using innovative approaches to housing solutions impact social problems · using innovative...
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The Source forHousing SolutionsUsing Innovative Approaches to
Impact Social Problems:
Supportive Housing As a Solution
NAMD Boot CampMay 18, 2014
CSH
CSH advances solutions that use housing as a platform for services to improve the lives of the most vulnerable people, maximize public resources and build healthy communities.
CSH
Since 1991, CSH has been advancing its mission by providing:
Policy Reform & Systems Change
Consulting and Training
Lending
Technical Assistance
Why Housing Matters
Health
Housing
Employment Status
Economic ClassPoverty
Race
Housing as a Social Determinant
house
The Source forHousing SolutionsHousing Matters.
What is supportive housing, how can it be a solution, and for whom?
HOUSING Permanent: Not time limited, not transitional;Affordable: For people coming out of institutions; Independent: Tenant holds lease with normal rights and responsibilities.
SERVICES Flexible: Designed to be responsive to tenants’ needs;Voluntary: Participation is not a condition of tenancy; Independent: Focus of services is on maintaining housing stability.
Supportive Housing
Supportive housing connects people to:
Health/Mental Health Services
Independent Living Skills
Child Care
Substance Abuse Services
Community Building Activities
Employment Services and Support
Budgeting &Financial Management Training
The Source forHousing Solutions
What is the Evidence Supportive Housing Works?
Impact on Health
Denver study found 50% of tenants placed into supportive housing experienced improved health status, 43% had improved mental health outcomes, and 15% reduced substance use
Seattle study found 30% reduction in alcohol use among chronic alcohol users in supportive housing
Supportive housing in San Francisco and Chicago had significantly higher survival rates for individuals with HIV/AIDS compared to control groups
Impact on Costs
• 41% to 67% decrease in Medicaid costs
• 24% to 34% fewer emergency room visits
• 27% to 29% fewer inpatient admissions and hospital days
• 87% fewer days in detox and fewer psychiatric inpatient admissions
Targeting Supportive Housing
Supportive Housing can reduce Medicaid costs for:
High Utilizers of Emergency Health Systems
People Exiting Institutional Care Settings
The Source forHousing SolutionsTargeting Supportive Housing
to High Utilizers Can Reduce Medicaid Costs
10% Highest Risk Homeless Persons
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$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
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Probation
Sheriff mental healthjailSheriff medical jail
Sheriff general jail
LAHSA homelessservices
GR HousingVouchersGeneral Relief
Food Stamps
Paramedics
Public Health
Mental Health
Private hospitals-ER
Health Srv - ER
Health Srvoutpatient clinicPrivate hospitals-inpatient
Health Srv hospital-inpatient
14
Source: 2,907 homeless GR recipients in LA County with DHS ER or inpatient records Deciles based on costs in all months whether homeless or housed. Source: Economic Roundtable, 2011
Medicaid Cost Drivers
Top 5% EnrolleesChildren 3.5%Adults 1.6%Disabled 29.2%Elderly 22.5%TOTAL 57%
Total = $265.4 billionTotal = 57.4 million
SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on MSIS 2004.
The Source forHousing Solutions
Supportive Housing can assist People Exiting Institutional Care Settings & Reduce Medicaid Costs
Rebalancing Medicaid Long-Term Services and Supports
Provision of Medicaid LTSS shifting from nursing facility care to community placement nationwide
All states currently have mechanisms in place to provide community-based service options through federal waivers and state plan options
Home and community-based (HCB) waiversState plan personal care services
Many states implementing managed long-term services and supports programs to better integrate primary, acute, behavioral health and LTSS with goal of serving more people in the community
Medicaid LTSS – The Numbers
2004-2009 expenditures increased at a greater rate for community services than nursing facility services, while total nursing facility expenditures remained twice as high
70% growth for community-based services12% growth for nursing facility servicesNursing facility expenditures $51.4 billion, community based services $28.7 billion
The average cost of community-based care for the elderly, disabled and for people with intellectual disabilities is about one-third of the average cost of institutional care (2008 data)
Elderly and disabled: $10,957 average per person compared to $29,533 for nursing facilityIntellectual disabilities: $42,896 average per person compared to $123,053 in an ICF-MR
Source: Houser, Ari, et al. Across the State- Profiles of Long-Term Services and Supports, AARP 2012
A Chance to Bend the Curve
The Source forHousing SolutionsHow do we get there
from here?
Leveraging Supportive Housing as Health Policy Solution
Target and prioritize high utilizers (high-cost Medicaid beneficiaries) through data matching
Target People Exiting Institutional Care Settings
Improve health care access and engagement through connection to medical/health homes
Expand and refine care management/coordination function of services
Medicaid Strategies: Health Homes
Using Section 2703 of the ACA to facilitate access and coordination of a comprehensive array of primary and acute physical health services, behavioral health care, and community-based services and supports.
State of Washington
State of New York
Medicaid Strategies: ACOs
Creating linkages between housing providers and health care providers that are ACO members; with focus on measuring quality and costs
In the Field…
State of Illinois – Heartland Health Outreach
Medicaid Strategies: HCBS - 1915i
Engaging Medicaid agencies to leverage 1915 waivers and design billable services that include tenancy support services and other supports that promote stability in the community
In the Field
State of Louisiana
Medicaid Strategies: 1115 Waivers
Engaging Medicaid agencies and working to include case management and tenancy supports in waivers to CMS
In the Field
State of New York
State of Texas
Medicaid Strategies: MCOs
Engaging Managed Care Organizations that are now targeting “hard to serve populations”
In the Field
State of Minnesota – Medica
Massachusetts – MA Behavioral Health Partnership
Tools for Advancing the Work
Medicaid Agency Engagement
CSH Social Innovation Fund
Medicaid crosswalks
Medicaid Business Cases
Building Provider Capacity
