Existing law establishes the Department of Housing and Community Development in the Business, Consumer Services, and Housing Agency and requires the department to administer various housing programs.

Existing law requires agencies and departments administering state programs to collaborate with the California Interagency Council on Homelessness to adopt guidelines and regulations that incorporate core components of housing policy. policy, including Housing First.

Existing law contains provisions governing the operation and financing of community mental health services for persons with mental health disorders in every county through locally administered and locally controlled community mental health programs.

This bill would require, upon appropriation by the Legislature, the Department of Housing and Community Development to establish and administer a grant program to allow local jurisdictions to implement programs to support those individuals who are most at risk for hospital and jail visits. The bill would award the grants to 10 unspecified counties. The bill would require the funds be used to bolster existing efforts to identify the most vulnerable individuals, offer additional support, and fund interventions for those individuals based on the individuals needs, as identified. the Coordination of Care for At-Risk Individuals Grant Program to provide grants to counties currently enrolled in the Data Driver Recovery Project for the innovative identification and intervention of frequent utilizers, as defined, and to aid in providing those individuals with services. This bill would require a grant recipient to meet specified criteria, including an expressed intent in coordinating with fellow counties to share data in order to identify frequent utilizers. The bill would require an applicant to the program to provide a proposal containing specified information, including a viable plan to identify frequent utilizers and performance metrics and goals the applicant seeks to achieve through the program.

Existing law specifies who is liable to punishment under the laws of this state, including all persons who commit any crime within the state, all who commit any specified offense without this state and bring the property stolen or embezzled within the state, as specified, those without the state who cause or aid, advise or encourage, another person to commit a crime within the state, and are afterwards found therein, and perjury when committed outside of California, to the extent provided by law, as specified.

This bill would make technical, nonsubstantive changes to these provisions.

Date of Hearing: May 17, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1499

Author:(Bauer-Kahan) – As Amended Ver:April 18, 2023

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

SUMMARY:

This bill requires the Department of Housing and Community Development (HCD) to establish a grant program for counties to identify “frequent utilizers” of multiple systems, such as jails, emergency rooms, and shelters, and to provide services to these individuals.

Among its provisions, this bill:

1. Requires HCD, upon appropriation by the Legislature, to establish the Coordination of Care for At-Risk Individuals Grant Program (the Program) to provide grants to counties enrolled in the Data Driver Recovery Project for the innovative identification and intervention of “frequent utilizers,” defined as highly vulnerable persons who cycle repeatedly through multiple systems, including jails, emergency rooms, shelters, and other public systems due to underlying behavioral health, housing, and other needs, and to aid in providing those individuals with services.
2. Defines the “Data Driven Recovery Project” as the 10 counties working to link criminal justice and behavioral health data to better understand the mental health needs of people in the criminal justice system. The project includes the counties of Calaveras, El Dorado, Lassen, Marin, Modoc, Nevada, Plumas, Sacramento, San Bernardino, and Yolo.
3. Requires counties to execute contracts with community-based organizations to provide necessary services for frequent utilizers.
4. Requires a county applying for the program to submit a proposal to HCD for the three-year renewable grant and specifies the contents of the proposal.
5. Requires HCD to score counties on specified criteria, including county need, experience, partnerships, contractual agreements, and demonstrated commitment, among other criteria.
6. Requires a grant recipient to engage in specified activities, when applicable, including pre-arrest diversion, universal screening for mental health and substance use disorders, assisted outpatient treatment, and any other service that supports highly vulnerable individuals.
7. Requires counties to submit an annual report to HCD including information on the number of frequent utilizers served, types of services provided, and outcomes, among other items.

FISCAL EFFECT:

1. Ongoing General Fund (GF) cost pressure of an unknown amount, but likely in the low-tens of millions of dollars, annually to fund the grant program. The author is pursuing $10 million for this program in the state budget.
2. HCD estimates ongoing GF cost pressure of $586,000 annually for three staff positons to implement and administer the grant program.

COMMENTS:

1. Purpose. The author seeks to assist at-risk individuals who repeatedly cycle through public systems due to underlying behavioral health and other needs. According to the author:

[This bill] establishes a program that would protect individuals from continuing in the cycle of frequent utilization of social services, emergency room visits and jail stays. California is an abundant state full of resources for vulnerable people in need of assistance. The problem is the ability to access these resources and the expenses tied to their usage. This grant program would create a streamlined effort to connect vulnerable individuals to the necessary help they need to succeed.

1. Background. Formerly incarcerated people are 27 times more likely to be unstably housed or homeless than the general public. Data shows that one-third to one-half of all people on parole in San Francisco and Los Angeles are experiencing homelessness at any point in time. In addition, about half of the people experiencing homelessness statewide report a history of incarceration. People on parole are seven times more likely to recidivate when homeless than when housed.

