Permanent Supportive Housing: A Key Ingredient to Recovery for Consumers

Presentation to the NAMI Maryland ConferenceAndrew Sperling

Director of Legislative Advocacy

NAMI National

andrew@nami.org

October 18, 2013

Permanent Supportive Housing (PSH)

• A cost effective intervention

• Numerous studies document cost effectiveness of providing permanent housing for people with disabilities:– New York/New York Culhane study on permanent

supportive housing

– University of Washington study in JAMA on “Housing First”

– Massachusetts study on chronically homeless people

– Health Affairs study on Medicaid long-term care costs

3 Legs of the PSH Stool

1. Capital– Investment to acquire or rehabilitate a property,

“bricks and sticks”

2. Ongoing rent or operating subsidy – Difference between tenant contributions and housing

operating costs (utilities, insurance, contribution to reserves, etc., NOT supportive services)

3. Housing related support services – Case management, peer support, rehabilitation, etc.,

NOT medication or therapy • Can be financed through the Medicaid Rehabilitation

option

Housing First

• Effective tool in ending chronic homelessness

• Avoids “managing” chronic homelessness through institutional costs such as shelters, corrections, public and emergency services

• Building flexible, individualized services such as medical, mental health, substance abuse and vocational services around housing

Housing First (continued)

• Studies demonstrate that cost savings are dependent on housing stability

• Three major features1. Simple expeditious application process, 2. No requirement for tenant to participate in or

complete treatment prior to obtaining structured housing, intensive case management available once housed,

3. Conditions of tenancy do not exceed normal conditions for other leaseholders.

Where do People with Disabilities Live?

• TAC “Worst Case” Needs Report– 1.1 - 1.4 million non-elderly adults renters with disabilities

with very low incomes have “worst case” housing needs• Paying more than 50% of income for rent and/or• Living in seriously substandard housing

• 412,000 adults ages 31-64 in nursing homes– 125,000 adults between ages 22-64 have mental illness

(41% increase since 2002)

• In Adult Care Homes = 330,000 adults with mental illness• In Group Homes = 500,000 adults with disabilities• In Emergency Shelters = 180,000 adults with disabilities

6

Priced Out in 2012 Study

• Compares SSI income to HUD Fair Market Rents• SSI = $698 monthly• 1 Bedroom rent of $758 = 104% of monthly SSI• Studio rent of $655 = 90% of monthly SSI• In 17 states, average one-bedroom rents were

higher than monthly SSI payments • SSI = 19.2% of average national AMI• 70,815 non-elderly people with disabilities in

Maryland on SSI• http://www.tacinc.org/knowledge-resources/priced-o

ut-findings/

Priced Out 2012 - Maryland

State and Metropolitan Statistical Area

SSI Monthly Payment

SSI as % Median Income

% SSI for Efficiency

% SSI for 1-

Bedroom

Baltimore-Towson $698.00 14.0% 121.0% 143.0%

Hagerstown $698.00 16.5% 76.0% 92.0%

Salisbury $698.00 16.5% 77.0% 96.0%

Montgomery-Prince Georges $698.00 11.1% 162.0% 171.0%

State Average $698.00 13.4% 134.0% 150.0%

SSI Income

Median Income

50% of Median Income

SSI Benefits 18% of Median Income30% of Median Income

Rent Subsidies Are Essential• 30% of income towards housing costs according to federal housing

affordability guidelines

• 30% of SSI = $200

• National Average 1 BR rent = $758

• “Housing Affordability Gap” = $558

• “Gap” must be filled by an on-going rental subsidy

• Big challenge – Section 8 is NOT an entitlement like Medicaid & SSI

– PHA waiting lists are long and often closed

Priced Out Message

HUD Rent Subsidy Programs

• Total units = 4.8 million

• Section 8 Housing Choice Vouchers = 2 million vouchers. – Only 19% assist people with disabilities

• Section 8 vouchers set aside for non-elderly disabled– Poor tracking, ineffective targeting upon turnover, no link to

supportive housing

• Clarification is needed regarding targeting of vouchers and establish preferences for priority populations – including people with serious mental illness – without violating civil rights laws (Section 504) or having to prove that the preference is to remedy past discrimination

Addressing the “Affordability Gap”

– 50,000 “Frelinghuysen” vouchers linked to “elderly only” designation – can be project-based

• 100 – Baltimore County Housing Authority• 100 – Carroll County Housing Authority• 175 – Baltimore City Housing Authority • 50 – Frederick Housing Authority• 660 – Montgomery County Housing Authority• 100 – St. Mary’s County Housing Authority

– 14,000 811 “mainstream” vouchers – cannot be project-based

• 100 – Anne Arundel County Housing Authority• 75 – Arc of the North Chesapeake

– NED Category 2 Vouchers• 40 – Baltimore City Housing Authority

HUD Rent Subsidy Programs

Addressing the “Affordability Gap”

