Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy and medication-assisted treatment (MAT) of addicted persons. Existing law specifies the medications a licensed narcotic treatment program may use for narcotic treatment replacement therapy and MAT by a licensed narcotic treatment program.

Existing law prohibits the unlawful denial of full and equal access to the benefits of, or the unlawful discrimination under, any program or activity that is conducted, operated, or administered by the state or by any state agency, that is funded directly by the state, or that receives any financial assistance from the state, for a person on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, or sexual orientation.

This bill would prohibit a state-funded program, as defined, from discriminating against, or denying access to housing or housing services to, individuals because they are currently undergoing MAT or taking authorized medications.

This bill would also make legislative findings and declarations.

Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy and medication-assisted treatment (MAT) of addicted persons. Existing law specifies the medications a licensed narcotic treatment program may use for narcotic treatment replacement therapy and MAT by a licensed narcotic treatment program.

Existing law prohibits the unlawful denial of full and equal access to the benefits of, or the unlawful discrimination under, any program or activity that is conducted, operated, or administered by the state or by any state agency, that is funded directly by the state, or that receives any financial assistance from the state, for a person on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, or sexual orientation.

This bill would also make legislative findings and declarations.

Existing law, the California Fair Employment and Housing Act, generally prohibits housing discrimination with respect to the personal characteristics of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, or genetic information.

Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy and medication-assisted treatment (MAT) of addicted persons. Existing law specifies the medications a licensed narcotic treatment program may use for narcotic treatment replacement therapy and MAT by a licensed narcotic treatment program.

This bill would revise the definition of disability to include a person receiving MAT or taking authorized medications, as defined, as part of a narcotic treatment program. This bill would apply this revised definition to provisions prohibiting housing discrimination.

Existing law prohibits the unlawful denial of full and equal access to the benefits of, or the unlawful discrimination under, any program or activity that is conducted, operated, or administered by the state or by any state agency, that is funded directly by the state, or that receives any financial assistance from the state, for a person on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, or sexual orientation.

This bill would require the Civil Rights Department to develop, maintain, and post on its internet website a list of persons, organizations and entities whose business involves renting, selling, or any other real estate transaction who discriminate against individuals currently undergoing MAT or taking authorized medications. The bill would prohibit specified agencies from expending any public funds on any person, organization, or entity identified by the department as discriminating against these individuals.

This bill would also make legislative findings and declarations.

Date of Hearing: May 10, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1339

Author:(Haney) – As Amended Ver:April 12, 2023

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill prohibits a state-funded program from discriminating against or denying access to housing or housing services to a person because the person is currently undergoing medication-assisted substance abuse treatment (MAT).

FISCAL EFFECT:

Ongoing costs (General Fund) to the Civil Rights Department (CRD). CRD anticipates a significant increase in inquiries regarding legal obligations created by this bill and an increase in disability discrimination complaints submitted to CRD. The amount of additional discrimination complaints is unknown but may be around 50 to 100 additional complaints. CRD estimates costs of $665,000 for fiscal year (FY) 2024-25 and $659,000 for FY 2025-26 for four new staff positions to draft administrative guidance and possible regulations, conduct statewide public outreach and education regarding disability rights laws and MAT, answer public inquiries, and investigate, mediate, and prosecute additional complaints. If the number of additional complaints significantly exceeds CRD’s estimate, costs from this bill will be higher.

COMMENTS:

1. Author’s Statement. According to the author:

To ensure California is aligned with Federal law, AB 1339 will clarify that providers accepting State funding cannot discriminate against individuals on MAT because it is directly tied to a protected disability. For contractors that violate the law, it will require contractor administrators to place contract in breach, including up to cancelling their contracts. This will give a more direct path for individuals to report and stop housing discrimination for individuals on MAT, placing the authority to act in the contract-holders hands.

1. Medically-Assisted Treatment. MAT combines medications with counseling and behavioral therapies to treat substance use disorders, including alcohol and opioid use disorders. Medications in a MAT protocol can ease the side effects of withdrawal and psychological cravings for a drug without producing the high associated with the drug. Addressing physical symptoms with MAT can help encourage someone with a substance use disorder to wean themselves off the drug while pursuing long-term sobriety. There are several FDA-approved medications used to treat alcohol and opioid use disorders like buprenorphine, which is generally administered in a doctor’s office, and naltrexone, which is a prescription medication. The FDA and public health organizations have endorsed MAT and found the treatment to be safe and effective in combination with counseling and other psychological therapies.
2. Housing Discrimination. Existing law prohibits anyone from discriminating against someone in the sale or rental of housing on the basis of a protected characteristic, including a mental or physical disability. Existing law also prohibits any state-funded or state-operated program from denying someone full and equal access to the program on the basis of a protected characteristic. However, it is unclear whether a substance use disorder – or use of MAT more specifically – qualifies as a protected disability under current law. Some state-funded housing programs like transitional homes and sober living facilities have traditionally banned MAT users and related medications due to concerns that the medications can cause a high or be misused within the facility. Contemporary MAT protocols do not appear to have the same capacity for abuse as older MAT medications, and the medical community’s understanding of substance use disorders and treatment has changed significantly in the past few decades.