The state funds two programs similar to the program proposed in this bill. The Innovation Incubator, administered by the Mental Health Services Oversight and Accountability Commission, and the Whole Person Care (WPC) Pilots, operated by the Department of Health Care Services (DHCS).

The Innovation Incubator. The Innovation Incubator works collaboratively with counties to better provide mental health services. Created in 2018 with $5 million in one-time funding, the Innovative Incubator supports county efforts to reduce unnecessary involvement in the criminal justice system by providing more effective behavioral health responses for individuals with behavioral health needs. Through this program, 10 counties working through two cohorts have linked criminal justice and behavioral health data to better understand the mental health needs of people in the criminal justice system. The first cohort comprises Sacramento, San Bernardino, Nevada, Plumas, and Yolo counties. The second cohort includes Calaveras, El Dorado, Lassen, Marin, and Modoc counties.

The WPC Pilots. The WPC Pilots allow counties, health or hospital authorities, or a consortium of entities serving a county or region to receive support to integrate care for Medi-Cal beneficiaries who have been identified as high users of multiple systems and continue to have poor health outcomes. The 2019-20 state budget encouraged additional counties to initiate WPC-like pilot capacity with a one-time funding allocation of $20 million and multi-year spending authority through June 30, 2025 from the Mental Health Services Fund. The 2019-20 state budget also provided a $100 million GF allocation (one-time with multi-year spending authority through June 30, 2025) for active WPC Pilot programs that provide housing services.

This bill creates a new program at HCD similar to the Innovation Incubator and WPC Pilots by providing highly flexible funding to 10 counties to resolve housing or mental health issues for individuals who frequent institutions such as jails and hospitals.

1. Related Legislation. AB 745 (Bryan) establishes a program to provide five-year renewable grants to counties to fund evidence-based housing, housing based services, and employment interventions to allow people with recent histories of incarceration to exit homelessness and remain stably housed. AB 745 is pending in this committee.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 26, 2023

ASSEMBLY COMMITTEE ON HOUSING AND COMMUNITY DEVELOPMENT

Buffy Wicks, Chair

ABPCA Bill Id:AB 1499 (

Author:Bauer-Kahan) – As Amended Ver:April 18, 2023

SUBJECT: Social services: Coordination of Care for At-Risk Individuals Grant Program

SUMMARY: Requires the Department of Housing and Community Development (HCD), upon appropriation by the Legislature, to create the Coordination of Care for At-Risk Individuals Grant Program (the program). Specifically, this bill:

1. Includes the following definitions:
2. “Frequent utilizer” means a highly vulnerable person who cycles repeatedly through multiple systems, including jails, emergency rooms, shelters, and other public systems due to underlying behavioral health, housing, and other needs.
3. “Data Driven Recovery Project” means the 10 counties working to link criminal justice and behavioral health data to better understand the mental health needs of people in the criminal justice system. The project includes the Counties of Calaveras, El Dorado, Lassen, Marin, Modoc, Nevada, Plumas, Sacramento, San Bernardino, and Yolo.
4. Requires the program to provide grants to 10 designated counties (Calaveras, El Dorado, Lassen, Marin, Modoc, Nevada, Plumas, Sacramento, San Bernardino, and Yolo) for the innovative identification and intervention of frequent utilizers in their county and to aid in providing those individuals with necessary social services.
5. Requires counties to execute contracts with community-based organizations to provide necessary services for frequent utilizers.
6. Requires counties to have expressed intent to coordinate with other counties when it comes to data sharing in order to identify frequent utilizers and build a network of agencies that provide services to frequent utilizers.
7. Requires a county applying for the program to submit a proposal to HCD for the three-year renewable grant that contains the following:
8. A viable plan to identify frequent utilizers with services based on evidence-based practices that will address potential issues, including, but not limited to, recidivism rates, behavioral health, and emergency health care systems;
9. Performance metrics and goals the applicant seeks to achieve through the program; and
10. A description of the applicant’s experience in successfully administering or overseeing, or the ability to successfully administer or oversee, the activities the applicant plans to fund through the program.
11. Requires HCD to score counties on at least the following criteria:
12. County need, which includes consideration of the number of frequent utilizers and their cost to the community in which the applicant will be serving eligible participants;
13. Experience in providing, or demonstrated ability to provide, evidence-based identification and intervention services to frequent utilizers;
14. The extent of the individual county’s coordination and collaboration with other counties in the state, the homeless continuum of care covering the geographic area, and community-based organizations with a history of serving frequent utilizers;
15. Experience using Housing First core components to address the needs of the eligible population;
16. Partnerships and contractual agreements demonstrating an ability of the applicant to administer or partner to administer funding for evidence-based services interventions, including, but not limited to, rental assistance;
17. Demonstrated commitment to address the needs of frequent utilizers through existing programs or programs planned to be implemented within 12 months; and
18. Proposed use of funds and the extent to which the proposed use will lead to overall reductions in cost for human services and need for human services in a specified area, including, but not limited to, homelessness, recidivism, and behavioral health issues.
19. Requires a grant recipient to engage in the following activities, when applicable:
20. Pre-arrest diversion;
21. Universal screening for mental health and substance use disorders;
22. Assisted outpatient treatment; and
23. Any other service that supports highly vulnerable individuals to promote anti-recidivism, assistance with behavioral health, and pre-arrest diversion that are offered through a trauma-informed, culturally competent approach.
24. Requires counties to submit an annual report to HCD including at least the following:
25. The number of frequent utilizers served;
26. The types of services that were provided to frequent utilizers;
27. Whether the grant recipient met performance metrics identified in their application;
28. Whether the grant recipient and the providers they contracted with are adhering to the core components of Housing First; and
29. The outcomes for frequent utilizers to the extent the data is available, including, but not limited to, permanent housing status, the status of any mental health treatments received, and recidivism rates.

