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Sustainable Community Living Option to
Support Transition and Prevent
Institutionalization
Candace BaldwinNCB Capital Impact
Diane DresslerMaryland Center for Developmental
Disabilities - Kennedy Krieger Institute
Leyla SarigolDC Dept of Health Care Finance
Robin WagnerLA Office of Aging and Adult Services
Agenda
• Introduction of Panelists
• Discussion Points– Community Living Options are necessary for the successful
implementation and sustainability of home and community based programs
– Programmatic and policy opportunities are available to create systems change for transition and diversion
– Cross agency collaboration, local partnerships and comprehensive strategy are key
– States have developed innovative programs to support and expand community living
• Open Discussion
It Takes More Than Money to Spark Lasting Economic Progress
• Empowering communities through
– Innovative community lending– Expert technical assistance– Effective policy development
• Key areas of work include
– Affordable cooperative housing– Cooperative service purchasing arrangements– Community-based and facility-based LTSS enhancement– Community-based health and behavioral care– Educational Facilities
Connecting Long Term Supports Policy with Real World Practices
• Center for Long Term Supports Innovation:– Mission to help older Americans and
people with disabilities to conduct their lives with maximum independence, dignity and connection to their communities
– Provide innovative, expert technical assistance to community-based organizations working in underserved and moderate- and low-income communities
Community Integration is More Than Just Physical Presence in the Community
• Comprehensive community integration programs need to include housing, education, employment, transportation and personal care services
• Planning for these programs are conducted at local levels
• Transparency in communication among multiple agencies is key
The Current Housing Environment is Volatile
Housing Environment Implications
Current state of the credit market Financing for affordable housing very tight, investors more risk adverse, cost of development is more expensive
State HFAs are balancing wide variety of housing needs
Maximizing spread of limited housing funds, localities must create gap financing, family housing competes with affordable/accessible housing needs
Homeownership declining due to subprime lending market fallout
Affordable rental units will be taken by families; loss of supply; decline in condo market could result in expanded multifamily rental supply
Aging out of Housing Subsidies Loss of critical mass of affordable rental units, lack of rental housing, subsidies not serving very low income
7
Community Living Includes a Wide Array of Housing Models
Permanent SupportiveHousing
Shared Housing
Accessible, affordable and integrated rental
Adult Family Homes
Cooperative Homeownership
8
Housing Support Programs Require Cross Sector, Cross Disability Collaborations
• Coalition of agencies to define mission, vision and key objectives
• Assess commonalities in similar housing for people needing some level of service coordination
• Dedicated staff person at the executive level to liaison cross systems
• Partner with legislative committees to foster cross system collaborations
Locally Based Strategies are Key to Community Living
• Public Housing Authorities • Public Housing units• Rental Assistance
• State Housing Finance Agencies• Housing Trust Funds – in large metro areas are managed by
local government• Low Income Housing Tax Credits• Tax Exempt Bonds
• Local Housing/Community Development Agencies• Participating Jurisdictions (HOME, CDBG, Rural Development)• Dedicated and unique housing finance programs• Transportation, ADRCs, CILs and others
Building Local Partnerships can Enhance Ability to Coordinate an Approach
• Public Housing Authorities –• Raise knowledge of PHA staff to understand needs and
preferences of MFP participants• Assess local housing needs and develop strategies to
address future plans and planning processes• Work with PHA to identify resources for housing
development and tenant based rental assistance
• Mission driven, affordable housing developers• Tend to have local service areas • Examples: Faith based organizations, Community
Development Corporations, coalitions/association of non profit developers
11
Create Living Options and Community Based Infrastructure Long Term
• Changes to existing housing finance programs and development of finance packaging will result in units long term (3-5 years)
• Focus on creating sustainable infrastructure for housing and services
• Long term strategies will be useful to sustain affordable, accessible and integrated housing for individuals with disabilities not served by the MFP Initiative
Opportunities on Horizon Provide Key Components
• Community Living Initiative– HUD and HHS – collaborating and assessing
intersection points
• Section 811 – New way to create unit mass
• Affordable Care Act– Emphasizes focus on HCBS– Encourages innovative strategies
Question & Answers
For More Information Candace Baldwin
Senior Policy AdvisorNCB Capital Impact
Center for Excellence in Long-Term Supports [email protected]
(703) 647-2352www.ncbcapitalimpact.org
Community Based Housing for People Transitioning from Institutions Through MFPChronology & Lessons from DC2008-2011+
Leylâ Sarıgöl, Project Director, DC Money Follows the Person Rebalancing DemonstrationNASUAD/HCBS 2011 National Home & Community Based Services ConferenceSeptember 13, 2011
Department of Health Care FinanceGovernment of the District of Columbia
For Official Government Use Only
16
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Chronology
MFP Target Group Housing FinancingYearI/DD EPD MH DD Local Funds Housing Choice
VouchersDCHA Public
HousingAlternative
Sources (811,HOME. etc)
2008 X X2009 x X2010 x X2011 x x X X2012 x x x x X X2013 X X X X X X2014+ X X X X X
COMMUNITY BASED HOUSING
17
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: LessonsLESSON 1: All politics are local. Control is local.– ADVICE: Get support at the highest level & at the grassroots level early & often.
