BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2821
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|AUTHOR: |Chiu |
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|VERSION: |June 16, 2016 |
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|HEARING DATE: |June 22, 2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Medi-Cal Housing Program
SUMMARY : Requires the Department of Housing and Community Development
to establish the Medi-Cal Housing Program, which would fund
competitive grants to pay for interim and long-term rental
assistance for homeless Medi-Cal beneficiaries who are eligible
for Supplemental Security Income. Establishes criteria for an
applicant to be eligible for a Medi-Cal Housing Program grant,
including having identified a source of funding for housing
transition services and tenancy sustaining services and which
agree to contribute funding for interim and long-term rental
assistance. Requires the Medi-Cal Housing Program to be funded,
subject to a legislative appropriation.
Existing law:
1)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.
2)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
3)Authorize DHCS, subject to federal approval, to create a
Medi-Cal Health Home Program for enrollees with chronic
conditions, as prescribed, as authorized under federal
Medicaid law.
This bill:
1)Requires HCD, in coordination with DHCS, to establish the
AB 2821 (Chiu) Page 2 of ?
Medi-Cal Housing Program on or before July 1, 2017, which
would fund competitive grants to pay for interim and long-term
rental assistance. Requires the Medi-Cal Housing Program to be
funded, subject to a legislative appropriation, and makes the
funding of grants subject to annual legislative
appropriations.
2)Requires HCD, on or before December 1, 2017, and every year
thereafter, subject to legislative appropriation, to award
grants on a competitive basis to eligible grant applicants
participating in a Whole Person Care (WPC) pilot that include
eligibility based on homelessness or a partnership with
Medi-Cal managed care plans administering the Health Homes
Program. Requires, if appropriations are made available in
future years, counties to compete for each round of five-year
grants.
3)Establishes criteria for an applicant to be eligible for a
Medi-Cal Housing Program grant, including requiring an
applicant to satisfy one or more of the following:
a) Is a lead agency participating in a WPC
pilot designed to provide services to people
experiencing homelessness;
b) Is a lead agency that previously
participated in a WPC pilot that has expired and the
applicant has decided to continue to provide
services to homeless people under the structures
developed in the WPC pilot; or,
c) Is located in a county with a Medi-Cal
managed care plan or plans participating in the
Health Home Program.
4)Requires an applicant, in order to be eligible for a Medi-Cal
Housing Program grant, to have identified a source of funding
for Housing Transition Services and Tenancy Sustaining
Services, as defined in the Centers for Medicare and Medicaid
Services' (CMS) Informational Bulletin regarding
Housing-Related Activities and Services for People with
Disabilities, that includes one or more of the following:
d) County general funds;
e) WPC pilot program funds; or,
f) The Health Home Program.
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5)Requires an applicant, in order to be eligible for a Medi-Cal
Housing Program grant, to agree to contribute funding for
interim and long-term rental assistance through one or more of
the following sources:
g) County general funds;
h) Flexible housing pools created through a
WPC pilot; or,
i) A county or partnering housing authority's
set-aside of at least 15% turn-over federal Housing
Choice Vouchers to residents experiencing
homelessness and who are eligible to receive WPC
pilot or Health Home Program services.
6)Requires an applicant, in order to be eligible for a Medi-Cal
Housing Program grant, to designate a process for
administering grant funds through agencies administering
housing programs, and to agree to collect and report data
under this bill to HCD and DHCS.
7)Requires an applicant to use grants awarded under this bill
for one or more of the following, which may be administered
through a housing pool, as defined in the WPC 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; and,
d) A county's administrative costs for up to 3%
of the total grant awarded.
8)Prohibits eligibility for a grant award from creating an
entitlement to grant funds, and makes eligibility subject to
the availability of funds.
9)Defines eligibility to receive assistance under a grant
awarded under the Medi-Cal Housing Program as a county
resident who meets all of the following requirements:
a) Is homeless upon initial eligibility;
b) Is a Medi-Cal beneficiary;
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c) Is eligible for Supplemental Security
Income;
d) Is eligible to receive services under
either the WPC pilot or the Health Home Program,
whichever is operative in the participating county
or region; and,
e) Is likely to improve his or her health
conditions with supportive housing.
10) Requires HCD to 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 changes in costs after each
participant's move in to permanent housing.
11) Requires an applicant awarded grant funds to report all of
the following data to HCD and DHCS at annual and midyear
intervals:
a) Data specified by HCD necessary to measure
the costs;
b) The number of participants and the type of
interventions offered through grant funds; and,
c) The number of participants living in
supportive housing or other permanent housing.
12) Requires HCD to collaborate with DHCS to provide available
fee-for-service data to the evaluator.
13) Requires the Legislature to consider the impact that
housing and supportive services have had in changing
utilization and health care costs, as identified in the
evaluation, of moving eligible participants into supportive
housing.
