State Strategies to Improve Health Through Housing Services

States are increasingly looking at housing as a component of health and well-being, particularly for individuals who are homeless or at risk of becoming homeless. Numerous studies show that housing supports for certain populations can improve health and reduce hospital expenditures and other costs for state and local governments. Some states are leveraging federal health care reform initiatives and Medicaid waivers to pay for housing services and supports; others are exploring private investment to support state efforts or examining successful local initiatives. In fact, the Centers for Medicare and Medicaid Services (CMS) Center for Medicaid and CHIP Services (CMCS) recently issued a bulletin describing state options for using Medicaid funding to support housing-related activities. Watch for additional NASHP projects on health and housing, as we bring our cross-agency Medicaid, public health, and behavioral health policy experience to bear on the pressing issues of health care and homelessness.

This chart contains state strategies to support health through housing services. The information is derived from state and federal documents, program descriptions, and other sources you will find linked in the text below. Special thanks to the Corporation for Supportive Housing, whose resources on Medicaid and housing have been invaluable.

Do you know of any state activities or emerging strategies that belong in this chart? Are you eager to update a fact we’ve included? Please send your suggestions, corrections or additions to aclary@nashp.org. We rely on your contributions to keep our community’s real-time learning fresh and relevant. Thank you!

 

Initiative Name Funding Mechanism What is Paid For Target Population Notes Partners Status
California California Bridge to Health Reform 1115 waiver proposal Rental subsidies, housing-based case management services, recuperative care. Individuals who:

  • Are currently homeless, or will be homeless after discharge from a prison, hospital, or other facility, AND
  • Have repeated ED, hospital, or nursing facility use, OR have two or more chronic conditions, or have mental health or substance use disorders.
Concepts: “Health plans could use a portion of capitation payments to pay a case rate for housing-based case management services for eligible populations.”The Integrated Care Savings Pool [plans, counties, local donors contribute] would be used to fund rental subsidies, housing-based case management services, and recuperative care for eligible populations.”Alternatively, the State would allow health plans to fund housing costs as allowable costs for eligible populations.” Regional partnerships of managed care organizations, city and county governments, hospitals, and housing and social service providers. Proposal submitted March 2015; pending
California ACA Section 2703 Health Homes A care manager will facilitate referrals to supportive housing and social services. High-cost, high-risk individuals with chronic conditions and/or serious and persistent mental illness. Community-based care management entities (FQHCs, hospitals, clinics) and community support services. Intends to submit 2703 SPA application in summer/fall 2015.
California Los Angeles County Housing for Health County funding–Housed within the LA County Department of Health Services (DHS)
  • Program negotiates directly with housing providers to obtain housing units and pays for supportive services. (See ASPE report)
  • The Flexible Housing Subsidy Poolsubsidizes rent and links tenants to services.
High utilizers of DHS services with complex medical and behavioral conditions. Housing for Health is a county-run program that integrates health and behavioral health care with stable housing. Case managers, health care providers, housing finance agencies, housing developers, philanthropic entities. Active
District of Columbia 1915 (c) waiver One-time transitional services, including security deposits, furniture and linens, set-up fees or deposits for utilities. Lifetime max. of $5000 per individual. Individuals with intellectual and developmental disabilities. Providers of services including supportive employment, habilitative, and shared living services. Active
District of Columbia DC Permanent Supportive Housing Program District Department of Mental Health funding Permanent housing and supportive services Homeless individuals and families who:

  • have a disabling condition, and
  • have been continually homeless for a year or more, or
  • who have had at least 4 episodes of homeless- ness in the past 3 years

.

