California Senate Bill SB433

California 2025-2026 Regular Session

• Introduced: 2/18/25
• Refer: 2/26/25
• Refer: 4/1/25
• Report Pass: 4/8/25
• Refer: 4/8/25
• Report Pass: 5/23/25
• Engrossed: 6/4/25
• Refer: 6/16/25
• Refer: 6/17/25
• Report Pass: 6/25/25
• Refer: 6/25/25
• Report Pass: 7/16/25
• Refer: 7/17/25

Caption

An act to amend Section 1569.147 of the Health and Safety Code, and to add Section 14005.395 to the Welfare and Institutions Code, relating to health and care facilities.

Summary

SB 433 would change California law governing residential care facilities for the elderly, especially those participating in Medi-Cal assisted living or similar waiver programs. The bill would allow the Department of Health Care Services and the Department of Social Services to waive the general prohibition on rent controls when needed for the assisted living benefit demonstration program, and it would also cap what a Medi-Cal-contracted residential care facility may charge a Medi-Cal resident for room and board. Under the bill, the resident could not be charged more than the difference between the resident’s income used for Medi-Cal eligibility and the state’s personal and incidental needs allowance for SSI/SSP recipients in nonmedical out-of-home care. The bill also adds a Medi-Cal eligibility rule: the amount a resident retains under this room-and-board structure would generally be excluded from countable income when determining Medi-Cal eligibility, except for any portion above the personal and incidental needs allowance. The new eligibility exclusion is intended to work alongside existing Medi-Cal income rules and would apply only if necessary federal approvals are obtained and federal financial participation is not jeopardized. In practical terms, SB 433 would affect residential care facilities for the elderly that contract with Medi-Cal, Medi-Cal beneficiaries living in those facilities, county agencies that determine Medi-Cal eligibility, and the state departments that oversee the assisted living waiver program. It would also create a state-mandated local program because counties would have additional responsibilities in applying the revised income rules. The bill includes a reimbursement provision for any mandated costs found by the Commission on State Mandates, while stating that no reimbursement is required for certain crime-related mandate language. The overall sentiment reflected in the voting history appears generally favorable, with multiple committee votes passing unanimously or near-unanimously and the bill clearing the Senate floor by a wide margin. At the same time, the bill was placed on the suspense file in committee and later held under submission, suggesting fiscal or policy caution even as it advanced. The available record does not include transcript debate, so the main evidence of sentiment comes from the votes and procedural actions rather than detailed discussion. The main point of contention appears to be the balance between consumer protection and facility flexibility. Supporters appear to be aiming to protect low-income Medi-Cal residents from excessive room-and-board charges and to make assisted living more accessible, while the existing statutory framework favors limited rent regulation for residential care facilities. The bill’s federal-approval condition and its impact on county Medi-Cal administration also suggest concerns about implementation, cost, and compliance with Medicaid rules.

Impact

SB 433 would amend Health and Safety Code Section 1569.147 and add Welfare and Institutions Code Section 14005.395. It would create a specific room-and-board cap for Medi-Cal-contracted residential care facilities for the elderly, limit what can be counted as income for Medi-Cal eligibility purposes, and authorize waiver of the state’s general rent-control prohibition in the assisted living waiver context. The bill would affect residential care facilities, Medi-Cal applicants and beneficiaries, county eligibility workers, and the state departments administering Medi-Cal and social services. It is conditioned on necessary federal approvals and could impose reimbursable state-mandated local costs on counties.

Sentiment

The bill’s procedural history suggests broad support, with committee and floor votes largely in favor and only limited opposition. It advanced through the Senate with a strong majority and continued moving through Assembly committees, though it was also placed on suspense and later held under submission, indicating that fiscal or implementation concerns remained. Overall, the tone appears supportive of the bill’s consumer-protection goals, tempered by caution about cost and administration.

Contention

The central policy tension is between limiting charges for vulnerable Medi-Cal residents and preserving the long-standing statutory rule that residential care facilities for the elderly are not subject to rent controls. Facility operators may be concerned about revenue limits and administrative constraints, while advocates for residents likely support the cap as a protection against excessive room-and-board charges. Counties may also have concerns because the bill changes Medi-Cal eligibility calculations and increases their workload, and state agencies must ensure the changes comply with federal Medicaid requirements.