The case study sites in this research provide examples of different approaches for delivering the services that help people with serious mental illnesses experiencing chronic homelessness get and keep housing, and for using Medicaid to pay for the services. Medicaid-covered mental health services that can be covered under the rehabilitative services option and delivered in PSH include, Rehabilitation Mental Health Services, Assertive Community Treatment, and services provided by Community Support Teams. Medicaid's targeted case management benefits also show promise as a way to cover some of the services that help people with SMI, but this approach was only used in two of the case study sites (California and Minnesota). Some of the behavioral health services and supports needed by people living in PSH can be covered as optional state plan home and community-based services under Section 1915(i).
Efforts to use Medicaid to pay for behavioral health services delivered through the program models that have been recognized as best practices for homeless people with co-occurring disorders sometimes run into administrative complexities (data system limitations, conflicting policies/procedures and payment mechanisms across types of services and benefits) and gaps in covered services. State agencies must resolve these challenges if Medicaid is to become a more consistent resource for services to people experiencing homelessness or living in PSH.