BILL NUMBER: AB 324 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 1, 2009
AMENDED IN ASSEMBLY APRIL 28, 2009
INTRODUCED BY Assembly Member Beall
( Principal coauthor: Assembly Member
Yamada )
(Principal coauthor: Senator Liu)
(Coauthor: Assembly Member Bonnie Lowenthal)
(Coauthors: Senators Hancock, Wiggins, and Wolk)
FEBRUARY 18, 2009
An act to amend Sections 9002, 9014, 9100, 9102, 9400, and 9545
of, and to add Section 9009 to, the Welfare and Institutions Code,
relating to aging.
LEGISLATIVE COUNSEL'S DIGEST
AB 324, as amended, Beall. Aging: Elder Economic Security Standard
Index.
Existing law, the Mello-Granlund Older Californians Act, creates
the California Department of Aging, with prescribed duties.
This bill would require the department, beginning in 2010, to
annually update the Elder Economic Security Standard Index (Elder
Index), as defined, for each county. This bill would require the
department to use the Elder Index to make prescribed calculations and
analyses relating to elders living below the Elder Index's poverty
threshold. This bill would permit the department to contract with the
UCLA Center for Health Policy Research
office of the President of the University of California to
carry out these requirements. This bill would also require the
department to report Elder Index data to each service area included
in the state plan.
Existing law requires each area agency on aging to create a plan
that considers available data and population trends, assesses the
need for services, identifies sources of funding for services, and
develops and implements a plan for the delivery of services based on
the need.
This bill would also require that the plan utilize the Elder
Index, specify the cost of meeting basic needs for elders in each
planning and service area, and identify which elders are living at or
below the Elder Index.
Under existing law, the department allocates funds to area
agencies on aging to implement various programs, with allocations to
be made in accordance with a prescribed funding formula. Under
existing law, the Linkages Program, a community-based services
program, provides care and case management services to frail elderly
and functionally impaired adults to help prevent or delay placement
in nursing facilities.
This bill would declare it to be the policy of the state that
specified state needs-based programs for elders use the Elder Index
or a percentage of the Elder Index to establish income eligibility
standards.
This bill would also require area agencies on aging to annually
update the intake form for the Linkages Program to include the most
current Elder Index, in order to identify elders in economic need and
refer these elders to other appropriate resources and programs.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. This act shall be known, and may be cited, as the
Elder Economic Dignity Act of 2009.
SEC. 2. The Legislature finds and declares all
of the following:
(a) The United States Census Bureau projects that the population
of people 65 years of age and older is expected to more than double
from the year 2000 to the year 2030, both nationally and in
California. People 65 years of age and older comprised 10.6 percent
of California's population in 2000 but will be 11.5 percent of the
state's population by 2010, and 17.8 percent in 2030.
(b) The United States Department of Health and Human Services uses
the Federal Poverty Guidelines as a benchmark to determine
eligibility for public assistance programs, and the Federal Poverty
Guidelines are derived from the United States Census Bureau's Federal
Poverty Thresholds, which are used to determine poverty rates. In
2008, the Federal Poverty Guidelines were ten thousand four hundred
dollars ($10,400) for a one-person household and fourteen thousand
dollars ($14,000) for a two-person household. In 2007, the official
poverty rate for the total population was 12.5 percent, according to
the most recent calculation by the United States Census Bureau.
(c) The Federal Poverty Guidelines are an inadequate and
antiquated measurement tool that uses a nearly 50-year-old
methodology. The method is based solely on one expense: food. It also
inaccurately assumes that households today still spend one-third of
their income on food when in fact the United States Department of
Agriculture states the number is actually one-tenth, or 10 percent.
