Medicaid Innovation Accelerator Program (IAP) - PowerPoint Presentation

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Medicaid Innovation Accelerator Program (IAP)

State Medicaid-Housing Agency Partnerships State ConveningMay 3-4, 2016Marriott MarquisWashington, D.C.Slide2

Welcome & Introductions

Vikki Wachino - Director, Center for Medicaid & CHIP Services (CMCS), Centers for Medicare & Medicaid Services (CMS)Kevin Martone – Executive Director, Technical Assistance Collaborative, Inc. (TAC)Slide3

Thank YouSlide4

Additional Thank YouSlide5

What Will We Achieve Through This Process? Slide6

Opening Panel Discussion

Moderator: Kathy Moses – Senior Program Officer, Center for Health Care Strategies Federal Panelists:Jennifer L. Ho - Senior Advisor on Housing & Services, U.S. Department of Housing & Urban Development (HUD)Mike Nardone - Director, Disabled & Elderly Health Programs Group, CMSMatthew Doherty - Executive Director, U.S. Interagency Council on Homelessness (USICH)Slide7

Medicaid Innovation Accelerator Program (IAP)

Session 1:Aligning Policy: The Role of Supportive Housing in Addressing State PrioritiesSlide8

Overview Presentation

Presenter: Kevin Martone – Executive Director, Technical Assistance Collaborative (TAC)Slide9

Supportive Housing

Housing is safe, decent and affordableIntegrated within communities; community-basedTenants have rights and responsibilities of tenancy Services and supports are voluntary, flexible and person-centeredSlide10

Housing is a Determinant of Health

As a physical determinant of health, access to safe, decent, affordable housing will impact health, functioning and quality of life. As a social determinant of health, residential segregation can have a negative impact on one’s health.Healthy People 2020. http://www.healthypeople.gov/2020/about/DOHAbout.aspx#socialfactorsSlide11

Priced Out in 2014

There is not one housing market in the United States where a person on SSI can afford housing at the Fair Market Rent.The national average rent for a modest one-bedroom rental unit was $780, equal to 104% of the national average monthly income of a one-person SSI household.TAC, Priced Out in 2014Slide12

Making the Case for Supportive Housing -Outcomes

Improved health and mental health outcomesReduced substance useReductions in emergency department (ED) useDecreased inpatient admissions and hospital daysReductions in Medicaid costsSlide13

Who Benefits from Supportive Housing?

Individuals with complex conditions: People with mental illnesses and/or substance use disordersPeople with intellectual and developmental disabilities Older adults and people with physical disabilitiesPeople with other disabling chronic conditionsThese individuals may frequently touch:Institutional settings (hospitals, nursing homes, or ICF/IID)Emergency departmentsOther residential or group settingsHomelessness

or chronic homelessness

Jail

or prisonSlide14

Alignment of Federal Policy

DOJ Statement on Community Integration (June 2011)HUD Olmstead Guidance, including “Olmstead Preference” (June 2013)CMS Home and Community-Based Services Final Rule (January 2014)CMS Informational Bulletin on Housing-related Activities and Services (June 2015)USICH Opening Doors strategic plan to end homelessnessSAMHSA Olmstead and Homeless Policy Academies, CABHI, CCBHCsHUD 811 PRA, in coordination with HHSSlide15

Challenges to State Level Alignment

Aligning Policy IssuesAligning Policy Implementation EffortsSlide16

A Common Intervention to “Competing” Demands

Key Policy IssuesHomelessnessDisabilitiesCommunity Integration Health IntegrationHigh UtilizersAffordable Housing Corrections InterventionSupportive

HousingSlide17

Five TakeawaysSlide18

Takeaway One

Supportive Housing is an evidence-based approach that can be a platform for states to address several priority areas.Slide19

Takeaway Two

Affordable housing, disability and Medicaid policy must align.Slide20

Takeaway Three

Implementing supportive housing at scale for priority populations cannot be done independently by single state agencies or non-profits alone.Slide21

Takeaway Four

Strategies to implement supportive housing to scale must have clearly defined roles and responsibilities, horizontally and vertically in systems.Slide22

Takeaway Five

Establishing supportive housing as a foundation for state priority populations will require bold changes to the policy, financing and organization of services and affordable housing. Slide23

Panel Discussion

Moderator: Fred Karnas – Senior Fellow, The Kresge FoundationState Panelists:Kate McEvoy - Director, Division of Health Services, Connecticut Department of Social ServicesPatricia Sylvester – Director of Housing Policy & Programs, Maryland Department of DisabilitiesSlide24

Medicaid Innovation Accelerator Program (IAP)

Session 2:Services & Partnerships to Ensure Successful TenancySlide25

Goals for this Session

What types of services do individuals benefit from in supportive housing and what is the role of services and partnerships in ensuring successful tenancyWhen, where and how should these services be made available and who provides themConsidering the complexity and differing needs of the target populations, what skills sets are needed by case managers and organizationsWhat are strategies to ensure that the right types of services are available at the right times and at the right intensitySlide26

Overview Presentation

Presenter: Nancy Mercer – Director, CSHSlide27

Supportive Housing as a Health Care Intervention

Data-driven identification of target populationPrioritization of highest-need, highest-cost clients, identified through dataHomeless, exiting institutions, high utilizer, with one or more chronic health conditionAssertive targeting, outreach and recruitmentTaking place in crisis health services, homeless, and institutional settings.

