disqualify themselves getting resources and not knowing they are going to transition into a new program. the other major part of medi-cal that affects individuals living with disabilities is the fact that the state of california has to offer the same benefit package to same individuals who receive traditional medi-cal and expansion medi-cal. in other states that have decided to expand their medi-cal programs, they don't always match their two benefit packages. had are in california they have done that. that really cuts down on administrative complexity but it also opens up the world of long-term services and support for the expansion population. that means that individuals who receive the expansion medi-cal are also going to have ak isses to ihhs, in

home supportive services program an long-term care. that is about the resource and asset limit. that's really important for people who are either get into expansion medi-cal and healthy when they came in and are going to have a need for services and maybe they weren't eligible for traditional medi-cal and because they are over the resource and asset limit and the income is over the threshold. now they are going to be able to benefit from the long-term services and support that are going to be available under the medi-cal expansion program. a note under the ihs program, recently the state and working with counties have decided that individuals who come in through expansion who need ihhs are not going to need a separate disability determination and that is good because that is an administrative hurdle and will go through the certification

for all people who apply for ihhs will go through and the county will do an assessment of need. the other program is covered california covered california is for individuals who have an income over 138 percent. it offers health insurance to people on the marketplace. there is four different plan options from bronze to platinum. when you buy on the marketplace you also receive financial assistance. that financial assistance is what makes that insurance really affordable. you so you might not qualify for free health insurance under the expansion medi-cal, but you are probably going to get a lot of financial assistance to help pay for your health insurance under the marketplace. individuals can qualify for a premium assistance if they have national weather service between 100 percent and 400 percent of the poverty level.

$46,000 you can have that and still get some form of financial assistance to purchase health insurance on the marketplace. there is also the availability of cost sharing assistance so individuals out of pocket expenses are also reduced. if you have 150-200, those two things can be combined. for people with low income they are going to have low premiums and also have reduced out of pocket cost. the thing to note about covered california and buying insurance on the marketplace is that you are not eligible for financial insurance if you have insurance that is

adequate. if you have medicare, you are not able to get financial assistance. if you have medi-cal you are not going to get financial assistance to purchase insurance on the marketplace and if you have insurance through your employer, and it's adequate and affordable, then you can't get financial assistance on the marketplace. i think those two things combined really provide and opportunity for individuals who didn't have health insurance before to have health insurance coverage. i think that's all i have to say about the two programs. >> do we have any questions from councilmembers or comments? >> thank you. i came in a little late. was there an initial date for roll out of this or is this just talking about the on going process. >> january 1st is when

everything rolled out. the expansion happened january 1st. and the ability to purchase became in october. open enrollment will end in march. >> in the next time for enrollment will be? >> next october. >> the enrollment period for the first year was extended quite a bit due to issues with roll out. next year it will be a smaller window unless something happens. >> have you heard any initial feedback regarding this new system in place since january from some of the consumers? >> yes, there has been a lot of feedback. this is a huge change. on the covered california side they are responding well to any problems. the provider directories, they have had to take those down and off line because they have been

inaccurate. a lot of the providers they thought were online aren't there. there is a lot of issues with materials going out and notices getting mixed up. that's normal with a huge transition. on the medi-cal expansion. this program is really difficult to, we are trying to put something into preexisting world where there are all of those legibility requirements. i think gloria can talk to you about it a lot is putting the systems that we have already in place in california has been a challenge and keeping them in the rules no response place is a challenge. it's an on going process. a lot of that is happening behind-the-scenes. a lot of the consumers are not seeing that yet. but there are a lot of things too that aren't happening yet. >> do you have any follow up questions regarding your center? >> we actually don't provide

direct service, but we do like to collect problems that people are seeing. thigh that -- i think that would be a good thing to do. the national program on help and the western center on law and poverty have been involved in the creation and mrelgs -- implementation of the program covered california. >> any other questions? i just have one, you were discussing one with medi-cal program with higher allowances. can you spill those out a little bit more. say if someone is on expanded medi-cal and they go, they become 65 and they have to live by a more strict requirement to receive medi-cal. are we talking loss of home, are we talking, do they have to spend down everything in their savings?

