Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. Acronyms
The following acronyms are mentioned in this report and/or appendices.
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. Notes
PSH is a phenomenon of the 1990s and 2000s, when homelessness assistance systems evolved and their goals shifted and changed. PSH beds available to end people's homelessness went from about zero in the late 1980s to estimates of 114,000 beds in fall 1996 (Burt et al. 1999), about 188,000 beds in January 2007, and 284,298 beds in January 2013 (H
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 9.6. Conditions Ripe for Integration, But It Will Take Work
If the promise of new and emerging approaches to integrated and cost-effective care for people experiencing chronic homelessness and PSH tenants is to be realized, many aspects of Medicaid state plans will have to be brought into alignment. Service definitions will need to be updated, examining them to assure that they can accommodate the evidence
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 9.3. Many Alternatives Available, and Useful
Chapters of this report have described many strategies being used in our case study sites to expand and integrate health and behavioral health care under Medicaid for our target population, and often for far larger groups such as all poor people (coverage expansion waivers, Accountable Care Organization), or all people with complex interacting dis
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 9.1. The Medicaid Context
This research has sought to identify the many ways that our case study states and communities are moving forward, using and modifying their Medicaid programs and health care delivery systems to better serve people with histories of chronic homelessness. Our findings indicate that Medicaid's configurations up through 2013 offered opportunities for
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 9. Conclusions
The past few years have been a time of great ferment in the health care world, with the next few years promising to see even more evolution and change. Medicaid is an important part of these changes, as states design and implement the coverage expansion aspects of the Affordable Care Act while also looking for ways to get better results from the h
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 8.6. Health Homes
The Affordable Care Act created a new optional Medicaid benefit that states may use to create "health homes" for people with chronic conditions, including mental health conditions, substance use disorders, and chronic physical conditions. 108 States may develop more than one health home benefit program for different target groups of beneficiar
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 8.4. Coverage for Services to Address Substance Use Disorders
In states that have expanded Medicaid eligibility under the provisions of the Affordable Care Act, a significant number of adults who are eligible because their incomes are low enough to qualify (up to 133 percent of the federal poverty level) are likely to have substance use disorders. The Affordable Care Act includes services for substance use d
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 8.3. Workforce Capacity
In several of the communities included in this study, health care providers and other stakeholders have been thinking about the workforce implications of the expansion of eligibility for Medicaid, coupled with potential changes in payment mechanisms as states increasingly move toward managed care arrangements for financing health care. Many commun
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 8.1. Introduction
Preceding chapters focused on a specific care delivery strategy and discussed the Medicaid benefits and financing mechanisms. During the study, we also encountered issues of a more general nature that will affect developments regardless of which service delivery and Medicaid financing mechanisms are chosen. Actions and decisions related to the Sup
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 8. Challenges and Opportunities
Chapter 8 Highlights
Olmstead . In 1999, the Supreme Court issued a decision in Olmstead that prohibits the unjustified segregation of people with disabilities. This decision was made based on an appeal of a case brought on behalf of two women in Georgia who alleged that their rights under Title II of the Americans with Disabilities A
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 7.4. Together4Health
T4H is an example of an Accountable Care Organization-like entity under development.
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 7.3. Hennepin Health
In Minnesota, a 2010 state law authorized the Department of Human Services to develop a Medicaid demonstration project to test alternative and innovative health care delivery systems, including Accountable Care Organizations. That year a state law also authorized Hennepin County to establish a pilot program to provide a health delivery network for
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 7.1. Introduction
This chapter looks at three innovative models for care coordination for individuals experiencing chronic homelessness. Two of the examples are initiatives to create Accountable Care Organizations (ACOs) or ACO-like models--Hennepin County, Minnesota's Hennepin Health and Chicago's Together4Health (T4H). These initiatives are led by providers from
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 6.6. Managed Care in a Behavioral Health Carve-Out--Louisiana's Behavioral Health Partnership
Louisiana has undertaken a multiyear, comprehensive redesign of its public behavioral health system for children and adults. The redesign has required numerous waivers and state plan amendments, some of which are still to come. Completion of the redesign's components is not expected until 2015 or 2016. Known as the Louisiana Behavioral Health Part
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 5.5. Payment Structures and Administrative Challenges
Many issues related to payment surfaced during the case studies. These related mainly to what aspects of the supports needed by people experiencing chronic homelessness and PSH tenants the Medicaid arrangements available during the study period (2010-2012) would and would not pay for. However, providers also described issues with respect to the me
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 4.5. Summary
Given their mission to serve low-income people and, in some cases, their Health Care for the Homeless resources, Health Centers can be critical players in linking primary care, behavioral health, and other services and supports to people with histories of chronic homelessness and to PSH tenants. Promising models are emerging, including co-locating
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 4.4. Sustaining and Expanding Innovative Programs: Addressing Challenges for Health Centers and Their Partners
As part of this case study project, we visited many Health Centers, including some that began as Health Care for the Homeless programs. Among the Health Centers that have been most engaged in serving people experiencing chronic homelessness and delivering services in PSH, innovative programs and integrated services have often been launched with su
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 4.2. Understanding Health Centers and Federally Qualified Health Centers Medicaid Reimbursement
Nationwide, over 1,100 federally funded Health Centers served over 21 million patients in 2012. 35 The majority of Health Center patients have incomes below the federal poverty level. Before 2014, more than one-third of Health Center patients were uninsured, and 40 percent of health center patients were Medicaid beneficiaries. Many patients wh
