Financing Community Supports in Partnership with Permanent

Supportive Housing: Medicaid Combined with

Other Funding Sources

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Financing Community Supports in Partnership with Permanent Supportive Housing:

Medicaid Combined with Other Funding Sources

SAMHSA and Bazelon Center for Mental Health Law Conference

Changing Systems: Changing LivesSeptember 29 and 30, 2008

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Permanent Supportive Housing

Permanent Supportive Housing (PSH) is possible when essential individualized supports are available and accessible

Individualized supports can be funded in a variety of ways

The good news is that we know more today than ever about how financing can be structured to support a person’s successful tenancy and personal recovery goals living in PSH

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How can supports be financed?

A mix of local and federal funds can be used to finance supports

No one source of funding covers all necessary service and support costs

Funding for services is sometimes attached to housing and sometimes separate—

Medicaid is attached to a person and their eligibility for services

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How can supports be financed?

Funding alone is not sufficient to build theprogram. Three strategies are key:

1. Blending funding sources into a single approach

2. Utilizing state and local funds to fill in gaps created when using Medicaid as a major fund source

3. Creating incentives and minimizing disincentives in policy and the allocation process

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Identifying supports and sources of funds---financing plan

To maximize financing using multiple sources, it is important to develop a financing plan:

Identify support by type of support and by function

Match each support with fund source and identify limits (including such items as provider qualifications and documentation requirements)

Identify benefits such as potential for credentialing peer counselors

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How supports are reinforced Identify the treatment or service planning requirements for

each fund source and ways that planning can become the responsibility of a single entity called a “clinical home”

Establish mechanism for consumers to set their recovery goals matched with one or more of the available supports

Articulate goals in a consumer's Individual Recovery Plan (IRP) with specific needs based objectives

Credential staff and peers with pre service competency requirements and post services coaching and supervision standards

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Key Community Supports

Life skills training

In-home supports

Employment and employment related follow-along services(supported employment)

Peer counseling and peer supports

Accessing natural community services and supports

Assistance and resources to obtain and keep housing

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Key Community Supports

Family/caregiver support

Crisis response

Assertive Community Treatment

Clinical/Community Support Case Management

Substance Abuse Treatment

Primary and Specialty Health Care

Medication-self management/symptom self-management

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Why Medicaid… Medicaid is not the only answer, but it has to be a big

part of any financing strategy

Medicaid brings needed federal funding to the state

Medicaid requires individualized support, critical to permanent supportive housing

Medicaid advances access, quality and choice

Medicaid can be more responsive and has more flexibility than often used

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Current Medicaid Policy Issues

Medicaid is difficult but not impossible to work with

States can get more things approved by CMS than they usually do

But new guidance from CMS on the Rehab Option and case management may make it more complex

Administrative reluctance and bureaucracy: plan amendments, waivers, audits, etc.

Eligibility: limits for single adults; limits re: substance abuse

On the plus side: CMS system change grants; new waiver and state plan possibilities

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Medicaid and Permanent Supportive Housing

Medicaid

Clinical treatment – MH and SA

Primary health and chronic health care

Rehabilitation Option

Tenancy supports and community

integration

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Relation Between Medicaid Funding and Evidence Based Practices

EBP Trad MRO TCM PC1915(c)

1915b)

1115

ACT X X X X

Sup. Emp X(not job)

X X X

Dual Dx X X X X X X X

Illness Mgt. X X X X X X

Family supp. X X X X

Peer Support X X X X

Sup. housing X(Not rent)

X X X

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Medicaid Solutions

Standard benefit plan across funding streams and eligibility categories (New Mexico, Arizona, Washington State, Massachusetts, Michigan)

Incentives for linkage with supportive housing (Maine, Michigan, Arizona, Pennsylvania, Massachusetts)

Waivers for eligibility enhancements (Maine, Massachusetts, Oregon, Minnesota, RI)

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Medicaid is Only Part of the Answer Other state/local general fund dollars (Match and gap-filling)

Creative programs such as D.C.’s SIL Program fill gaps

Federal housing subsidy funds (HUD McKinney/Vento; HUD Section 8; HOME, Public Housing, Section 811, etc.)

Federal employment funds (Ticket to Work; DOL Workforce Investment Act; DOL VR funds)

Other federal funds (HRSA, Child Welfare, SAMHSA grants, etc.)

Federal Veterans Services Grant/Per Diem program Veteran’s Integrated Service Network

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Conclusion PSH can be financed by a combination of

funding sources---financing plan can identify how to do this

Medicaid is key to bringing PSH to scale---otherwise PSH is generally funded at a “project level”

Supports that can’t be funded by Medicaid can be blended into a PSH to reinforce good service planning and deployment of resources

Self determination, independence and recovery are the results