Serving extremely low-income families especially  formerly homeless with mental illness is a daunting challenge that many housing authorities take on.  The barriers and issues that come with serving these hard to house populations can sometimes lead them back to a state of homelessness when problems arise.  Housing authorities are inherently there to help house the most vulnerable and keep them housed.  If your housing authority does not consider itself in the permanent supportive housing game, it is time to change the mentality immediately.

A Game Changer:

If your housing authority has a preference for homeless individuals or families, you should be working with a mental health or Medicaid authority in your community.  In fact, there are most likely residents living in your properties right now suffering from severe mental illness who are extremely low-income.  Why should you start working with these organizations?

On January 1, 2014, in states that have chosen to expand Medicaid eligibility under the Affordable Care Act, nearly all chronically homeless people who lacked health insurance became eligible for Medicaid. Even in states that have not expanded their Medicaid programs, Medicaid still offers eligible beneficiaries experiencing homelessness critical health and supportive services.  What Medicaid can do is finance many of the health and behavioral health elements of the supportive services without which people often fail to get or remain in housing.

The Affordable Care Act expanded the eligibility for Medicaid in many ways.  Before the care act came into law, single adults who were not elderly or disabled were not typically eligible for Medicaid.   However; people with incomes below 133% of federal poverty levels are now good to go.

Getting Out the Word:

The states who have taken to the medicaid expansion early are at the forefront and can serve these extremely low income persons, homeless and those with mental illness.  However; outreach is key.  Public housing authorities should be knocking on the doors of health organizations to help sign up those who might qualify for these services.

The Housing:

The lingo around permanent supportive housing is a little different than the public housing world but the basics are the same.

• Single-Site Housing, in which the tenants receiving support services live in units in the same apartment building or a group of buildings that offer affordable housing.
• Scattered-Site Housing, in which tenants live in apartments throughout the community, often leased from private owners with rental assistance provided through government subsidies; supportive services may be delivered through home visits or provided at other locations in the community.
• Mixed Housing, in which tenants live in developments, usually affordable housing, that contain a mix of supportive housing tenants and other tenants not part of the supportive housing program.

The Supports:

A recent government report shows the major benefits of permanent supportive housing. Housing authorities that partner and bring in Medicaid covered services can see the following benefits to their residents:

• Manage chronic medical conditions
• Ppreventive and primary care.
• Understand and manage the symptoms of mental illness and develop coping skills.
• Provide assistance with the identification of individual strengths, preferences, hopes, and choices.
• Restore and strengthen interpersonal, functional, and community living skills that have been impaired by behavioral health disorders.
• Motivate changes in risky behaviors and harmful substance use, engage people in treatment for substance use disorders, and support recovery.
• Identify risk factors for relapse and develop relapse prevention plans and strategies.
• Get and keep housing by providing help to find and apply for housing, building skills to negotiate with landlords and get along with neighbors, and problem-solving to support stable living in the community.
• Obtain other benefits and access to community resources.
• Reduce frequent and avoidable hospitalizations, emergency room visits, stays in detox programs, nursing homes, or other crisis or institutional care.

Benefits to Housing Authorities:

If your housing authority is wondering why it should be getting more involved in this world, think about how the supports could assist your residents suffering from mental illness or those who were formerly homeless.

• Healthier, happier residents.
• Residents who may be able to obtain and and retain employment.
• Less resident conflict and issues.
• Less wear and tear on your units
• Higher retention rates and less unit turnover

Another Level:

In 2015, some states starting using Medicaid dollars to actually pay for housing subsidies or as soft money for the development of affordable units.  In NYC, $34 million was used on a development project.  It seems that each state is handling this differently right now but housing authorities should be on the forefront of partnering and seeing if any of these dollars could be leveraged and combined with existing subsidies to help house low-income families.

Conclusion:

Now is the time for public housing authorities to recognize and self identify as permanent supportive housing organizations.  Now that Medicaid expansion is allowing for our tenants to get the help they need, public housing authorities can offer the stable home situation that are the life-blood for consistent and meaningful improvement.