BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2821|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2821
Author: Chiu (D) and Santiago (D), et al.
Amended: 8/19/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/22/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE TRANS. & HOUSING COMMITTEE: 10-1, 6/28/16
AYES: Beall, Cannella, Allen, Bates, Galgiani, Leyva, McGuire,
Mendoza, Roth, Wieckowski
NOES: Gaines
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 63-13, 6/2/16 - See last page for vote
SUBJECT: Housing for a Healthy California Program
SOURCE: Corporation for Supportive Housing
Housing California
DIGEST: This bill requires the Department of Housing and
Community Development to establish the Housing for a Healthy
California Program, which would fund competitive grants to pay
for interim and long-term rental assistance for homeless
Medi-Cal beneficiaries who meet specified criteria, including
who are eligible for Supplemental Security Income. Establishes
criteria for an applicant to be eligible for a grant, including
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having identified a source of funding for housing transition
services and tenancy sustaining services and which agrees to
contribute funding for interim and long-term rental assistance.
Requires the Housing for a Healthy California Program to be
funded, upon appropriation by the Legislature.
Senate Floor Amendments of 8/19/16 rename the Medi-Cal Housing
Program as the Housing for a Healthy California Program, expand
the definition of "long-term rental assistance," delay
implementation dates in this bill, and delete references to and
obligations of the Department of Health Care Services under this
bill.
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. 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:
1) Requires HCD to establish the Housing for a Healthy
California Program on or before October 1, 2017, which would
fund competitive grants to pay for interim and long-term
rental assistance. Requires the Housing for a Healthy
California 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 April 1, 2018, and every year
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thereafter, subject to legislative appropriation, to award
grants on a competitive basis to eligible grant applicants.
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
Housing for a Healthy California Program grant, including
requiring an applicant to 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. Permits funding
for these services to include, but not be limited to, one or
more of the following:
a) County general funds;
b) Whole Person Care pilot program funds;
c) The Health Home Program; or,
d) Other county-controlled funding to provide these
services to eligible participants.
4) Requires an applicant, in order to be eligible for a Housing
for a Healthy California Program grant, to agree to
contribute funding for interim and long-term rental
assistance through an identified source.
5) Requires an applicant, in order to be eligible for a Housing
for a Healthy California 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.
6) 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:
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
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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.
7) Prohibits eligibility for a grant award from creating an
entitlement to grant funds, and makes eligibility subject to
the availability of funds.
8) Defines eligibility to receive assistance under a grant
awarded under the Housing for a Healthy California Program as
a county resident who 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 WPC
pilot or the Health Home Program, or a locally controlled
services program funding or providing services in
supportive housing; and
e) Is likely to improve his or her health conditions with
supportive housing.
9) Requires HCD to coordinate with DHCS to match Program
participant data to Medi-Cal data to identify outcomes among
participants as well as changes in health care costs
associated with housing and services provided under the
Housing for a Healthy California 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
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housing.
10)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
and outcomes of the Program;
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.
11)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.
12)Requires HCD to reimburse DHCS for the costs of
collaborating in matching and providing relevant data. Caps
HCD administrative costs for program administration at no
more than 5% of the funds appropriated for the Housing for a
Healthy California Program.
13)Requires HCD, on or before October 1, 2017, to draft
guidelines for stakeholder comment to fund competitive grants
to pay for interim and long-term rental assistance under the
Housing for a Healthy California Program. Requires the
guidelines to detail competitive scoring criteria that
includes, but is not limited to, scoring that awards points
based upon specified criteria.
14)Requires HCD to collect data midyear and annually from the
Housing for a Healthy California Program grantees.
15)Requires HCD to contract with an independent evaluator, or
work with an evaluator contracted with DHCS, to analyze data
to determine changes in health care costs associated with
services provided under the Housing for a Healthy California
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Program by no later than April 1, 2018. Requires HCD to
provide data collected to the evaluator on a regular basis as
needed.
16)Requires HCD to report data collected to specified
legislative budget and policy committees, by October 1, 2019,
for grants awarded in 2018, and in subsequent years
thereafter in which the Housing for a Healthy California
Program is allocated additional funds.
17)Permits HCD or DHCS to enter into exclusive or nonexclusive
contracts on a bid or negotiated basis to implement this
bill.
18)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.
