Pay for Success Feasibility Report: Volunteers of America Delaware Valley

This report summarizes conclusions and next steps resulting from the Technical Assistance provided by CSH to the Volunteers of America Delaware Valley. CSH believes the local partnership has the opportunity to successfully finish designing, structuring and implementing a Pay for Success supportive housing project if there is commitment from an entity at the county or state level to making success payments for outcomes achieved. We have documented a number of options for finalizing a target population, outcomes of interest, success metric payment terms and evaluation in the event that an end payer is identified.

Supportive Housing & Healthcare Utilization Outcomes State of the Literature

While these links between poor health and living on the streets or in unstable accommodation are intuitive for many stakeholders in the supportive housing sector, the literature on this topic is wide-ranging and immense. In order to clarify the scope of existing literature, we have reviewed twenty-five studies published between 2002 and 2017 to determine:

  • Healthcare metrics best evaluated in the evidence base
  • Studies that describe anticipated cost avoidance and cost savings for the
    healthcare sector

In addressing these topics, we highlight areas of concern with the current evidence base and the limitations of studies published to date. We hope that supportive housing and healthcare providers can use this briefing as a starting point for further exploration of the studies that most closely align with their interests.

Please note that this is not an academic meta-analysis of supportive housing studies nor has it been peer reviewed. We do not make any claim as to the strength of individual studies. Instead, this briefing describes the content of a subset of publicly available evaluations in order to draw attention to studies that may be of interest to our audience.

HEART Alliance for Sustainable Families Preliminary Evaluation Findings

This report provides interested stakeholders with a preliminary overview of the outcome
and process evaluations for the HEART (Housing, Empowerment, Achievement,
Recovery and Triumph) Alliance for Sustainable Families. HEART is one of five
national demonstration sites funded by the Children’s Bureau of the Administration of
Children and Families with the United States Department of Health and Human
Services. HEART is a five year demonstration project from October 1, 2012 through
September 30, 2017. This report covers two years of HEART research study data.

HEART is a collaborative community-based supportive housing initiative designed to
assist 50 high risk and high need families in Broward County, Florida achieve family
strengthening as well as housing and economic stability. HEART represents an alliance
of 15 child welfare, housing, legal, health, and social service organizations collectively
working to improve child protection as well as family permanency and well-being.
HEART provides clinical case management, subsidized housing, economic selfsufficiency,
life coaching, legal counsel, health/behavioral health support, and domestic
violence prevention. HEART employs evidence-based interventions such as
Strengthening Families, Trauma-focused Cognitive Behavioral Therapy, and the Center
for Working Families.

Using a Housing First model, HEART seeks to stabilize families involved with the child
welfare system who are at risk of/or experiencing homelessness. To gauge this impact,
Kids In Distress, Inc. (KID) subcontracted with Barry University researchers to conduct
the five-year evaluation of HEART.

A Quick Guide to Medicaid Waivers and State Plan Amendments

Medicaid is public health insurance. It pays for medically-necessary healthcare services. States provide Medicaid through a contract with the Centers for Medicare and Medicaid Services (CMS) called a Medicaid State Plan. There are specific federal guidelines that every state plan must include; however states may apply to CMS to create new benefits and serve specific populations under specific authorities called waivers and plan amendments. Many states are seeking waivers and/or plan amendments in order to pay for pre-tenancy and tenancy-sustaining services in supportive housing. This Quick Guide provides an overview of the Medicaid authorities most suitable for creating Medicaid Supportive Housing Services Benefits.

CSH tracks the progress of states that are pursuing and implementing Supportive Housing Services Benefits. Check out the federal and state policy section of csh.org/health for the latest updates

Using Medicaid to Pay for Services in Permanent Supportive Housing: Steps for CoC Leads to Get Started

The Homeless Systems and Continuums of Care have been focused on engaging mainstream resources. This “How To” guide offers a framework and concrete strategies for programs and COCs to consider Medicaid funding to sustain and expand their capacity in supportive housing.

This publication was co-authored with the National Alliance to End Homelessness and Technical Assistance Collaborative.

Integrated Healthcare & Supportive Housing: A Report on a PCDC/CSH Market Assessment & Convening

Poor health both contributes to homelessness and is exacerbated by prolonged periods of housing instability. Homelessness limits access to appropriate care, worsens pre-existing conditions, and adds new health challenges, causing many high-need homeless individuals to cycle between shelters, emergency rooms, hospitals, jails, and other institutions. Alternatively, supportive housing – affordable housing coupled with supportive services – is proven to help vulnerable people stay housed, improve their health, and stabilize their lives. While there is a robust body of literature that points to supportive housing’s efficacy, especially related to promoting housing stability, enhanced supportive housing models – linking supportive housing and community health providers – show even stronger outcomes, particularly around improving tenants’ health status and dramatically reducing their costly use of crisis and inpatient services. To address the specific challenges faced by chronically homeless and medically vulnerable individuals and families, FQHCs, hospitals, behavioral health providers, other health providers and health plans, are increasingly collaborating and forming new partnerships to more effectively coordinate client-centered, integrated healthcare in an effort to improve outcomes and reduce costs for supportive housing tenants.

With evidence of the effectiveness of the early health and housing coordination models, PCDC and CSH, collaborated to identify ways our resources and expertise can facilitate partnerships between FQHCs and supportive housing providers. With the support of The Kresge Foundation, we conducted an assessment of the environment in several states to determine the need and demand for lending or other financial tools to promote and expand FQHC coordination with supportive housing developments. To help identify ways our organizations can assist the field, we convened industry experts to explore both the challenges and the key factors that can foster greater opportunities for integration across the sectors. This report summarizes our findings.