LESSON 2: Communication & trust are keys to success.– ADVICE: Know the right people & talk to them at the right time.
LESSON 3: You have to focus on housing. Get information & follow up.– ADVICE: Dedicate human & financial capital to housing coordination.
COMMUNITY BASED HOUSING
18
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Lesson 1LESSON 1: All politics are local. Control is local.
ADVICE: Get support at the highest level & at the grassroots level early & often.
Mayor
City AdministratorHousing Authority
BoardCity Council
Advocacy Groups
COMMUNITY BASED HOUSING
19
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Lesson 1LESSON 1: All politics are local. Control is local.ADVICE: Get support at the highest level & at the grassroots level early & often.
Mayor, City Council, DDS/DDA Local funding for housing
Mayor, Advocates Set-aside of Long-Term Care Housing Choice Vouchers
City Administrator’s Office Interagency collaboration
Mayor Cease & desist use of MFP HCV set-aside
Mayor, DCHA Board Opportunity to get MFP HCV set-aside back
Advocates Olmstead Litigation
20
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Lesson 2
LESSON 2: Communication & trust are keys to success.
ADVICE: Know the right people & talk to them at the right time.
DC Office of Planning
DCOA/ADRCDHS PSH
Developers/Property Managers
COMMUNITY BASED HOUSING
Housing Authority
Operations
21
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Lesson 2Lesson #2: Communication & trust are keys to success.Advice: Know the right people & talk to them at the right time.
Office of Planning Where is accessible housing? How do we get it?
Housing Authority Operations • Access to voucher/market units & public housing• Weekly coordinating call• NEPD voucher application & award allocation• Action to hold onto MFP voucher set-aside
Office on Aging/ADRC • Exchange: LTC Vouchers• MFP/ADRC $
Dept. of Human Services/PSH • Exchange: Training, Client Aid• Key Information
Developers/Property Managers • Opportunities to request & hold units to spec• Negotiations for special circumstances-timeline
22
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Lesson 3LESSON 3: You have to focus on housing. Get information & follow up.
ADVICE: Dedicate human & financial capital to housing coordination.
Housing Consultant
Transition
CoordinatorsHousing Specialist
Advocacy Groups
COMMUNITY BASED HOUSING
Project Manager
23
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Lesson 3LESSON 3: You have to focus on housing. Get information & follow up.ADVICE: Dedicate human & financial capital to housing coordination.
Project DirectorArticulate vision & strategy to secure & maintain resources. The Glue!
Connect project to local resources & advocate to keep them
Advocates Local housing opportunities - especially accessible housing
Transition Coordinators Connect individuals to appropriate resources through transition Complete applications, coordinate logistics for individuals
Housing Consultant Connect project to promising national strategies.Provide guidance & manpower to implement strategies
Housing Specialist Maintain relationships with developers, property managers. Maintain pool of housing, identify units for participants. Transition services: household set-up, inspection
24
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Housing for DC’s MFP Rebalancing Demonstration: Contact
Leylâ Sarıgöl, Project Director
DC Money Follows the Person Rebalancing Demonstration
202.442.5918 office
Division of Long Term Care
District of Columbia Department of Health Care Finance
899 N. Captiol Street NE, 6th Floor
Washington, DC 20002
www.kennedykrieger.org
Maryland Housing Partnerships
Diane DresslerProgram Director, Training and
Services for AdultsMaryland Center for
Developmental Disabilities
www.kennedykrieger.org26
Creating Affordable Housing for People with Disabilities
DD Council
Dept. of Housing & Community Development
DHMH: MedicaidDept. of Disabilities
Developmental Disabilities Admin.