Rather than adding use of MAT as a protected characteristic in California’s existing anti-discrimination statutes, this bill adds a separate statute that prohibits any state-funded program that provides temporary or permanent housing or housing-based services from discriminating against someone using MAT. According to the analysis of this bill by the Assembly Committee on Judiciary, this approach is consistent with federal antidiscrimination regulations, which specifically prohibit housing discrimination against someone receiving MAT.

Analysis Prepared by: Annika Carlson / APPR. / (916) 319-2081

Date of Hearing: April 11, 2023

ASSEMBLY COMMITTEE ON JUDICIARY

Brian Maienschein, Chair

ABPCA Bill Id:AB 1339

Author:(Haney) – As Amended Ver:April 3, 2023

As Proposed to be Amended

SUBJECT: Discrimination: disability: medication-assisted treatment

KEY ISSUE: should providers of state-funded housing be prohibited from Discriminating against persons receiving mediCATION-assisted treatment as part of a narcotic treatment program?

SYNOPSIS

Rates of opioid addiction have skyrocketed in California and throughout the nation. Medical professionals and drug counselors agree that medication-assisted treatment (MAT) is one of the most effective forms of treatment for addiction. MAT and other forms of “narcotic replacement therapy” rely on the use of “replacement” drugs that satisfy the physical craving for opioids but without the addictive qualities or dangers of overdose. In short, it is a way for persons to safely wean themselves from their dependency. Successful treatment also requires having safe and affordable housing options conducive to recovery; yet, persons receiving MAT treatment often face housing discrimination, in part due to the misunderstanding that MAT entails continued use of dangerous drugs. The problem is especially acute for formerly incarcerated persons. According to the California Department of Corrections and Rehabilitation, as of February of 2023, the state’s prisons housed more than 15,500 people receiving MAT; both their recovery and their successful reentry into the community depend upon access to housing.

This bill would ease one of the obstacles to successful recovery and reentry by prohibiting providers of state-funded programs from denying housing to persons because of their MAT status. Existing law already prohibits housing discrimination on the basis of any physical or mental disability; however, it is not clear that opioid addiction constitutes a “disability” under existing law. This bill, therefore, expressly prohibits a “state-funded program” that provides housing from discriminating against persons because they are receiving MAT treatment. The bill is sponsored by the California Association of Alcohol and Drug Executives and supported by other health and social welfare associations. There is no registered opposition to this bill.

The author will take a clarifying amendment in this Committee. The amendment is reflected in the summary below.

SUMMARY: Prohibits a state-funded program from discriminating against, or denying access to, housing or housing services to individuals because they are undergoing medication-assisted treatment (MAT) or taking authorized medications as part of a narcotic treatment program that uses narcotic replacement therapy or medication-assisted treatment. Specifically, this bill:

1. Makes findings and declarations relating to the scope of opioid addiction in California, the effectiveness of MAT and narcotic replacement in treating opioid addiction, and the need to ensure, consistent with state anti-discrimination laws and policies, that persons receiving treatment are not denied the housing that is an essential part of their recovery.
2. Defines “medication-assisted treatment,” or MAT, to mean the use of any FDA-approved medically assisted therapy to treat a substance use disorder, including opioid use disorder and alcohol use disorder, and that, whenever possible, is provided through a program licensed and certified by the State Department of Health Care Services.
3. Defines “state-funded program” to mean any program that funds, implements, or administers state moneys for the purpose of providing temporary or permanent housing or housing-based service, with the exception of federally funded programs with requirements inconsistent with this section. Specifies that a state-funded program includes both of the following:
   1. Moneys allocated or administered by a state agency, department, authority, or commission.
   2. A program supported by local assistance funding, in addition to funding from state moneys, distributed by any county, city, or political subdivision of the state, including a special district.
4. Provides that a state-funded program shall not discriminate against, or deny access to housing or housing services to, individuals because they are currently undergoing medication-assisted treatment or taking authorized medications as part of a narcotic treatment program that uses narcotic replacement therapy or medication-assisted treatment.