Instead of food, the United States Bureau of Labor Statistics,
Consumer Expenditure Survey indicates that households spend closer to
one-third of their budget on housing. The Federal Poverty Thresholds
exclude the actual costs of housing, health care, transportation,
and other essential services. Although updated annually using the
Consumer Price Index, the Federal Poverty Thresholds are calculated
in the exact same way today, in 2009, as they were in 1962. According
to a Senior Fellow at the Brookings Institute, no other economic
statistic in use today relies on these antiquated methods. Moreover,
this "one-size-fits-all" measurement tool does not take into account
factors such as the significant variation in the cost of living
across the states, counties, and cities, or the ages of household
members.
(d) Despite these significant shortcomings in the underlying data
and methodology, the Federal Poverty Guidelines continue to be used
to determine eligibility for 82 different state and federal programs,
and are used by state and federal policymakers as a benchmark to
determine funding allocations to local communities, and to justify
cuts to public benefits. Without a precise poverty measurement tool,
policy and fiscal decisions intended to tackle poverty will continue
to be imprecise.
(e) Many of California's elders often do not receive any public
assistance because their incomes are just above the official Federal
Poverty Guidelines, and are therefore forced to make untenable
choices among basic needs, such as choices between eating three meals
a day, foregoing medications, or paying for shelter. Most of these
elders have worked hard all of their lives, yet still struggle to pay
their bills and live with dignity and economic security in their
later years. Although often described as "falling through the cracks,"
this group is neither small nor marginal, as that phrase suggests,
but rather, it is a substantial proportion of California's aging
community.
(f) Using the antiquated Federal Poverty Threshold, the United
States Census Bureau reports that, for 2006, only 7.9 percent
(295,000) of California's elders live below the official poverty
level. This is a significant underestimate of the number of
Californians 65 years of age and older who do not have enough to
adequately cover their most basic needs. A recent study conducted by
the University of California, Los Angeles, in collaboration with the
Insight Center for Community Economic Development, found that
approximately 47 percent (1.76 million) of California's elders 65
years of age and older do not have enough income to adequately cover
their most basic needs, including food, shelter, medicine, and
transportation, the study documents that approximately 40 percent
(1.46 million) of California's elders "fall through the cracks"
because they have incomes above the official Federal Poverty
Thresholds but below what they actually need to make ends meet in
today's economy.
(g) The Elder Economic Security Standard Index (Elder Index) is a
more sophisticated and updated 21st century calculation of poverty
that provides a more accurate picture of the true economic needs of
elders and their families. Calculated by the University of
California, Los Angeles, in partnership with the Insight Center for
Community Economic Development, Wider Opportunities for Women, and
the Gerontology Institute at the University of Massachusetts, Boston,
the new Elder Index quantifies the actual costs elders, 65 years of
age and older, face in meeting all of their basic needs, including
food, shelter, health care, transportation, utilities, and essential
household items, in the private market.
(h) The Elder Index is specific to the costs that elders face. It
factors in state and local differences in the cost of living, as well
as an elder's housing situation and health care needs.
(i) The Elder Index serves as the guiding tool for broad-based
planning, evaluation, research, advocacy, and outreach at the
national, state, and local levels. By 2012, each county in every
state across the nation will have a customized Elder Index. Among the
current five pilot states using the Elder Index, the State of
Massachusetts is already using it for planning, programming, and
increasing the asset limits for Medicaid home- and community-based
services from two thousand dollars ($2,000) to ten thousand dollars
($10,000). The Pennsylvania Department of Aging, Illinois
Congressional Representative Jan Schakowsky, and former Wisconsin
State Assembly Speaker Michael Huebsch have also endorsed the Elder
Index in their respective states.
(j) A more accurate calculation of the poverty rate among elders
will result in a more targeted distribution of federal funding to
states to support elders, more effective programs, and strategic
planning.
SEC. 3. SEC. 2. Section 9002 of the
Welfare and Institutions Code is amended to read:
9002. The Legislature finds and declares all of the following:
(a) Programs shall be initiated, promoted, and developed through
all of the following:
(1) Volunteers and volunteer groups.
(2) Partnership with local governmental agencies.
