The agencies that provide PSH for the chronically homeless people in Group 2 usually are not themselves qualified as Medicaid providers. Rather, their tenants in Group 2 are most likely to receive Medicaid-reimbursed services through a FQHC--an HCH program or CHC--that partners with a housing provider. FQHC providers receive Medicaid reimbursement for encounters between Medicaid-eligible people and clinicians such as doctors, psychiatrists, mid-level practitioners (nurse practitioners or physicians assistants), and LCSWs. A basic challenge with this financing mechanism is that it does not usually cover the cost of the care coordination services, or glue, provided by case managers who work with PSH tenants. In addition, depending on each states specific Medicaid plan, some FQHCs may not receive reimbursement for behavioral health services provided by LCSWs.
In Massachusetts, where virtually every homeless and formerly homeless person can qualify for Medicaid on the basis of low income, coverage for most behavioral health services is carved out and administered by the Massachusetts Behavioral Health Partnership (MBHP). Unlike carve-out arrangements in many other states, MBHP is responsible for a broad array of behavioral health services to meet the needs of people with or without SMIs. MBHP contracts for behavioral health services using a variety of unit and bundled rates. In one initiative, targeted to persons who meet the federal definition of chronic homelessness, MBHP reimburses providers of community support program services through a bundled daily rate, rather than requiring discrete billing for each 15-minute encounter as was earlier the case. This daily rate is set at a level that covers activities that help maintain contact with clients and with service team members, to assure that supports are delivered in an integrated manner. Through MBHP, Massachusetts is able to provide Medicaid funding for the range of services needed by PSH tenants in Group 2 who qualify for behavioral health services on the basis of substance abuse or mental health problems but who do not have SMI.