EXISTING LAW:

1. Prohibits the unlawful denial of full and equal access to the benefits of, or the unlawful discrimination under, any program or activity that is conducted, operated, or administered by the state or by any state agency, that is funded directly by the state, or that receives any financial assistance from the state, for a person on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, or sexual orientation. (Government Code Section 11135.)
2. Prohibits the owner of any housing accommodation from discriminating against any person because of the race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, or genetic information of that person. (Government Section 12955.)

FISCAL EFFECT: As currently in print this bill is keyed fiscal.

COMMENTS: According to the author, “AB 1339 will prohibit persons accepting state funding from discriminating against individuals on MAT [and thereby] give a more direct path for individuals to report and stop housing discrimination.” The author writes that an additional goal of the bill is “to educate individuals on what MAT is and how effective it can be for individuals addressing their addiction.” Finally, the author contends that AB 1339 will align state law with federal law, which prohibits housing discrimination on the basis of MAT status.

Background. Rates of opioid addiction have skyrocketed in California and throughout the nation. Medical professionals and drug counselors agree that medication-assisted treatment (MAT) is highly effective in treating opioid use disorder. MAT and other forms of “narcotic replacement therapy” rely on the use of “replacement” drugs that satisfy the physical craving for opioids but without their addictive qualities or dangers of overdose. In short, it is a way for persons to safely wean themselves from their dependency. Successful treatment also requires having safe and affordable housing options conducive to recovery; yet, persons receiving MAT treatment often face housing discrimination, in part due to the misunderstanding that MAT entails continued use of dangerous drugs. The problem is especially acute for formerly incarcerated persons. According to the California Department of Corrections and Rehabilitation, as of February of 2023, the state’s prisons housed more than 15,500 people receiving MAT; both their recovery and their successful reentry into the community depend upon access to housing.

This bill would ease one of the obstacles to successful recovery and reentry by prohibiting providers of state-funded programs from denying housing to persons because of their MAT status. Existing state law already prohibits housing discrimination on the basis of any physical or mental disability; however, it does not appear that opioid addiction constitutes a “disability” under existing law. This bill, therefore, expressly prohibits a “state-funded program” that provides housing from discriminating against persons because they are receiving MAT treatment. The bill defines “state-funded program” to mean any program that funds, implements, or administers state funds for the purpose of providing temporary or permanent housing. State funding includes any money allocated by a state agency, department, or commission, or by any local government entity or special district. Significantly, the bill applies to any government “funded” program, not just a government-operated program. Thus, it would apply to a private entity that received state funding for the purpose of providing housing. As discussed below, this bill is consistent with federal laws and regulations that prohibit discrimination against persons receiving MAT in federally-funded housing programs.

Disability discrimination under existing state law. California’s Fair Employment and Housing Act (FEHA) prohibits discrimination in the sale or rental of housing on the basis of a person’s protected characteristics, including a person’s “disability,” which is defined to include mental or physical disabilities that limit a major life activity. Similarly, the Government Code prohibits any state-funded or state-operated program – which may include housing programs – from discriminating against any person on the basis of “mental disability, physical disability, [or] medical condition.” While one might assume that opioid addition constitutes a medical condition, mental disability, or physical disability, the definitions are either too narrow or too ambiguous to adequately protect someone receiving MAT. “Medical condition” is limited to genetic or inherited characteristics or health impairments related to a diagnosis of cancer. The definitions of both “physical disability” and “mental disability” exclude “current unlawful use of controlled substances or other drugs.” (See Government Code Section 12926 (i), (j), and (m).) While the use of MAT drugs as part of a prescribed therapy would not be “unlawful” – and therefore not necessarily excluded from the definition – a person undergoing MAT does not clearly fit into the existing definitions. The introduced version of this bill would have redefined “disability” to expressly include a person receiving MAT; however, doing so would have had a broader reach than the author intended, potentially extending to reach fully private housing under Government Code Section 12955. The author, therefore, amended the bill to add a new code section dealing solely with MAT and state-funded or state-operated housing programs.

