CSH Medicaid Crosswalk for New Hampshire

The just released New Hampshire Medicaid Supportive Housing Services Crosswalk examines the extent to which services covered under New Hampshire’s Medicaid program align with supportive housing services for adults with significant needs. CSH conducted this Medicaid Crosswalk with funding from the New Hampshire Housing Finance Authority, in partnership with Families in Transition and the New Hampshire Department of Health and Human Services. Several best practices and recommendations are identified in the report. Among them, CSH recommends that:

  • a supportive housing services benefit be included as a Medicaid waiver or state plan amendment; new hampshire
  • supportive housing and case management services be covered and expanded to include individuals with substance use disorders;
  • resulting cost savings be redirected to behavioral health and housing systems;
  • training be provided to all stakeholder organizations (managed care organizations and health and housing providers) on the role of supportive housing as a health intervention.

Read more about the process, findings, and recommendations in the New Hampshire’s Medicaid Crosswalk.

Stakeholder education is already underway, through the Supportive Housing Medicaid Institute, funded by the Endowment for Health.

Additionally, CSH staff will present this week at New Hampshire’s Annual Homeless Providers Conference on the topics of health and housing innovations and Medicaid service funding opportunities around the country.

MA Pay for Success Milestone

Pay for Success initiative to reduce chronic individual homelessness successfully houses over 250 individuals in first year

The first-in-the-nation Pay for Success initiative to reduce chronic individual homelessness in Massachusetts has successfully placed over 250 individuals in stable, supportive housing, exceeding the minimum goal set by the Commonwealth for its first year by over 50 individuals and paving the way for significant cost savings in emergency room and inpatient care.

The Pay for Success initiative being implemented by the Massachusetts Alliance for Supportive Housing (MASH) for the Commonwealth of Massachusetts focuses on providing permanent, low-threshold supportive housing to those who would otherwise rely on costly emergency resources, enabling them to address their often complex health issues more effectively than they would on the streets or in shelters. MASH is a partnership of the Massachusetts Housing & Shelter Alliance (MHSA), United Way of Massachusetts Bay and Merrimack Valley and Corporation for Supportive Housing (CSH).

“Preliminary data suggests that by focusing on housing chronically homeless individuals and longterm homeless individuals who are high utilizers of emergency care, the Pay for Success initiative will have a significant impact on the utilization of emergency resources,” said Joe Finn, President and Executive Director of the Massachusetts Housing & Shelter Alliance.

MASH conducted a comprehensive assessment of the individuals placed in permanent supportive housing this year through the Pay for Success initiative. It found that in the six months prior to entering housing, the 250 individuals housed through the Pay for Success initiative this year as of June 1, 2016, had accumulated:

  • 18,917 nights in shelter
  • 1,816 days in the hospital
  • 541 emergency room visits
  • 690 nights in detox treatment

Of the 250 tenants, 200 have been enrolled in the MassHealth Pay for Success Community Support Program for People Experiencing Chronic Homelessness (CSPECH) program, an innovation of the Massachusetts Behavioral Health Partnership and MHSA that is recognized nationally as a model for funding the support services component of permanent supportive housing with Medicaid dollars.

“The collaboration with our partners in the private sector to provide supportive housing to address chronic homelessness will greatly improve the quality of life for many of our most vulnerable residents while also saving the Commonwealth money,” said Secretary of Administration and Finance Kristen Lepore. “I applaud the early success of this initiative and am proud of the work by the Baker-Polito Administration and the Massachusetts Alliance for Supportive Housing to end homelessness in our state.”

“This Pay for Success initiative is enabling the Commonwealth to rapidly scale approaches such as the ‘Housing First’ model and MHSA’s Home & Healthy for Good program at a rate that would not be possible without the upfront private capital and philanthropic investment of the partnership,” said Jeffery Hayward, Chief of External Affairs at United Way of Massachusetts Bay and Merrimack Valley. “It is exciting to see models that are proven to work funded at a level that is providing dignity to some of our most vulnerable individuals, significantly reducing our state’s chronically homeless individual population and creating potential savings in other costs like incarceration, shelter and emergency care.”

The innovative Pay for Success initiative leverages a mix of philanthropic funding and private investor capital from Santander Bank, CSH and United Way to provide the upfront funding for social services. If the goals of the PFS initiative are met, the government compensates the investors for undertaking the investment risk. If the goals are not met, the government is not obligated to repay the investors.