>> well, kind of. it depends. the very first thing that is different in expanded medi-cal is how income is counted. instead of using, the way that medi-cal income is counted under the traditional program is pretty complicated. there are a lot of -- the way the income in the household is counted. the different exceptions and deductions for income is a complicated process. when the affordable care act was created they said we are going to make income count a lot easy eefrment -- easier. they are going to take a modified growth to tax. they would use the income and that was it. it used to be easy. the national health program put out over a 60 page book on that. it's not as easy as it seems. but it certainly is easier than the traditional

medi-cal. yes, it's going to take counseling individuals who are transitioning to understand how their income will now be counted. with their resource and assets, we call it a cliff because you go from not having any assets and resource limit to having an asset and resource limit of $2,000. there are certain things excluded like you can have one vehicle. the fact that you can only have $2,000 sitting in your bank account is a huge cliff when you didn't have that asset or resource. they will they would have to spend down in order to become eligible for traditional medi-cal. >> someone unlucky to be born maybe she's 6 4 this year has to learn two systems? >> yeah. exactly. it's very unfortunate. they will be

transitioning so quickly and not able to take advantage of the new program for very long. >> any comments or questions from staff. >> we'll take public comment after our next speaker has spoken. thank you. ms. martinez? hi. >> good afternoon. i just want to say two things before i start. i'm filling in for somebody who normally comes and unfortunately i do not have lots of number information for you all today. i want to apologize about that. i have some speaking points from the woman who normally comes. thank you. the first point i want to talk to is the fact that here in san francisco county we had over

43,000 medi-cal enrollment through january of this year and this includes those who transitioned from the low income program. these 30,000 applications that we've had have been both for the expansion and for traditional medi-cal. and these are applications coming from all channels. mail in, walk in. online, quick transfer calls from covered california and even folks applying for coverage through the covered california website. in addition to these numbers the agency has helped enrolled 16,000 people into covered california these are numbers

through end of december. then a reminder, just as amber mentioned, open enrollment for covered california ends march 31st. there is no open enrollment period for medi-cal. you can enroll year around. the reminder for adults 19-64 including those with disabilities, a lot is repetitive from what amber went over. a reminder for adult 19-64 including those with disabilities who have their modified adjusted growth income at or below 138 percent of the federal poverty line would qualify for the new medi-cal expansion and the adults exceeding this threshold as well as seniors who do not qualify for the

aca rules would to have apply for traditional medi-cal. this is very similar to the asset and resource requirement for the ssi program. accountable income is counted a lot differently under traditional medi-cal. and also i want to make a note that the applications for traditional medi-cal have also increased since this year, since january. since a ca implementation. again, something else that amber has already mentioned. adults aging out of the expansion, going from 64-65, they are not automatically transitioned. we don't have enough information to do that because of those asset and resource requirements. they need to apply for medi-cal based on those traditional rules. and

hsa is working in putting a process in place that would allow us to notify somebody 2-3 months in advance so they will know they are aging out and they can make the effort to get us the information we need so the transition can be seamless and hopefully automatic to some degree. again, there is specific considerations that an individual has to make potential tax implications from one rule to the other because there's no property tax under the expansion. one last thing i have is hsa is in the process of renovating lobbying at the food stamp office on mission street the beginning of the summer. the public will begin soon to see new disability accommodation republican variations based

-- renovations based on this council. >> thank you, it all does bare worth repeating. it's very complicated and confusing for a lot of folks. any questions for ms. martinez from the council? any from staff? >> carla johnson. a quick clarification about the renovation on mission. i think the input for disability is more from staff of the mayor's office. one of the things we do from the access program is we do field inspections from all facilities to make sure they are fully ada compliant. this is one of our projects. we are proud to be a partner with you there. >> great. >> all right. i will ask for

any public comment on this topic? >> thank you. james cansini with seniors and disability action. the issues coming forward is really big. two things i want to acknowledge, not to say everything is great in san francisco because there is obviously problems but we are ahead of the game in comparison to other counties. one of the things is prior to becoming 65. they are going to notify them in advance. that's pretty important. i wanted to acknowledge that's a success. it's a positive step in the right direction and also at the statewide level something that is kind of really big.

when i first found out about it, i thought wait, am i the only one that thinks it's a big thing? no. it is a big thing but that means you can get ihhs without becoming totally broke down to $2,000. that's big. i have been told by ihhs here that if people are current ly in the traditional medi-cal and they go over the asset limit, they will be reassessed back into expansion medi-cal. so, it's a kind of default way of eliminating a lot of that asset test barrier. except for the one critical area and this is area they need to constantly address and that is eligibility cliff that they mentioned before. that is the

fact that when someone is 65, they still have to meet that $2,000 asset limit to continue to get medi-cal and support. that's really a problem. we are calling that the gift of the maji. you have to give away all your money. there is loopholes but there is a lot of positive things in it too. i want to thank you all for having this hearing and thanks to presenters for coming. thank you very much. >> thank you. any other public comment? all right. we will move to item no. 9. updates from the department of aging adult services. jason adamek. intake manager at dos. >> thank you for having me.