Supportive housing

Quality, safe and affordable housing

Informed property/landlord management

Housing-related services to assist people to get and keep housing

Care management, service coordination

Patient Navigation

Primary and behavioral health care

27Slide28

Core Components of Quality

Supportive Housing Services Slide29

Types of Services Needed to

Ensure Successful TenancyLet’s start with who we are going to serve…Slide30

Potential Beneficiaries of Housing-Related Services

Individuals may transition from a variety of circumstances including:Institutional settings (hospitals, nursing homes, or ICF/IID);Residential treatment centers;Assisted living facilities;Homelessness or chronic homelessness;Correctional facilities;Foster care; andOther settings that do not meet home and community-based settings requirements.Slide31

State IAP Partnerships TrackTarget Populations

Data compiled from Expression of Interest forms for IAP CI-LTSS HRSP, 2015.Slide32

Housing-Related Services

Individual Housing Transition Services (Pre-Tenancy)Conducting screening and assessment of housing preferences/ barriers related to successful tenancy Developing an individualized housing support plan based on assessment

Assisting with rent subsidy application/certification and housing application processes

Assisting with housing search process

Identifying resources to cover start-up expenses, moving costs and other one-time expenses

Ensuring housing unit is safe and ready for move-in

Assisting in arranging for and supporting the details of move-in

Developing an individualized housing support crisis plan Slide33

Housing-Related Services

Individual Housing & Tenancy Sustaining ServicesProviding early identification/ intervention for behaviors that may jeopardize housingEducation/training on the role, rights and responsibilities of the tenant and landlord

Coaching on developing/maintaining relationships with landlords/property managers

Assisting in resolving disputes with landlords and/or neighbors

Advocacy/linkage with community resources to prevent eviction

Assisting with the housing recertification process

Coordinating with tenant to review/update/ modify housing support and crisis plan

Continuing training on being a good tenant and lease compliance Slide34

Other Needed Services

Outreach & In-reach Services Discharge PlanningService Assessment Service Plan Development Care Coordination Service Monitoring Assistance with Daily Living Skills Equipment, Technology, and Modifications Job Skills Training/Education including Supported Employment Transportation Support Caregiver/Family Support Health ManagementCounseling and TherapiesPeer Supports Skill Development and Acquisition Other services needed by the target population(s)Slide35

Services that Support Successful Tenancy are Delivered Where & When Needed

Mobile, delivered primarily at home and in the community Staff are available to meet when it works for the individual vs. traditional 9-5 hours24/7 Support Plans are created to pro-actively address potential crisis situationsPeer supports and natural supports are developed to help individuals build sustainable non-paid safety nets of supportSlide36

Who Provides the Services?

Services specific to getting and keeping housing may be provided by:

Case managers

Transition coordinators

Others who make up an individual’s supportive services “safety net”

Housing specialists or housing coordinators

Social Workers

Nurse Case Managers

Employment Specialists

Peer Support Specialists

Psychiatric providers

Substance

use

providers

Health

care providers

Direct support paraprofessionals

Engaged

landlords and property managers

Natural supportsSlide37

Provider Qualifications & Skills Sets

Provider qualifications should reflect:-- Qualifications established for eligible providers in your state -- Agency-based qualifications for delivering housing-related services Providing services in supportive housing requires certain skills sets/proficiency in techniques like:Engagement, transition and person-centered planning, and assessments related to supportive housingMotivational Interviewing, Stages of Change and Harm ReductionRecovery and Wellness Coaching

Trauma-Informed Care and Illness Management

Other evidence-based best practices specific to the target populationsSlide38

Strategies to Consider

Forge new institutional and cross-agency partnerships…Avoid duplication or temptation to build from scratch… leverage the strengths of the right system/agency/staff to play the right role (Supportive Housing and Health)Emerging service coordination models to identify strengths and gaps in meeting complex needs and to overcome barriers in real time

Intensive

Service Model and Small Case Loads: 10:1

Effective engagement requires Housing First approach (for some), flexibility and partnerships

Increased TA/training

on

motivational interviewing, harm reduction, and coping with loss

Navigating

substance use and harm reduction in the context of eviction prevention and housing retention