Housed in Department of Human Services; Department of Mental Health uses its own funds to subsidize rent, and works with the DC housing authority to get rent subsidies. District shelters or homeless service providers assess potential beneficiaries. Active
Illinois The Path to Transformation 1115 waiver proposal Performance incentive payments to MCOs could be reinvested into supportive housing capital, rental assistance, or services. Individuals with serious mental illness and/or substance use disorders, including those who are homeless. Illinois’s 1115 waiver would incentivize Medicaid health plans, Accountable Care Entities, and Care Coordination Entities who are at risk financially to invest in housing and housing supports for their patients by establishing an incentive-based bonus pool. MCOs Pending
Louisiana 1915 (c) [and other 1915 waivers] Home and Community- Based Services waivers Support for acquiring and securing housing, budgeting, establishing credit, and meeting tenancy obligations. Communicating with landlords about necessary accom- modations for disability. Also provides assistance when housing is jeopardized. Individuals with a significant, long-term physical disability, and disabilities related to behavioral health and who meet low-income requirements. Permanent supportive housing is part of the Community Choices 1915 (c) waiver. Louisiana Housing Corporation Active
Massachusetts Pay for Success Social impact investment:

  • Philanthropy,
  • Private capital investments,
  • State Housing and Community Develop- ment rental vouchers,
  • Mass. Medicaid.
Supportive housing Chronically homeless individuals The initiative aims to provide up to 500 units of housing over six years. Corporation for Supportive Housing, Mass. Housing & Shelter Alliance, United Way Launched in December 2014
Minnesota Hennepin Health (Hennepin County) Medicaid ACOs Housing and transportation assistance, work and financial support, care coordination. Housing navigation services to prioritized population. Medicaid recipients who are enrolled in the Hennepin Health Managed Care Organization, including adults, families and children who are: homeless or unstably housed, identified as high risk for future costs, and whose health is directly impacted by their housing. A 2014 Health Affairs article on Hennepin Health found that the program shifted care from hospitals to outpatient settings. County Human Services and Public Health Departments; Metropolitan Health Plan, NorthPoint Health and Wellness Center; Hennepin County Human Services. Active
New York Health Home SPA Comprehensive case management; health home networks partner with supportive housing providers. Individuals with chronic conditions, including mental health or substance use disorders. More information available here, here, and here. Supportive housing providers, shelters, corrections systems. Active
New York DSRIP/1115 waiver Supportive housing services Medical or behavioral health patients who are at risk during transitions into the community. Select DSRIP projects address supportive housing. Community housing providers home care service providers, others. Active
Oregon 1115 waiver
  • Support to locate and obtain housing;
  • care coordination.
  • Transitional services to a supported environment;
  • case manage- ment.
  • Room and board.
  • Adults with serious mental illness.
  • Individuals with SMI and possibly SUD who are homeless or at risk of being homeless.
Community organizations; state and county agencies. Active
Oregon Oregon Congregate Housing with Services (Pilot sites) SIM Social, support, and health services provided to individuals living in low-income housing or communities. Low income single adults and people with disabilities in subsidized low-income housing or other low-income communities. More information in the SIM grant narrative. State agencies; housing, mental health, CCO constituent service organizations. Active
Texas DSRIP/1115 waiver Varies by regional project:Supportive housing services; transitional housing services; patient navigators.

  • Austin will increase psychiatric services for the homeless.
  • Houston will provide financial support, physical and behavioral health care, permanent supportive housing services to 200 chronically homeless individuals.
Varies by regional project: Adults with SMI, HIV or TB; teens and young adults; chronically homeless individuals. Other providers; community organizations. Active
Texas The Money Follows the Person (MFP) behavioral health pilot. Money Follows the Person A local relocation specialist works with the Texas Department of State Health Services to secure housing for individuals transitioning into the community. Individuals transitioning from nursing facilities to the community. See the June 2015 CMCS bulletin for more information on the Texas MFP program. State and local housing agencies and organizations. Active
Washington Roads to Community Living Money Follows the Person Individualized housing-related services, including one-time-only moving expenditures. The program pays for services for one year after the person has moved into the community. People with complex long-term care needs transitioning into the community from facilities See the June 2015 CMCS bulletin for more information on Washington MFP program. State and local housing agencies; human service agencies. Active
Washington Section 2703 Health Home SPA Care coordination including referrals to housing resources. Individuals with at least one chronic illness and at risk for another. More information is available in the December 2014 interim report. Community housing organizations; the state housing finance commission. Active
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