(3) Coordinated efforts of state agencies.
(4) Coordination and cooperation with federal programs.
(5) Partnership with private health and social service agencies.
(6) Participation by older individuals in the planning and
operation of all programs and services that may affect them.
(b) It shall be the policy of this state to give attention to the
unique concerns of our most frail and vulnerable older individuals.
(c) Recognizing the diversity in geography, economy, culture, and
lifestyles in California and the diversity of local senior citizen
networks, it shall be the policy of this state to encourage and
emphasize local control to achieve the most effective blend of state
and local authority.
(d) In recognition of the many governmental programs serving
seniors, and as specified in paragraph (2) of subdivision (c) of
Section 9102, the California Department of Aging should coordinate,
as existing resources permit, with other state departments in doing
all of the following:
(1) Promote clear and simplified access to information assistance
and services arrangements.
(2) Ensure that older individuals retain the right of free choice
in planning and managing their lives.
(3) Ensure that health and social services are available that do
all of the following:
(A) Allow older individuals to live independently at home or with
others.
(B) Provide for advocacy for expansion of existing programs that
prevent or minimize illness or social isolation, and allow
individuals to maximize their dignity and choice of living.
(C) Provide for protection of older individuals from physical and
mental abuse, neglect, and fraudulent practices.
(4) Foster both preventive and primary health care, including
mental and physical health care, to keep older individuals active and
contributing members of society.
(5) Encourage public and private development of suitable housing.
(6) Develop and seek support for plans to ensure access to
information, counseling, and screening.
(7) Encourage public and private development of suitable housing
and recreational opportunities to meet the needs of older
individuals.
(8) Encourage development of efficient community services
including access to low-cost transportation services, that provide a
choice in supported living arrangements and social assistance in a
coordinated manner and that are readily available when needed.
(9) Encourage and develop meaningful employment opportunities for
older individuals.
(10) Encourage the development of barrier-free construction and
the removal of architectural barriers, so that more facilities are
accessible to older individuals.
(11) Promote development of programs to educate persons who work
with older individuals in gerontology and geriatrics.
(12) Encourage and support intergenerational programming and
participation by community organizations and institutions to promote
better understanding among the generations.
(e) The California Department of Aging shall ensure that, to the
extent possible, the services provided for in accordance with this
division shall be coordinated and integrated with services provided
to older individuals by other entities of the state. That integration
may include, but not be limited to, the reconfiguration of state
departments into a coordinated unit that can provide for multiple
services to the same consumers. Services provided under this division
shall be managed, directly or through contract, by local area
agencies on aging or other local systems.
(f) It shall be the policy of the state that new California state
needs-based programs, and current California state programs which are
later modified to become needs based, shall use the Elder Economic
Security Standard Index or a percentage of the Elder Economic
Security Index to establish income eligibility standards.
SEC. 4. SEC. 3. Section 9009 is
added to the Welfare and Institutions Code, to read:
9009. "Elder Economic Security Standard Index" means an index
that quantifies the costs that elders face in meeting their basic
needs, including, but not limited to, food, shelter, health care,
transportation, utilities, and essential household items, in the
private market. It is derived by applying the existing publicly
available methodology, developed by the Wider Opportunities for Women
and Gerontology Institute, to publicly available data sources on the
costs to live in each county of the state.
SEC. 5. SEC. 4. Section 9014 of the
Welfare and Institutions Code is amended to read:
9014. "Greatest economic need" means the need resulting from an
income level at or below the thresholds established by the Elder
Economic Security Standard Index.
SEC. 6. SEC. 5. Section 9100 of the
Welfare and Institutions Code is amended to read:
9100. (a) There is in the Health and Welfare Agency the
California Department of Aging.
(b) The department's mission shall be to provide leadership to the
area agencies on aging in developing systems of home- and
community-based services that maintain individuals in their own homes
or least restrictive homelike environments.