Forms of discrimination against MAT patients and federal law. While this bill would prohibit discrimination in any state-funded program that offers housing or housing services, the author and sponsor are especially concerned with reentry and rehabilitation programs – for example, sober living facilities and half-way houses – that discriminate against MAT patients on the assumption that they may bring drugs into these otherwise drug-free housing and treatment programs. However, the author and sponsor contend that this fear is based on misconceptions about MAT. For example, the recovery houses assume that MAT drugs, some of which create a “high,” could fall into the hands of other recovery house residents. However, while older drugs like methadone create a high and may be subject to abuse, they can only be administered in a clinical setting. Newer drugs, like FDA-approved buprenorphine, do not create a high or the possibility of abuse, and even they are typically administered in a doctor’s office or clinical setting. Naltrexone, on the other hand, is a prescription medication approved to treat opioid use disorder (and alcohol use disorder) by blocking opioid receptors and reducing cravings. There is no abuse potential with naltrexone because it does not produce a “high.” (See U.S. Department of Social Services, Know Your Rights: Rights for Individuals on Medication-Assisted Treatment, at https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/Know-Your-Rights-Brochure.pdf, hereafter USDSS, Know Your Rights.)

Recognizing the relative safety of these drugs and the controlled ways in which they are administered, various federal laws protect MAT patients and persons suffering from an opioid use disorder (OUD) from discrimination. The federal Fair Housing Act (FHA), in particular, prohibits housing discrimination based on a person’s “disability,” and its regulations expressly define this to include a person receiving MAT. Nonetheless, such discrimination still occurs, and often in the situations identified by the author: residential recovery settings. According to the U.S. Department of Social Services:

Housing discrimination related to MAT sometimes arises in the context of residences for individuals in recovery. Individuals who live or want to live in halfway houses, recovery homes, or other residences for individuals in recovery are sometimes excluded because of their participation in MAT. This is illegal even though this type of discrimination occurs with some frequency. (USDSS, Know Your Rights, p. 10.)

Although it is apparently rare for a MAT patient to possess any significant quantity of MAT drugs, federal law recognizes that recovery houses have a reasonable interest in MAT drugs from falling into the hands of other residents attempting to achieve sobriety. Federal law and regulation requires such residences to grant a “reasonable accommodation” for individuals in MAT, provided the requested accommodation does not impose an “undue burden.” Examples of reasonable accommodations include requiring the MAT patient to take the drug at an off-site location or requiring that drugs be stored in a locked box or cabinet. Just as the reasonable accommodation must not impose an undue burden on the recovery residence, however, so too the residence cannot impose unreasonably stringent rules that effectively prevent the MAT patient from ever living there. (Id. pp. 10-11.)

In sum, by prohibiting discrimination against MAT patients in state-funded programs that provide housing or housing services, this bill would, as the author maintains, align California with existing federal law protections.

Proposed Author Amendment. The author will take the following clarifying amendment in this Committee:

• On page 5, line 26, after “individuals” insert: because they are

ARGUMENTS IN SUPPORT: The California Chapter of the National Association of Social Workers of California (NASW-CA) supports this bill because it will “prohibit housing providers from discriminating against people on MAT, as those on MAT are denied housing for their use of this treatment.” NASW-CA believes that AB 1339 will “clarify existing law” by prohibiting “providers accepting state funding from [discriminating and denying] housing to individuals on MAT treatment.”

The National Health Law Program (NHLP) argues that while California has made significant efforts to ensure increased availability of MAT, “these initiatives must go in hand with efforts to outlaw discrimination in other areas against people receiving MAT. This type of treatment is still subject to bias because many individuals in positions of power erroneously believe that the treatment involves substituting addiction to one drug for addiction to another. Nothing can be further from the truth. MAT is evidence-based and does not risk development of further addiction. . . There is no reason to deny state-funded housing benefits to someone who is receiving MAT.” AB 1339 will give MAT patients “the peace of mind that accessing life-saving treatment will not negatively impact their livelihood in other areas.”

The Kennedy Forum points out that there are over 15,500 incarcerated persons on MAT treatment who will need housing upon their release from prison. The Kennedy Forum contends that “approximately 41% of individuals released in the prior year from State Prison were identified as having moderate to high residential reentry instability.” Even though both federal and California laws protect persons with disabilities from discrimination, “individuals on MAT are often discriminated against by being denied housing that would support them in their recovery. . . . AB 1339 would clarify that [laws] prohibiting housing discrimination would apply to individuals receiving MAT.”

REGISTERED SUPPORT / OPPOSITION:

Support

CA Association of Alcohol and Drug Executives, INC

Health Right 360

National Association of Social Workers, California Chapter

National Health Law Program

The Kennedy Forum

Opposition

None on file

Analysis Prepared by: Tom Clark / JUD. / (916) 319-2334