BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2968|
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THIRD READING
Bill No: AB 2968
Author: Leno (D)
Amended: 8/16/06 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/21/06
AYES: Ortiz, Runner, Aanestad, Alquist, Chesbro, Cox,
Figueroa, Kuehl, Maldonado
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 76-1, 5/30/06 - See last page for vote
SUBJECT : Medi-Cal: community-living support benefit
SOURCE : San Francisco Department of Public Health
San Francisco Mayors Office
DIGEST : This bill requires the Department of Health
Services to develop and implement a program to provide a
community-living support benefit, as specified, for
Medi-Cal beneficiaries who are residents of San Francisco
and would otherwise be homeless, living in shelters, or
institutionalized.
Senate Floor Amendments of 8/16/06 clarify the services
available and the ability to modify the eligibility
criteria for the community-living support benefit.
ANALYSIS :
CONTINUED
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Existing law:
1. Provides for the Medi-Cal program, administered by the
Department of Health Services (DHS), and under which
qualified low-income persons receive health care
benefits, subject to applicable state and federal laws.
2. Establishes the Residential Care Facilities for the
Elderly Act under which facilities licensed by
Department of Social Services 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 California Statewide Supportive Housing
Initiative Act (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.
This bill:
1. Makes a number of findings and declarations regarding
Medi-Cal eligible persons in community-based housing and
their link to either community-based or site-based
health-related or psychosocial services.
2. 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.
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3. 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.
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.
4. 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/she would benefit from
supportive housing as defined in the SHIA.
B. DHS determines that he/she is eligible for
placement in a skilled nursing or intermediate care
facility.
5. 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.
6. Requires, as a condition of implementation of the
project established in this bill, the Board of
Supervisors of the City and County of San Francisco to
adopt a resolution providing county funds for use by the
state to match federal Medicaid funds for the project
and for any costs associated with implementing and
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monitoring the waiver.
7. 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.
8. Specifies that services available through the
community-living support benefit will not duplicate
services available through the Medi-Cal state plan,
other Medi-Cal waivers, and other programs financed by
the state.
9. Permits DHS to modify the eligibility criteria for the
community-living support benefit if this is needed to
qualify the benefit for federal financial participation.
10.Specifies that the Department of Mental Health is
responsible for the determination of whether the
individual applying for services would benefit from
supportive housing, which aligns the bill with current
practice.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/16/06)
San Francisco Department of Public Health (co-source)
San Francisco Mayor's Office (co-source)
American Federation of State, County, & Municipal Employees
California Association for Health Services at Home
Independent Living Resource Center
On Lok Senior Health Services
Protection and Advocacy, Inc.
San Francisco Senior Centers, Inc.
ARGUMENTS IN SUPPORT : Proponents write that this bill
supports alternatives to institutionalization at Laguna
Honda Hospital including residential care facilities,
residential care facilities for the elderly, and the
permanent supportive housing provided through the City's
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Direct Access to Housing program. Access to these
alternatives would be expanded at no additional costs to
the state because beneficiaries are already eligible for
the services that would be made available to beneficiaries
in community-based settings through this benefit.
Proponents add that ensuring that individuals with chronic
and disabling health conditions receive services in the
least restrictive setting is a mandate on states
established by the 1999 Olmstead v. L.C. Supreme Court
decision. This bill is consistent with this goal and with
language in California's Olmstead Plan stating that it is a
priority to ensure "the availability of housing options
that can be augmented by supports that facilitate the full
inclusion of the person into the community."
ASSEMBLY FLOOR :
AYES: Aghazarian, Arambula, Baca, Bass, Benoit, Berg,
Bermudez, Blakeslee, Bogh, Calderon, Canciamilla, Chan,
Chavez, Chu, Cohn, Coto, Daucher, De La Torre, DeVore,
Dymally, Emmerson, Evans, Frommer, Garcia, Goldberg,
Hancock, Harman, Jerome Horton, Shirley Horton, Houston,
Jones, Karnette, Keene, Klehs, Koretz, La Malfa, La Suer,
Laird, Leno, Leslie, Levine, Lieber, Lieu, Liu, Matthews,
Maze, McCarthy, Montanez, Mountjoy, Mullin, Nakanishi,
Nation, Nava, Negrete McLeod, Niello, Oropeza, Parra,
Pavley, Plescia, Richman, Ridley-Thomas, Sharon Runner,
Ruskin, Saldana, Salinas, Spitzer, Strickland, Torrico,
Tran, Umberg, Vargas, Villines, Wolk, Wyland, Yee, Nunez
NOES: Haynes
NO VOTE RECORDED: Cogdill, Huff, Walters
CTW:mel 8/16/06 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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