Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 8.2. Potential for Using the Health Home Option for Residents of Permanent Supportive Housing


In several states, supportive housing service-providers and other advocates are talking with Medicaid program officials about potential opportunities to provide health home services to target populations that will include PSH residents. Some supportive housing service-providers, especially FQHCs, are assessing their ability to become a health home, and some are working to build the capacity to meet current or anticipated health home provider standards. Other supportive housing service-providers are seeking to develop collaborative partnerships with health care providers who are more likely to become health homes.

Several state officials who participated in site visits for this study expressed some hesitation about their fiscal capacity to pursue the new health home option, even though federal matching funding would cover 90 percent of costs for the first two years of implementation. They have some interest in pursuing the option if the state could craft target criteria in a way that would achieve overall savings, by providing health home services to people with complex health problems who are high-users of hospital inpatient care.

In Illinois, HHO and a few other provider organizations that now serve chronically homeless people are consulting with state Medicaid officials about the possibility of a pilot “health home” project, with the target population strictly limited to chronically homeless, multiply disabled, frequent users of crisis public services. Careful assessment and targeting would be needed to achieve cost neutrality or potential savings in state costs by the time federal matching contributions are reduced to the standard rate after two years.

The pilot project would use Medicaid managed care financing to deliver comprehensive health and behavioral health services. Services could be coupled with housing supported by HUD housing subsidies provided through a partnership with the Chicago Housing Authority and a grant recently awarded to the AIDS Foundation of Chicago through HUD’s SHP for new PSH units for chronically homeless persons.

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