As affordable housing continues to become a larger and larger issue throughout the USA, the topic of supported housing services is becoming more important.  It is simply almost impossible to house many individuals without strong supports in place to assist them.  These can be the chronically homeless, persons with serious mental illness, general mental health and substance use disorder.  Some Medicaid programs have figured out that partnering with affordable housing programs can help their members live healthier more fruitful lives and reduce medical costs at the same time.

The supports can include:

• Tenancy support services include education and training on tenants’ and landlords’ role, rights, and responsibilities; assistance in resolving disputes with landlords and neighbors to reduce the risk of eviction; assistance with housing recertification; and others.
• State-level housing services are “strategic, collaborative” activities to assist in identifying and securing housing resources. Among the activities for which Medicaid financing is available are development of agreements with local housing and community development agencies to facilitate access to housing resources, and participation in these agencies’ planning processes.

Lets examine 5 of the top Medicaid Supported Housing programs in country::

1. Louisiana- This state is an early adopter in the Medicaid and Supported Housing world.   They used a 1915 (c) waiver to set up this assistance that includes
   • Pre-tenancy services
   • Move-in services
   • Ongoing tenancy services

   According to Robin Wagner, Deputy Assistant Secretary of DHH’s Office of Aging and Adult Services, this is because providing tenancy support services requires a special set of skills and activities, such as negotiating reasonable accommodations for people with disabilities and working with tenants and landlords when crises that threaten continued tenancy arise, that are outside what most care managers are prepared to do.

2. New York- The Medicaid redesign team has done some very innovative work around social determinants of health.  They realized early on that paying for supported services through Medicaid would be an innovative way to drive health outcomes.The Medicaid Redesign Team created numerous supportive housing programs to provide vulnerable high–cost Medicaid members with rental subsidies, new capital construction and pilot projects to test new models of care. Since 2012, over 12,000 high acuity Medicaid members have been served. Early findings demonstrate that investments in social determinants, such as housing, can have a profound impact on health care costs and utilization, including:
   

   • 40% reduction in inpatient days
   • 26% reduction in emergency department visits
   • 15% reduction in overall Medicaid health expenditures

   3. Arizona- The State of Arizona has taken an innovative approach to supported housing within the Medicaid system.  Medicaid handles supported housing services for persons with Serious Mental Illness (SMI), General Mental Health and Substance Abuse (GMH/SU) disorder.  This takes place with contract requirements for regional behavioral health agencies and integrated health plans working through out the state.

    

   4. Washington State- Washington is going through a Medicaid transformation as they look to integrate all of their healthcare systems.  Washington took an interesting approach which includes providing community supports.  These come in the way of supported housing and supported employment.  The programs are being run through one vendor and have limitations as far as how much can be utilized.    Check out more here- 

There are some great resources out there if you want to understand how/why Medicaid can and should be paying for  supported housing services.  I would recommend starting here

What other states have a great Medicaid Supported Housing program?  Email us at info@housing-futures.org