HHS/ASPE. U. S. Department of Health and Human Services.Background

Housing Status Assessment Guide for
State TANF and Medicaid Programs

Report to the
Office of the Assistant Secretary for Planning and Evaluation
(ASPE) and
Health Resources and Services Administration (HRSA)
U.S. Department of Health and Human Services (HHS)

Winter 2009

Prepared by:
Tom Albanese, Michelle Wood, and Brooke Spellman
Abt Associates Inc.

Additional information regarding this project can be obtained from the Federal Project Officers:  Flavio Menascé (202-260-0384, Flavio.Menasce@hhs.gov), Anne Fletcher (202-690-5739, Anne.Fletcher@hhs.gov) and Lynnette Araki (301-443-6204, LAraki@hrsa.gov).  Contract No:  233-02-008806TK004.  Views expressed are those of the authors and do not represent official positions of the Department of Health and Human Services, Abt Associates, their trustees, or sponsors.

This report is available on the Internet at:
http://aspe.hhs.gov/hsp/09/HomelessnessData/HousingStatusGuide

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How to Obtain a Printed Copy

Contents

  1. Introduction
  2. Housing Status Assessment Tool
  3. Implementation
  4. Summary

Endnotes

Introduction

In 2006, the U.S. Department of Health and Human Services (HHS) undertook a study to explore the extent to which states collect data on housing status and homelessness from applicants for Medicaid and/or Temporary Assistance for Needy Families (TANF), the two largest HHS mainstream programs that may serve individuals or families experiencing homelessness.  The project complements Departmental efforts to increase access to HHS mainstream resources for persons experiencing homelessness.[1]

The study found that states collect three general categories of information related to housing status and homelessness on TANF and Medicaid applications:

The study also found that more than half of all states collect at least one of four homelessness indicator questions on their TANF, Medicaid, or combined applications.  The four homelessness indicator questions found on the applications were:

Approximately a quarter of all states collect additional information to understand risk of homelessness.  The items found on the applications that relate to risk factors for homelessness were:

While the questions currently used by states may provide a basic understanding of an applicant’s housing situation at the time of TANF or Medicaid application, they do not by themselves provide sufficient information to assess housing stability or risk of homelessness, or to conduct needs identification or housing-related service referrals.  In addition to ensuring access to mainstream resources for persons experiencing homelessness, the Department is also interested in efforts that ensure persons who are homeless or at-risk of homelessness are quickly identified and linked to appropriate supports.

In support of this broader goal of using the entitlement benefit assessment process to make referrals to homelessness services, this Housing Status Assessment Guide for State TANF and Medicaid Programs is intended to provide recommendations on a set of standardized housing status and homelessness risk questions that could be incorporated into state applications for TANF and/or Medicaid.  The Guide includes a Housing Status Assessment Tool, as well as a Housing Status Summary and an Assistance Priority & Response Matrix that could be used following assessment to determine the relative priority and appropriate intervention for each family or individual, based on present housing needs, as well as links to relevant federal resources.

It is important to note that modifying current application and data collection procedures is not intended to be a requirement for states interested in using this Guide.  The taxonomy of questions presented in this Guide is provided solely as a resource for states interested in modifying current application questions and to promote coordination between mainstream social service programs and housing and homelessness assistance providers. Adopting the assessment questions presented here might also allow states and localities to collect uniform data related to applicants’ housing status that could be used for more extensive analysis to help inform program planning and policy decisions.

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Housing Status Assessment Tool

Asking TANF or Medicaid applicants detailed and standardized questions related to housing status and risk for homelessness can help states identify quickly their relative need and potential eligibility for homelessness prevention, emergency housing, and housing stabilization assistance and facilitate referral to other public and privately funded assistance.  This can be especially useful since federally funded programs targeted to persons who are homeless or at-risk of homelessness operate by a set of eligibility criteria established by the federal McKinney-Vento Act and federal regulations.  Knowledge of potential eligibility for these programs can help expedite service referral and reduce inappropriate referrals.

The Housing Status Assessment Tool presented here includes questions focused on immediate and short-term housing status.  Questions are sequenced in a manner to allow staff who interview TANF or Medicaid applicants to ascertain quickly:

Staff completing the assessment with an applicant (or the applicant themselves, if self-administered) are directed to skip to the next relevant question based on their responses.  Instructions preceding each question indicate the relevance of the question to previous responses.  Most questions include fixed response options and, where appropriate, an opportunity to provide a supplemental open-ended or individualized response.