“So many vulnerable people have been helped already; it is certainly an achievement that this initiative has exceeded its minimum goal for the first year,” said Deborah De Santis, President and CEO of CSH. “But even more impressive is the scope of the providers they have attracted to the table as partners, particularly the healthcare and managed care organizations that recognize we can reduce costs and improve the health of vulnerable people through the stability that comes with supportive housing.”

“These first-year results demonstrate how important it is for the public and private sectors to work together to create innovative, results-based strategies to address chronic homelessness,” said Gwen Robinson, Managing Director, Corporate Social Responsibility, at Santander Bank.
The Pay for Success initiative, led by the Massachusetts Housing & Shelter Alliance, United Way of Massachusetts Bay and Merrimack Valley and CSH, will provide at least 500 units of stable, supportive housing for up to 800 individuals, reducing the Commonwealth’s number of chronically homeless individuals by half over six years.

Home to Stay

Home to Stay: Creating Quality
Supportive Housing for Aging Tenants
New York City’s Supportive Housing Aging Learning Collaborative
Core Competencies Checklist & Resource Guide

Recognizing very little is known about the homeless aging population and far less about those aging in place within supportive housing, the CSH New York City Supportive Housing Aging Learning Collaborative has released “Home to Stay: Creating Quality Supportive Housing for Aging Tenants Core Competencies Checklist & Resource Guide.” The Learning Collaborative developed this new Guide to call attention to the unique housing and service needs experienced by aging formerly homeless adults. It also provides promising approaches for improving supportive housing providers’ capacity to deliver and coordinate flexible and responsive services to aging residents with complex health and social support needs.

The guide serves as a 3-in-1 resource for New York City supportive housing providers:

  • A self-assessment guide for agencies to assess their readiness to respond to the needs of aging adults, from physical space as well as program design aspects.
  • A compilation of accumulated promising practices for serving aging tenants, including effective socialization strategies, care coordination, staffing models, and other issues/areas important to aging tenants and the providers who serve them.
  • A guide to NYC-specific resources to promote healthy aging in place in supportive housing.
  • NYC aging

“Our mission at the New York City Department for the Aging (DFTA) is to work for the empowerment, independence, dignity and quality-of-life of New York City’s diverse older adults and for the support of their families through advocacy, education, and the coordination and delivery of services.   This City’s large older adult population is one of the most diverse in the nation with wide-ranging service needs. Through the provision of DFTA services, we aim to address the social, culture and care needs of all of our City’s aging, especially the most vulnerable among us. The DFTA-related resources provided in the CSH Core Competencies Guide will expand providers’ awareness of and access to critical supports that promote healthy aging in place. We encourage the expansion of partnerships with community-based organizations for the provision of programs and services to foster independence, safety, wellness, community participation, and quality-of life.” -Karen Taylor, Assistant Commissioner, Bureau of Community Services, NYC Department for the Aging

photo1“The aging process never stops, until it does with conclusive finality.  Each person experiences a shifting relationship to health, physical capacity, emotional status, and community shaped by the dynamic interplay of class, race, ethnicity, and gender.   Complicated enough with advantageous alignments; a deal more dicey if histories of homelessness and chronic mental health conditions are factors.  Project FIND, where I work, has a unique focus on older adults, partnering in keeping them housed, independent, connected and respected.  One of our residential programs, the Woodstock Hotel, is designed to be responsive to the needs of 280 formerly homeless or very low income persons over the age of 54.  Poverty and homelessness often accelerate the aging process, but they do not alter core universal imperatives for friendship, engagement, respect, accommodation.  The CSH Core Competencies Guide touches on many of the considerations provider agencies will encounter as their tenants reach their golden years.” -David Gillcrist, Executive Director, Project FIND

photo2

Age-friendly NYC is a partnership of the Office of the Mayor, the New York City Council, and the New York Academy of Medicine that works to maximize the social, physical, and economic participation of older people to improve their overall health and wellbeing and strengthen communities. Some of the improvements made by Age-friendly NYC include a reduction in senior pedestrian fatalities by 11%; increased walkability through the addition of public seating; new programming for older people at parks, educational, and cultural institutions; and a better consumer experience offered by many local businesses. Access to safe, accessible, and affordable housing has been a priority for Age-friendly NYC since its inception in 2007. Age-friendly resources included in this guide are intended to help supportive housing providers in addressing the broader determinants of health for their aging tenants to mitigate the risks of falls, polypharmacy, and elder abuse; prevent/reduce social isolation; and promote increased physical activity and healthy choices.” – Lindsay Goldman, Director, Healthy Aging, Center for Health Policy and Programs, The New York Academy of Medicine

