CSH recognizes that states addressing Health Related Social Needs (HRSN) will improve individual health outcomes and the health of communities while reducing Medicaid spending. An increasing number of states have approved Medicaid waivers and State Plan Amendments or SPAs that cover HRSN services. All of those waivers have included Housing Related Services (HRS) as one of the HSRN services. Using Medicaid funding for Supportive Housing services gives states the potential to scale the evidenced based model of Supportive Housing. CSH is also advocating for six strategies combined with these new services to create more supportive housing. The first and most important of these strategies is to align affordable housing with the services at the system level.
Black, Indigenous, and People of Color (BIPOC) are overrepresented among people experiencing homelessness and housing instability, families involved with the child welfare system, people impacted by mass incarceration and those forced to live in congregate care settings. All these populations are impacted by racism. One aspect of the strategy would be to grow supportive housing capacity and make access more fair. States are looking to both increase supportive housing capacity and supportive housing quality via new HRSN programs.
States are also looking to expand supportive housing to serve new people and populations to ensure people live in the most community-integrated setting possible to ensure compliance with the Olmstead decision.
Approved Medicaid 1115 waivers in a number of states now cover recuperative care (what the homeless sector calls Medical Respite) and 6 months of housing assistance. CA’s CalAIM programs gives Managed Care Plans the option to cover 90 days of recuperative care and up to 6 months of post hospitalization housing. CA is applying to cover Transitional Rental Assistance to cover a broader population that just those leaving the hospital. Arizona, New Jersey, Oregon and Washington are also approved for up to 6 months of housing for broader populations including those experiencing or at risk of homelessness, those leaving institution care or congregate settings and child welfare involved families. Given the nation’s housing crisis, linking those persons to long term housing options such as Permanent Supportive Housing or other long term affordable options will be crucial to this demonstration model’s success.
Over twenty states already have some type of supportive housing services program or benefit in place, and the Corporation for Supportive Housing’s (CSH’s) map can help you find where your state is in this process.
Since CMS views these services as part of the state’s Home and Community Based Services (HCBS) program, states are commonly required to administer the program as a component of the state’s current HCBS program. Twenty-two states have Managed Long-Term Services and Supports (LTSS) programs, so states may choose to administer the program through a Managed Care delivery system with providers billing MCOs for these services. In states that do not have Managed LTSS, tenancy support services can be added to the state’s current HCBS system and bill the state directly via the state’s Medicaid Management Information System (MMIS). States may also choose other delivery systems options such as Third-Party Administrator, which gives a single Managed Care like entity the administrative oversight of the program. In either model, supportive housing providers will need startup funding AND technical assistance to make this shift with distinctive administrative implications for agencies.