EXISTING LAW:

1. Defines “Housing First” as the evidence-based model that uses housing as a tool, rather than a reward for recovery. It connects homeless people to housing as quickly as possible and does not make housing contingent on participation in services. Housing First includes time-limited rental or services assistance, so long as the housing and service provider assists the recipient in accessing permanent housing and in securing longer-term rental assistance, income assistance, or employment. (Welfare and Institutions Code (WIC) Section 8255)
2. Defines “Core Components of Housing First” to mean all of the following:
3. Tenant screening and selection practices that promote accepting applicants regardless of their sobriety or use of substances, completion of treatment, or participation in services;
4. Applicants are not rejected on the basis of poor credit or financial history, poor or lack of rental history, criminal convictions unrelated to tenancy, or behaviors that indicate a lack of “housing readiness;”
5. Acceptance of referrals directly from shelters, street outreach, drop-in centers, and other parts of crisis response systems frequented by vulnerable people experiencing homelessness;
6. Supportive services that emphasize engagement and problem-solving over therapeutic goals and service plans that are highly tenant-driven without predetermined goals;
7. Participation in services or program compliance is not a condition of permanent housing tenancy;
8. Tenants have a lease and all the rights and responsibilities of tenancy, as outlined in the Civil Code, Health and Safety Code, and Government codes;
9. The use of alcohol or drugs in and of itself, without other lease violations, is not grounds for eviction;
10. In communities with coordinated assessment with entry systems, incentives for funding promote tenant selection plans for supportive housing that prioritize eligible tenants based on criteria other than “first-come-first-serve,” including, but not limited to, the duration or frequency of homelessness, vulnerability to early mortality, or high utilization of crisis services. Prioritization may include triage tools, developed through local data, to identify high-cost, high-need homeless residents;
11. Case managers and service coordinators who are trained in and actively employ evidence-based practices;
12. Services are informed by a harm-reduction philosophy that recognizes drug and alcohol use and addiction as part of tenants’ lives, where tenants are engaged in non-judgmental communication regarding drug and alcohol use, and where tenants are offered education regarding how to avoid risky behaviors and engage in safer practices, as well as participating in evidence-based treatment if the tenant so chooses; and
13. The project and specific apartment may include special features that accommodate disabilities, reduce harm, and promote health and community and independence among tenants. (WIC 8255)

FISCAL EFFECT: Unknown

COMMENTS:

Author’s Statement: According to the author, “A 2021 State Audit Report found that counties are lacking in their oversight for realignment spending and are withholding surplus funds that could be used to improve public safety. AB 1499 establishes a program that would protect individuals from continuing in the cycle of frequent utilization of social services, emergency room visits and jail stays. California is an abundant state full of resources for vulnerable people in need of assistance. The problem is the ability to access these resources and the expenses tied to their usage. This grant program would create a streamlined effort to connect vulnerable individuals to the necessary help they need to succeed.”

Background: Formerly incarcerated people are 27 times more likely to be unstably housed or homeless than the general public. In fact, one-third to one-half of all people on parole in San Francisco and Los Angeles are experiencing homelessness at any point in time. In addition, about half of people experiencing homelessness statewide report a history of incarceration. People on parole are seven times more likely to recidivate when homeless than when housed. African Americans are almost seven times more likely to be homeless than the general population in California, driven by systemic racism that includes disproportionate incarceration, and discharges from prisons and jails into homelessness.

