| 1 | 1 | | CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2394Introduced by Assembly Member ReyesFebruary 17, 2022 An act to add Chapter 15 (commencing with Section 9900) to Division 8.5 of the Welfare and Institutions Code, relating to long-term services and supports. LEGISLATIVE COUNSEL'S DIGESTAB 2394, as introduced, Reyes. Long-term services and supports.Existing law, contingent upon the appropriation of funds for that purpose by the Legislature, establishes the Aging and Disability Resource Connection (ADRC) program, to be administered by the California Department of Aging, to provide information to consumers and their families on available long-term services and supports (LTSS) programs and to assist older adults, caregivers, and persons with disabilities in accessing LTSS programs at the local level.This bill would establish the California Long-Term Services and Supports Benefits Board (LTSS Board), to be composed of 10 specified members, including, among others, the Treasurer as chair, the Secretary of California Health and Human Services as vice chair, and 4 members to be appointed by the Governor. The bill would require the LTSS Board to manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which the bill would create in the State Treasury, to, upon appropriation, finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities. The bill would also create the California Long-Term Services and Supports Advisory Committee for the purpose of providing ongoing advice and recommendations to the LTSS Board.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(1) Almost 8,000,000 Californians are either older adults or individuals with physical and mental disabilities. This population includes adults with developmental disabilities, individuals with traumatic injuries or acquired disabilities, and individuals 65 years of age or older with functional impairments due to age.(2) This population is expected to grow significantly over the next decade due to demographic shifts, increased longevity, and a corresponding increase in disability. It will also be much more racially and ethnically diverse. In addition, more older adults are likely to live alone.(3) As a result, these individuals will need more and better access to long-term services and supports. Based on data from the 2015 American Community Survey, over 1,000,000 Californians will need long-term services and supports by 2030. Of those, 55 percent will be 65 years of age or older(4) The current private long-term services and supports market is broken. Over the last 20 years, the number of companies offering these products has shrunk from over 100 to less than 12. This leaves families to rely on their own resources. Paying out of pocket for long-term services and supports is highly expensive and creates a significant long-term financial and social burden for families.(5) According to the AARP/SCAN 2020 LTSS Scorecard, only 4.2 percent of Californians over 40 years of age have purchased long-term care insurance. The cost of private pay nursing home care is 232 percent of the annual median income of California households with persons 65 years of age or older. The lowest cost care option, home care, is 71 percent of the annual median income of older California households.(6) When costs are high for people who pay privately and do not have long-term care insurance, they will more quickly deplete their life savings and turn to the public safety net. If that safety net is inadequate, people may rely so heavily on family caregivers that those caregivers damage their own health and well-being and long-term earnings due to cutting back on work hours or dropping out of the workforce altogether.(7) At least 90 percent of older adults receiving help with daily activities receive some informal care, and about two-thirds receive only informal care. AARPs Cost of Caregiving research showed that on average, family caregivers pay nearly $7,000 out of pocket each year to assist their older loved ones. Nationally, family caregivers, who are the backbone of our LTSS system, are overwhelmingly women (86 percent), most are people of color (59 percent), and about one-quarter are immigrants. These caregivers usually work without any compensation and almost one-half of informal caregivers said they have personal tasks they cannot handle or do not have enough time for themselves. This impacts their ability to participate in the workforce and save for retirement, and ultimately contributes to the feminization of poverty. Nearly two-thirds of individuals 65 years of age and older living in poverty are women. The failure to address this will increase poverty for the next generation.(8) Younger people with disabilities, with or without families, bear the significant burden of paying out-of-pocket for long-term services and supports if they do not qualify for Medi-Cal. Younger people with disabilities find it difficult to save for retirement, or even contemplate retirement, due to the need to continually pay for the long-term services and supports they need to maintain their health and independence, and to function.(9) Long-term services and supports help individuals maintain their dignity, autonomy, individuality, privacy, sense of safety, security, and order. Most individuals prefer to remain in their homes for as long as possible, particularly in light of the COVID-19 pandemic.(10) Long-term services and supports include a broad range of services that enable older adults and individuals with physical and mental disabilities to live independently in their communities. They include personal care services, assistance with health needs, assistance with activities of daily living, including bathing, dressing, toileting, and cooking, adult day services, transportation, social services, in-home support care, assisted living, home modifications, assistive technology, nutrition assistance, person-centered care coordination, supportive services, and nursing facility services.(11) Long-term services and supports are not adequately covered by Medicare. The Medi-Cal program covers some long-term care services and supports, but because spending down to become eligible for Medi-Cal is the primary means by which older adults and individuals with disabilities currently receive access to paid long-term services and supports, the shifting demographics will create significant budget pressures for the Medi-Cal program and the In-Home Supportive Services (IHSS) program.(12) This crisis worsens every day. It is one that can no longer be ignored. It is bankrupting families and steadily increasing the burden on all taxpayers. The solution must be the creation of, and funding for, a long-term services and support benefit. This will require placing shared funding responsibilities on all Californians. Funding should be provided by those that ultimately will use the benefit and through other dedicated sources of funding that are outside of the Medicaid program or the General Fund.