The Housing Status Assessment Tool begins with questions concerning the applicant’s current housing situation and, depending on the response, proceeds to examine the stability of current housing (if an applicant was housed the previous night).  If presently unstably housed, respondents are asked to identify why they are at risk, when they will need to leave their current housing, whether resources are available or needed to prevent loss of housing and, if indicated, what type of assistance is needed.  For example, if an applicant indicates that (s)he is presently residing in an apartment that (s)he rents, the applicant is then directed to questions regarding receipt of housing subsidy, whether an eviction notice has been received and, if so, whether resources are available or additional resources are needed to mitigate the eviction.  If currently without any housing (including emergency shelter) or if loss of housing is imminent or unavoidable, applicants are asked about other safe housing options and the length of time alternative housing may be available.  Applicants who currently and in the near future have a safe place to stay are then asked if assistance is needed to maintain or stabilize housing and, if so, what type of assistance.  Lastly, applicants are asked about other sources of assistance they may be receiving related to their housing needs.

The tool concludes with a summary Housing Status Assessment section that allows the intake worker and/or applicant to identify the level of housing stability that best matches the applicant’s current housing situation. An additional Assistance Priority & Response Matrix may be used to prioritize applicants for immediate or other assistance as indicated by their present housing status and corresponding needs.  Thus, intake workers can quickly determine the relative severity of an applicant’s present situation and identify appropriate responses.

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Implementation

As noted earlier, implementing this Housing Status Assessment Tool would be optional.  States (or counties or localities within states) that choose to use the Housing Status Assessment Tool and corresponding Matrix would have various options for implementing the tool and some might choose to modify the tool presented here to meet specific state or local needs.  Ideally, the Tool would be incorporated into an on-line application, so a “behind the scenes” decision tree model could prompt respondents for more information and communicate available options for assistance.  States that choose to incorporate the Tool into online applications could automate the questions so that skip patterns are followed automatically based on responses to initial items.

However, the Tool also could be appended to paper applications if desired.  Use as a paper assessment form has some limitations. An intake worker (and/or applicant) would need to follow skip instructions associated with questions to ensure relevant questions are selected and answered. This could prove a difficult and awkward task.  In such instances, we recommend that the tool be used as part of a structured interview process, allowing intake staff to guide applicants through questions to ensure appropriate and consistent use of the Tool and correct application of the skip patterns.

The Tool also could be administered independently of the application, as part of other screening or case management processes to all applicants or it could be targeted to those who identify housing as a potential issue.  This may be a more efficient approach, given that most TANF and Medicaid applicants are likely to have stable housing at the time of application.  To use the tool in a more selective or targeted fashion states may choose to include one or more “ filter” questions that would prompt use of the Tool by the intake worker or other staff.  Such questions could also be used as a simplified way to identify and collect data from applicants who are homeless or otherwise experiencing some level of housing instability.  The following are suggested questions that could serve this purpose:

States that decide to use the Housing Status Assessment Tool (or some variation) may also choose to make the questions voluntary for TANF and Medicaid applicants.  If so, a comment could be added to the tool to inform applicants that responses to these questions are not mandatory for the TANF or Medicaid application to be considered.  If the information were to be shared with other service providers, a state, county or local community that implements the Housing Status Assessment Tool may also want to consider asking for permission from applicants to share the information with other providers.

Ultimately, use of the Tool in whatever manner would allow states to rapidly assess and respond to critical housing needs that applicants may be facing.  However, an effective and appropriate response requires at least a basic knowledge of local homeless prevention and emergency housing assistance resources.  States may need to modify particular questions or the summary assessment within the Tool to reflect the local service environment.

Homeless assistance programs and, in many communities, homeless prevention programs, are inventoried under a planning body called the “Continuum of Care” (CoC).  We recommend that states and localities that choose to implement the Tool make contact with the CoC lead entity for the communities where housing assessment will occur as part of the TANF and/or Medicaid application process.  Each CoC is responsible for coordinating annual applications to the U.S. Department of Housing & Urban Development for Homeless Assistance Program funding for their respective geography.  Urban communities typically have their own CoC, while rural communities often participate in CoCs that oversee larger geographic regions.  CoC lead entities can provide current information on local emergency, transitional, and supportive housing options for persons who are homeless or imminently homeless.  In some communities, the CoC lead entity may also be able to facilitate referral arrangements and/or provide training for intake staff on local resources, basic eligibility requirements, and referral protocols.