Mental Hygiene Admin.
HUD: Baltimore Field Office
MD Assn. of Housing & Redevelopment Agencies
Centers for Independent Living
The Coordinating Center
MD Affordable Housing CoalitionOn Our Own
of MD
People on the Go
MD MFP
MD Disability Law Center
The Partners
MD Center for Developmental Disabilities
www.kennedykrieger.org
The Beginning…Partnerships to Create Resources
• 2001: Olmstead Housing Task Force– Accomplishments
• QAP set aside: 10%• Housing and Disability Services Resource Guide• Cross-training • Relationship with PHAs
• 2003: Governor’s Commission on Housing Policy– Special Needs Housing Subcommittee
• Bridge Subsidy Demonstration Program
27
www.kennedykrieger.org
2007:Bridge Subsidy Demonstration Program
• MOU between State Housing Agency (SHA), State Health Dept., CILs and certain PHAs
• Funded by SHA revenue
• Tenant Based Rental Assistance for up to 3 yrs. –tenant pays 30% income for rent + utility allowance
• Participant receives Housing Choice Voucher
• Eligibility– Adult– SSI cash payment– Income below $15,000– Individualized service plan
28
www.kennedykrieger.org
• Outcomes:– 110 people with disabilities received rental assistance
– 77 participants to date have transitioned to a Housing Choice Voucher (Section 8)
– Developed tenant training program
– Developed collaborative process for program implementation
– Acquired statutory authority to implement a permanent Bridge program
29
2007:Bridge Subsidy Demonstration Program
www.kennedykrieger.org
• Infrastructure from Bridge Subsidy Demonstration Program, with these changes– Rental assistance for 5 years– Administrative fees to PHAs
• Funding = $1 million DDA/MFP rebalancing funds
• Priority populations – Transitioning from institutions– Transitioning from group homes– Homeless and at risk for institutionalization
• Outcome– 20 participants have received the subsidy
30
2010:DDA/MFP Bridge Subsidy Program
www.kennedykrieger.org
2010: Vouchers for Non-Elderly Disabled
Applications
• 11 PHAs applied for Category 1 and 2 vouchers
• Support letters and service system information from partnering disability organizations
Awards
• Category 1: 260 statewide– Montgomery County = 160– Carroll County = 100
• Category 2: 112– Baltimore County = 50– Baltimore City = 40– DHCD = 12– Howard County = 10
31
www.kennedykrieger.org
• MOU: Partnership between The Weinberg Foundation, DHCD and DHMH– Facilitated by MD Department of Disabilities
• $1million for capital costs of DHCD funded development– Units affordable at 15-30% AMI– Affordable for 40 years
• Weinberg approves units & provides funds to DHCD
• DHCD disburses funds and monitors compliance
• DHMH refers qualified tenants– Tenant pays 30% income for rent
32
2011: Weinberg Apartments
www.kennedykrieger.org
• Formed in April 2011 by MD Dept. of Disabilities– Broad base of partnering organizations
• Preparing for HUD 811 NOFA – Fall 2011?– HUD 811 revised in 2010 to expand impact by providing
Project Rental Assistance (PRA)– Affordable housing at SSI level of income
• Need to create infrastructure to implement PRA– Partnership between SHA and Medicaid– Consumer involvement– Tenant eligibility and referral mechanism– Unit identification on initial lease-up and turn-over– Training for housing and disability organizations
33
2011:HUD 811 Steering Committee
www.kennedykrieger.org
Building Partnerships
• Become informed– What housing resources exist?– How are they used?– Who administers them?
• Seek advice/technical assistance from affordable housing experts on how and where to start– NCB Capital Impact– Technical Assistance Collaborative, Inc. (TAC)– National Disability Institute– National Low Income Housing Coalition
…to name a few
34
www.kennedykrieger.org
• Seek and participate in training/conferences about housing programs– HUD– Local PHA membership organization (local NAHRO affiliate)– Local housing organizations
• Offer training for housing organizations– Disability service systems– Reasonable accommodations/Section 504 compliance– MFP/Medicaid
35
Building Partnerships
www.kennedykrieger.org
• Establish a statewide committee– Include broad-based stakeholder representation– Expand to local areas with statewide support
• Build knowledge & trust - Make small changes at first– Consolidated Plan– LIHTC QAP– Demonstration/pilot programs
• Support housing organizations– Crisis support for PHAs, landlords– Support letters for LIHTC projects, special needs vouchers
36
Get Started
www.kennedykrieger.org
Keep Your Eyes on the Prize!