(13) This legislation creates the infrastructure to administer the benefit, and the recently completed state-funded actuarial study for funding long-term services and supports provides the roadmap.SEC. 2. Chapter 15 (commencing with Section 9900) is added to Division 8.5 of the Welfare and Institutions Code, to read: CHAPTER 15. Long-Term Services and Supports9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members:(1) The Treasurer, who shall serve as the chair.(2) The Secretary of California Health and Human Services, who shall serve as the vice chair.(3) The Director of Finance, or the directors designee.(4) The Controller, or the controllers designee.(5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules.(6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly.(7) The following individuals, who shall be appointed by the Governor:(A) A person who is 60 years of age or older and who is a consumer of long-term services and supports.(B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports.(C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability.(D) A representative of a labor union that is the designated representative of in-home supportive services providers. (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California.(2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust.9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows:(1) At least one member of the advisory committee shall be each of the following:(A) A provider of long-term services and supports.(B) A consumer of publicly financed long-term services and supports.(C) A representative of a labor union that is the designated representative of in-home supportive services providers.(D) An advocate for older adults.(E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports.(F) A family caregiver.(2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor.(b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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| 3 | 3 | | CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2394Introduced by Assembly Member ReyesFebruary 17, 2022 An act to add Chapter 15 (commencing with Section 9900) to Division 8.5 of the Welfare and Institutions Code, relating to long-term services and supports. LEGISLATIVE COUNSEL'S DIGESTAB 2394, as introduced, Reyes. Long-term services and supports.Existing law, contingent upon the appropriation of funds for that purpose by the Legislature, establishes the Aging and Disability Resource Connection (ADRC) program, to be administered by the California Department of Aging, to provide information to consumers and their families on available long-term services and supports (LTSS) programs and to assist older adults, caregivers, and persons with disabilities in accessing LTSS programs at the local level.This bill would establish the California Long-Term Services and Supports Benefits Board (LTSS Board), to be composed of 10 specified members, including, among others, the Treasurer as chair, the Secretary of California Health and Human Services as vice chair, and 4 members to be appointed by the Governor. The bill would require the LTSS Board to manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which the bill would create in the State Treasury, to, upon appropriation, finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities. The bill would also create the California Long-Term Services and Supports Advisory Committee for the purpose of providing ongoing advice and recommendations to the LTSS Board.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO |
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| 9 | 9 | | CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION |
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| 11 | 11 | | Assembly Bill |
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| 12 | 12 | | |
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| 13 | 13 | | No. 2394 |
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| 15 | 15 | | Introduced by Assembly Member ReyesFebruary 17, 2022 |
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| 17 | 17 | | Introduced by Assembly Member Reyes |
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| 18 | 18 | | February 17, 2022 |
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| 20 | 20 | | An act to add Chapter 15 (commencing with Section 9900) to Division 8.5 of the Welfare and Institutions Code, relating to long-term services and supports. |
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| 21 | 21 | | |
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| 22 | 22 | | LEGISLATIVE COUNSEL'S DIGEST |
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| 23 | 23 | | |
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| 24 | 24 | | ## LEGISLATIVE COUNSEL'S DIGEST |
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| 25 | 25 | | |
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| 26 | 26 | | AB 2394, as introduced, Reyes. Long-term services and supports. |
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| 27 | 27 | | |
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| 28 | 28 | | Existing law, contingent upon the appropriation of funds for that purpose by the Legislature, establishes the Aging and Disability Resource Connection (ADRC) program, to be administered by the California Department of Aging, to provide information to consumers and their families on available long-term services and supports (LTSS) programs and to assist older adults, caregivers, and persons with disabilities in accessing LTSS programs at the local level.This bill would establish the California Long-Term Services and Supports Benefits Board (LTSS Board), to be composed of 10 specified members, including, among others, the Treasurer as chair, the Secretary of California Health and Human Services as vice chair, and 4 members to be appointed by the Governor. The bill would require the LTSS Board to manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which the bill would create in the State Treasury, to, upon appropriation, finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities. The bill would also create the California Long-Term Services and Supports Advisory Committee for the purpose of providing ongoing advice and recommendations to the LTSS Board. |
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| 29 | 29 | | |
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| 30 | 30 | | Existing law, contingent upon the appropriation of funds for that purpose by the Legislature, establishes the Aging and Disability Resource Connection (ADRC) program, to be administered by the California Department of Aging, to provide information to consumers and their families on available long-term services and supports (LTSS) programs and to assist older adults, caregivers, and persons with disabilities in accessing LTSS programs at the local level. |
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| 31 | 31 | | |
