BILL ANALYSIS Ó
AB 2821
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Date of Hearing: April 13, 2016
ASSEMBLY COMMITTEE ON HOUSING AND COMMUNITY DEVELOPMENT
David Chiu, Chair
AB 2821
(Chiu) - As Amended March 29, 2016
SUBJECT: Medi-Cal Housing Program
SUMMARY: Creates the Medi-Cal Housing Program to provide
support to counties who participate in the Whole Person Care
pilot program with funding for rental assistance for homeless
Medi-Cal recipients Specifically, this bill:
1)Makes legislative findings.
2)Defines "homelessness" to mean the federal definition in
Section 578.3 of Title 24 of the Code of Federal Regulations.
3)Defines "interim housing" to mean a safe place for participate
to live temporarily while waiting to move into housing
affordable to the participant including recuperative or
respite care not funded for longer than period of nine months.
4)Defines "long-term rental assistance" to mean a rental subsidy
provided to a housing provider to assist a tenant to pay the
difference between 30% of the tenant's income and the costs of
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operating the assisted unit.
5)Defines "supportive housing" to mean housing with no limit on
length of stay, occupied by the target population, and that is
linked to onsite or offsite services that assist the resident
in retaining the housing, improving his or her health status,
and maximizing his or her ability to live and, when possible,
work in the community.
6)Defines the "Whole Person Care pilot program" to mean the
program included in the 1115 Medical Waiver finalized on
December 30, 2015.
7)Requires the Department of Housing and Community Development
(HCD) in coordination with the Department of Health Care
Services (DHCS) to do all of the following:
a) On or before July 1, 2017, create the Medi-Cal Housing
Program;
b) On or before July 1, 2017, draft guidelines for
stakeholder comment to fund grants to eligible counties to
pay for long-term housing costs under the Medi-Cal Housing
Program;
c) On or before January 1, 2018 and every year thereafter,
subject to appropriation by the Legislature, award grants
to eligible counties and regions participating in a Whole
Person Care pilot program;
d) Collect data midyear and annually from counties and
regions receiving grants awarded under the Medi-Cal Housing
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Program.
e) 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
Committee on Housing and Community Development, and the
Senate Committee on Transportation and Housing.
1)Provides that a county or a region including more than one
county will be eligible for a Medi-Cal Housing Program grant
if the county or region's lead entity meets all of the
following requirements:
a) Meets one of the following descriptions:
i. Is either a lead entity participating in a
Whole Person Care pilot program under Medi-Cal 2020
Waiver;
ii. Is a lead entity that had previously
participated in a Whole Person Care pilot that has
expired; or
iii. Is a county with Medi-Cal managed care plan
participating in the health home Program
a) Has formed collaborative relationships with at least one
health plan, county health and behavioral health agency, at
least one housing authority and established relevant
continuums of care along with nonprofit housing homeless
service providers, to enable the county or region to carry
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out the requirements of the Medi-Cal Housing Program
b) Has identified a source of funding for care management
and other services including one or more of the following:
i. County general funds;
ii. Whole Person Care housing pilot pool and
management care programs; or
iii. The Health Home Program
a) Has designated a process for administering grant funds
through agencies administering housing programs;
b) Agrees to collect and report data to HCD and DHCS.
1)Requires a county or region awarded grant funds to form
agreements with health plans to collect Medi-Cal data
regarding members' overall health costs
2)Requires a county or region awarded grant funds to at annual
and midyear intervals report the following data to HCD and
DHCS:
a) A comparison of health care costs of residents receiving
long-term rental assistance under the Whole Person Care
Housing Program to health care costs of homeless resident
not receiving long-term rental assistance.
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b) The number of participants and the type of interventions
offered through grant funds.
c) The number of participants receiving long-term rental
assistance living in supportive housing other housing that
does not limit length of stay.
1)Requires a county or region to use grants awarded through the
Medi-Cal Housing Program for one or more of the following:
a) Long-term rental assistance for period up to five years
as determined by the eligible county;
b) Interim housing; or
c) A county's administrative costs for up to 5% of the
total grant awarded.
1)Provides that a county resident is eligible to receive
assistance 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; and
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c) Is eligible for services in programs identified by
participating counties or regions.
1)Provide that the Medi-Cal Housing Program is subject to an
initial unspecified appropriation after which funding for the
program will come from decreased costs of care as reported by
participating counties of moving eligible participants to
supportive housing.
2)Allow HCD to use no more than 5% of funds from the Medi-Cal
Housing Program for purpose of administering the program.
EXISTING LAW:
FISCAL EFFECT: Unknown.
COMMENTS:
Background : Homelessness often creates an institutional
circuit, where those experiencing it long enough cycle through
living on the streets, emergency department visit, inpatient
admissions, incarceration, and often nursing home stays. This
circuit is expensive to our public systems. Homeless
individuals cost our public systems an average of $2,897 per
month, two-thirds incurred through the health system. Half of
all homeless people have a history of incarceration. If homeless
when discharged from prison or jail, parolees and probationers
are seven times more likely to recidivate than people who are
housed. Homeless Californians incur disproportionate Medi-Cal
costs and achieve poor health outcomes. Many experience a
combination of chronic medical, mental health, and substance
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abuse conditions, as well as social determinants that negatively
impact their ability to access care.
Homeless frequent users continue to increase their inpatient
costs despite high Medi-Cal costs because they cannot obtain
sufficient rest, follow a healthy diet, store medications, or
regularly attend appointments so long as they are unhoused.
Two-thirds of frequent users have both medical and behavioral
health conditions, are homeless, and die 30 years younger than
average.
In March 2015, the Department of Health Care Services (DHCS)
proposed using Medi-Cal to fund services and housing
assistance-supportive housing-acknowledging decades of research
demonstrating supportive housing decreases Medicaid costs among
homeless beneficiaries. The Federal Centers for Medicare &
Medicaid Services (CMS) approved use of federal Medicaid dollars
to fund services in supportive housing. Though CMS rejected
using federal Medicaid dollars to pay for housing, CMS stated
the State could use its own State dollars (through Medi-Cal or
otherwise) to fund housing subsidies. In fact, a number of other
states and jurisdictions within California, including the State
of New York and the County of Los Angeles, pay for housing costs
through health systems.
The final 1115 Medicaid Waiver in California includes the Whole
Person Care pilot program, which allows counties to tap into
federal funds to pay for care management supports, services
helping people find housing, and services promoting housing
stability DHCS is also working to implement a new Health Home
Program that would fund services for high-cost homeless
beneficiaries.
This bill would create the Medi-Cal Housing Program to provide
funding to counties that participate in the Whole Person Care
pilot program with funding for rental assistance. The program
would be funded through an initial appropriation, however, over
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time the funding for the program would come from costs savings
to Medi-Cal achieved by moving homeless Medi-Cal recipients into
supportive housing.
Purpose of this bill : 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. This bill would complete the
"Whole Person Care" nature of the 1115 pilots and the Health
Home Program by creating a program which would fund rental
subsidies tied to services dollars included in the 1115 Waiver
and the Health Home Program.
Double referred : If AB 2821 passes this committee, the bill
will be referred to the Committee on Health.
REGISTERED SUPPORT / OPPOSITION:
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Support
Corporation for Supportive Housing (co-sponsor)
Housing California (co-sponsor)
Casa Major, Inc.
Community Housing Partnership
Episcopal Community Services of San Francisco
Western Center on Law and Poverty
Opposition
None on file
Analysis Prepared by:Lisa Engel / H. & C.D. / (961) 319-2085,
Lisa Engel / H. & C.D. / (916) 319-2085
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