(c) In fulfilling its mission, the department shall develop
minimum standards for service delivery to ensure that its programs
meet consumer needs, operate in a cost-effective manner, and preserve
the independence and dignity of aging Californians. In accomplishing
its mission, the department shall consider available data and
population trends in developing programs and policies, collaborate
with area agencies on aging, the commission, and other state and
local agencies, and consider the views of advocates, consumers and
their families, and service providers. The department shall also
report the Elder Economic Security Standard Index data for each
service area in its state plan.
(d) The minimum standards for its programs shall ensure that the
system meets all of the following requirements:
(1) Have the flexibility to respond to the needs of individuals,
their families and caregivers.
(2) Provide for consumer choice and self-determination.
(3) Enable consumers to be involved in designing and monitoring
the system.
(4) Be equally accessible to diverse populations regardless of
income, consistent with existing state and federal law.
(5) Have consistent statewide policy, with local control and
implementation.
(6) Include preventive services and home- and community-based
support.
(7) Have cost containment and fiscal incentives consistent with
the delivery of appropriate services at the appropriate level.
SEC. 7. SEC. 6. Section 9102 of the
Welfare and Institutions Code is amended to read:
9102. The duties and powers of the department shall be:
(a) To administer all programs under the Older Americans Act of
1965, as amended, and this division, including providing ongoing
oversight, monitoring, and service quality evaluation to ensure that
service providers are meeting standards of service performance
established by the department. This shall include, but is not limited
to, all of the following:
(1) Setting program standards and providing standard materials for
training.
(2) Providing technical assistance to area agencies on aging,
program managers, staff, and volunteers providing services.
(3) Development of the state plan on aging according to federal
law.
(4) Maintain a clearinghouse of information related to the
interests and needs of older individuals and provide referral
services, if appropriate.
(5) Maintain a management information and reporting system;
including a database on service utilization patterns and demographic
characteristics of the older population to be cross-classified by
age, sex, race, and other information required for the planning
process, and eliminate redundant and unnecessary reporting
requirements.
(6) Encourage and support the involvement of volunteers in
services to older individuals.
(7) Seek ways to utilize the private sector to assume greater
responsibility in meeting the needs of older individuals.
(8) Encourage internships to be coordinated with schools of
gerontology or related disciplines, including internships for older
individuals.
(b) The department shall have primary responsibility for
information received and dispersed to the area agencies on aging.
(c) The department shall be responsible for activities that
promote the development, coordination, and utilization of resources
to meet the long-term care needs of older individuals, consistent
with its mission. The responsibilities shall include, but not be
limited to, all of the following:
(1) Conduct research in the areas of alternative social and health
care systems for older individuals.
(2) As specified in Section 9002, coordinate with agencies and
departments that administer health, social, and related services for
the purposes of policy development, development of care standards,
consistency in application of policy, evaluation of alternative uses
of available resources toward greater effectiveness in service
delivery, including seeking additional federal and private dollars to
support achievement of program goals, and ensure ongoing response to
the identified special needs of the chronically impaired to provide
support that maximizes their level of functioning.
(3) Monitor and evaluate programs and services administered by the
department, utilizing standardized methodology.
(4) Develop and implement training and technical assistance
programs designed to achieve program goals.
(5) Establish criteria for the designation, sanctioning ,
and defunding of area agencies on aging.
(d) In conjunction with the management information and reporting
system required under paragraph (5) of subdivision (a), beginning in
the 2006 calendar year, the department shall annually submit by
January 10 of each year, to the budget, fiscal, and policy committees
of the Legislature, and the Legislative Analyst, all of the
following information:
(1) The number of persons served statewide in each of the prior
and current fiscal years for each state or federally funded program
or service administered by the department. This information shall
also be provided for each Area Agency on Aging
area agency on aging service area.
(2) To the extent feasible, the number of unduplicated persons
served statewide in the prior and current fiscal years for all state
or federally funded programs and services administered by the
department. To the extent feasible, this information shall also be
provided for each Area Agency on Aging area
agency on aging service area.
