The Housing Choice Voucher (HCV) program for institutionalized, non-elderly disabled (NED) people stems from the 1999 case Olmstead v. L.C. (527 U.S. 581), in which the U.S. Supreme Court declared that people with disabilities are entitled to receive services in "the most integrated setting appropriate." This ruling required states to expand options for individuals with disabilities to live in community residences rather than institutions such as nursing facilities. Key to making community-based independent living possible is the availability of affordable, accessible housing.
To help expand the availability of rental subsidies for disabled individuals admitted to institutions who would be at risk of longer stays without such assistance, the U.S. Department of Housing and Urban Development (HUD), in collaboration with the Centers for Medicare and Medicaid Services, funded 948 Category 2 HCVs for NED individuals (referred to as NED2 vouchers). HUD allocated these HCVs to 28 public housing authorities (PHAs) in 15 states in January 2011 and required each PHA to partner with its state health and human services (HHS) agency or the state Money Follows the Person (MFP) demonstration program. These collaborating entities would be responsible for arranging and coordinating access to the community-based services and supports voucher recipients would need after leaving institutional settings. Citing long waiting lists for regular HCVs and the major barrier presented by unaffordable housing to MFP programs, federal officials expected each NED2 voucher to be issued and leased (that is, used to rent a unit) within one year of the award and for the vouchers to have a positive impact on the overall rate of transition in the designated areas.
This report summarizes the major findings of an evaluation, conducted by Mathematica Policy Research under a contract with the U.S. Department of Health and Human Services, Office of the Assistant Secretary of Planning and Evaluation, of the implementation of the NED2 HCV program and its effects on enabling institutionalized individuals to make transitions to community housing.
The study had two specific objectives: (1) to identify effective implementation methods by examining the rate at which the vouchers were issued and leased overall and by site, comparing the implementation approaches used by the PHAs and their HHS/MFP partners, and analyzing patterns between implementation approaches and voucher distribution rates; and (2) to estimate the impact of the NED2 program on the rate of transition from institutions to community-based settings among the eligible population in selected sites.
The report is organized as follows. In Chapter I, we provide an overview of the origin and need for the NED2 voucher program and a brief description of its design. In Chapter II, we explain the methods and major findings from the implementation and process analysis, which examined trends in voucher distribution in 13 of the 28 PHA regions (those that were provided with more than 35 vouchers each), and describe the barriers to and facilitators of program implementation across the sites and within each one. In Chapter III, we present methods, data, and findings from the impact analysis on the rate of transitions from nursing facilities (nearly all voucher users initially resided in such settings and data were unavailable for those in other institutions) to the community in the eligible population in the five sites with sufficient and reliable data. In Chapter IV, we draw conclusions from both analyses to provide lessons that can inform and improve future policies and programs designed to help low-income NED individuals make successful transitions from institutions to the community. Chapter II, Chapter III, and Chapter IV are summarized briefly below.