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| 32 | 32 | | This bill would establish the California Long-Term Services and Supports Benefits Board (LTSS Board), to be composed of 10 specified members, including, among others, the Treasurer as chair, the Secretary of California Health and Human Services as vice chair, and 4 members to be appointed by the Governor. The bill would require the LTSS Board to manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which the bill would create in the State Treasury, to, upon appropriation, finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities. The bill would also create the California Long-Term Services and Supports Advisory Committee for the purpose of providing ongoing advice and recommendations to the LTSS Board. |
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| 33 | 33 | | |
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| 34 | 34 | | ## Digest Key |
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| 35 | 35 | | |
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| 36 | 36 | | ## Bill Text |
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| 37 | 37 | | |
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| 38 | 38 | | The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(1) Almost 8,000,000 Californians are either older adults or individuals with physical and mental disabilities. This population includes adults with developmental disabilities, individuals with traumatic injuries or acquired disabilities, and individuals 65 years of age or older with functional impairments due to age.(2) This population is expected to grow significantly over the next decade due to demographic shifts, increased longevity, and a corresponding increase in disability. It will also be much more racially and ethnically diverse. In addition, more older adults are likely to live alone.(3) As a result, these individuals will need more and better access to long-term services and supports. Based on data from the 2015 American Community Survey, over 1,000,000 Californians will need long-term services and supports by 2030. Of those, 55 percent will be 65 years of age or older(4) The current private long-term services and supports market is broken. Over the last 20 years, the number of companies offering these products has shrunk from over 100 to less than 12. This leaves families to rely on their own resources. Paying out of pocket for long-term services and supports is highly expensive and creates a significant long-term financial and social burden for families.(5) According to the AARP/SCAN 2020 LTSS Scorecard, only 4.2 percent of Californians over 40 years of age have purchased long-term care insurance. The cost of private pay nursing home care is 232 percent of the annual median income of California households with persons 65 years of age or older. The lowest cost care option, home care, is 71 percent of the annual median income of older California households.(6) When costs are high for people who pay privately and do not have long-term care insurance, they will more quickly deplete their life savings and turn to the public safety net. If that safety net is inadequate, people may rely so heavily on family caregivers that those caregivers damage their own health and well-being and long-term earnings due to cutting back on work hours or dropping out of the workforce altogether.(7) At least 90 percent of older adults receiving help with daily activities receive some informal care, and about two-thirds receive only informal care. AARPs Cost of Caregiving research showed that on average, family caregivers pay nearly $7,000 out of pocket each year to assist their older loved ones. Nationally, family caregivers, who are the backbone of our LTSS system, are overwhelmingly women (86 percent), most are people of color (59 percent), and about one-quarter are immigrants. These caregivers usually work without any compensation and almost one-half of informal caregivers said they have personal tasks they cannot handle or do not have enough time for themselves. This impacts their ability to participate in the workforce and save for retirement, and ultimately contributes to the feminization of poverty. Nearly two-thirds of individuals 65 years of age and older living in poverty are women. The failure to address this will increase poverty for the next generation.(8) Younger people with disabilities, with or without families, bear the significant burden of paying out-of-pocket for long-term services and supports if they do not qualify for Medi-Cal. Younger people with disabilities find it difficult to save for retirement, or even contemplate retirement, due to the need to continually pay for the long-term services and supports they need to maintain their health and independence, and to function.(9) Long-term services and supports help individuals maintain their dignity, autonomy, individuality, privacy, sense of safety, security, and order. Most individuals prefer to remain in their homes for as long as possible, particularly in light of the COVID-19 pandemic.(10) Long-term services and supports include a broad range of services that enable older adults and individuals with physical and mental disabilities to live independently in their communities. They include personal care services, assistance with health needs, assistance with activities of daily living, including bathing, dressing, toileting, and cooking, adult day services, transportation, social services, in-home support care, assisted living, home modifications, assistive technology, nutrition assistance, person-centered care coordination, supportive services, and nursing facility services.(11) Long-term services and supports are not adequately covered by Medicare. The Medi-Cal program covers some long-term care services and supports, but because spending down to become eligible for Medi-Cal is the primary means by which older adults and individuals with disabilities currently receive access to paid long-term services and supports, the shifting demographics will create significant budget pressures for the Medi-Cal program and the In-Home Supportive Services (IHSS) program.(12) This crisis worsens every day. It is one that can no longer be ignored. It is bankrupting families and steadily increasing the burden on all taxpayers. The solution must be the creation of, and funding for, a long-term services and support benefit. This will require placing shared funding responsibilities on all Californians. Funding should be provided by those that ultimately will use the benefit and through other dedicated sources of funding that are outside of the Medicaid program or the General Fund.(13) This legislation creates the infrastructure to administer the benefit, and the recently completed state-funded actuarial study for funding long-term services and supports provides the roadmap.SEC. 2. Chapter 15 (commencing with Section 9900) is added to Division 8.5 of the Welfare and Institutions Code, to read: CHAPTER 15. Long-Term Services and Supports9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members:(1) The Treasurer, who shall serve as the chair.(2) The Secretary of California Health and Human Services, who shall serve as the vice chair.(3) The Director of Finance, or the directors designee.