14) Requires HCD to reimburse DHCS for the costs of
collaborating in the design and implementation of the program.
Caps HDC administrative costs for program administration at no
more than 5% of the funds appropriated for the Medi-Cal
Housing Program.
15) Requires HCD, on or before July 1, 2017, to draft
guidelines for stakeholder comment to fund competitive grants
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to pay for interim and long-term rental assistance under the
Medi-Cal Housing Program. Requires the guidelines to detail
competitive scoring criteria that includes, but is not limited
to, scoring that awards points based upon specified criteria,
including:
a) Need;
b) Ability to administer a program offering
interim and long-term rental assistance to people
experiencing homelessness;
c) Partnerships with affordable and supportive
housing providers and Medi-Cal managed care plans;
d) 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 WPC pilot and the
Health Home Program; and,
e) Coordination with community-based housing
and homeless service providers, behavioral health
providers, and safety net providers, including
community health centers.
16) Requires HCD to collect data midyear and annually 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.
17) Requires HCD to contract with an independent evaluator to
analyze data to determine changes in health care costs
associated with services provided under the Medi-Cal Housing
Program by no later than January 1, 2018. Requires HCD to
provide data collected to the evaluator on a regular basis as
needed.
18) Requires HCD to report date collected to specified
legislative budget and policy committees, by March 31, 2019,
for grants awarded in 2017, and in subsequent years thereafter
in which the Medi-Cal Housing Program is allocated additional
funds.
1)Permits HCD or DHCS to enter into exclusive or nonexclusive
contracts on a bid or negotiated basis to implement this bill,
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and exempts contracts entered into or amended under this bill
from specified provisions of the Government and Public
Contract Codes, and from the review or approval of the
Department of General Services.
19) Requires HDC and DHCS to implement the provisions developed
under this bill only after all necessary federal approvals for
the Health Homes Program have been obtained and to the extent
other federal financial participation is not jeopardized.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
this bill does not make an appropriation, but codifying the
program results in cost pressure to fund the program. A group of
Assembly members, which includes the author, proposed a $650
million package of proposals for affordable housing, including
$30 million to fund the Medi-Cal Housing Program (MCHP).
1)Assuming a one-time $30 million General Fund (GF)
appropriation for the grant program, $500,000 to HCD to
develop the grant program criteria, and $335,000 annually
ongoing for the life of the program.
2)Costs to DHCS to consult on program design are expected to be
absorbable within existing resources. To the extent it is
helpful to the program design to have more involvement from
DHCS staff in the program design, some of the one-time program
development costs could be shifted to DHCS (GF).
PRIOR
VOTES :
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|Assembly Floor: |63 - 13 |
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|Assembly Appropriations Committee: |15 - 5 |
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|Assembly Housing and Community | 6 - 1 |
|Development Committee: | |
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COMMENTS :
1)Author's statement. According to the author, California is
home to 20% of the country's homeless population. Homelessness
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often creates an institutional circuit, where those
experiencing it long enough cycle through living on the
streets, emergency department visits, inpatient admissions,
incarceration, and often nursing home stays. In addition to
the moral cost to society, this circuit is expensive to our
public systems: homeless individuals cost our public systems
an average of $2,897 per month, two-thirds of that incurred
through the health system. This bill attempts to coordinate
delivery of services between the health and housing systems to
further our goal of eliminating homelessness.
2)Medi-Cal 2020, Whole Person Care and Health Homes Programs. In
order to be eligible for a Medi-Cal Housing Program grant, an
applicant must be a lead agency participating in a WPC pilot
designed to provide services to people experiencing
homelessness, a lead agency that previously participated in a
WPC pilot that continues to provide services to homeless
people, or be located in a county with a Medi-Cal managed care
plan/plans participating in the Health Home Program.
The state's most recent Section 1115 Medicaid waiver (known as
"Medi-Cal 2020") included the WPC program as a new feature
that was not in previous Section 1115 waivers. WPC is
essentially a grant program over the five years of the waiver,
the goal of which is the coordination of health, behavioral
health, and social services, as applicable, in a
patient-centered manner with the goals of improved beneficiary
health and well-being through more efficient and effective use
of resources. WPC pilots will provide an option for
participating entities to receive support to integrate care
for beneficiaries who are high-risk and high-utilizers of
multiple systems and continue to have poor health outcomes.
The lead entity for WPC programs can be a county, a city and
county, a health or hospital authority, a county or University
of California hospital, a district and municipal public
hospital, or an agency or department, a federally recognized
tribe, or a tribal health program. WPC pilots will include
collaboration between two or more public entities (e.g. county
mental health plans and local housing authorities), at least
one Medi-Cal managed care health plan, and other community
entities with the goal of improving health outcomes for the
WPC population.
