Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis. A. Implementation Analysis: Conclusions and Lessons Learned


We found that effective voucher distribution appears to be associated with a highly coordinated effort between PHAs and HHS partners and certain implementation processes. These findings provide lessons that, if broadly applied, could improve the efficiency and effectiveness of similar programs in the future:

  • Ensure good communication and strong partnerships between PHA and HHS/MFP staff. By far, the most important facilitator of successful issuing and leasing of vouchers was regular and open communication between PHA and HHS/MFP staff, including managers and frontline staff. Strong partnerships between housing and Medicaid agencies are the backbone of the supportive housing model, suggesting that establishing and maintaining this infrastructure is well worth the investment. To ensure vouchers go to PHAs that are committed to such collaboration, HUD's award criteria could place greater weight on evidence of the PHA-HHS/MFP partnerships.38

  • Assign dedicated program staff and centralize monitoring. Sites that were most successful in leasing vouchers each had a dedicated staff member assigned to track referrals and monitor application status, facilitate communication between transition coordinators and PHA staff, and be accountable for resolving problems or barriers.

  • Align the time line for voucher use with program startup needs. In PHAs that did not have experience with specialized vouchers of this type, the initial phase of the program involved many activities: creating a database to track referrals, developing cross-agency MOUs, assigning and training staff, and developing outreach and marketing strategies. In some sites, both Medicaid and PHA policies had to be modified to accommodate the special needs and characteristics of the target group. Policymakers should take into account these program startup processes when setting expectations regarding the period of time required to issue and lease all vouchers.

  • Employ HHS/MFP housing specialists. Because housing and Medicaid agencies operate under complex federal, state and local policies and procedures, state or local housing specialists who are familiar with both sets of programs are critical assets. Sites that struggled to issue and lease all of their NED2 vouchers were more likely to lack dedicated housing specialists.

  • Relax rules governing voucher portability. Sites with open or relaxed portability rules were able to issue or lease their vouchers faster than those with limiting porting rules. The inclusion of a "no absorption" policy in program regulations would remove the financial disincentive to porting vouchers.

Even among PHAs and HHS/MFP partners with demonstrated capacity to support a NED2 voucher program, additional barriers remain. Potential voucher users may still struggle to find affordable units. It can be difficult in many communities to find housing units that are accessible to those with physical disabilities. Concerted efforts by HHS/MFP staff are important to address landlord concerns about applicants' poor credit or criminal histories; staff can establish strong relationships with landlords and assure them of ongoing help to maintain voucher eligibility, as well as continuation of health and social supports. In the long-term, efforts to overcome these barriers may reduce total public expenditures if the costs to Medicaid, Medicare, and HUD/PHAs of supporting such individuals in the community are less than the cost to Medicaid and Medicare of longer stays in an institution. Lessons learned from the NED2 program may also be useful for finding and maintaining stable housing for people who are homeless and other vulnerable populations which may face similar barriers, such as missing documentation, bad credit, and criminal backgrounds.

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