(4) The Controller, or the controllers designee.(5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules.(6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly.(7) The following individuals, who shall be appointed by the Governor:(A) A person who is 60 years of age or older and who is a consumer of long-term services and supports.(B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports.(C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability.(D) A representative of a labor union that is the designated representative of in-home supportive services providers. (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California.(2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust.9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows:(1) At least one member of the advisory committee shall be each of the following:(A) A provider of long-term services and supports.(B) A consumer of publicly financed long-term services and supports.(C) A representative of a labor union that is the designated representative of in-home supportive services providers.(D) An advocate for older adults.(E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports.(F) A family caregiver.(2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor.(b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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| 39 | 39 | | |
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| 40 | 40 | | The people of the State of California do enact as follows: |
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| 41 | 41 | | |
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| 42 | 42 | | ## The people of the State of California do enact as follows: |
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| 43 | 43 | | |
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| 44 | 44 | | SECTION 1. The Legislature finds and declares all of the following:(1) Almost 8,000,000 Californians are either older adults or individuals with physical and mental disabilities. This population includes adults with developmental disabilities, individuals with traumatic injuries or acquired disabilities, and individuals 65 years of age or older with functional impairments due to age.(2) This population is expected to grow significantly over the next decade due to demographic shifts, increased longevity, and a corresponding increase in disability. It will also be much more racially and ethnically diverse. In addition, more older adults are likely to live alone.(3) As a result, these individuals will need more and better access to long-term services and supports. Based on data from the 2015 American Community Survey, over 1,000,000 Californians will need long-term services and supports by 2030. Of those, 55 percent will be 65 years of age or older(4) The current private long-term services and supports market is broken. Over the last 20 years, the number of companies offering these products has shrunk from over 100 to less than 12. This leaves families to rely on their own resources. Paying out of pocket for long-term services and supports is highly expensive and creates a significant long-term financial and social burden for families.(5) According to the AARP/SCAN 2020 LTSS Scorecard, only 4.2 percent of Californians over 40 years of age have purchased long-term care insurance. The cost of private pay nursing home care is 232 percent of the annual median income of California households with persons 65 years of age or older. The lowest cost care option, home care, is 71 percent of the annual median income of older California households.(6) When costs are high for people who pay privately and do not have long-term care insurance, they will more quickly deplete their life savings and turn to the public safety net. If that safety net is inadequate, people may rely so heavily on family caregivers that those caregivers damage their own health and well-being and long-term earnings due to cutting back on work hours or dropping out of the workforce altogether.(7) At least 90 percent of older adults receiving help with daily activities receive some informal care, and about two-thirds receive only informal care. AARPs Cost of Caregiving research showed that on average, family caregivers pay nearly $7,000 out of pocket each year to assist their older loved ones. Nationally, family caregivers, who are the backbone of our LTSS system, are overwhelmingly women (86 percent), most are people of color (59 percent), and about one-quarter are immigrants. These caregivers usually work without any compensation and almost one-half of informal caregivers said they have personal tasks they cannot handle or do not have enough time for themselves. This impacts their ability to participate in the workforce and save for retirement, and ultimately contributes to the feminization of poverty. Nearly two-thirds of individuals 65 years of age and older living in poverty are women. The failure to address this will increase poverty for the next generation.(8) Younger people with disabilities, with or without families, bear the significant burden of paying out-of-pocket for long-term services and supports if they do not qualify for Medi-Cal. Younger people with disabilities find it difficult to save for retirement, or even contemplate retirement, due to the need to continually pay for the long-term services and supports they need to maintain their health and independence, and to function.(9) Long-term services and supports help individuals maintain their dignity, autonomy, individuality, privacy, sense of safety, security, and order. Most individuals prefer to remain in their homes for as long as possible, particularly in light of the COVID-19 pandemic.(10) Long-term services and supports include a broad range of services that enable older adults and individuals with physical and mental disabilities to live independently in their communities. They include personal care services, assistance with health needs, assistance with activities of daily living, including bathing, dressing, toileting, and cooking, adult day services, transportation, social services, in-home support care, assisted living, home modifications, assistive technology, nutrition assistance, person-centered care coordination, supportive services, and nursing facility services.(11) Long-term services and supports are not adequately covered by Medicare. The Medi-Cal program covers some long-term care services and supports, but because spending down to become eligible for Medi-Cal is the primary means by which older adults and individuals with disabilities currently receive access to paid long-term services and supports, the shifting demographics will create significant budget pressures for the Medi-Cal program and the In-Home Supportive Services (IHSS) program.(12) This crisis worsens every day. It is one that can no longer be ignored. It is bankrupting families and steadily increasing the burden on all taxpayers. The solution must be the creation of, and funding for, a long-term services and support benefit. This will require placing shared funding responsibilities on all Californians. Funding should be provided by those that ultimately will use the benefit and through other dedicated sources of funding that are outside of the Medicaid program or the General Fund.(13) This legislation creates the infrastructure to administer the benefit, and the recently completed state-funded actuarial study for funding long-term services and supports provides the roadmap. |
