Chronic Individuals

Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People. Introduction to This Paper

This Issue Paper focuses on the roles that PHAs can play in expanding opportunities for chronically homeless people to move into housing, including the participation of PHAs in expanding the supply of PSH. A November 2011 HHS/ASPE Research Brief presents the findings of another ASPE project, in that case focusing on homeless families with children

Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People. Second Phase: Case Studies of New Strategies

The second phase of this study involves case studies of six communities that are on their way toward early implementation of the ACAs Medicaid provisions or other Medicaid-related policies and practices designed to deliver care to chronically homeless people. The study will follow the six communities through fall 2012, watching as they design an

Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People. The Study's First Phase: Literature Synthesis, Environmental Scan, and Site Visits

The chronically homeless people on whom this study focuses have multiple, complex, and interacting physical and behavioral health conditions. Achieving the best results for these clients and the public institutions and systems from which they get care requires effective engagement, service delivery, and care coordination. To understand how this ca

Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People. Preface to the Issue Papers

In 2014, most homeless people will become Medicaid-eligible under the Affordable Care Act (ACA) of 2010 based on their low incomes. Many homeless people have complex physical and behavioral health conditions for which they seek care through frequent use of emergency rooms and inpatient hospitalization, at considerable cost in public resources.

Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People

This Issue Paper looks at innovative ways that public housing agencies are supporting housing for formerly homeless people in the communities the researchers visited.

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Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. Notes

The Kaiser Commission on Medicaid and the Uninsured has published Medicaid: a Primer which explains key information about the Medicaid program. This publication, available at http://www.kff.org/medicaid/upload/7334-04.pdf provides clear explanations about Medicaid for readers who want more information about mandatory and optional benefits,

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 9. Conclusions and Implications

Many people are applying considerable effort to finding ways to use Medicaid more consistently to reimburse the costs of services to address the health and behavioral health problems of formerly homeless PSH tenants in ways that help them stay healthy and housed. One of the questions looming over PSH providers--how can we get our clients enrolled?

8.2. Potential for Using the Health Home Option

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

8.1. Who is Eligible for Health Home Services?

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 8.1. Who is Eligible for Health Home Services?

States have some flexibility in defining the population who will be eligible to receive health home services. The law describes chronic conditions that include a mental health condition, a substance use disorder, asthma, diabetes, heart disease, and obesity, and also gives the Secretary of HHS authority to expand this list of chronic conditions. T

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 8. Health Homes

The ACA established a new state Medicaid option to provide health home services for enrollees with chronic conditions. A health home is intended to provide enhanced integration and coordination of primary, acute, behavioral health (mental health and substance use), and long-term services and supports for people with chronic illness across

7.4. Looking Ahead to 2014: How is Managed Care

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 7.4. Looking Ahead to 2014: How is Managed Care Likely to Change?

Many states are likely to rely on managed care delivery and payment mechanisms as they expand coverage to people who are newly eligible for Medicaid. Medicaid managed care enrollment will likely keep expanding to include other groups of people with disabilities who are currently enrolled in Medicaid. This will make it increasingly important for PS

7.3. Challenges, Obstacles, and Limitations of

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 7.3. Challenges, Obstacles, and Limitations of Managed Care

7.3.1. The Usual Managed Care Organizations Are Not Geared to Serving Chronically Homeless People

7.2. New Arrangements for Managed Care for

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 7.2. New Arrangements for Managed Care for Residents of Permanent Supportive Housing

In Louisiana , the state has selected a MCO that is responsible for administering its new behavioral health carve-out. Included in covered services are services to people in PSH or eligible for PSH. Negotiations are under way on the level of funding that will be provided.

7.1. How Does Managed Care Deliver Services

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 7.1. How Does Managed Care Deliver Services Linked to Permanent Supportive Housing

Capitated financing and the quality or performance standards included in many managed care contracts change the financial incentives for health care providers. If reimbursement is no longer provided on a FFS basis for hospitalizations and emergency room visits, this creates incentives for the MCO or the network of health care providers under contr

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 7. Managed CARE

States are increasingly relying on managed care approaches to finance and deliver health care and behavioral health services to people enrolled in Medicaid. Under a managed care approach, states provide capitated financing to Managed Care Organizations (MCOs) that then contract with health care providers under arrangements intended to reduce costs

6.6. Looking Ahead to 2014: How is Home and

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.6. Looking Ahead to 2014: How is Home and Community-Based Services Likely to Change?

A number of provisions in the ACA provide new or expanded opportunities for states to use Medicaid to finance HCBS for people with disabilities, including enhanced Medicaid matching payments, demonstrations, and new state plan options. 38 States may be able to develop more unified or consistent approaches to creating and financing services in p

6.5. Challenges, Obstacles, and Limitations of

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.5. Challenges, Obstacles, and Limitations of Home and Community-Based Services

While it would appear that state efforts to enable people with disabilities to live in non-institutional, community-based settings should align with efforts to use PSH to end homelessness for people with poor health and high levels of disability, often that is not the case. 6.5.1. Separate Service-Providers, Advocates, and Government Organiza

6.4. How Can Home and Community-Based Services be

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.4. How Can Home and Community-Based Services be Provided to Permanent Supportive Housing Residents?

For the most part, people living in institutional settings are not homeless, although a growing number of older and vulnerable homeless adults are entering nursing homes or other long-term care facilities, often after a period of inpatient hospitalization for an acute medical and/or psychiatric crisis.

6.3. Who is Eligible for Home and Community-Based

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.3. Who is Eligible for Home and Community-Based Services

In PSH for chronically homeless people it is likely that some tenants meet clinical needs-based eligibility criteria for HCBS, while other tenants who are less disabled may not be eligible to receive these services.

6.2. Home and Community-Based Services Option/

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 6.2. Home and Community-Based Services Option/State Plan (1915i) Services

Recent changes in federal law 30 allow states to provide HCBS services, without a waiver, as optional benefits by making a Medicaid SPA. The purpose of 1915i is to expand access to HCBS to persons with disabilities who are not at an institutional level of care. Therefore, states that want to add this optional benefit must establish needs-based

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