Housing is an integral element in the social determinants of health (see Public Health = Population Health and Is Housing Health Care?). Permanent supportive housing (PSH) for the most at-risk populations is a combination of housing, health care, and supportive services. But funding for PSH can be confusing – there is no single funding stream that can be used to cover all of these components of supportive housing.
So what is a state to do? A couple of weeks ago, I wrote about how the housing component of PSH is funded (see A Question Of Permanent Supportive Housing) – a combination of programs under the U.S. Department of Housing and Urban Development (HUD), including the Continuum of Care, Section 811 and Section 202 Housing. Also an essential, but frequently misunderstood, ingredient in permanent supportive housing is supportive services.
The Centers for Medicare and Medicaid Services (CMS) has made it clear that Medicaid funds can’t be used to subsidize or fund housing services (Medicaid Financing For Services In Supportive Housing For Chronically Homeless People: Current Practices and Opportunities). This means states have to be creative.
- Hawaii’s housing support services are authorized as part of the state’s 1115 waiver, QUEST Expanded. Services include tenancy supports services such as finding and retaining housing, lease compliance, and training to be a good tenant.
- Louisiana’s housing support services are funded through a 1915(i) state plan option as part of the Community Psychiatric Support and Treatment benefit. Services include “restoration, rehabilitation, and support to develop skills to locate, rent, and keep a home, landlord/tenant negotiations, selecting a roommate, and renter’s rights and responsibilities.”
- Michigan’s housing support services are authorized through a 1915(b) waiver, Managed Specialty Services and Supports Program as part of the Support Coordination benefit. Services help achieve independent living such as applying for housing, budgeting, finding a roommate, etc.
California and Illinois both have 1115 waiver proposals submitted to CMS that request to use state waiver savings to implement supportive housing initiatives. Illinois wishes to create an incentive pool that provides bonus funding to managed care entities that keep their beneficiaries in stable housing. California’s proposal is two-fold. First the state wants to begin covering tenancy-based case management services and second, develop regional housing partnership that incentivizes stakeholders to work together and create innovative models that integrate housing and health care. In both of these states, CMS may decide not to approve all elements of the waiver requests because some of the proposed support services may be out of the scope of Medicaid.
This is a great time for provider organizations and housing agencies to test out new ideas and present them to health plans, accountable care organizations (ACOs), and other care coordination entities that could benefit from having their beneficiaries in stable housing. Provider organizations can reach out and serve the PSH population by:
- Establishing a relationship with a housing organization and become one of their preferred providers. This means the housing organization will most often refer consumers to your organization for services. Because Medicaid beneficiaries must have a choice of providers, they can choose to receive services elsewhere, but having a consistent relationship with PSH consumers and housing organizations can build trust with new consumers and make them more comfortable receiving services at your organization.
- Becoming an “in-house” provider for health services. With the advent of the PPACA most PSH consumers are now eligible for Medicaid. One option many housing organizations are exploring is having a physical or behavioral health provider come to a supportive housing establishment for a certain number of hours a week to provide easily accessible services to consumers.
For more specific information on how states are using Medicaid to fund support services related to housing, check out How Are States Using Medicaid To Fund Support Services For Supportive Housing? An OPEN MINDS Market Intelligence Report. This report is free to all premium members – and can be purchased in our e-store for $495. This report answers a number of questions:
- What is Permanent Supportive Housing?
- How Are Services Funded Under The Permanent Supportive Housing Model?
- What States Are Using Medicaid To Cover Support Services For Housing Initiatives?
- What States Have Pending Medicaid Waiver Requests For Supportive Housing Initiatives?
- What States Have Had Supportive Housing Medicaid Waiver Requests Denied By CMS?
- How Can Non-Housing Providers Access Supportive Housing Funds?
For an in-depth look at housing programs in action, join us at the 2015 OPEN MINDS Strategy & Innovation Institute for the session, Housing & Health Care: Emerging Models To Provide Housing & Treatment Services For Complex Consumers, where Luke Crabtree, Chief Executive Officer, Project Transition; Cal Hedigan, Deputy CEO, Community Access; Alysia Pascaris, Deputy CEO, Community Access; and Jeff Kirschner, MHSA, Executive Vice President, Greater Cincinnati Behavioral Health Services will discuss their housing programs.