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| 45 | 45 | | |
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| 46 | 46 | | SECTION 1. The Legislature finds and declares all of the following:(1) Almost 8,000,000 Californians are either older adults or individuals with physical and mental disabilities. This population includes adults with developmental disabilities, individuals with traumatic injuries or acquired disabilities, and individuals 65 years of age or older with functional impairments due to age.(2) This population is expected to grow significantly over the next decade due to demographic shifts, increased longevity, and a corresponding increase in disability. It will also be much more racially and ethnically diverse. In addition, more older adults are likely to live alone.(3) As a result, these individuals will need more and better access to long-term services and supports. Based on data from the 2015 American Community Survey, over 1,000,000 Californians will need long-term services and supports by 2030. Of those, 55 percent will be 65 years of age or older(4) The current private long-term services and supports market is broken. Over the last 20 years, the number of companies offering these products has shrunk from over 100 to less than 12. This leaves families to rely on their own resources. Paying out of pocket for long-term services and supports is highly expensive and creates a significant long-term financial and social burden for families.(5) According to the AARP/SCAN 2020 LTSS Scorecard, only 4.2 percent of Californians over 40 years of age have purchased long-term care insurance. The cost of private pay nursing home care is 232 percent of the annual median income of California households with persons 65 years of age or older. The lowest cost care option, home care, is 71 percent of the annual median income of older California households.(6) When costs are high for people who pay privately and do not have long-term care insurance, they will more quickly deplete their life savings and turn to the public safety net. If that safety net is inadequate, people may rely so heavily on family caregivers that those caregivers damage their own health and well-being and long-term earnings due to cutting back on work hours or dropping out of the workforce altogether.(7) At least 90 percent of older adults receiving help with daily activities receive some informal care, and about two-thirds receive only informal care. AARPs Cost of Caregiving research showed that on average, family caregivers pay nearly $7,000 out of pocket each year to assist their older loved ones. Nationally, family caregivers, who are the backbone of our LTSS system, are overwhelmingly women (86 percent), most are people of color (59 percent), and about one-quarter are immigrants. These caregivers usually work without any compensation and almost one-half of informal caregivers said they have personal tasks they cannot handle or do not have enough time for themselves. This impacts their ability to participate in the workforce and save for retirement, and ultimately contributes to the feminization of poverty. Nearly two-thirds of individuals 65 years of age and older living in poverty are women. The failure to address this will increase poverty for the next generation.(8) Younger people with disabilities, with or without families, bear the significant burden of paying out-of-pocket for long-term services and supports if they do not qualify for Medi-Cal. Younger people with disabilities find it difficult to save for retirement, or even contemplate retirement, due to the need to continually pay for the long-term services and supports they need to maintain their health and independence, and to function.(9) Long-term services and supports help individuals maintain their dignity, autonomy, individuality, privacy, sense of safety, security, and order. Most individuals prefer to remain in their homes for as long as possible, particularly in light of the COVID-19 pandemic.(10) Long-term services and supports include a broad range of services that enable older adults and individuals with physical and mental disabilities to live independently in their communities. They include personal care services, assistance with health needs, assistance with activities of daily living, including bathing, dressing, toileting, and cooking, adult day services, transportation, social services, in-home support care, assisted living, home modifications, assistive technology, nutrition assistance, person-centered care coordination, supportive services, and nursing facility services.(11) Long-term services and supports are not adequately covered by Medicare. The Medi-Cal program covers some long-term care services and supports, but because spending down to become eligible for Medi-Cal is the primary means by which older adults and individuals with disabilities currently receive access to paid long-term services and supports, the shifting demographics will create significant budget pressures for the Medi-Cal program and the In-Home Supportive Services (IHSS) program.(12) This crisis worsens every day. It is one that can no longer be ignored. It is bankrupting families and steadily increasing the burden on all taxpayers. The solution must be the creation of, and funding for, a long-term services and support benefit. This will require placing shared funding responsibilities on all Californians. Funding should be provided by those that ultimately will use the benefit and through other dedicated sources of funding that are outside of the Medicaid program or the General Fund.(13) This legislation creates the infrastructure to administer the benefit, and the recently completed state-funded actuarial study for funding long-term services and supports provides the roadmap. |
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| 47 | 47 | | |
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| 48 | 48 | | SECTION 1. The Legislature finds and declares all of the following: |
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| 49 | 49 | | |
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| 50 | 50 | | ### SECTION 1. |
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| 51 | 51 | | |
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| 52 | 52 | | (1) Almost 8,000,000 Californians are either older adults or individuals with physical and mental disabilities. This population includes adults with developmental disabilities, individuals with traumatic injuries or acquired disabilities, and individuals 65 years of age or older with functional impairments due to age. |
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| 53 | 53 | | |