Communication strategies for service coordination across systems, including

EHR, health assessments and service plansSlide39

Panel Discussion

Moderator: Marti Knisley - Senior Consultant, TACPanelists: Christy Respress - Executive Director, Pathways to Housing DC Dee Curry - Supportive Housing Tenant, Pathways to Housing DC

Kelly Cunningham -

Deputy

Medicaid Administrator, Illinois Department of Healthcare and Family Services Slide40

Medicaid Innovation Accelerator Program (IAP)

Session 3:The Housing in Supportive Housing Slide41

Overview Presentation

Presenters:Lisa Sloane - Senior Policy Advisor, TACDebbie Thiele - Director, CSH Slide42

Housing Resources for Supportive HousingSlide43

Supportive Housing Models

Single-siteApartment buildings exclusively or primarily housing individuals and/or families who need supportive housing

Scattered-site

Rent subsidized apartments leased in open market

Integrated/clustered

Apartment buildings with units set-aside for people who need supportive housingSlide44

Supportive Housing Models

Supportive housing must meet the “settings” requirements for Home and Community-Based Services (HCBS):Integrated in and supports full access to the greater community to the same degree of access as individuals not receiving Medicaid HCBS; Is selected by the individual from among setting options;

Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;

Optimizes autonomy and independence in making life choices; and

Facilitates choice regarding services and who provides them. Slide45

HCBS Settings Rule

Additional requirements for provider-owned or controlled home and community-based residential settings:The individual has a lease or other legally enforceable agreement providing similar protections; The individual has privacy in their unit including lockable doors, choice of roommates and freedom to furnish or decorate the unit; The individual controls his/her own schedule including access to food at any time; The individual can have visitors at any time; and The setting is physically accessible. Modifications of these additional requirements are allowed only if they are: supported by a specific assessed need, justified in the person-centered service plan, and documented in the person-centered service plan.Slide46

Financing Supportive Housing

Address the affordability gapAlign housing and services funding

Capital

Operating

ServicesSlide47

Capital Financing

Funding for both the hard and soft costs of new construction and rehabilitation (e.g. land acquisition, construction costs, architectural services). Slide48

Operating & Rental Subsidies

Operating subsidies: Fill the gap between all tenant rents and the cost of operating the building. Project-based.Rental subsidies: Fill the gap between a tenant’s rent and the market rent on their unit. Project- or Tenant-based.Slide49

Putting It All Together: Panel DiscussionSlide50

Closing the Affordability Gap: Some Challenges

How to gain access to scarce “mainstream” affordable housing resourcesFederal and state budget constraints, e.g. HCV, HOME, CDBG cutsEven when housing is affordable, can still be hard to identify resources for utility and security depositsMany individuals in target populations face barriers due to background checks, screeningHousing program requirements that are not aligned with each other make development difficultHow to efficiently access local resources, e.g. PHASlide51

Other Important Considerations

How target population can be prioritized for Supportive Housing or mainstream affordable housing resourcesOwner needs to fill the unit! If the applicant is not connected quickly enough, will lose the opportunityCompeting target populationsEffective communication from services agency to housing agency about housing needsSlide52

Panel Discussion

Moderator: Diane Yentel - President & CEO, National Low Income Housing CoalitionState Panelists:Steve DiLella - Director, Individual & Family Support Program Unit, Connecticut Department of HousingJanel Winter - Director, Division of Housing Community Resources, New Jersey Department of Community AffairsSlide53

Medicaid Innovation Accelerator Program (IAP)

Session 6:Aligning State Housing Development: Policy, Planning & Delivery for the Target Populations Slide54

Session Participants

Moderator - Jennifer L. Ho, Senior Advisor on Housing & Services, HUDState Panelists – Nicole Sweazy - Executive Director, Louisiana Housing Authority Carla Falkenstein - Director of Western Region, Pennsylvania Housing Finance AgencySlide55

Focus of Panel Discussion

How state services and housing partners worked together to identify and implement the targeted programs.Mechanisms by which the state was able to ensure the housing resources are targeted to selected population(s). Slide56

Guiding Questions for Panelists

In your efforts to align housing resources to create supportive housing for your state’s target populations, was your decision making informed by data from your service partners, e.g. the need for a specific number or type of housing units?Have your service partners brought resources to the table other than the actual services? What are some of the challenges in ensuring individuals have housing choices?Have you encountered any fair housing issues and how have you dealt with these?Slide57

Guiding Questions for Panelists

What have you not done yet that you are hoping to do in the future around supportive housing?Do you have any lessons learned for other states based on your experience aligning housing and services for various target populations?   What advice would you give other states who are trying to develop and implement supportive housing to serve these target populations?If you could go back and start over again, is there anything you would do differently?Do you have any recommendations for states that are interested in developing supportive housing programs that serve multiple target populations?