BILL ANALYSIS Ó
SENATE COMMITTEE ON TRANSPORTATION AND HOUSING
Senator Jim Beall, Chair
2015 - 2016 Regular
Bill No: AB 2821 Hearing Date: 6/28/2016
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|Author: |Chiu |
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|Version: |6/16/2016 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Alison Dinmore |
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SUBJECT: Medi-Cal Housing Program
DIGEST: This bill creates the Medi-Cal Housing Program to
provide support to counties that participate in the Whole Person
Care pilot program with funding for rental assistance for
homeless Medi-Cal recipients.
ANALYSIS:
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) Authorizes 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:
AB 2821 (Chiu) Page 2 of ?
1) Defines "interim housing" as 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% of his or
her income toward the cost of the interim housing. This may
also include recuperative or respite care and shall not be
funded for longer than nine months.
2) Defines "long-term rental assistance" as 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% of the tenant's income and the costs of operating the
assisted housing unit.
3) Defines "permanent housing" as a housing unit where the
landlord does not limit the 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.
4) Defines "supportive housing" as housing with no limit on
length of stay, that is occupied by the target population,
and that is linked to onsite or offsite services that assist
the supportive-housing 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.
5) Defines "Whole Person Care pilot" to mean the program
included in the Medi-Cal 2020 Waiver Special Terms and
Conditions, as finalized on December 20, 2015, or any
amendment to those Special Terms and Conditions.
6) Requires the Department of HCD, in collaboration with the
DHCS, to do the following:
a) Establish the Medi-Cal Housing Program, on or before
July 1, 2017.
b) Draft guidelines for stakeholder comment, on or
before July 1, 2017, to fund competitive grants to pay
AB 2821 (Chiu) Page 3 of ?
for interim and long-term rental assistance under the
Medi-Cal Housing Program. The criteria shall detail
competitive scoring criteria including, but not limited
to, all of the following:
i. Need, which includes consideration of the
number of individuals experiencing homelessness and
the impact of the housing costs in the applicant's
geographic area.
ii. Ability of the applicant to administer a
program offering interim and long-term rental
assistance to people experiencing homelessness.
iii. The applicant's documented partnerships with
affordable and supportive housing providers in the
applicant's geographic area.
iv. 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.
v. 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 or the Health Home Program.
vi. Coordinating with community-based housing and
homeless service providers, behavioral health
providers, and safety net providers, including
community health centers.
a) Award grants, on or before December 1, 2017 and
annually thereafter, 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. If appropriations are made available in the
future years, counties shall compete for each round of
five-year grants.
b) Collect data mid-year and annually from the Medi-Cal
Housing Program grantees or from the Medi-Cal
managed-care plan partnering with applicants, as well as
AB 2821 (Chiu) Page 4 of ?
other Medi-Cal data available from DHCS.
c) Contract with an independent evaluator to analyze
data collected to determine changes in health care costs
associated with services provided under the Medi-Cal
Housing Program, no later than January 1, 2018. HCD
shall provide, on a regular basis as needed, collected
data to the evaluator.
d) Report data 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,
to the Legislature.
1) Requires the applicant to meet the following requirements:
a) The agency is a lead agency participating or that
previously participated in the Whole Person Care pilot,
or is located in a county with a Medi-Cal managed-care
plan or plans participating in the Health Home Program.
b) Has identified a source of funding for care
management and other services, including one or more of
the following: county general funds, Whole Person Care
pilot program funds, or the Health Home Program.
c) Agrees to contribute funding for interim and
long-term rental assistance through one or more of the
following: county general funds, flexible housing pools
created through a Whole Person Care pilot, or a county
partnering housing authority's set-aside of at least 15%
turn-over federal Housing Choice (Section 8) Vouchers to
residents experiencing homelessness and who are eligible
to receive Whole Person Care pilot or Health Home Program
services.
d) Has designated a process for administering grant
funds through agencies administering housing programs.
AB 2821 (Chiu) Page 5 of ?
e) Agrees to collect and report data to HCD and DHCS.
1) 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 into permanent housing.
2) Requires a recipient to use grants for one or more of the
following, which may be administered through a housing pool:
long-term rental assistance for a period up to five years; 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; interim
housing; or a county's administrative costs for up to 3% of
the total grant awarded.
3) Provides that a county resident is eligible to receive
assistance 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
e) Is likely to improve his or her health condition
with supportive housing
AB 2821 (Chiu) Page 6 of ?
1) Provides that the Medi-Cal Housing Program is subject to
an initial appropriation by the Legislature. The funding of
grants is subject to annual appropriation by the
Legislature. The Legislature shall consider the impact that
housing and supportive services have had in changing
utilization and health care costs of moving eligible
participants into supportive housing.
COMMENTS:
1) Purpose of the bill. According to the author, California
is home to 20% of the country's homeless population.
Homelessness often creates an institutional circuit, where
those experiencing it long enough cycle through living on
the streets, ER visits, inpatient admissions, incarceration,
and often nursing home stays. In addition to the moral cost
to society, this circuit is expensive to the state's public
systems: homeless individuals cost the state's 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 California's goal of eliminating
homelessness. This bill creates the Medi-Cal Housing Program
to pay for the cost of housing homeless individuals enrolled
in counties' Whole Person Care pilot programs. As part of
the program, the health care costs of individuals enrolled
in the Whole Person Care pilot program prior to and after
being housed will be evaluated and compared to determine any
health costs savings.
2) Homelessness. 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 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
AB 2821 (Chiu) Page 7 of ?
of frequent users have both medical and behavioral health
conditions, are homeless, and die 30 years younger than
average.
3) Background on Whole Person Care pilot. In March 2015,
DHCS proposed using Medi-Cal to fund supportive housing,
acknowledging decades of research demonstrating that this
form of housing decreases Medicaid costs among homeless
beneficiaries. The Federal Centers for Medicare and
Medicaid Services (CMS) approved the use of federal Medicaid
dollars to fund services in supportive housing. While CMS
rejected using federal Medicaid dollars to pay for housing,
CMS stated that California could use its own dollars
(through Medi-Cal or otherwise) to fund housing subsidies.
A number of jurisdictions, including the State of New York
and the County of Los Angeles, already pay for housing costs
through health systems.
4) 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 management supports,
services helping people find housing, and services promoting
housing stability. DHCS is also working to implement a new
Health Home Program, created under the Affordable Care Act,
which would fund services for high-cost homeless
beneficiaries.
5) Medi-Cal Housing Program. This bill would complete the
Whole Person Care piece of the 1115 pilots and the Health
Home Program by creating a program that funds rental
subsidies tied to services dollars included in the 1115
Waiver and the Health Home Program. The program would be
funded by an initial appropriation from the Legislature.
6) Double-referral. This bill was heard in the Senate Health
Committee on June 22 and passed out on a 9-0 vote.
Assembly Votes:
Floor: 63-13
Appr: 15-5
Health: 14-2
H&CD: 6-1
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes
AB 2821 (Chiu) Page 8 of ?
Local: No
POSITIONS: (Communicated to the committee before noon on
Wednesday,
June 22, 2016.)
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
Community Housing Partnership
Casa Major, Inc
County Behavioral Health Directors Association of California
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
OPPOSITION:
None received
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