Although many challenges and themes reported across PHAs were common to all, regardless of their level of success, some key differences were evident among those able to issue and lease their vouchers earlier than others. In this section, we first discuss challenges common to all sites, particularly challenges centered on the identification and referral of eligible applicants and problems in leasing of issued vouchers and those unique to participant characteristics or circumstances. Then we turn to a discussion of the implementation processes distinguishing the PHAs more successful in issuing and leasing awarded vouchers.
1. Challenges in Identifying and Referring Eligible Applicants
Many PHAs reported receiving very few referrals in the initial months following program rollout, with a lack of communication between PHA and HHS/MFP staff the most commonly cited reason. In many sites, particularly California, Georgia, and Ohio, it was noted that because the transition coordinators had no previous working history with the PHAs receiving the awards, establishing lines of communication and working partnerships took time. The housing specialist in Ohio noted that much of the first half of 2011 was dedicated to engaging the PHAs there, bringing all the relevant staff together, and implementing an effective communication plan. Georgia's circumstance was unique in that the position of statewide MFP housing specialist, the holder of which was responsible for overseeing the partnership, was vacant for most of the program period. The MFP lead agency in Orange County effectively stopped making referrals to the PHA in mid-2011, due to staffing constraints; with no communication with its local partner. As a result, the PHA spent months working with the state team, HUD, and TAC to adopt eventually a contingency plan through which it was able to begin receiving referrals from other lead agencies. Every site that was ultimately successful in issuing and leasing vouchers cited communication among staff as a crucial facilitator.
Initially, PHA rules, or rules governing the PHAs, were themselves a barrier to referrals. In several sites, including Decatur, Lynn, Pasadena, and Orange County, the number of participants wanting to move to the PHA's jurisdiction was insufficient. This was particularly a problem in Decatur, where the PHA did not alter its policy to permit immediate porting. In contrast, after receiving few initial referrals, the PHA in Lynn began allowing vouchers to be ported to surrounding jurisdictions. When that change still produced too few referrals, the program went statewide. A lack of clarity from HUD on porting rules was noted by several state teams, although whether this affected the rate of referrals in those states is not clear. As noted earlier, California worked closely with regional HUD offices and the TA providers to establish open portability rules. These would have had a positive effect on the PHA in Orange County, in particular, which was not receiving a sufficient number of referrals; however, ultimately the statewide plan was never adopted.
Finally, many transition coordinators and case managers lacked a background in housing and may not have been sufficiently educated about housing options during the initial months of implementation. Washington, for example, noted that MFP transition coordinators and case managers initially made few referrals because, they said, most institutional residents preferred to move in with family, into assisted living facilities, or into group homes; fewer wanted to move to apartments and live on their own, for which they would need NED2 vouchers. MFP transition coordinators also said finding suitable apartments required more work and greater knowledge of housing rules. The regional housing specialists, who were responsible for coordinating activities between the local coordinators and the PHAs, stepped up their education and training efforts; ultimately, this led to an increase in both the quantity and suitability of referrals. Staff at the Snohomish PHA, for example, claimed one reason for their success was that the MFP transition coordinators became very good at identifying and referring candidates more likely to qualify for and use the vouchers.
2. Challenges in Leasing Issued Vouchers
By far, the top two barriers to leasing issued vouchers were lack of accessible housing and lack of affordable housing. These obstacles were cited by every PHA and state HHS/MFP team. Lack of affordable housing was a main reason for establishing this and other HCV programs; however, even with vouchers, transition teams often struggled to identify affordable units.
Even when an acceptable unit could be identified, the landlord was often unwilling to reserve it while the service plan was being implemented--a barrier noted by the teams in several states. In California, for example, where MFP often covers the housing deposit for cash-strapped participants, local agencies must navigate a lengthy bureaucratic process that often takes months in order to receive these advances from the state program. Receiving the necessary approvals for the various services and supports in a participant's service plan may take a similarly prolonged period of time. In a state like California, where vacancy rates are low, landlords simply move on to more readily available renters. HHS/MFP staff in other states also noted that obtaining authorization for all of the services needed to implement a community-based care plan could take weeks or months. The process could be even more challenging with a participant making a transition to a rural community in which fewer community-based services and supports are available.
Establishing relationships with landlords and property developers was cited as a critical factor in Maryland's relative success in leasing vouchers. Due to perceived risks, landlords might be reluctant to rent to people with disabilities or complex medical conditions, as noted by program staff in several sites. But intensive outreach could make a difference. Both PHAs in Maryland conducted outreach and/or held occasional workshops to educate developers and landlords about leasing to people with disabilities. Over time, the PHAs forged solid working relationships that allowed for an easier voucher leasing process. Transition coordinators in the state had a list of properties run by familiar and reliable landlords and often were able to identify a unit prior even to submitting the application. Compared to staff in other sites, the transition team in Maryland spent less time persuading landlords to hold properties, allowing for a smoother leasing process.