Up to $300 million in federal funding is available annually
for WPC over the five years of Medi-Cal 2020. No single WPC
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pilot will be awarded more than 30% of total available funding
unless additional funds are available after all initial awards
are made. The non-federal share of funds used to draw down
federal Medicaid funding is through intergovernmental
transfers from governmental entities, such as counties or
public Medi-Cal managed care plans.
The federal Affordable Care Act allows states to elect the
Health Home option in their Medicaid program and receive a 90%
federal Medicaid matching rate for two years for these
services. Federal law defines the individuals eligible for
health home services as individuals meeting one of the
following: (a) having at least two chronic conditions; (b)
having one chronic condition and are at risk of having a
second chronic condition; or (c) having one serious and
persistent mental health condition. AB 361 (Mitchell), Chapter
642, Statutes of 2013 authorized DHCS to implement the Health
Homes for Enrollees with Chronic Conditions option.
3)Medicaid coverage of housing-related activities and services
for individuals with disabilities. This bill requires an
applicant, in order to be eligible for a Medi-Cal Housing
Program grant, to have identified a source of funding for
Housing Transition Services and Tenancy Sustaining Services,
as defined in the CMS Informational Bulletin regarding
Housing-Related Activities and Services for People with
Disabilities. The identified funding must include one or more
of the following fund sources: (a) county general funds; (b)
WPC pilot program funds, or (c) the Health Home Program.
Under the referenced CMS guidance, federal financial
participation in Medicaid is not available for room and board,
but Medicaid will provide reimbursement for certain
housing-related activities, with the goal of promoting
community integration for individuals with disabilities, older
adults needed long-term services and supports and those
experiencing chronic homelessness.
Housing-related activities and services are defined in the
bulletin as: (a) individual housing transition services,
defined as services that support an individual's ability to
prepare for and transition to housing; (b) individual housing
and tenancy sustaining services, defined as services that
support the individual in being a successful tenant in his/her
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housing arrangement and thus able to sustain tenancy; and (c)
state-level housing related collaborative activities, defined
as services that support collaborative efforts across public
agencies and the private sector that assist a state in
identifying and securing housing options for individuals with
disabilities, older adults needing long-term services and
supports, and those experiencing chronic homelessness.
4)Double referral. This bill is double referred. Should it pass
out of this committee, this bill will be referred to the
Governance and Finance Committee.
5)Related legislation. AB 1618 (Committee on Budget), a budget
trailer bill, establishes the "No Place Like Home Program"
administered by the HCD, in consultation with an Advisory
Committee, and specifies the membership to distribute $2
billion among the counties to finance capital costs, including
acquisition, design, construction, rehabilitation or
preservation and capitalized operating costs of permanent
supportive housing for persons who are eligible for services
under Proposition 63 (Mental Health Services Act) and are
homeless, chronically homeless, or at risk of chronic
homelessness. Funds for the program would be through the
issuance of bonds by the State Treasurer that are secured by
Proposition 63 revenues. AB 1618, as of June 17, 2016, is on
the Senate Floor.
A proposal for additional $400 million for housing was not
included in the budget bill. Instead, the Legislature and the
Brown Administration agreed to continue discussions about the
Governor's May Revise legislative proposal to require
ministerial "by right" land use entitlements for multifamily
infill housing developments that include affordable housing.
The Governor's May Revise states local land use decisions
surrounding housing production have contributed to low
inventories, even though demand has steadily increased, and
local land use permitting and review processes have lengthened
the approval process and increased production costs. The
Governor's May Revise proposal is aimed at improving housing
affordability by increasing the supply and reducing its costs.
The May Revise states the proposal would help constrain
development costs, improve the pace of housing production, and
encourage an increase in housing supply, and that it is
counterproductive to continue providing funding for affordable
housing under a system that slows down approvals in areas
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already vetted and zoned for housing.
6)Support. This bill is jointly sponsored by the Corporation for
Supportive Housing and Housing California, which argue
Californians experiencing homelessness incur disproportionate
Medi-Cal costs, are frequent users of hospitals and
corrections systems, and have poor health outcomes. The
co-sponsors argue that evidence shows significant decreased
health costs from moving people off the streets and into
stable housing. The co-sponsors conclude this bill would
complete the WPC and the Health Home Program by creating a
Medi-Cal Housing Program which would fund rental assistance to
fund rental assistance tied to services.
SUPPORT AND OPPOSITION :
Support: Corporation for Supportive Housing (co-sponsor)
Housing California (co-sponsor)
California Chapter of the American College of
Emergency Physicians
California Commission on Aging
California Council of Community Behavioral Health
Agencies
Casa Major, Inc.
Community Housing Partnership
County Behavioral Health Directors Association
Episcopal Community Services of San Francisco
League of California Cities
Mental Health America of California
PATH Ventures
United Way of Greater Los Angeles
Western Center on Law and Poverty
Oppose: None on file
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