BILL ANALYSIS
AB 2968
Page 1
Date of Hearing: April 18, 2006
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 2968 (Leno) - As Amended: April 5, 2006
SUBJECT : Medi-Cal: community-living support benefit.
SUMMARY : Requires the Department of Health Services (DHS) to
develop and implement a program to provide a community-living
support benefit (benefit), as specified, for Medi-Cal
beneficiaries who are residents of San Francisco (SF) and would
otherwise be homeless, living in shelters, or institutionalized.
Specifically, this bill :
1)Requires DHS to develop and implement a program to provide a
community-living support program for Medi-Cal beneficiaries,
to the extent federal financial participation is available,
and requires DHS to submit any waiver application,
modification of any existing waiver, or amendment to the
state's Medicaid plan, necessary to provide this benefit.
2)Requires the community-living support benefit to include both
of the following:
a) Reimbursement for an array of health-related and
psychosocial services provided or coordinated at
community-based housing sites, including but not limited
to, assisted living units, residential care facilities for
the elderly, publicly funded senior and disabled housing
projects, or supportive housing sites that serve
chronically homeless individuals; and,
b) Access to community-living support services provided or
coordinated at the community-based housing site, including
but not limited, personal care and health services, such as
are required in a licensed residential care facility for
the elderly, and support services, as defined in existing
law relating to supportive housing programs.
3)Requires that individuals be eligible for the benefit
established by this bill if they are Medi-Cal eligible, and a
resident of San Francisco, who would otherwise be homeless,
living in shelters or institutionalized, and who meet one or
both of the following criteria:
a) DHS determines that he or she would benefit from
supportive housing as defined in the California Statewide
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Supportive Housing Initiative Act (SHIA); and,
b) DHS determines that he or she is eligible for placement
in a skilled nursing or intermediate care facility.
4)Requires DHS to seek to maximize resources for community-based
housing by coordinating the community-living support benefits
with existing efforts to coordinate care, improve health
outcomes, and reduce long-term care costs for the targeted
population.
5)Includes legislative findings stating that due to the unique
circumstances facing Medi-Cal recipients in the City and
County of San Francisco, who are residing in community-based
housing, special legislation, rather than a general statute,
is necessary.
EXISTING LAW:
1)Provides for the Medi-Cal progam, administered by DHS, and
under which qualified low-income persons receive health care
benefits, including care in certain institutional settings,
subject to applicable state and federal laws.
2)Establishes the Residential Care Facilities for the Elderly
Act (RCFEs) under which facilities licensed by Department of
Social Services (DSS) provide varying levels of protective
supervision, personal care, or health-related services to
persons 60 years of age or older, but also to persons under 60
years of age with compatible needs.
3)Establishes the SHIA, which defines supportive housing as
housing for low income adults with specified health and mental
health conditions, but also including families with children,
elderly persons, young adults aging out of the foster care
system, individuals exiting from institutional settings,
veterans, or homeless people. Supportive housing for these
purposes has no limit on length of stay, is occupied by the
target population, and is linked to onsite or offsite services
that assist the tenant to retain the housing, improve his or
her health status, maximize their ability to live and, when
possible, to work, in the community.
FISCAL EFFECT : Unknown
COMMENTS :
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1)PURPOSE OF THIS BILL. According to the author, this bill is
needed to allow SF City and County to offer community-based
alternatives to residents of Laguna Honda Hospital (LHH) or
those at risk of institutionalization. The author points out
that SF has experience providing financial supplements to keep
people in community alternatives, such as RCFEs, and continues
to do so. However, according to the sponsors, the Mayor of SF
and SF Department of Public Health, the need exceeds city
resources. This bill will provide access to a Medicaid funded
"wraparound," allowing SF to offer many more SF residents a
community alternative to admission to LHH. The sponsors
state that this bill will result in bundling medical and
support services, such as personal care, case management and
mental health, together in an all inclusive rate, not unlike
the nursing home rate. According to the sponsors, SF
currently pays an additional $95 per day for Medi-Cal
residents in LHH, and is willing to continue to do that, but
needs the flexibility to use the combination of their
contribution and Medi-Cal funds to serve residents in the
community instead of at LHH.
2)MEDICAID AND HOME AND COMMUNITY-BASED SERVICES. The three ways
state Medicaid programs can provide home and community-based
services are: a) through the home health benefit (a mandatory
Medicaid benefit that historically has emphasized skilled,
medically-oriented services in the home, but states have the
discretion to cover a number of therapeutic services); b) through
one of several optional state plan services (including personal
care, rehabilitation services, private duty nursing, physical
therapy, occupational therapy, and transportation services); and,
c) through home and community-based services waivers. Some of
California's Medi-Cal home and community-based services include
the In-Home Supportive Services program (a state plan benefit),
the Adult Day Health Care Program (a state plan benefit), the six
1915(C) waivers including the AIDS waiver, the developmentally
disabled waiver, the In-Home Medical Care waiver, the Nursing
Facility A/B waiver, the Nursing Facility Subacute waiver, and
the Multipurpose Senior Services Program waiver.
3)Assisted Living Waiver Pilot Project (ALWPP) . AB 499
(Aroner), Chapter 557, Statutes of 2000, requires DHS to
implement pilot projects to test the efficacy of assisted
living as a new Medi-Cal waiver benefit. This Medicaid home
and community-based services waiver program will serve
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eligible residents in both licensed RCFEs and in publicly
subsidized housing settings. A key goal of the pilot project
is to enable low-income, Medi-Cal eligible recipients, who
would otherwise require inpatient nursing facility services,
to remain in or relocate to community settings. The waiver
has been approved by CMS and will serve elderly individuals or
individuals with disabilities who meet the nursing facility
level of care but who can be served outside of a nursing
facility. To participate in the ALWPP, beneficiaries must
have full-scope Medi-Cal eligibility, without a share of cost,
meet the skilled nursing facility level of care, and be at
least 21 years of age. The Governor's 2006-07 Budget proposes
six staff at DHS and $1.2 million ($476,000 General Fund) for
implementation of the ALWPP in three counties (Sacramento, San
Joaquin and Los Angeles.) The project is expected to serve
500-1,000 persons over three years.
4)PREVIOUS LEGISLATION. AB 468 (Yee), as introduced in 2005,
required DHS to develop, and request approval of, a federal
Medicaid waiver for reimbursement of similar services for
Medi-Cal beneficiaries in supportive housing facilities
administered by a local governmental entity. AB 468 was
amended to deal with school nutrition issues and is currently
in the Senate. AB 499 (Aroner), Chapter 557, Statutes of
2000, requires DHS to implement a pilot project testing the
efficacy of an assisted living Medi-Cal waiver.
5)POLICY QUESTIONS :
a) If DHS is able to secure federal financial participation
for this type of program, should participation be limited
to SF County?
b) Should this bill be amended to allow SF city, or any
participating city or county, to use city or county funds
to match federal Medicaid funds, thus drawing down
additional federal funds for these types of projects
without additional state costs?
c) Technical issue . This bill references various code
sections relating to other programs, such as Continuing
Care Retirement Communities (CCRCs), because those sections
of law contain useful, relevant definitions. It might,
however, be confusing to do it this way since there will be
no real connection between CCRCs and this bill. This bill
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could be amended to simply include the applicable
definitions.
REGISTERED SUPPORT / OPPOSITION :
Support
San Francisco Mayor's Office (co-sponsor)
San Francisco Department of Public Health (co-sponsor)
California Association of Homes and Services for the Aging
Opposition
None on file.
Analysis Prepared by : Deborah Kelch / HEALTH / (916) 319-2097