Committee approves SB 433 to limit room-and-board charges for Medi‑Cal assisted‑living waiver participants

The Assembly Aging and Long-Term Care Committee voted to pass SB 433 by Senator Ruh-Sah Wahab to establish an income-based cap on residential care facility room-and-board charges for participants in the Medi‑Cal assisted living waiver and CalAIM assisted living facility transitions community support programs.

The measure, as presented by Senator Wahab, would cross-reference an existing waiver provision so that Department of Health Care Services (DHCS) and the Department of Social Services (CDSS) can apply protections that preserve a $179 personal needs allowance for eligible program participants in 2025.

Supporters told the committee the change is intended to prevent displacement of low-income Medi‑Cal beneficiaries who live in licensed residential care facilities for the elderly (RCFEs). "Imagine living for a whole month on $179," said Hagar Dickman, director of long‑term services and supports advocacy for Justice in Aging, during her testimony in support. Dickman and other sponsors said some assisted‑living providers have increased private room‑and‑board charges for non‑SSI Medi‑Cal participants to levels those residents cannot afford, sometimes pressuring family members to cover shortfalls or using unaffordable rates as a route to eviction.

"Participants also typically have high care needs," Dickman said, describing residents as often having dementia, Alzheimer's disease or significant disabilities and relying on Medi‑Cal for personal care while paying room and board from limited income.

Maura Gibney, executive director of California Advocates for Nursing Home Reform, said her organization fields calls from people who report facilities charging "exorbitant monthly rates to low income residents" and that SB 433 would "allow them to keep a small amount of money to preserve their independence and dignity."

Opponents — including representatives of small residential care operators and statewide assisted‑living trade associations — said the bill could be read as imposing rent‑control‑style limits on providers or could create regulatory confusion. George Kootenarian, representing a statewide trade association for small RCFEs, said two areas of concern remained: (1) a cross‑reference in the bill to a Welfare and Institutions Code provision that allows DHCS and CDSS to waive parts of the RCFE Act, and (2) language that one trade witness said could be interpreted to apply to Medi‑Cal services beyond the currently existing assisted living programs. "At worst, this language creates confusion by completely conflating DHCS's and DSS's waiver authority," Kootenarian said.

Selena Copi Hornback of the California Assisted Living Association told the committee that current law specifically bars rent‑control rules from applying to licensed RCFEs and said the cross‑reference in SB 433 is being misinterpreted by sponsors; she said providers continue to be concerned that the bill "would expose assisted living providers participating in Medi‑Cal programs to rent control." Advocates and the author replied that the bill does not create new rent‑control powers and that the cross‑reference is intended only to ensure DHCS and CDSS have clear authority to protect consumers within the assisted‑living waiver programs.

Senator Wahab closed by saying the bill "merely cross references a pre‑existing provision in the Welfare and Institutions Code" and that the legislation "does not create new powers for the departments, but is necessary to facilitate their ability to protect consumers." She asked for an aye vote.

The committee ordered the bill passed and re‑referred it to the Committee on Human Services. The clerk announced the recorded vote as five ayes and one no on the call; the transcript records individual votes of Arambola (aye), Ellis (no), Arons (aye), Avila‑Farias (aye), Blanca Rubio (aye) and Sharp‑Collins (aye).

SB 433 drew multiple organizational supporters in the hearing record, including Justice in Aging; California Advocates for Nursing Home Reform; CANHR (as referenced in testimony); the Western Center on Law and Poverty; the California Commission on Aging; and the California Long Term Care Ombudsman Association. Opponents who registered or testified included a statewide trade association representing small RCFEs, the California Assisted Living Association and LeadingAge California.

The committee action sends the measure to the next relevant policy committee; further amendments or fiscal details may be added in subsequent committee hearings.