Kristen-Miller.CSH_“We undertook the mission of compiling this Guide book because the Learning Collaborative has realized there are good practices and resources out there, it’s just that no one has zeroed in and pulled them together in one clear document. Our goal is to shine a spotlight on what is working and share this information with as many providers as possible. We chose to include check lists as a way to make the Guide tangible and convenient for providers. We also are hopeful the many resources cited will come in handy. The bottom line is always about improving the overall quality of life for aging tenants in supportive housing and those now homeless who should be in supportive housing.” -Kristin Miller, Director, CSH Metro (New York, New Jersey, Pennsylvania)

The Core Competencies Checklist & Resource Guide is made possible through the generous support of Mizuho USA Foundation, Inc. of Mizuho Bank, and The Fan Fox and Leslie R. Samuels Foundation, Inc.

 

Medicaid Crosswalk Released for Pennsylvania

Housing as Health

As evidence continues to establish supportive housing as an intervention that stabilizes people with chronic illnesses, providers and states are exploring ways to ensure Medicaid programs cover the services that supportive housing residents need.

To this end, CSH has worked in many jurisdictions, including Pennsylvania, to maximize use of Medicaid resources for services. In an effort to increase the availability of services to formerly homeless Pennsylvanians and expand access to supportive housing, the PA Housing as Health Coalition partnered with CSH to explore ways to make intense services like substance use treatment and mental health recovery more available and accessible. The CSH Pennsylvania Medicaid Crosswalk 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. Read the blog about the Crosswalk posted by the Pennsylvania Health Access Network.

The media covered the release of the Crosswalk and CSH’s work in Pennsylvania — Group Calls for Medicaid Expansion to Cover Housing Support Services (90.5 WESA NPR, July 25, 2016) — and now the “Housing as Health” campaign has been formed to carry the message across the state.

The Housing as Health campaign is a statewide coalition of physical and behavioral healthcare providers, social services, housing-related entities, faith and community groups, advocates, and people enrolled in Medicaid.  To learn more about the Housing as Health campaign, click here.

Ready to join the campaign?  Click here to formally sign on.

Read the CSH-authored Business Case for a Medicaid Supportive Housing Services Benefit in Pennsylvania.

 

Pennsylvania Medicaid Supportive Housing Services Crosswalk

As evidence continues to establish supportive housing as an intervention that stabilizes people with chronic illnesses, providers and states are exploring ways to ensure Medicaid programs cover the services that supportive housing residents need. To this end, CSH has worked in many jurisdictions, including Pennsylvania, to maximize use of Medicaid resources for services. In an effort to increase the availability of services to formerly homeless Pennsylvanians and expand access to supportive housing, the PA Housing as Health Coalition partnered with CSH to explore ways to make intense services like substance use treatment and mental health recovery more available and accessible. The newly released Pennsylvania Medicaid Crosswalk 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. Read the blog about the Crosswalk posted by the Pennsylvania Health Access Network.

CSH Urges “Smart” Supportive Housing Strategy for Reentry

Testimony of CSH

New York State Assembly Committee on Correction and Subcommittee on Transitional Services Joint Public Hearing

Devising a Smart Supportive Housing Strategy for Ex-Offenders upon Reentry

My name is Kristin Miller, and I am the Director of the Metro Program at the Corporation for Supportive Housing (CSH). CSH’s mission is to advance solutions that use housing as a platform to deliver services, improve the lives of the most vulnerable people, and build healthy communities. CSH has 25-year track record of innovation and investment in New York, leading demonstration projects, analyzing data and assisting in the creation of over 15 thousand permanent supportive and affordable housing units across the state. CSH is deeply committed to improving access to supportive housing for people with criminal justice histories and has been working in this arena for more than a decade.