Comments
1)Author's statement. 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, 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee analysis of the
previous version of this bill:
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1)Unknown annual costs to provide grants to support rental
assistance for homeless Medi-Cal beneficiaries (General
Fund/GF). The bill does not appropriate any funding for the
program nor does it specify a projected level of funding for
future years. Staff notes that the author and other members of
the Assembly had proposed to include $60 million in the
current year budget to fund this bill (as part of a larger
program for affordable housing). That funding was not included
in the enacted Budget Act.
2)One-time costs of about $500,000 to develop program
requirements, consult with stakeholders, and adopt program
guidelines by the HCD (GF). This bill requires HCD to develop
the program immediately, whereas actually funding grants under
the program would be subject to an appropriation by the
Legislature. Therefore, HCD would incur the upfront
administrative costs, regardless of whether the Legislature
appropriated money in future years for the program.
3)Ongoing costs of about $300,000 per year to administer the
grant program by HCD (GF). Based on the initial proposal for
$60 million in initial funding, the Department anticipated
needing about $300,000 per year to administer the grant
program.
4)Ongoing costs, likely in the low hundreds of thousands per
year, to contract with an independent evaluator to analyze
program data, including health care spending data for program
participants (GF). The bill requires HCD to contract for an
independent evaluation. The bill does not place an end date on
the evaluation of the program, therefore staff assumes that
program evaluation will be an ongoing cost.
5)Ongoing costs, likely in the low hundreds of thousands, for
DHCS to coordinate with HCD and to collect and report on
Medi-Cal expenditures for participating Medi-Cal beneficiaries
(GF and federal funds). The bill requires the independent
evaluator to determine changes in health care costs for
participating Medi-Cal beneficiaries. DHCS will likely incur
staff costs to compile both fee-for-service and managed care
expenditure data.
6)Unknown, but significant future public savings are likely due
to reduced health care costs for participating individuals, to
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the extent the program is funded (GF, local funds, federal
funds). There are numerous published studies that have shown
significant reductions in public spending when homeless
individuals who are high-utilizers of public services are
provided housing as well as physical and mental health
services. Those studies have shown a strong cost-benefit ratio
to "housing first" pilot projects. To the extent that this
program is funded and funding is targeted towards
high-utilizers of health care services, the program is likely
to generate future cost savings in avoided health care costs
(as well as potential savings due to decreased costs in the
criminal justice system). Cost savings could accrue to the
state due to reductions in hospitalizations at private
hospitals, to local governments due to reductions in
hospitalizations at public hospitals or psychiatric hospitals,
and to the federal government which provides matching funds
for Medi-Cal services. Because of the complexity of financing
for Medi-Cal services, cost savings to the state may or not
fully offset state expenditures.
SUPPORT: (Verified8/22/16)
Corporation for Supportive Housing (co-source)
Housing California (co-source)
California Association of Public Hospitals and Health Systems
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
County of San Bernardino
Disability Rights California
Episcopal Community Services of San Francisco
League of California Cities
Mental Health America of California
PATH Ventures
Southern California Association of Nonprofit Housing
United Way of Greater Los Angeles
Western Center on Law and Poverty
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OPPOSITION: (Verified8/22/16)
Department of Finance
ARGUMENTS IN SUPPORT: The Corporation for Supportive Housing
and Housing California argue Californians experiencing
homelessness incur disproportionate Medi-Cal costs, are frequent
users of hospitals and corrections systems, and have poor health
outcomes. Supporters argue that evidence shows significant
decreased health costs from moving people off the streets and
into stable housing, and this bill will fund rental assistance
tied to services.
ARGUMENTS IN OPPOSITION:The Department of Finance opposes this
bill because it may result in significant GF costs without
generating any additional federal funding in the Medi-Cal
program for housing initiatives.
ASSEMBLY FLOOR: 63-13, 6/2/16
AYES: Achadjian, Alejo, Arambula, Atkins, Baker, Bloom,
Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau,
Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd,
Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Roger Hernández,
Holden, Irwin, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, McCarty, Medina, Mullin, Nazarian,
O'Donnell, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Waldron, Weber, Wilk,
Williams, Wood, Rendon
NOES: Travis Allen, Brough, Dahle, Beth Gaines, Gallagher,
Grove, Hadley, Harper, Jones, Mathis, Obernolte, Olsen, Wagner
NO VOTE RECORDED: Bigelow, Mayes, Melendez, Patterson
Prepared by:Scott Bain / HEALTH / (916) 651-4111
8/23/16 9:59:37
**** END ****
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