3. Challenges Related to Participant Characteristics and Circumstances
Missing documentation, bad credit, and a criminal background on the part of applicants were major challenges reported by staff in most of the sites. Most state teams noted that applicants often lacked the necessary eligibility documentation, such as a birth certificate, state-issued identification card, or Social Security card, or required additional time to locate these and other documents. Contrary to the expectations of some PHA staff, many participants had criminal backgrounds that prevented them from being either approved for vouchers or accepted by landlords. Also commonly cited as a barrier to leasing was bad credit, often incurred as a result of the injury that led to the participant's disability. Other participant-specific barriers included applicants not showing up for their briefings, participants changing their minds about making transitions from institutional settings to the community, and deterioration of health that prevented them from making transitions.
4. Implementation Procedures Associated with Successful Voucher Issuing and Leasing
Factors associated with quicker issuing and leasing of vouchers included strong lines of communication between PHA and HHS/MFP staff, a centralized or streamlined set of referral procedures, involvement of an HHS/MFP housing specialist, and relaxed portability rules (see Table II.2). These characteristics were identified as facilitators of success in the nine sites that eventually issued or leased all of their assigned vouchers: Baltimore City, Baltimore County, Cincinnati, Longview, Lucas County, Lynn, New Jersey, Snohomish County, and Tacoma. Conversely, the absence of many or all of these characteristics was identified as the reason for slower success in Austin, Decatur, Orange County, and Pasadena.20
Lack of communication and of preexisting partnerships was identified as a critical reason for either a slow or rocky rollout of the NED2 program. Both Washington and Ohio spent the initial months establishing working relationships among all frontline staff, developing day-to-day procedures, building the necessary databases, checklists, and resources, and promoting regular communication. Because of the need to make these upfront investments, many states did not officially rollout their NED2 programs until summer 2011. Communication between the PHAs in Pasadena, Orange County, and Decatur and their respective assigned MFP teams remained minimal and at times non-existent through much of 2011 and 2012, which was regarded as a critical reason for the low number of vouchers issued in these sites.
The programs in Washington, Ohio, Massachusetts, New Jersey, and Maryland each benefited from having a single statewide coordinator, an intermediary coordinating entity, or a team of regional program coordinators responsible for ensuring continual progress and accountable for identifying bottlenecks and barriers. States that set up this type of centralized implementation model, in which referrals made by transition coordinators were shepherded through a very specific and streamlined review process before being received by PHA staff, had greater success. Conversely, California operated a decentralized model in which referrals came to PHAs directly from various local agency staff, with very little involvement from the state MFP team; this allowed inconsistencies in quality and required greater effort and involvement on the part of PHA staff.
States with dedicated housing coordinators or specialists at the state or local level, such as Ohio, Washington, Maryland, and New Jersey, had much greater success than states without them, such as Georgia and California. Findings from a recent Mathematica MFP evaluation study highlighted the important role housing specialists play in boosting the number of people who move from institutions back to the community (Lipson et al. 2011). Housing specialists are better situated to provide training and education about housing issues and PHA policies directly to the transition coordinators and case managers, and are better equipped to communicate with PHA staff--benefits perhaps most apparent in Washington, which had three regional housing specialists responsible for overseeing a smooth referral process between local transition coordinators and the PHAs.
Several states expressed initial confusion about whether HUD permitted immediate use of the NED2 vouchers in jurisdictions outside of the receiving PHA, causing several PHAs initially to restrict porting. Some PHA staff would have appreciated a policy that restricted absorption,21 which would have removed the financial disincentive to port vouchers. Sites that established immediate porting rules earlier in the program, such as New Jersey and sites in Maryland, showed earlier signs of success. Massachusetts witnessed increased success only after broadening its porting policy. Sites that strictly abided by the standard regulations governing portability, such as Georgia, Texas, and California, were much slower to see vouchers leased.
In conclusion, although implementing the NED2 program proved far more difficult than many PHAs and their partners expected, all program representatives expressed a firm belief that the program was well worth the effort to the individual voucher users, most of whom would have otherwise remained in institutions longer. All eight states included in this analysis also indicated that the NOFA application process, and the NED2 program itself, had strengthened the states' housing/Medicaid partnerships, and several planned to leverage the newly enhanced relationship to pursue future funding opportunities. Whether the vouchers affected the overall rate of transitions to the community among the eligible group in each region is examined in the next chapter.