Letter to the Assembly Aging Committee in opposition to ALWPP by Dion Aroner, the author of AB 499

I am the author of AB 499 (statutes of 2000) which requires the State of California to develop a pilot program to permit Medi-Cal reimbursements for services provided in Residential Care Facilities for the Elderly (RCFEs).   

Statute requires the state to develop a pilot program to allow eligible participants to live in the “least restrictive”, most “home-like” settings and to allow “aging in place” for current RCFE residents.

AB 499 statute is straightforward and consistent with the goals of the U.S. Supreme Court’s Olmstead decision that requires that individuals who could benefit from independent living services be offered them in the least restrictive setting possible. The court recognized the fact that many low-income patients end up in skilled nursing homes by default, not because they require nursing assistance.  AB 499 requires participants be “medi-cal and nursing home eligible” but does not mandate the state restrict eligibility to only patients who need nurses.

AB 499’s eligibility requirements are consistent with standards used by the In Home Supportive Services (IHSS) program where recipients must be Medi-Cal eligible and at risk of pre-mature institutionalization but do not need nurses in order to receive state funding for care services at home.    

The Department of Health misinterprets statute and defeats the spirit of AB 499 by developing a pilot program, called the Assisted Living Waiver Pilot Program (ALWPP), that restricts participant eligibility to only patients who need nurses and provider participation to only RCFEs that have nursing services.  

Most RCFEs in California are small 4-6 bed settings that cannot afford to hire nurses.   The proposed ALWPP eliminates from participation the most “home-like” and “least restrictive” of all care settings with the highest staff to resident ratio of any care setting in the state. 

Limiting ALWPP provider participation to only settings that have nurses would eliminate the prospect of “aging in place” for current RCFE residents.

This faulty interpretation of statute reflects an institutional bias that creates rather than removes barriers to Olmstead reform in California:  AB 499 was never intended to create mini-nursing homes out of community based care settings.

I request that Assemblywoman Berg (head of the Assembly Aging Committee) request a legal opinion from either/both Legislative Counsel and the California Attorney General for the purpose of reviewing the statute and clarifying to DHS that AB 499’s intent is to allow “aging in place” for current RCFE residents and to permit participants to live in the “least restrictive” and most “home-like” setting--not obligate RCFE providers to have nurses nor restrict ALWPP participation to only patients who require nurse attention.

Dion Aroner (former California Assemblywoman)
AJE Partners
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