Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 9.2. The Homelessness Assistance System Context


Agencies involved in providing PSH may offer only the housing part of the package, only the services part, or both. The most common configuration is some amount of partnering, as even the providers with the most integrated and comprehensive approaches to delivering housing and services will still develop relationships with other agencies offering additional services and supports, and help link their tenants to them.

For Medicaid to be a funding source for services that PSH tenants need, the agencies offering those services must be or become Medicaid providers, the tenants must be eligible for and enrolled in Medicaid, and the services they need must be covered through the Medicaid state plan or approved waivers and available to the tenants. On the service side, most behavioral health service providers are likely to be Medicaid providers, offering supports to people whose mental illnesses, with or without cooccurring disorders, qualify them to become clients of public mental health systems. As we saw in Chapter 5, people who are homeless and meet this criterion are the most likely to benefit from services covered by Medicaid, although some of the supports they need will remain outside the scope of Medicaid and may need to be covered by other resources.

Agencies that offer mostly the housing component of PSH are rarely Medicaid providers, and appear more likely to establish collaborative relationships with one or more Medicaid providers than to become one themselves. Given the changes in Medicaid that began in January 2014, many such agencies are assessing the feasibility and value of becoming Medicaid providers themselves or strengthening collaborative partnerships with other providers who are able to obtain Medicaid financing for services they deliver to PSH tenants.

Even with collaborative relationships in place, however, different PSH tenants will have access to different levels and types of Medicaid-reimbursable services, depending on their eligibility for Medicaid and, within Medicaid-covered benefits, for specialized mental health services.

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