(3) Total estimated statewide expenditures in the prior, current,
and budget fiscal years for each state or federally funded program or
service administered by the department. This information shall also
be provided for each Area Agency on Aging
area agency on aging service area.
(e) The report required by subdivision (d) shall be suspended
until the 2010-11 fiscal year. In lieu of that information, the
department shall submit to the budget, fiscal, and policy committees
of the Legislature, and the Legislative Analyst, by March 1 of each
year, copies of the program factsheets for each state and federal
program administered by the department. The department shall update
the information included in the program factsheets annually, before
submitting them as required by this subdivision.
(f) The department shall annually, beginning in the 2010 calendar
year, update the Elder Economic Security Standard Index for each
county in the state, using the methodology developed for the 2008
Elder Economic Security Standard Index. The department shall
annually, beginning in the 2010 calendar year, calculate the number,
percentage, and demographic profile of elders living below the
updated Elder Economic Security Standard Index for that year by
utilizing the most recent demographic data available. The department
shall analyze the number and percentage of elders living below the
updated Elder Economic Security Standard Index for that year by
county, race, ethnicity, gender, age, housing situation, and other
relevant demographic factors. The department may contract with the
UCLA Center for Health Policy Research office
of the President of the University of California for purposes
of carrying out the requirements of this subdivision.
SEC. 8. SEC. 7. Section 9400 of the
Welfare and Institutions Code is amended to read:
9400. (a) The Legislature hereby declares and recognizes the area
agencies on aging to be the local units on aging in California that
are supported from an array of sources, including federal funding
largely through the federal Older Americans Act (42 U.S.C. Sec. 3001,
et seq.), state and local government assistance, the private sector,
and individual contributions for services.
(b) Area agencies on aging shall operate in compliance with the
Older Americans Act and applicable regulations.
(c) Each area agency on aging shall maintain a professional staff
that is supplemented by volunteers, governed by a board of directors
or elected officials, and whose activities are reviewed by an
advisory council consisting primarily of older individuals from the
community.
(d) Each area agency on aging shall create a plan that considers
available data and population trends, utilizes the Elder Economic
Security Standard Index, specifies the costs of meeting basic needs
for elders in each planning and service area, identifies which elders
are living at or below the Elder Economic Security Standard Index,
assesses the needs for services provided under this division
reflective of the community needs, identifies sources for funding
those services, and develops and implements a plan for delivery of
those services based on those needs. Each plan shall include
developing area home- and community-based systems of care that
maintain individuals in their own homes or least restrictive
environment, providing better access to these services through
information and referral, outreach, and transportation, and
advocating for the elderly on local, state, and national levels.
(e) Area agencies on aging shall function as the community link at
the local level for development of home- and community-based
services provided under the department's programs.
(f) The area agencies on aging shall implement subdivision (b) of
Section 9100 at the local level, with particular emphasis on
coordinating with the local systems to enable individuals to live out
their lives with maximum independence and dignity in their own homes
and communities through the development of comprehensive and
coordinated systems of home- and community-based care. Nothing in
this division shall preclude local determination and designation of
service coordinators other than area agencies on aging, for
development and implementation of the long-term care integration
pilot projects set forth in Article 4.05 (commencing with Section
14139.05) of Chapter 7 of Part 3 of Division 9.
(g) In fulfilling their mission, area agencies on aging shall
build upon the resources and the commitment unique to each community
and shall be guided by a 10-point description of a community-based
system that shall do all of the following:
(1) Have a visible focal point of contact where anyone can go or
call for help, information, or referral on any aging issue.
(2) Provide a range of service options.
(3) Ensure that these options are readily accessible to all older
individuals, whether independent, semi-independent, or totally
dependent, no matter what their income.
(4) Include a commitment of public, private, and voluntary
resources committed to supporting the system.
