior to each
participant’s move into permanent housing, as well as changes in
costs after each participant’s move into permanent housing.

(b) An applicant awarded grant funds shall, at annual and
midyear intervals, report all of the following data to begin delete HCD and
DHCS: end delete begin insert HCD: end insert

(1) Data specified by HCD necessary to measure the costs

begin delete described in subdivision (a). end delete begin insert and outcomes of the program. end insert

(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.

begin delete

(c) HCD shall collaborate with DHCS to provide available
fee-for-service data to the evaluator.

end delete

begin delete 53574. end delete

begin insert 53594. end insert   

An applicant shall use grants awarded pursuant to this
part for one or more of the following, which may be administered
through a housing begin delete pool, as defined in the Whole Person Care pilot: end delete

begin insert pool: end insert

(a) Long-term rental assistance for periods of 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.

begin delete 53575. end delete

begin insert 53595. end insert   

A county resident is eligible to receive assistance
pursuant to a grant awarded under the begin delete Medi-Cal Housing Program end delete
begin insert program end insert 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.

begin delete

(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.

end delete begin insert

(d) Is eligible to receive services under a program providing
services promoting housing stability, including, but not limited to,
the following:

end insert begin insert

(1) The Whole Person Care pilot program.

end insert begin insert

(2) Health Home Program.

end insert begin insert

(3) A locally controlled services program funding or providing
services in supportive housing.

end insert

(e) Is likely to improve his or her health conditions with
supportive housing.

begin delete 53576. end delete

begin insert 53596. end insert   

The begin delete Medi-Cal Housing Program end delete begin insert program end insert shall be
funded upon appropriation by the 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 begin delete 53571, end delete begin insert 53591, end insert of moving
eligible participants into supportive housing.

begin delete 53577. end delete

begin insert 53597. end insert   

HCD shall reimburse DHCS for the costs of
collaborating in begin delete the design and implementation of the program. end delete
begin insert matching and providing relevant data. end insert HCD shall use no more
than 5 percent of the funds appropriated for the begin delete Medi-Cal Housing
Program end delete begin insert program end insert for purposes of administering the program.

begin delete 53578. end delete

begin insert 53598. end insert   

(a) For purposes of implementing this part, HCD begin delete or
DHCS end delete 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.

begin delete

(b) HCD and DHCS shall implement the provisions developed
pursuant to this part only after all necessary federal approvals have
been obtained for the Health Home Program and to the extent that
other federal financial participation is not jeopardized.

end delete begin insert

(b) Any guidelines that are adopted, amended, or repealed to
implement this chapter shall not be subject to Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code.

end insert

begin delete 53579. end delete

begin insert 53599. end insert   

Implementation of this part shall be contingent on an
appropriation provided for this purpose in the annual Budget Act
or other measure.