1. What progress is currently being made in California to comply with the Supreme Court Olmstead decision for the low-income frail/disabled with advanced custodial care needs who would like to age in place in the care setting of their choice?

2. Does DHS intend to develop any statistical information as to the number of residents at Residential Care Facilities for the Elderly (RCFEs) who end up in skilled nursing facilities (SNFs) not because they need this level of care but because they run out of private funds?

3. What measures currently are being developed that would allow RCFE residents to age in place? When does the Department of Health (DHS) plan to submit a separate, RCFE waiver to the federal government that would allow aging in place in these settings?

4. Does DHS conduct any exit interviews when former In Home Supportive Services (IHSS) recipients end up in SNFs?

5. What measures are currently being developed that would allow IHSS recipients who do not need nurses but can no longer live at home to use medi-cal funds to pay for RCFE settings instead of being forced into nursing homes?

6. What is the percentage of low-income SNF long-term care residents that have only identical care needs as patients who currently reside in custodial care settings which provide assistance, for example, with dressing, bathing, help out of bed, incontinence, wheelchairs, dementia, etc.? Also, what percentage of SNF patients have prohibited health care conditions which are not allowed in RCFE settings (for example, patients with i.v.'s, tracheotomies, g-tubes, ventilators, open wounds, etc)?

7. According to DHS, all Assisted Living Waiver Pilot Program (ALWPP) participants must receive some care from nurses. If these participants, according to the ALWPP scoring assessment tool. have identical care needs as many current RCFE residents, is it prudent public policy to force potential ALWPP providers to pay for nurses for patients who normally would not need nurses? 

8. Will the ALWPP template be used for all nursing home transition participants?

a. If so:

i. Will the state still require nurses for nursing home transition participants who have only custodial care needs?

ii. Will all future nursing home transition patients receive funding for private rooms?

9. When aging in place is implemented will all future RCFE residents at risk of pre-mature institutionalization who are currently in shared rooms be ugraded to private rooms once they run out of money?  Will all future Olmstead participants receive medi-cal funding for private rooms?

10. How is spending more medi-cal dollars than is strictly necessary consistent with the goals of the California Medi-cal Redesign Initiative which mandates the state develop ways to cut state expenditures by using medi-cal dollars more wisely?

11. What medi-cal cost savings could be realized to the state if all future nursing home transition participants who choose to live in RCFEs are given shared and not private rooms?

12. What medi-cal cost savings to the state could be realized if the state does not fund nurses for nursing home transition participants with identical care needs as current RCFE residents?

13. What is the fiscal incentive for expanding medi-cal waiver slots in the future if Olmstead measures that involve new medi-cal dollars do not save the state money?

14. Since nursing home does not involve new medi-cal dollars and care in community care settings is usually far more affordable than government funded institutional care what priority does quickly enacting nursing home transition have in a state that is currently facing a huge budget crisis?