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!

The Arizona Crosswalk was sponsored by St. Luke's Health Initiatives and focuses on improving access to behavioral health services for the state’s Medicaid beneficiaries who need supportive housing services.

The Colorado Crosswalk  was sponsored by the Governor's Office and led the state to host a Medicaid Academy  for supportive housing service providers to learn how to seek or maximize Medicaid reimbursements within the behavioral health system.

The Connecticut Crosswalk examined the package of services offered under the State's 1915c Home and Community Based Services Waiver for people with serious mental illness discharged from nursing homes. The services provided through this Medicaid mechanism serve as an excellent example for any potential Medicaid coverage for individuals experiencing chronic homelessness with chronic behavioral health conditions.

The Illinois Crosswalk was completed in collaboration with Heartland Alliance and Health & Disability Advocates when organizations including the Chicago Alliance to End Homelessness, Supportive Housing Providers Association and the AIDS Foundation of Chicago wanted to gain an understanding of which supportive housing services are Medicaid reimbursable. The Crosswalk led to recommendations regarding Illinois' implementation of health reform to improve Medicaid reimbursement for services in supportive housing and the inclusion of tenancy support services in the state’s proposed 1115 Waiver.

The New Hampshire Crosswalk was sponsored by New Hampshire Housing Finance Authority in partnership with Families in Transition and the New Hampshire Department of Health and Human Services. It examines the extent to which services covered under New Hampshire’s Medicaid program align with supportive housing services for adults with significant needs. The Crosswalk identified a need for policy changes to more specifically pay for tenancy support services, opportunities for partnership between providers and MCOs, and a Medicaid Academy for providers.

CSH’s Report on the North Dakota Crosswalk was sponsored by the Grand Forks Housing Authority in partnership with the Department of Human Services (DHS) as a catalyst for state-wide discussions about including tenancy supports in the Medicaid program. DSH initiated the Crosswalk using guidance from the Centers for Medicare and Medicaid Services Innovation Accelerator Program’s Medicaid Housing-Related Services and Partnerships Track.

Pennsylvania's Crosswalk was sponsored by Pennsylvania Health Access Network, the Housing Alliance of Pennsylvania, the Pennsylvania Health Law Project, and Project HOME. It provides the state, managed care entities, and service providers with a valuable tool that could help them access additional resources to support programs that are proven to help those experiencing homelessness attain stability and life-long success.

The Washington State Crosswalk is part of a comprehensive white paper on Creating a Medicaid Supportive Housing Services Benefit, which lays out a framework for states to create benefits to pay for pre-tenancy and tenancy-sustaining services. The paper was a catalyst for stakeholder engagement led by the Washington Low Income Housing Alliance  and the state’s work to include a supportive housing services benefit in its recently-approved 1115 Waiver.

In partnership with New Mexico’s Behavioral Health Services Division (BHSD) and Medical Assistance Division (MAD), CSH conducted a Medicaid  Supportive Housing Services Crosswalk. This Medicaid Crosswalk is part of the CSH feasibility technical assistance that New Mexico’s Human Services Department is participating in that is focused on evaluating the potential of the Pay For Success model as a tool to scale supportive housing for vulnerable populations in New Mexico.





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