Content by Keyword: Chronic Individuals

States may operate several different HCBS 1915c waiver programs, each designed to target different groups of people based on age, diagnosis, or condition. States may also receive a waiver of Medicaid’s “statewideness” requirements and offer some HCBS waiver services in a particular jurisdiction or region of the state or operate statewide but se

Medicaid-covered HCBS may be available under an HCBS waiver (1915c) or they may be optional HCBS services covered without a waiver under a Medicaid SPA (1915i). HCBS are intended to offer alternatives to institutional care for people with disabling health conditions.

Much uncertainty exists about the scope of substance abuse treatment services that Medicaid will cover for newly eligible people in 2014. An additional issue is the implication of requirements for “parity” between benefits for treatment of substance abuse disorders and medical and surgical benefits, which are pending promulgation and testing.

5.3.1. Medicaid-Reimbursed Substance Abuse Services Cannot Be Delivered On-Site in Permanent Supportive Housing

Service-providers working in PSH help tenants with problems related to substance use, but they rarely receive Medicaid reimbursement for these services. PSH case managers work to motivate tenants to recognize and seek help for substance use problems and to achieve recovery goals. They connect tenants to other programs that offer treatment services

In most states persons with substance use disorders are not eligible for Medicaid enrollment unless they are part of a group with “categorical” eligibility for another reason. Among chronically homeless people this is most likely to be another disabling health conditions such as SMI, a physical disability or a disabling medical condition. When p

Research on homelessness has found that a large portion of people experiencing chronic homelessness have substance abuse disorders, 25 and this was confirmed by interviews with service-providers in the site visits for this project.

The ACA authorizes expansion of a SAMHSA grant program to help integrate primary care with community-based mental health services. This increase in demonstration sites for behavioral health and primary care integration may create opportunities for more PSH service-providers to deliver comprehensive care to homeless people and PSH tenants.

Most states have separate rules governing Medicaid-reimbursed medical care and behavioral health care services, including rules that cover provider qualifications, program sites, record-keeping, and payment mechanisms. While many providers are making major investments in new electronic health record systems, these systems generally do not offer th

For homeless people and residents of PSH, eligibility for and access to integrated care depends in part on whether the partnership between an FQHC and behavioral health services takes place within a program that is limited to serving persons with SMI, or in a clinic or program with the capacity and funding to serve a broader population. During sit

The communities we visited for this project offered excellent examples of collaboration to deliver integrated primary care and behavioral health care services, both among separate organizations and across programs operated by the same organization. Mental health programs and FQHCs can be co-located programs that operate within the same building bu

Combining the capacity of FQHCs and mental health service-providers and the reimbursement mechanisms available to the two types of organizations can create a more comprehensive and flexible package of services for chronically homeless people. For example, the FQHC reimbursement mechanism may be used to cover services to people who have mental heal

States may use Benchmark Plans to make Medicaid services available to some or all people who become Medicaid beneficiaries in 2014, including homeless people and PSH tenants.

3.3.1. Covered Services and Rules for Documenting Costs Can Be Inconsistent with Service Models

All three of the states we visited use the MRO to provide Medicaid reimbursement for a range of services delivered in community settings, including PSH. 18 3.2.1. Massachusetts

Each state establishes its own specific criteria for eligibility for community mental health services. Generally, in order for services to be covered there must be “a need for mental health services for a mental disorder or suspected mental disorder,” and the person must meet the first of the following three criteria, plus either one or both of

Given the prevalence of mental illness among chronically homeless people, providing mental health services in a community setting is essential for meeting the needs of chronically homeless people who move into PSH. Nearly every state uses the Medicaid Rehabilitation Option (MRO) to provide Medicaid reimbursement for some community-based mental hea

When nearly all homeless people gain eligibility for Medicaid under the ACA, more FQHCs will likely find it feasible to deliver health care services tailored to meet the needs of PSH residents. HCH providers and other FQHCs that are already committed to serving homeless people and other people with complex health and psycho-social challenges will

While some FQHCs have succeeded in providing comprehensive care to PSH residents, they have had to overcome challenges created by the current Medicaid system that include incomplete coverage of services, billing rules that make integrated care difficult, and ambiguity about how long HCH providers can serve people in supportive housing who no longe

In each of the three communities visited for this project, FQHCs are actively involved in delivering services to PSH residents. These Health Centers use several different models of service delivery. Most are well-established organizations that have been serving homeless people or other vulnerable populations with complex health problems for a deca