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| 54 | 54 | | (2) This population is expected to grow significantly over the next decade due to demographic shifts, increased longevity, and a corresponding increase in disability. It will also be much more racially and ethnically diverse. In addition, more older adults are likely to live alone. |
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| 55 | 55 | | |
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| 56 | 56 | | (3) As a result, these individuals will need more and better access to long-term services and supports. Based on data from the 2015 American Community Survey, over 1,000,000 Californians will need long-term services and supports by 2030. Of those, 55 percent will be 65 years of age or older |
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| 57 | 57 | | |
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| 58 | 58 | | (4) The current private long-term services and supports market is broken. Over the last 20 years, the number of companies offering these products has shrunk from over 100 to less than 12. This leaves families to rely on their own resources. Paying out of pocket for long-term services and supports is highly expensive and creates a significant long-term financial and social burden for families. |
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| 59 | 59 | | |
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| 60 | 60 | | (5) According to the AARP/SCAN 2020 LTSS Scorecard, only 4.2 percent of Californians over 40 years of age have purchased long-term care insurance. The cost of private pay nursing home care is 232 percent of the annual median income of California households with persons 65 years of age or older. The lowest cost care option, home care, is 71 percent of the annual median income of older California households. |
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| 61 | 61 | | |
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| 62 | 62 | | (6) When costs are high for people who pay privately and do not have long-term care insurance, they will more quickly deplete their life savings and turn to the public safety net. If that safety net is inadequate, people may rely so heavily on family caregivers that those caregivers damage their own health and well-being and long-term earnings due to cutting back on work hours or dropping out of the workforce altogether. |
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| 63 | 63 | | |
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| 64 | 64 | | (7) At least 90 percent of older adults receiving help with daily activities receive some informal care, and about two-thirds receive only informal care. AARPs Cost of Caregiving research showed that on average, family caregivers pay nearly $7,000 out of pocket each year to assist their older loved ones. Nationally, family caregivers, who are the backbone of our LTSS system, are overwhelmingly women (86 percent), most are people of color (59 percent), and about one-quarter are immigrants. These caregivers usually work without any compensation and almost one-half of informal caregivers said they have personal tasks they cannot handle or do not have enough time for themselves. This impacts their ability to participate in the workforce and save for retirement, and ultimately contributes to the feminization of poverty. Nearly two-thirds of individuals 65 years of age and older living in poverty are women. The failure to address this will increase poverty for the next generation. |
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| 65 | 65 | | |
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| 66 | 66 | | (8) Younger people with disabilities, with or without families, bear the significant burden of paying out-of-pocket for long-term services and supports if they do not qualify for Medi-Cal. Younger people with disabilities find it difficult to save for retirement, or even contemplate retirement, due to the need to continually pay for the long-term services and supports they need to maintain their health and independence, and to function. |
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| 67 | 67 | | |
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| 68 | 68 | | (9) Long-term services and supports help individuals maintain their dignity, autonomy, individuality, privacy, sense of safety, security, and order. Most individuals prefer to remain in their homes for as long as possible, particularly in light of the COVID-19 pandemic. |
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| 69 | 69 | | |
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| 70 | 70 | | (10) Long-term services and supports include a broad range of services that enable older adults and individuals with physical and mental disabilities to live independently in their communities. They include personal care services, assistance with health needs, assistance with activities of daily living, including bathing, dressing, toileting, and cooking, adult day services, transportation, social services, in-home support care, assisted living, home modifications, assistive technology, nutrition assistance, person-centered care coordination, supportive services, and nursing facility services. |
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| 71 | 71 | | |
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| 72 | 72 | | (11) Long-term services and supports are not adequately covered by Medicare. The Medi-Cal program covers some long-term care services and supports, but because spending down to become eligible for Medi-Cal is the primary means by which older adults and individuals with disabilities currently receive access to paid long-term services and supports, the shifting demographics will create significant budget pressures for the Medi-Cal program and the In-Home Supportive Services (IHSS) program. |
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| 73 | 73 | | |
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| 74 | 74 | | (12) This crisis worsens every day. It is one that can no longer be ignored. It is bankrupting families and steadily increasing the burden on all taxpayers. The solution must be the creation of, and funding for, a long-term services and support benefit. This will require placing shared funding responsibilities on all Californians. Funding should be provided by those that ultimately will use the benefit and through other dedicated sources of funding that are outside of the Medicaid program or the General Fund. |
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| 75 | 75 | | |
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| 76 | 76 | | (13) This legislation creates the infrastructure to administer the benefit, and the recently completed state-funded actuarial study for funding long-term services and supports provides the roadmap. |
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| 77 | 77 | | |
