Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 9.4. Accountable Care Organizations, Care Coordination Entities, and Similar Structures


Three of our case study sites--Hennepin Health in Minnesota, Housing for Health in Los Angeles, and Together4Health in Chicago--were mounting innovative approaches for the integrated and coordinated care that evidence shows has promise for people with complex needs and histories of chronic homelessness. All link Medicaid-funded services with housing and other resources to create housing-service networks. County health departments are at the center of the first two, while the third is a newly created limited liability company with a membership that includes hospitals, community clinics, behavioral health agencies, housing and supportive service providers, and advocates. All bring diverse participating providers together to address each member's needs holistically and improve efficiency and quality of care, at the same time expecting to realize savings that can be re-invested to improve the model.

Hennepin Health has been operating since January 2012, while Housing for Health and Together4Health were in the early stages of implementation at the end of this study. All offer important lessons for what it takes to pull together provider organizations of differing expertise and capacity across a large and diverse metropolitan area. All are designed to address the needs of users of safety net services and all include social determinants of health (e.g., poverty, housing) as factors their care must address if it is to help clients resolve their issues and become or remain stable community residents. All recognize homelessness as a social determinant of health, and all accept (or will accept) clients whose disabilities or care needs are primarily related to physical health conditions and substance use disorders, along with those who have a serious mental illness. All are organized to address complex and interacting needs for care and support.

These three approaches also are designed to overcome three of the most persistent gaps in care for PSH tenants and people with disabilities and histories of chronic homelessness. First, they pay for many of the activities that we sometimes call "the glue," the things that help connect people to care and assure that they get what they need in ways that take the whole person into consideration. Second, they cover people with and without serious mental illness--although access to specific types of Medicaid-reimbursed behavioral health care will still depend on a consumer meeting the relevant eligibility criteria. Third, they offer the full extent of services a chronically homeless person or PSH tenant with complex and interacting health and behavioral health conditions might need, including primary and specialty medical care, mental health and substance use disorder treatment, and solid links to social services and housing.

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