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Summary

The Housing Status Assessment Tool and corresponding Matrix included in this Guide would allow states to assess the housing status and related needs of applicants in a more comprehensive way than is possible now. We would encourage states to use these resources to promote efforts to assist TANF and Medicaid applicants to meet immediate housing needs and to develop a stable foundation necessary to address other household needs and achieve greater self-sufficiency.  Such efforts can and should serve to improve service coordination and linkage with local homeless and housing service delivery systems.

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Housing Status Assessment Tool

[The version below displays the text of the questionnaire for accessibility purposes. To see the questionnaire in the correct layout, view the PDF version.]

  1. Where did you stay last night?  [Please select the one response that best describes where you stayed last night]
      a.      Emergency shelter, including hotel or motel voucher paid for by a social service or charitable organization
      b.      Transitional housing for homeless persons
      c.      Permanent supportive housing for formerly homeless persons
      d.      Psychiatric hospital or other psychiatric facility
      e.      Substance abuse treatment facility or other detox facility
      f.       Hospital (non-psychiatric)
      g.      Jail, prison or juvenile detention facility
      h.      Half-way or three-quarter-way home for persons with criminal offenses
      i.        Room, apartment or house that you rent
      j.        Apartment or house that you own
      k.      In a friend’s or family member’s room, apartment or house
      l.        Hotel or motel paid for without emergency shelter voucher
      m.    Foster care home or foster care group home
      n.      Group home or other supervised residential care facility
      o.      Place not meant for human habitation (street, car, park, etc.)
      p.      Other (please describe):_______________________________________________
      q.      Don’t know
      r.       Refused
  1. How long have you stayed in the place you stayed last night?  [Please select the one response that best describes how long you have stayed there]
      a.       One week or less
      b.       More than one week, but less than one month
      c.       One to three months
      d.       More than three months, but less than one year
      e.       One year or longer
      f.        Don’t know
      g.       Refused

[If your response to question 1 was (i), please answer the following question]

  1. Is this housing subsidized?  That is, are you paying lower rent because the Federal, state, or local government is paying for part of your rent?  (This assistance could be Public Housing, a Section 8 Voucher, a Section 8 project or privately owned subsidized housing, or some other type of assistance). 
      Yes
      No

 

 [If your response to question 1 was (a), (b), (c), (d), (e), (f),  (h), (i), (j), (k), (l), (m), (n), or (p), please answer the following question]

 

  1. Are you able and interested in staying in this housing for the foreseeable future?
      Yes (SKIP to 10)
      No
  1. Why do you need or want to leave?

[Please check all of the reasons why you need to leave the place you stayed last night]
      a.       Received an eviction notice
      b.       Non-payment of rent or past due rent
      c.       Unable to pay future rent because lost housing subsidy, job, or other income source
      d.       Non-payment of utilities or utility shut-off
      e.       Housekeeping concerns (failure to maintain cleanliness of the unit)
      f.        Housing is or will be condemned
      g.       Friend or family member being evicted or threatened with eviction
      h.       Threat of abuse by partner, family member, or other
      i.         Being discharged or service is being terminated
      j.         Personal conflict with others
      k.       Other health or safety concerns
      l.         Other lease violation(s) (please describe):______________________
      m.     Other (please describe):____________________________________
      n.       Don’t know
      o.       Refused

  1. When do you need to leave?

[Please choose the response that best matches your situation]
      a.       Today
      b.       Next two to three days
      c.       Within next seven days
      d.       Within next two to three weeks
      e.       Within next thirty days
      f.        Within next two months
      g.       Other (please describe):_____________________________________
      h.       Don’t know
      i.         Refused

 

[If your response to question 5 was (a), (b), (c) or (d), please answer the following question]

  1. If you paid the rent you owe or paid to have your utility turned back on, would your landlord allow you to stay?
      Yes
      No (SKIP to 8)
    1. Do you have enough money or can you borrow money to do this?
      Yes (SKIP to 10)
      No

[If your response to question 1 was (g), or (o) or your response to question 4 was No, please answer the following question]

  1. Is there other safe housing where you [and your family] can stay tonight (if you have to leave immediately) or when you leave the place you are currently staying?
      Yes
      No (SKIP to 9)
    1. How many nights can you stay in that place?