An estimated 25,000 people are released from New York State prisons each year and, of these, nearly half return to New York City.[1] Of all the issues facing returning prisoners, the need to secure safe, affordable housing is one of the most essential. Many of those released each year are homeless and have traditionally cycled out of prison and into the shelter system or unlicensed, unregulated three-quarter houses. In fact, analyses of the NYC Department of Homeless Services shelter populations indicate that between 20 and 23% of homeless adults have been incarcerated at some point in the two years prior to entering shelter and about 19 percent of persons released from NY State prisons listed shelters as their first known address. [2],[3]

There is an evidence-based, cost-effective solution. Supportive housing, a model coupling affordable housing and support services, is effective in improving outcomes for this population while also decreasing public systems use. CSH piloted the Frequent Users Services Enhancement (FUSE) initiative here in New York almost 8 years ago, which utilized supportive housing as an intervention for people cycling between the criminal justice system and homeless system. The Columbia University Mailman School of Public Health completed an evaluation of this groundbreaking initiative that placed over 200 individuals into supportive housing. [4] The rigorous evaluation compared the outcomes of FUSE participants versus a comparison group, and demonstrated some major findings impacting the use of jails, shelters and crisis care services.

The evaluation indicates that supportive housing can reduce homelessness, incarceration and costs of public systems. FUSE participants averaged just over two-weeks of shelter stays in the 24 months after placement into housing as compared to the 164 days in shelters spent by the comparison group. Overall FUSE generated a $15,000 cost offset for each participant.

While this model has become a nationally recognized approach and is being implemented in almost 20 communities across the country, here in New York people with criminal justice histories have been shortchanged in every supportive housing production initiative to date, and thus, very few units have been targeted at this population.

In this year’s State of the State address, Governor Cuomo proposed a bold housing plan and committed to creating 20,000 new units of supportive housing over the next 15 years, with 6,000 of the new units to be created over the next 5 years. In order to deliver on this promise, the Governor must sign an MOU with Legislative leadership before the end of session, which is this Thursday, June 16th. Additionally, last September, the Governor adopted the New York State Council on Reentry and Reintegration’s recommendation to “include the formerly incarcerated as a target population for supportive housing”. As such, a portion of the 20,000 new supportive housing units will be targeted to serve this population.

This commitment could effectively stop the cycle of homelessness and criminal justice involvement for the thousands of New Yorkers exiting prisons each year. We ask that Governor Cuomo honor these commitments by signing an MOU before session ends on Thursday, and targets a portion of these units to people exiting the criminal justice system.


[1] NYS DOCCS. 2010. 2007 Releases: Three Year Post Release Follow-up. Albany: New York State Department of Corrections and Community Supervision.

[2] Burt et al. 1999; Eberle et al. 2001; Kushel et al. 2005; Schlay & Rossi 1992.

[3] Navarro, Mireya. November 14, 2013. Ban on Former Inmates in Public Housing Is Eased. The New York Times.

[4] Aidala, Angela; McAllister, William; Yomogida, Maiko; Shubert, Virginia. 2013. “Reducing Homelessness, Incarceration and Costs through Supportive Housing – The New York City FUSE Evaluation”. Columbia University Mailman School of Public Health.

CSH Testimony to Gov’s Task Force on Combating Heroin in NY

Written Comments of the Corporation for Supportive Housing (CSH)

Governor’s Task Force to Combat Heroin and Prescription Drug Abuse

Submitted by Kristin Miller, Director of CSH Metro Region

Lieutenant Governor Hochul, Commissioner González-Sánchez, members of the Governor’s Task Force. Thank you for the opportunity to submit testimony to this important and distinguished group of policymakers and advocates.

CSH has offered similar testimony to the New York Senate Task Force on Heroin and Opioid Addiction and applauds the efforts of New York Governor Andrew Cuomo and the Legislature, including Senator Terrance Murphy who serves on this Task Force as well, for elevating this issue and keeping it in the spotlight where it belongs.

CSH has a 25-year track record of innovation and investment in New York. Since 1991, CSH has made nearly $140M in loans to supportive housing developers for the creation of over 15,000 permanent supportive and affordable housing units in this state. Through our promotion of supportive housing, we are intimately familiar with the housing and services needs of residents who struggle with substance addiction and desperately seek stable lives to pursue recovery.

As you have undoubtedly heard again and again as you travel throughout the state, heroin and opioids are destroying people’s lives and damaging families and neighborhoods. My testimony is focused on supportive housing, a proven solution and valuable tool in our fight to stem this epidemic.

