Arizona’s Medicaid System is Fighting Homelessness

It might sound counter-intuitive, but Arizona’s Medicaid also called AHCCCS is becoming one of the major players combating homelessness in the state.  Arizona’s Medicaid system is already one of the most well run and well thought Medicaid programs in the country.  The advances by AHCCCS, their health plans, behavioral health plans and providers are well known in the healthcare world.   However; AHCCCS is becoming known for it’s work around housing and homelessness.

Background:

AHCCCS has built up a portfolio of permanent supportive housing over the last 10-15 years that has allowed it to house over 3,000 members every single month.  Many of those housed are individuals with mental illness and or substance use disorder.   The programs are funded with state general funds and AHCCCS writes policy and provides contract oversight   Three regional behavioral health authorities (RBHAs) operate the programs (Mercy Care, Arizona Complete Health and Steward Health, while a host of providers and contractors like Hom Inc, Catholic Charities and public housing authorities help by doing the nuts & bolts for the housing.

Governor’s Goal Council on Ending Homelessness:

In mid-2018, the Governor of Arizona Doug Ducey started a goal council group to combat the rise in homelessness in the state with a focus on high density areas of homelessness like Phoenix.  Director Mike Trailor from the Department of Economic Securities (DES) was asked to lead the group.  The group is made up of a cross-sector group of government, private business, police and citizen groups.  One of the largest players has been the Medicaid Department AHCCCS.  Three major metrics came out of this goal council.

  1. Decrease homelessness in downtown Phoenix by 80% by 2021
  2. Decrease the number of formerly incarcerated individuals being released into homelessness.
  3. Increase the number of affordable housing units.

How Medicaid is Making an Impact:   Project H2-Healthcare and Housing-    

AHCCCS was uniquely positioned to respond to this emergency because of the housing work they have been doing for the last 10 years.  In response to the homeless crisis in downtown Phoenix, AHCCCS launched a plan with Mercy Care and Community Bridges Inc (a service provider) to immediate house 100 homeless individuals from downtown Phoenix.  They are calling the program Project H2 (Housing and Healthcare) To ensure that community priorities were taken into account, this was done in conjunction with the coordinated entry system for Maricopa County.

The Plan and 3 Public Housing Partners: Arizona is a Medicaid expansion state which means that almost anyone who is homeless is already a Medicaid member or should be if they are not.  Without getting into Medicaid lingo, AHCCCS braided together funds from several sources that would allow them to provide 12-24 months of rental assistance as well as security deposit and utility assistance for 100 homeless individuals.  AHCCCS leveraged Mercy Care the RBHA for Maricopa County to implement.  Mercy Care created a partnership with 3 public housing authorities to create exit vouchers for the 100 individuals.  Phoenix Housing , Maricopa County Housing and Tempe Housing all agreed to partner with AHCCCS and Mercy Care.  AHCCCS would provide funding to housing the homeless individuals for 12-24 months as well as the supportive services to help the individuals find housing and stabilize.  Once stabilization takes place, the public housing authorities will use homeless preferences to begin moving the individuals onto their programs.

Supported Housing Services and Other Health Plan Involvement: The initial outreach and navigation are being provided by Community Bridges Inc.  They are a peer run organization that is well known in the community for their services and peer supports.  A team has been outreaching homeless individuals in downtown Phoenix and getting them to coordinated entry.  They are getting them document ready and then referred to the PHAs for eligibility and voucher issuance.   They will be helping with housing navigation and documentation as needed.

There are 7 health plans in Arizona and all of them will be assisting this project.  As homeless individuals are leased up, their respective health plans will work with AHCCCS to ensure ongoing housing services are being provided so they stay successfully housed.

Conclusion: 

This program is a good example of how the healthcare can and should provide a major lift in helping the homeless in our cities and states.  A large population of the homeless have mental health, physical health and substance use issues that require a professional touch.  Having health plans and their network of behavioral and physical healthcare providers brings the expertise necessary to ensure health is being accounted for while individuals try to find housing and stabilize.

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