[Please choose the response that best matches your situation]
      a.       Only one night
      b.       Two to three days
      c.       Three days to one week
      d.       More than one week, but less than one month
      e.       One to three months
      f.        More than three months, but less than one year
      g.       One year or longer
      h.       Don’t know
      i.         Refused

[If your response to question 8.a. is (a), (b), or (c)]

  1. Do you need assistance finding someplace to stay tonight or will you possibly need assistance in the near future?
      Yes (SKIP to 11)
      No

[If your response to question 4 was YES, or your response to question 6 is (d), (e), (f), or (g), or your response to question 8 is (d), (e), (f), or (g), please answer the following question]

  1. Do you need assistance to be able to stay in your current housing OR to find and maintain other, safer or more stable housing?
      Yes
      No (END)

[If your response to question 10 was Yes, please answer the following question]

  1. What type of assistance do you need?

[Please choose one or more responses that best describe your need(s)]
      (a)    Financial help for first month’s rent, utilities, or other one-time costs
      (b)    Ongoing rent subsidy to afford housing
      (c)    Rental housing information
      (d)    Help finding housing that meets my/my family’s needs
      (e)    Weatherization assistance
      (f)     Housing repairs
      (g)    Legal assistance
      (h)    Landlord mediation
      (i)      Budgeting assistance
      (j)      Other (describe):__________________________________________
      (k)    Other (describe):__________________________________________

12.  Right now, are you receiving help related to any of these needs from any other agency?
      Yes
      No (END)

    1. Please describe the help or services you are receiving:

    1. What is the name of the person and agency/organization or program they work for that is helping you now?

Name:____________________________________________________________

Agency/program:__________________________________________________

    1. May we contact this person (or agency/program, if staff name unknown) if needed to assist you with this crisis?  For example, we might contact them to see if they have resources to assist you with finding or keeping your housing.
      Yes (END)
      No (END)

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Housing Status Summary

Identify the housing status that best matches the current housing situation, based on the responses to the questions above.  If this list of questions were automated, responses to questions could be mapped directly to this housing status summary. 

Check Housing Status Situational Characteristics
  Literally Homeless[2]
  • Staying in emergency shelter or transitional housing, including hotel or motel voucher paid for by a social service or charitable organization, OR
  • Staying in place not meant for human habitation (e.g., streets, parks, abandoned buildings, and subway tunnels), OR
  • Leaving current housing or institutional setting and has no safe, non-emergency housing to stay in tonight, AND
  • Lack the resources and support networks needed to maintain or obtain safe, non-emergency housing tonight
  Imminent Risk of Literal Homelessness
  • Currently housed and being evicted, being asked to leave, or need to leave for other reason (e.g., health/safety concerns, unaffordable rent, institutional discharge, host family/friend risk, family conflict, etc.)  AND
  • Expected to lose their housing within one week (7 days), AND
  • Lacking the resources and support networks needed to maintain or obtain housing
  Precariously Housed
  • Currently housed and potentially at-risk of losing housing due to eviction, being asked to leave, or need to leave for other reason (e.g., health/safety concerns, unaffordable rent, service termination, host family/friend risk, family conflict, etc.)  AND
  • May or may not have resources and support networks needed to maintain or obtain housing
  Stably Housed
  • Currently housed and not at-risk of losing housing, AND/OR
  • Have resources and support networks needed to maintain or obtain housing

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Assistance Priority & Response Matrix

Check Priority Level Housing Status Need Description Housing Intervention
  1 Literally Homeless

and

Needs Immediate Assistance

  • Immediate housing needs not met
  • Needs immediate assistance to secure housing tonight
  • Needs assistance to obtain and maintain housing
Immediate:  Facilitate access to emergency housing related assistance.  May include:
  • Referral to emergency shelter
  • Referral to/provision of emergency hotel voucher
  • Linkage to community information and referral service

Short-term:  Facilitate access to housing placement and stabilization assistance.  May include:

  • Referral to in-house and/or community-based housing placement assistance (e.g., financial, legal, service coordination, etc.)
  • Linkage to community information and referral service
  2 Imminent Risk of Literal Homelessness

and

Needs Immediate Assistance

  • Immediate housing needs not met
  • Needs immediate assistance to obtain and maintain housing
Immediate:  Facilitate access to homelessness prevention related assistance and emergency housing assistance (in event of homelessness).  May include:
  • Referral to in-house and/or community-based prevention assistance (e.g., financial, legal, mediation, weatherization, etc.)
  • Information and/or referral to emergency shelter
  • Information and/or referral to other emergency aid organization
  • Linkage to community information and referral service