Veterans Supportive Housing

• Vouchers: tenant-based, project-based and sponsor-based

• Targeted to veterans experiencing chronic homelessness• $75 million in new funds expected in 2013 and beyond• Combined with services from the VA• VASH Vouchers in Maryland:

275 – Baltimore County Housing Authority

305 – Baltimore City Housing Authority

80 – Montgomery County Housing Authority

VASH

• Public housing units =1.1 million units (affect of “elderly only” housing policies)– Only 16% assist people with disabilities

• HUD “Assisted Housing” = 1.2 million units (affect of “elderly only” housing policies)– Only 17% assist people with disabilities

• Other programs = 443,000 units– Section 811 = 30,000 units– Homeless programs = 50,000

HUD Rent Subsidy Programs

Addressing the “Affordability Gap”

Rent Subsidies

• Section 8 Vouchers targeted to people with disabilities – Three types of Section 8 vouchers:

• tenant-based• sponsor-based • project-based

• HUD Homeless Assistance programs• HUD VASH • Section 811

What Works

Section 811 Project-Based Rental Assistance Demonstration

• Authorized by the Frank Melville Supportive Housing Investment Act to promote integrated housing

• Goal: Sustainable, state-driven strategies to expand PSH• Created the new PRA option administered by State

Housing Agencies through a formal partnership with the State Human Service/Medicaid agency

• State Housing agency commits PRA funding to either new or existing units. No 811 capital is used.

• HHS/Medicaid makes service commitments • No more than 25 percent of the units in any property can

be set-aside as supportive housing

Integrated PRA Approach

• Modeled from successful efforts in NC, LA, and PA• 5 PRA units in a 100 unit property financed with LIHTC• 10 barrier free PRA units in a 40 unit non-profit owned

property jointly financed by the State Housing Agency and local government

• 2 PRA units in a 20 unit rental housing development financed with HUD HOME funds

• 20 PRA units in a 100 unit “mixed income” public housing revitalization project.

• Highly cost-effective PRA subsidy ensures deep affordability

PRA Demo Formal Partnership

• State Housing and HHS/Medicaid agencies must have formal agreement before submitting the PRA application to HUD

• The agreement must specify:– Target population(s) to be assisted with PRA funds– Methods of outreach and referral to assure PRA units

are occupied by the target population in a timely manner

– State commitments of voluntary supportive services for people receiving PRA assistance

First PRA Demo NOFA Competition

• First PRA NOFA published on May 15, 2012

• Applications were due on August 2nd

• NOFA included $85 million in PRA funding for an estimated 2,800 units

• 35 States plus DC submitted applications

• Awards announced on Feb. 12, 2013

• 13 States – including Maryland – were awarded a total of $98 million

• 3,530 new PRA units will be created (compared to 948 over 2 years in FY10-FY 11)

Maryland’s 811 PRA Program

• $10,917,383 to serve 150 individuals with disabilities, age 18 and over and below 62 years of age at selection, with income at or below 30% of AMI who are Medicaid recipients

• Tenants will be referred by DHMH and MDOD, under the following prioritized criteria:– Institutionalized Medicaid Recipients– Households At Risk of Institutionalization Due to Current Housing

Situation– Developmental Disabilities Administration (DDA) Community

Pathways Waiver Participants moving from Group Homes, Alternative Living Units (ALUs) to independent renting and Mental Hygiene Administration (MHA) Residential Rehabilitation Program participants moving to independent renting, and

– Homeless persons who are Medicaid recipients.

Maryland’s 811 PRA Program

• 50/50 split between Baltimore and DC Metropolitan areas• DHCD and local Public Housing Authorities (PHAs) are also

committing to provide local preferences for up to 97 Housing Choice Vouchers (HCV) or public housing units to support non-elderly disabled clients.

• DHMH will make available the following voluntary support services to tenants in PRA units who are eligible for Medicaid funded services, including : – Psychiatric Rehabilitation Program Services, and other State

Plan behavioral health services– Community Pathways Waiver – New Directions Waiver– Medical Day Care Waiver– Medical Assistance Personal Care

Critical Element Source Examples

Capital • HFA• State or local govt.• Private foundation

• Low Income Housing Tax Credits

• Bonds/Trust Funds• HOME• Foundation Funds

Operating Subsidy • HUD • Section 811 PRA Demo

• S+C PBA• Section 8 PBV

Support Services • State Medicaid Agency

• State Human Services Agency

• Money Follows Person

• Home and Community-based Waiver Services

• State services funds• Rehab option

Supportive HousingPartnership

Source: TAC

More Information

http://811resourcecenter.tacinc.org/

http://www.tacinc.org/knowledge-resources/vouchers-database/