The Innovation Incubator: The Mental Health Services Oversight and Accountability Commission administers the Innovation Incubator to work collaboratively with counties to find breakthrough solutions to enable better provision of mental health services. Created in 2018 with $5 million in one-time funding, the Incubator has supported county efforts in building and implementing unique strategies that reduce unnecessary involvement in the criminal justice system by providing more effective behavioral health responses for individuals with behavioral health needs. The Incubator also assists counties with building core capacities for innovation and continuous improvement. The Innovation Incubator seeks to help counties build the capacity to innovate new solutions, continuously improve essential programs, and sustain programs that provide the most value to clients and communities. The Incubator supports and links counties that have identified an opportunity for improvement with subject matter experts and experienced practitioners to adapt, test, and assess novel strategies and services. In addition to developing specific advances in service delivery, the Incubator supports cross-county collaboration, and building capacities within counties for performance management and continuous improvement. Ten counties are working through two cohorts linked criminal justice and behavioral health data to better understand the mental health needs of people in the criminal justice system. The first cohort comprises Sacramento, San Bernardino, Nevada, Plumas, and Yolo counties. The second cohort includes Calaveras, El Dorado, Lassen, Marin, and Modoc counties.

Housing for a Healthy California (HHC) Program: The HHC program was established by AB 74 (Chiu), Chapter 777, Statutes of 2017, and funded supportive housing for individuals who were recipients of or eligible for health care provided through the Medi-Cal program. The goal of the HHC program is to reduce the financial burden on local and state resources due to the overutilization of emergency departments, inpatient care, nursing home stays and use of corrections systems and law enforcement resources as the point of health care provision for people who are chronically homeless or homeless and a high-cost health user. AB 74 (Chiu) directed HCD to utilize the 2018-2021 federal National Housing Trust Fund (NHTF) allocation for HHC in order to fund a competitive grant application process open to housing developers for operating reserve grants and capital loans. AB 74 also allowed HCD to utilize other revenue sources for HHC purposes. A portion of the HHC funding was allocated competitively to counties for acquisition, new construction, reconstruction, rehabilitation, administrative costs, capitalized operating subsidy reserves, and rental subsidies and rental assistance for existing and new supportive housing opportunities to assist the HHC program’s target population. The final HHC awards were issued in 2021 and the program has not been re-funded since.

Whole Person Care (WPC) Pilots: The overarching goal of the WPC Pilots, operated by the Department of Health Care Services (DHCS), is the coordination of health, behavioral health, and social services, as applicable, in a patient-centered manner with the goals of improved beneficiary health and wellbeing through more efficient and effective use of resources. WPC Pilots provide an option to a county, a city and county, a health or hospital authority, or a consortium of any of the above entities serving a county or region to receive support to integrate care for a particularly vulnerable group of Medi-Cal beneficiaries who have been identified as high users of multiple systems and continue to have poor health outcomes. Many of these pilot programs target individuals who are mentally ill and are experiencing homelessness or who are at risk of homelessness, and have a demonstrated medical need for housing and/or supportive services. Through collaborative leadership and systematic coordination among public and private entities, WPC Pilot entities identify target populations, share data between systems, coordinate care real time, and evaluate individual and population progress – all with the goal of providing comprehensive coordinated care for the beneficiary, resulting in better health outcomes.

California has worked with 25 WPC Pilot programs to provide target populations with a range of comprehensive services and supports to address unmet needs and improve the quality and outcomes of high-risk populations. The 2019-20 Governor’s Budget encouraged additional counties to initiate WPC-like pilot capacity with a one-time funding allocation of $20 million and multi-year spending authority through June 30, 2025 from the Mental Health Services Fund. The 2019-20 Governor’s Budget also invested $100 million in General Fund (one-time with multi-year spending authority through June 30, 2025) for active WPC Pilot programs that provided housing services. These WPC Pilots informed the launch of CalAIM, the state’s retooling of the behavioral health system for Medi-Cal recipients.

Purposes of This Bill: This bill would create a new program at HCD like the Innovation Incubator, Housing for a Healthy California, and WPC Pilots. This bill would provide highly flexible funding to ten counties to resolve housing or mental health issues for individuals who frequent institutions such as jails and hospitals. The committee may wish to consider if it makes more sense to continue this type of program at the Mental Health Services Oversight and Accountability Commission or re-fund the HHC or WPC housing program rather that create a new program at HCD.

Arguments in Support: According to Initiate Justice, this bill creates a program for at-risk individuals who have been identified as the most vulnerable and offer them support. By doing so, the state can reduce long-term homelessness, improve lives, and save millions of dollars.

Arguments in Opposition: None on file.

Related Legislation:

AB 745 (Bryan), of the current legislative session, would establish a program to provide five-year renewable grants to counties to fund evidence-based housing, housing based services, and employment interventions to allow people with recent histories of incarceration to exit homelessness and remain stably housed. This bill passed out of this committee 7-0 and is pending hearing in the Assembly Committee on Appropriations.

REGISTERED SUPPORT / OPPOSITION:

Support

Initiate Justice

Opposition

None on file.

Analysis Prepared by: Lisa Engel / H. & C.D. / (916) 319-2085