BILL NUMBER: AB 2821 AMENDED
BILL TEXT
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
INTRODUCED BY Assembly Members Chiu and Santiago
(Principal coauthor: Assembly Member Atkins)
FEBRUARY 19, 2016
An act to add Part 14 14.2
(commencing with Section 53570) 53590)
to Division 31 of the Health and Safety Code, relating to housing.
LEGISLATIVE COUNSEL'S DIGEST
AB 2821, as amended, Chiu. Medi-Cal Housing
for a Healthy California 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,
HCD to, on or before July 1, 2017,
October 1, 2017, establish the Medi-Cal
Housing for a Healthy California Program and on
or before December 1, 2017, April 1, 2018,
and every year thereafter, subject to appropriation by the
Legislature, award grants on a competitive basis to eligible 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 with Medi-Cal managed
care plans administering the Health Home Program.
applicants based on guidelines that HCD would draft, as
prescribed, and other requirements. 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
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. 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.
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
Medi-Cal Housing Program program if he
or she meets specified requirements, including that the person is
homeless, is a Medi-Cal beneficiary, is eligible for Supplemental
Security Income, and is eligible to receive
services under the Whole Person Care pilot or the Health
Home Program. certain services, and is likely to
improve his or her health with supportive services. The bill
would provide that the program shall be funded upon appropriation by
the Legislature. The bill would also authorize HCD and DHCS,
HCD, 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
to the extent that other federal financial participation is not
jeopardized. 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.
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.
(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)
(b) 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. "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 fe deral Centers for
Medicare and Medicaid Services on December 30, 2015, or in any
subsequent amendment to the STCs.
SEC. 2. Part 14 14.2 (commencing
with Section 53570) 53590) is added to
Division 31 of the Health and Safety Code, to read:
PART 14. 14.2. Medi-Cal
Housing for a Healthy California Program
53570. 53590. For purposes of this
part, all of the following definitions shall apply:
(a) "Applicant" means a county or a city collaborating with a
county to secure services funding.
(a)
(b) "DHCS" means the State Department of Health Care
Services.
(b)
(c) "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.
(c)
(d) "HCD" means the Department of Housing and Community
Development.
(d)
(e) "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. "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).
(e)
(f) "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.
(f)
(g) "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 rent. rent or
reasonable market rent as determined by HCD.
(g)
(h) "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.
(i) "Program" means the Housing for a Healthy California Program
created by this part.
(h)
(j) "Supportive housing" has the same meaning as in
Section 50675.14.
(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.
53571. HCD, in coordination with DHCS,
53591. HCD shall do all of the following:
(a) On or before July 1, 2017, October 1,
2017, establish the Medi-Cal Housing
for a Healthy California Program.
(b) On or before July 1, 2017, October 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. 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 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.
(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.
(5)
(4) A comprehensive plan to connect interim housing,
long-term rental assistance, and project-based supportive housing
resources made available under the Medi-Cal Housing Program
with services made available through the Whole Person Care pilot and
the Health Home Program. resources.
(6)
(5) 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 December 1, 2017, April
1, 2018, and every year thereafter, subject to appropriation by
the Legislature, award grants on a competitive basis to eligible
grant 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.
applicants. 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 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. program grantees.
(e) No later than January April 1,
2018, contract with an independent evaluator or work with an
evaluator who is contracted with DHCS to analyze data collected
pursuant to Section 53573 to determine changes in health care costs
associated with services provided under the Medi-Cal Housing
Program. program. HCD shall provide, on a
regular basis as needed, collected data to the evaluator.
(f) (1) By March 31, 2019, On or before
October 1, 2019, for grants awarded in 2017,
2018, and in subsequent years thereafter in which the
Medi-Cal Housing Program program 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.
(g) HCD is encouraged to consult with DHCS where appropriate to
carry out the intent of this section.
53572. 53592. An applicant shall be
eligible for a Medi-Cal Housing Program
program 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:
(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
(a) Identify 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 shall include may include,
but are not limited to, one or more of the following:
(1) County general funds.
(2) Whole Person Care pilot program funds.
(3) The Health Home Program.
(4) Other county-controlled funding to provide these services to
eligible participants.
(c) Agrees
(b) Agree to contribute funding
for interim and long-term rental assistance through one or
more of the following sources: an identified source.
(1) County general funds.
(2) 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 Housing Choice Vouchers to residents experiencing
homelessness and who are eligible to receive Whole Person Care pilot
or Health Home Program services.
(d)
(c) Has designated a process for administering grant
funds through agencies administering housing programs.
(e) Agrees
(d) Agree to collect and report
data, as described in Section 53573, to HCD and DHCS.
53593, to HCD.
53573. 53593. (a) HCD shall
coordinate with DHCS to identify a process for collecting
and providing match program participant data,
consistent with state and federal privacy law, to Medi-Cal data
regarding to identify outcomes among
participants as well as changes in health care costs associated
with housing and services provided under the
Medi-Cal Housing Program program 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 HCD and DHCS:
HCD:
(1) Data specified by HCD necessary to measure the costs
described in subdivision (a). and outcomes of the
program.
(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.
53574. 53594. An applicant shall
use grants awarded pursuant to this part for one or more of the
following, which may be administered through a housing pool,
as defined in the Whole Person Care pilot: pool:
(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.
53575. 53595. A county resident is
eligible to receive assistance pursuant to a grant awarded under the
Medi-Cal Housing Program 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.
(d) Is eligible to receive services under a program providing
services promoting housing stability, including, but not limited to,
the following:
(1) The Whole Person Care pilot program.
(2) Health Home Program.
(3) A locally controlled services program funding or providing
services in supportive housing.
(e) Is likely to improve his or her health conditions with
supportive housing.
53576. 53596. The Medi-Cal
Housing Program program 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 53571, 53591, of
moving eligible participants into supportive housing.
53577. 53597. HCD shall reimburse
DHCS for the costs of collaborating in the design and
implementation of the program. matching and providing
relevant data. HCD shall use no more than 5 percent of the
funds appropriated for the Medi-Cal Housing Program
program for purposes of administering the
program.
53578. 53598. (a) For purposes of
implementing this part, 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) 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.
(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.
53579. 53599. Implementation of
this part shall be contingent on an appropriation provided for this
purpose in the annual Budget Act or other measure.