Short-term:  Facilitate access to housing placement and/or stabilization assistance.  May include:

  • Referral to in-house and/or community-based housing placement or stabilization assistance (e.g., financial, legal, service coordination, etc.)
  • Linkage to community information and referral service
  3 Literally Homeless

and

Needs Assistance to Obtain Housing

  • Immediate housing needs met
  • Needs assistance to obtain and maintain housing
Immediate: Confirm receipt of emergency housing assistance

Short-term:  Facilitate access to housing placement and stabilization assistance.  May include:

  • Referral to in-house and/or community-based housing placement assistance (e.g., financial, legal, etc.)
  • Linkage to community information and referral service
  4 Precariously Housed

and

Needs Assistance to Obtain or Maintain Housing

  • Immediate housing needs met
  • Needs assistance to reduce risk and obtain or maintain housing
Immediate:  Facilitate access to homelessness prevention related assistance and emergency housing assistance (in event of homelessness).  May include:
  • Referral to in-house and/or community-based prevention assistance (e.g., financial, legal, mediation, weatherization, etc.)
  • Information and/or referral to emergency shelter
  • Information and/or referral to other emergency aid organization
  • Linkage to community information and referral service

Short-term:  Facilitate access to housing placement and/or stabilization assistance.  May include:

  • Referral to in-house and/or community-based housing placement or stabilization assistance (e.g., financial, legal, service coordination, etc.)
  • Linkage to community information and referral service
  5 Literally Homeless or Precariously Housed

and

Does Not Need Assistance to Obtain or Maintain Housing

  • Immediate housing needs met
  • Does not need assistance to obtain or to maintain housing
Immediate:  Confirm receipt of emergency housing assistance, if applicable.  Provide information on housing related assistance (in event of future instability).  May include:
  • Information about in-house and/or community-based prevention assistance (e.g., financial, legal, mediation, weatherization, etc.)
  • Linkage to community information and referral service

Short-term:  No assistance needed

  6 Stably Housed

and

Does Not Need Assistance to Obtain or Maintain Housing

  • Currently housed
  • Does not need assistance to maintain housing
Immediate: Provide information on housing related assistance (in event of future instability).  May include:
  • Information about in-house and/or community-based prevention assistance (e.g., financial, legal, mediation, weatherization, etc.)
  • Linkage to community information and referral service

Short-term:  No assistance needed

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Additional Resources

FirstStep

FirstStep is an online resource developed through a partnership between the U.S. Department of Health and Human Services and the U.S. Department of Housing and Urban Development (HUD).  FirstStep is an easy-to-use, interactive tool for case managers, outreach workers, and others working with people who are homeless or at-risk of homelessness.  The information on the website is designed to help staff assist clients to access benefits from federally funded programs and includes advice, timesaving tips, and related tools and resources. http://www.cms.hhs.gov/apps/firststep/index.html

HUD Homeless Assistance Programs

There are a variety of housing and homeless assistance programs funded by HUD.  To learn more about these programs visit:  http://www.hud.gov/offices/cpd/homeless/programs/index.cfm and http://www.hudhre.info/index.cfm?do=viewHomelessAndHousingProgramInfo

Continuum of Care (CoC) Contacts and Local Homeless Assistance Information

Information about local and regional CoCs, including contact information for lead CoC entities, can be found at:  http://www.hud.gov/offices/cpd/homeless/local/.

For additional information on state and local homeless assistance and related programs visit:  http://www.hud.gov/homeless/hmlsagen.cfm.

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Endnotes

[1]       U.S. Department of Health and Human Services.  2009.  Homelessness Data in Health and Human Services Mainstream Programs (available at http://aspe.hhs.gov/hsp/09/HomelessnessData/index.shtml).

[2]       The terms “literal homelessness” and “literally homeless” are used to describe individuals or families who live in emergency shelters or transitional housing, and those who sleep in places not meant for human habitation (for example, streets, parks, abandoned buildings, and subway tunnels).  These terms are not intended as an official definition of homelessness but are used to categorize housing status.  The terms were defined in the First Annual Homelessness Assessment Report (AHAR).

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How to Obtain a Printed Copy

To obtain a printed copy of this report, send the title and your mailing information to:

Human Services Policy, Room 404E
Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
200 Independence Ave, SW
Washington, DC 20201

Fax:  (202) 690-6562
Email:  pic@hhs.gov


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Last updated:  04/03/09