37
www.kennedykrieger.org
Diane DresslerMaryland Center for Developmental Disabilities
at Kennedy Krieger Institute
7000 Tudsbury Road
Baltimore, MD 21244
443-923-9555
38
Contact Information
Louisiana’s Cross‐Disability Permanent Supportive Housing
(PSH) ProgramRobin Wagner
Deputy Assistant Secretary Office of Aging & Adult Services
Louisiana Department of Health & Hospitals
History & Purpose
• Leveraged from recovery effort associated with 2005 Hurricanes Katrina & Rita– Bulk of units being completed 2010‐12
Two Policy Goals:• Prevent and reduce homelessness among people with disabilities
• Prevent and reduce unnecessary institutionalization of people with disabilities
Scope
• Cross‐disability – mental health, addictive disorders, physical disabilities, developmental disabilities, & elders with disabilities
• Regional – serving only South Louisiana at this time (area affected by 2005 hurricanes)
• Units – 3,000 PSH Units – 2,000 Project Based units for all populations– 1,000 Shelter‐Plus Care units for homeless households/persons with disabilities
Key Principles
• High quality housing• Community‐integrated housing• Services to support independence and successful tenancy, but
• Services are not a condition of tenancy• Housing providers should provide housing, not services
• Service providers should provide services, not housing
Status
• Currently housing 2, 357 households (1,698 in Greater New Orleans)
• Aug 1 sample of 1,331 households:– 477 behavioral health– 137 developmental disabilities– 15 age‐related disabilities– 102 chronic illness– 173 physical disabilities– 427 households reported have member(s) with more than one type of disability
• 44 institutional transitions
Status
• Additional 1,145 receiving pre‐tenancy services
• Rental subsidies obtained for 3,248 PSH units• 98% retention rate (only 2% with negative outcome)
• 9% of N.O. households have improved income
DowntownRehab
New Construction in Mid‐City
Model – The Components
• Low Income Housing Tax Credit Program– High quality– Integrated: 5% to 15% PSH unit set‐aside
• Rental Subsidy– Project‐based Section 8 (2,000 vouchers)– Shelter‐Plus Care (1,000 vouchers)
• Services– Community Development Block Grant (to start)– Medicaid for sustainability
Model – The State Agencies
• Louisiana Housing Finance Agency– for Low Income Housing Tax Credits
• Louisiana Office of Community Development– for Community Development Block Grant $$s for services
– for administration of project‐based subsidies• La. Department of Health and Hospitals
– for referral, services delivery, and integration with Medicaid program
Model – Other Necessary Partners• Homeless Coalitions• Housing Developers• Community‐based Service Providers• Communities themselves
Outside Help:• Technical Assistance Collaborative• Melville Trust• Robert Woods Johnson• Common Ground, New York
Model – Service Delivery
• DHH‐affiliated regional entities do outreach, identify applicants, assist with application, manage wait lists, contract and monitor CDBG‐funded services
• Contracted social service agencies provide housing support teams, Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT)
• Medicaid HCBS services and Money Follows Person also come into play
Working Relationships
• To Office of Community Development: Ever hear of Medicaid?
• To Developers: You have a poor people problem, and we can help.
• To La. Housing Finance Agency Board: There’s a lot of us and we’ve got our orange stickers on.
• Between Homeless Coalitions & Disability Community: What is a home?
• To all the partners, ongoing: Good faith and delivering .…
The Future: Sustainability & Expansion
• Incorporating services into HCBS waivers, 1915 (i) for mental health, and contract for Statewide Management Organization for behavioral health
• Tightening targeting criteria slightly (over 85% currently qualify for Medicaid)
• Tied closely to MFP and institutional downsizing (preference points & streamlined referral)
• Will cost‐allocate and stretch CDBG for non‐Medicaid population
• Continuing incentives for PSH units in LIHTC program• Developer & housing provider support• Using 811 in LIHTC for statewide expansion
Issues/Lessons
•Housing subsidy is critical•Benefit of single housing entity at state level•Current battle is on the local front: NIMBY