(5) Involve collaborative decisionmaking among public, private,
voluntary, religious, and fraternal organizations, as well as older
individuals and consumers in the community.
(6) Offer special help or targeted resources for the most
vulnerable older individuals, those in danger of losing their
independence.
(7) Provide effective referral from agency to agency to ensure
that information or assistance is received, no matter how or where
contact is made in the community.
(8) Evidence sufficient flexibility to respond with appropriate
individualized assistance, especially for the vulnerable older
individuals.
(9) Have a unique character that is tailored to the specific
nature of the community.
(10) Be directed by leaders in the community who have the respect,
capacity, and authority necessary to convene all interested persons
to assess needs, design solutions, track overall success, stimulate
change, and plan community responses for the present and for the
future.
SEC. 9. SEC. 8. Section 9545 of the
Welfare and Institutions Code is amended to read:
9545. (a) The Legislature finds and declares that the purpose of
the Linkages Program shall be to provide care and case management
services to frail elderly and functionally impaired adults to help
prevent or delay placement in nursing facilities. For purposes of
this section, "care or case management" means all of the following:
(1) As appropriate, ongoing care or case management to frail
elderly and functionally impaired adults to help prevent or delay
placement in nursing facilities.
(2) Client assessment, in conjunction with the development of a
service plan with the participant and other appropriate persons, to
provide for needs identified by the assessment.
(3) Authorization and arrangement for the purchase of services, or
referral, with followup, to volunteer, informal, or third-party
payer services. Contractors shall maximize to the fullest extent
possible the use of existing services resources before using program
funds to purchase services for clients. Any benefits received as a
result of these purchases either shall not be considered income for
purposes of programs provided for under Division 9 (commencing with
Section 10000) or shall not be considered an alternative resource
pursuant to Section 12301.
(4) Service and participant monitoring to determine that the
services obtained are appropriate to need, of acceptable quality, and
provided in a timely manner.
(5) Follow up with clients, including periodic contact and
initiation of an interim assessment, if deemed necessary, prior to
scheduled reassessment.
(6) Assistance to older individuals entering or returning home
from nursing facilities and who need help to make the transition.
(7) Comprehensive and timely information, when necessary, to
individuals and their families about the availability of community
resources, to assist functionally impaired adults and the frail
elderly to maintain the maximum independence permitted by their
functional ability.
(8) Short-term specialized assistance, including timely
one-time only assistance in securing community resources, counseling,
and the arrangement of an action plan, when there is a temporary
probable threat to the ability of the frail elderly person or
functionally impaired adult to remain in the most independent living
arrangement permitted by his or her functional ability.
(b) Area agencies on aging shall be required to annually update
the Linkages Program intake form to include the most current Elder
Economic Security Standard Index, as adopted by the department
pursuant to Section 9102, in order to identify elders in economic
need and to refer these elders to other resources and programs.
(c) Contractors of the Linkages Program shall have experience in
community long-term care services and capability to serve the frail
elderly and functionally impaired adults, and where applicable,
ensure separateness of the programs and demonstrate protective
measures to avoid conflict of interest.
(d) Contractors of the Linkages Program shall have a systematic
means of capturing and reporting all required community-based
services program data.
(e) (1) Each county shall deposit funds collected pursuant to
Section 1465.5 of the Penal Code in its general fund, to be available
for use only for the support of services provided under this chapter
in that county, including county administrative costs not exceeding
10 percent of the funds collected, except as otherwise provided in
this subdivision. A county may join with other counties to establish
and fund a program of services under this chapter.
(2) Funds utilized pursuant to this section shall not supplant, be
offset against, or in any way reduce funds otherwise appropriated
for the support of services provided under this chapter.
SEC. 10. SEC. 9. Nothing in this act
shall be construed to mandate changes in the current funding
allocations to area agencies on aging made pursuant to subparagraph
(A) of paragraph (2) of subdivision (b) of Section 9112 of the
Welfare and Institutions Code.