Examples from the Field

Supportive Housing: An Opioid Crisis Solution

States are struggling with the rapid development of strategies to address the opioid epidemic.  While new resources are flowing from both federal and state budgets, efforts to address and serve persons with opioid disorders who experience homelessness are at their beginnings, and have not yet been articulated or adopted as far-reaching programs in many states. Supportive housing is an innovative and proven solution to some of communities' toughest problems, including substance use addiction.

Medicaid Supportive Housing Services Crosswalks

Improving Medicaid reimbursement for tenancy support services is an essential strategy for financing supportive housing services.

A Medicaid Crosswalk helps states to answer three key questions.

  1. To what degree does Medicaid pay for supportive housing services today?
  2. What are the gaps and opportunities that need to be addressed to maximize Medicaid’s coverage of pre-tenancy and tenancy-sustaining services?
  3. Which changes in practice or policy are most strategic for our state to pursue?


Find out what states are learning from their Medicaid Crosswalks!

State Medicaid Programs that pay for supportive housing services.

The Centers for Medicare and Medicaid Services (CMS) recognize the importance of supportive housing services. In the June 2015 Information Bulletin to State Medicaid Directors, CMS outlined ways that states can incorporate pre-tenancy and tenancy-sustaining services into their Medicaid programs. This critical development changes the way supportive housing is financed by creating a sustainable source of revenue for the core services in supportive housing. Nearly a dozen states are now working with stakeholders and CMS to create Medicaid Supportive Housing Service Benefits. Five states are leading the way.

These five states are leading the way:

To address the needs of persons with disabilities experiencing long-term homelessness, Massachusetts developed the Community Support Program for People Experiencing Chronic Homelessness (CSPECH) in 2006. Initially capped at 50 persons, it is now offered by all managed care organizations in the state through a Pay for Success (PFS) initiative. Results indicate that health care costs have decreased on average $10,000 per person per year for those able to move from chronic homelessness to supportive housing.  Read the profile on CSPECH and check out this Infographic on the CSPECH program.

Sixty-seven percent of participants in Louisiana’s supportive housing programs now have their tenancy supports covered under Medicaid, and the percentage continues to increase. Louisiana used a number of Medicaid authorities to create these benefits. Eligible beneficiaries include those who have a significant, long-term disability, are receiving services from the Louisiana Department of Health, and are in need of housing and tenancy support services.  Priority is given to persons/households who are homeless or institutionalized.

Through an 1115 Waiver, Texas established a $11.4 billion Delivery System Reform Incentive Pool/Payment “DSRIP” program that allows local communities to spur innovation. Two cities have focused on health and housing. Austin utilizes Medicaid to fund comprehensive services for 75 individuals experiencing homelessness and mental illness, and Houston provide services for 200 individuals through partnerships between federally-qualified health clinics and local homeless service providers.

California’s Whole Person Care Pilot allows Counties to tap into $300 million per year to provide pre-tenancy and tenancy-sustaining service, and to establish partnerships with health plans, homeless continuums of care, homeless services and housing providers, and other agencies to create more effective ways to address homelessness. Approved through an 1115 Waiver in December 2015, counties may use funds for outreach, engagement, move-in costs, and services in supportive housing for people who are high users of multiple systems. Counties must match federal investment for each of the five years of the Waiver.

Washington State will serve up to 4,000 people with Foundational Community Supports benefits that will pay for pre-tenancy and tenancy-sustaining services and supported employment under an 1115 Waiver approved in early 2017. The benefits will serve individuals who are experiencing chronic homelessness, individuals at highest risk for expensive care and negative outcomes, and those who have frequent or lengthy institutional contacts, frequent or lengthy adult residential care stays, frequent turnover of in-home caregivers.

CSH provides regular updates on the status of states pursuing Medicaid Supportive Housing Services Benefits.

Connecting Housing and Health Services
Through our work as a Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care (BPHC) technical assistance provider, CSH and our partners at the National Healthcare for the Homeless Council provide on the ground training and assistance, webinars and resources to improve healthcare outcomes for extremely low-income individuals who frequently use crisis health systems, have housing instability, and lack a connection to primary and preventive care services.

Read about communities that have successfully linked housing and healthcare.




Health + Housing


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