CSH this year released Supportive Housing’s Vital Role in Addressing the Opioid Epidemic in New York State , which provides a background of the opioid epidemic in New York communities and cites research showing supportive housing as a solution for individuals facing substance use disorders. Supportive housing combines affordable housing and services that help people facing complex challenges live with stability, autonomy and dignity. It has been demonstrated that through the stability found in supportive housing, people using heroin successfully avail themselves to the treatments that address their substance use disorder.[1] In fact, a study published in 2014 by the National Center on Addiction and Substance Abuse found that supportive housing was successful in reducing the use of, and costs associated with, substance abuse and crisis care services, including shelters, detox centers, jails and medical care (hospitalizations and emergency room visits). The findings suggest that individuals actively using substances can be housed successfully and stabilized without forcing treatment requirements on them.[2]

New York, too, knows supportive housing is an answer. Governor Cuomo and New York City Mayor Bill de Blasio have publicly committed to creating a combined total of 35,000 new supportive housing units in the City and throughout the rest of the state within the next 15 years.

CSH congratulates the Mayor and Governor for taking these important steps to house our most vulnerable New Yorkers. We urge this Task Force to help us ensure these new units are realized as soon as possible, and that people and communities living with the opioid epidemic have access to them and the important services they will need to achieve substance use recovery.

Housing is essential as an anchor of stability. Home forms a firm platform from which individuals can pursue the services they need. It is our responsibility to make sure our most vulnerable New Yorkers have access to the services as well as a home. That is what supportive housing provides. A person consumed by addiction can have access to the best treatments in the world, but recovery is highly unlikely if they are living on the street or in a shelter.

Without supportive housing, many individuals with opioid or heroin addiction will continue to cycle endlessly between homelessness and expensive public services delivery systems including inpatient hospital beds, psychiatric centers, detox services, jails and prisons, at an enormous public and human cost.

We ask members of this Task Force to help these individuals by ensuring that the recent commitments to new supportive housing in New York are realized, and that these resources are accessible to people struggling with substance use disorders, particularly heroin and opioid addictions.

_____________________

[1] Gray, Paul; Fraser, Penny. Housing and heroin use: The role of floating support. Drugs: Education, Prevention, and Policy. Vol. 12, Iss. 4, 2005.

[2] Neighbors, Charles; Hall, Gerod; et.al. Evaluation of NY/NY III Housing for Active Substance Users. The National Center on Addiction and Substance Abuse. 2014.

New Recommendations Released – Call for Fair Treatment for the Formerly Incarcerated

Today, CSH and 16 community partners released a set of recommendations to the New York City Supportive Housing Task Force focused squarely on the overwhelming need to ensure supportive housing for persons with criminal justice histories.

People reentering our communities from incarceration have been shortchanged in every New York State and City supportive housing agreement to date. In the face of incredible barriers, many who have served their time are confronted with a second punishment when they attempt to begin new lives but are denied access to affordable housing and the services they desperately need to stabilize. This sets off a chain of despair that often leads to homelessness, poverty and recidivism.

CSH and its partners know it doesn’t have to be this way. Of all the issues facing returning prisoners, the need to secure stable, affordable housing is one of the most essential, and supportive housing can and should play a crucial role.

Over 77,000 people were released from New York City Department of Corrections’ jails in FY 2015[1] and Mayor Bill de Blasio’s recently announced plan to add 15,000 units of supportive housing to the City provides an unparalleled opportunity to address the needs of the growing numbers of individuals hoping to rebound, rebuild and reestablish in our community.

These collaborative recommendations call for at least 15% of new supportive housing resources to be dedicated to individuals and families with criminal justice histories. CSH and its partners also recommend:

  • targeting criteria to ensure access to housing for people who need it the most
  • policies that bar discrimination and assure equal access to supportive housing for people with criminal justice histories
  • strategies to better develop the referral system for justice-involved populations
  • effective programming structure and service budget guidance

CSH and its partners believe that by including this population in the next supportive housing agreement, the City can expect reductions in recidivism, parole violations, shelter use, and use of crisis services, particularly among those who find their new home in supportive housing.

[1] NYC Mayor’s Office of Operations, Preliminary Fiscal 2015 Mayor’s Management Report