when the speakers were talking about long-term services and support. our unit at the department of aging adult services is the central door for getting that information. i want to give everyone a friendly reminder about that service as well as some updates about have happened in the unit. our unit has expanded particularly arnl traditional care services. first i want to give everybody our number again. you can reach us by e-mail. dos eas at sf.org. we providing services to seniors and family members and other professionals as

well. when case manager social workers need, when they need help trying to figure out how to serve a consumer or client, they call us as well. we are staffed with licensed clinical social workers with masters degree in social work. we are not your average everyday phone service. we do provide a robust type of assessment as well as intake. the in takes that we do are in home support services. adult protective services, home delivered meals for seniors, the community living fund which is a special case management fund to prevent institutionalization and settings like laguna hospital and other services we provide which is part of the information assistance umbrella which we have spoken to this council before is

options counseling. this is a resource we have with the independent living center where we can help and assess and guide people in their long-term and short-term needs. developing action plans with individuals. it's not case management. it's really more consumer centered and it is something that probably more comes from the independent living center model that we've kind of gotten on board with in the last couple of years. it's a great service and it goes beyond just one phone call. it can be a long term relationship working with that consumer to achieve their goals around their long-term services and support. the new project we started since april and the fund has come through center of center for medicaid services is transitional care services for acute hospital

discharges. so this is a very very large endeavor. we get at this point about 300 referrals a month. we are trying to reach to 400-500 referrals a month. the one problem, every great program has a group of people left out. the funding we get is for people who are in medicare a or b. the people with medi-cal, medicare are legible. at this point cms isn't funding medi-cal only. it is for people who are medicare a and b and who aren't through managed hmo. what it provides is when people go to a hospital a lot of times people get rehospitalized because they don't understand their medication and plan and they don't have the transportation,

ihh s, you make the it. there is a lot of things that can be put in place to prevent rehospitalization. it's a great program and we've started doing in takes since april. although this program has been in existence for a number of years, but because of the expansion of it because of cms funding we have been able to extend our program. something that we are starting to do this month on going which is a really big deal in my world is we are piloting rather than doing the in takes in house at dos, we are slowly rolling out our intake services for hospitals directly. the reason why we do transitional care service in takes is because most, ihss

meals when those are in place, that helps to prevent rehospitalization. so in partnership with discharge planners we can be at their bedside really doing a full assessment for the services that people need. again starting with this medicare population, but doing realtime, the ihss referral and meal referral and other services, i feel is a big gap in the hospitals is discharge planners have very little time to spend with their patients and sometimes make referrals without having seeing the patients. this is a time to be at a place where people are most vulnerable in the hospital. our hope is to be in all the hospitals the next year. we are piloting this at san francisco general

hospital and cpmc and because this is the largest amount of referrals for the population. hopefully over time we can expand this type of program. although not funded through cms but expand it to the medi-cal program especially general hospital who can expand this type of service for people on medi-cal only. 355-6700. our e-mail address is daas @ sf governor.org.

>> thank you for that information. especially with that new pilot program. it sounds very intriguing to have more on-site attention to care. we get calls from independent living resource center from transition specialist at the hospital. there is so little time they have between patients to have programs set up. what i'm curious is for other organizations that possibly want to make sure that maybe their services are also known to your workers going out there, is there a way to contact them through number to know ahead of time to provide a more robust transition outline or outline more resources available to them. >> sure. absolutely. part of our expansion of our program is our extension of internal training for our staff. there is a supervisor here in the unit who is responsible for

the training. so getting a really robust training for internal staff and doing more trainings for the whole community. so we are reviving and expanding trainings coming up. we have what is called the bethany center. it's longstanding training center but we want to expand that and do that more often and have that as a space to talk about these changes and have people from ilrc and there is many communities agencies out there doing great work that relates to this transitional services but having more robust training program for internal staff. >> that sounds great. this you very much. >> any other councilmember comments? all right. i have a question. i believe it was through das, a couple years ago you started a program for

people in the community who paired with people who were transitioning out of long-term care facilities and they had a mentor to show them the basics of how to transition, how to use munis perhaps or where the grocery store is, those sorts of things. is that program snil -- still? >> i believe it's still in existence but i don't know. >> okay. it seems to me it's an important piece. >> sure. >> staff? >> my first action is i want to repeat your e-mail address. i would just say your e-mail address is: daas at

sfgov.org. >> thank you. >> then my comment to the council is it's been a little while since we've had an update from das. i can see there is a lot of great things taking place at das and i might suggest that you may want to invite them on a regular basis. it's great to hear what you are doing. >> consider yourself reinvited and there are a lot. your agency does a lot for the disability and senior communities. we would like to keep abreast. >> great, thank you. >> is there any public comment on this item? seeing none.

anything from the bridge line? no. all right. we'll move on to i believe item no. 7 is next now which is the discussion of a possible resolution on transportation platforms. i'm going to have the resolution read by councilmember zarda. >> resolution no. 2014-01. mayor's disability council resolution supporting the san francisco municipal transportation feasibility study for construction and redesign of accessible platforms for the light rail system including passenger amenities. whereas effective transportation is an important aspect of building communities that include people with