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| 78 | 78 | | SEC. 2. Chapter 15 (commencing with Section 9900) is added to Division 8.5 of the Welfare and Institutions Code, to read: CHAPTER 15. Long-Term Services and Supports9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members:(1) The Treasurer, who shall serve as the chair.(2) The Secretary of California Health and Human Services, who shall serve as the vice chair.(3) The Director of Finance, or the directors designee.(4) The Controller, or the controllers designee.(5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules.(6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly.(7) The following individuals, who shall be appointed by the Governor:(A) A person who is 60 years of age or older and who is a consumer of long-term services and supports.(B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports.(C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability.(D) A representative of a labor union that is the designated representative of in-home supportive services providers. (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California.(2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust.9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows:(1) At least one member of the advisory committee shall be each of the following:(A) A provider of long-term services and supports.(B) A consumer of publicly financed long-term services and supports.(C) A representative of a labor union that is the designated representative of in-home supportive services providers.(D) An advocate for older adults.(E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports.(F) A family caregiver.(2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor.(b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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| 79 | 79 | | |
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| 80 | 80 | | SEC. 2. Chapter 15 (commencing with Section 9900) is added to Division 8.5 of the Welfare and Institutions Code, to read: |
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| 81 | 81 | | |
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| 82 | 82 | | ### SEC. 2. |
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| 83 | 83 | | |
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| 84 | 84 | | CHAPTER 15. Long-Term Services and Supports9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members:(1) The Treasurer, who shall serve as the chair.(2) The Secretary of California Health and Human Services, who shall serve as the vice chair.(3) The Director of Finance, or the directors designee.(4) The Controller, or the controllers designee.(5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules.(6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly.(7) The following individuals, who shall be appointed by the Governor:(A) A person who is 60 years of age or older and who is a consumer of long-term services and supports.(B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports.(C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability.(D) A representative of a labor union that is the designated representative of in-home supportive services providers. (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California.(2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust.9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows:(1) At least one member of the advisory committee shall be each of the following:(A) A provider of long-term services and supports.(B) A consumer of publicly financed long-term services and supports.(C) A representative of a labor union that is the designated representative of in-home supportive services providers.(D) An advocate for older adults.(E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports.(F) A family caregiver.(2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor.(b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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| 85 | 85 | | |
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| 86 | 86 | | CHAPTER 15. Long-Term Services and Supports9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members:(1) The Treasurer, who shall serve as the chair.(2) The Secretary of California Health and Human Services, who shall serve as the vice chair.(3) The Director of Finance, or the directors designee.(4) The Controller, or the controllers designee.(5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules.(6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly.(7) The following individuals, who shall be appointed by the Governor:(A) A person who is 60 years of age or older and who is a consumer of long-term services and supports.(B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports.(C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability.(D) A representative of a labor union that is the designated representative of in-home supportive services providers. (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California.(2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust.9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows:(1) At least one member of the advisory committee shall be each of the following:(A) A provider of long-term services and supports.(B) A consumer of publicly financed long-term services and supports.(C) A representative of a labor union that is the designated representative of in-home supportive services providers.(D) An advocate for older adults.(E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports.(F) A family caregiver.(2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor.(b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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| 87 | 87 | | |
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| 88 | 88 | | CHAPTER 15. Long-Term Services and Supports |
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| 89 | 89 | | |
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| 90 | 90 | | CHAPTER 15. Long-Term Services and Supports |
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| 91 | 91 | | |
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| 92 | 92 | | 9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members:(1) The Treasurer, who shall serve as the chair.(2) The Secretary of California Health and Human Services, who shall serve as the vice chair.(3) The Director of Finance, or the directors designee.(4) The Controller, or the controllers designee.(5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules.(6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly.(7) The following individuals, who shall be appointed by the Governor:(A) A person who is 60 years of age or older and who is a consumer of long-term services and supports.(B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports.(C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability.(D) A representative of a labor union that is the designated representative of in-home supportive services providers. (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California.(2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust. |
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| 93 | 93 | | |
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| 94 | 94 | | |
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| 95 | 95 | | |
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| 96 | 96 | | 9900. (a) There is hereby created in state government the California Long-Term Services and Supports Benefits Board (LTSS Board), which shall consist of the following 10 members: |
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| 97 | 97 | | |
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| 98 | 98 | | (1) The Treasurer, who shall serve as the chair. |
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| 99 | 99 | | |
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| 100 | 100 | | (2) The Secretary of California Health and Human Services, who shall serve as the vice chair. |
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| 101 | 101 | | |
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| 102 | 102 | | (3) The Director of Finance, or the directors designee. |
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| 103 | 103 | | |
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| 104 | 104 | | (4) The Controller, or the controllers designee. |
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| 105 | 105 | | |
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| 106 | 106 | | (5) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Senate Committee on Rules. |
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| 107 | 107 | | |
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| 108 | 108 | | (6) An individual with expertise in the provision and financing of long-term services and supports who shall be appointed by the Speaker of the Assembly. |
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| 109 | 109 | | |
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| 110 | 110 | | (7) The following individuals, who shall be appointed by the Governor: |
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| 111 | 111 | | |
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| 112 | 112 | | (A) A person who is 60 years of age or older and who is a consumer of long-term services and supports. |
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| 113 | 113 | | |
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| 114 | 114 | | (B) A person who has lived with a disability, a chronic condition, or both, for a majority of their life and who is a consumer of long-term services and supports. |
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| 115 | 115 | | |
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| 116 | 116 | | (C) A person who serves as an unpaid family caregiver to an older adult or individual with a disability. |
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| 117 | 117 | | |
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| 118 | 118 | | (D) A representative of a labor union that is the designated representative of in-home supportive services providers. |
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| 119 | 119 | | |
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| 120 | 120 | | (b) (1) The LTSS Board shall manage and invest revenue deposited in the California Long-Term Services and Supports Benefits Trust Fund (LTSS Trust), which is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, to finance long-term services and supports for eligible older adults and individuals with physical and mental disabilities in California. |
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| 121 | 121 | | |
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| 122 | 122 | | (2) After sufficient funds are deposited in the LTSS Trust to be self-sustaining, all costs of administration shall be paid out of funds in the LTSS Trust. |
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| 123 | 123 | | |
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| 124 | 124 | | 9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows:(1) At least one member of the advisory committee shall be each of the following:(A) A provider of long-term services and supports.(B) A consumer of publicly financed long-term services and supports.(C) A representative of a labor union that is the designated representative of in-home supportive services providers.(D) An advocate for older adults.(E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports.(F) A family caregiver.(2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor.(b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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| 125 | 125 | | |
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| 126 | 126 | | |
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| 127 | 127 | | |
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| 128 | 128 | | 9901. (a) There is hereby created within state government the California Long-Term Services and Supports Advisory Committee, which shall consist of nine members that have experience in aging and disability services. The appointments shall be made as follows: |
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| 129 | 129 | | |
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| 130 | 130 | | (1) At least one member of the advisory committee shall be each of the following: |
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| 131 | 131 | | |
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| 132 | 132 | | (A) A provider of long-term services and supports. |
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| 133 | 133 | | |
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| 134 | 134 | | (B) A consumer of publicly financed long-term services and supports. |
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| 135 | 135 | | |
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| 136 | 136 | | (C) A representative of a labor union that is the designated representative of in-home supportive services providers. |
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| 137 | 137 | | |
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| 138 | 138 | | (D) An advocate for older adults. |
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| 139 | 139 | | |
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| 140 | 140 | | (E) An advocate for persons with physical and mental disabilities who rely upon long-term services and supports. |
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| 141 | 141 | | |
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| 142 | 142 | | (F) A family caregiver. |
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| 143 | 143 | | |
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| 144 | 144 | | (2) Three members each shall be appointed by the Senate Committee on Rules, the Speaker of the Assembly, and the Governor. |
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| 145 | 145 | | |
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| 146 | 146 | | (b) The advisory committee shall provide ongoing advice and recommendations to the LTSS Board. |
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