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CSH Releases Keeping Families Together Guidebook

CSH is proud to release our new guide to creating supportive housing for child welfare-involved families. Created with the support of the Robert Wood Johnson Foundation, the guide is based on lessons learned from our Keeping Families Together pilot and related efforts to help communities knit together local, state and federal resources around these fragile families. Use the guidebook as a tool to help you support the spread of supportive housing models to stabilize the highest-risk families. 

Download the keeping families together guidebook

CSH is in Alaska!

This June, CSH participated in the National American Indian Housing Council’s Annual Conference in Anchorage, Alaska. Liz Drapa and Jonathan Hunter attended the conference and highlighted our work under the American Indian Supportive Housing Initiative (AISHI). At the conference, Liz & Jonathan presented with partners from the Makah Tribe in Washington State and White Earth in Minnesota on supportive housing, and met with officials from the Alaska Mental Health Trust to discuss supportive housing efforts in Alaska.

Under AISHI, CSH partners with Tribal Nations and American Indian organizations to develop affordable housing linked to services to end homelessness. We blend tested supportive housing models with tribal culture and traditional service approaches to build programs that work in American Indian communities.

Working closely with tribal leaders, state and federal government representatives, and American Indian nonprofits and community members, we provide:

  • Technical assistance tailored for Tribal Nations and American Indian nonprofit organizations.
  • Training and capacity building to strengthen their ability to develop, manage and operate supportive housing.
  • Expertise and resources to address development and operation challenges.
  • Low-cost loans and grants to spur the development of new supportive housing projects.
  • Advocacy and policy reform to address barriers to supportive housing and bring resources to tribes and American Indian organizations.

Read more about our consulting work 

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What the Supreme Court’s Health Reform Decision Means for Tenants of Supportive Housing

The Supreme Court’s ruling to uphold the Affordable Care Act was an historic win for uninsured Americans. While most media coverage has focused on the individual insurance mandate, which requires all Americans who can afford it to have health insurance, maintaining the constitutionality of Medicaid expansion was also a major victory. So what’s next and what does this mean for tenants of supportive housing?

Looking ahead, Medicaid will be a vital part of financing the services for tenants of supportive housing.  In the past, a significant subset of people in supportive housing were not eligible for Medicaid, including people with a substance use disorder as a primary diagnosis, people with chronic but not serious physical illnesses, and people with a mental illness or cognitive impairment that does not qualify as a serious mental illness or disability. The Affordable Care Act made most of these men and women eligible by expanding Medicaid to people with incomes below 138% (with 5% income disregard) of the federal poverty level (FPL), regardless of illness or disability.

The Court’s ruling last week declared that this expansion of Medicaid is constitutional, including the federal government’s incentives for states to participate in the expansion.  However, the Court said the federal government may not penalize states that do not participate—making the expansion optional for states.  CSH and supportive housing advocates must work aggressively to encourage participation among states to expand Medicaid to people below 138% of the poverty line.

Fortunately, there is a strong case to make for states to expand Medicaid to these populations. Federal incentives to expand Medicaid eligibility are strong: the federal government covers 90-100% of Medicaid costs for the several years for newly enrolled beneficiaries as opposed to about 50% for currently enrolled Medicaid beneficiaries.  This enhanced federal match represents a huge financial “carrot” to states and counties, where the cost of providing uncompensated care to uninsured people drives up costs for state and local governments, hospital systems, and taxpayers alike.  Adopting Medicaid expansion and taking advantage of the enhanced federal match can help states and communities address their budgetary woes, while giving health care access to many low-income and vulnerable individuals.

As we move forward, advocates of supportive housing must also work to ensure that the services people access in supportive housing are included in the insurance benefit package and reimbursable through Medicaid.  Currently, newly eligible people will only have basic Medicaid coverage, which means care coordination, specialty care, case management, long-term mental health treatment and intensive substance use treatment most likely will not be included in their basic benefit package. We must work together  to encourage states not only to expand Medicaid coverage, but also to create benefit packages that allow tenants of  supportive housing to have their service needs reimbursed by Medicaid.  There are a number  options available for securing these benefits, including but not limited to the following:

  • Home and Community Based Services (HCBS) are available through either Medicaid waivers or state plan amendments and can target those leaving institutions or at-risk of institutional care. Using a range of supportive housing approaches, people can be integrated in their community and avoid expensive hospital or nursing home care.


  • The Health Home state plan amendment option temporarily provides additional funds to states that establish a mechanism for providers to create coordinated networks that comprehensively meet the complex needs of patients with chronic health conditions. Given what we know about the affect permanent housing can have on a person’s health and the inability to maintain good health outcomes without housing, supportive housing services should be a key component of any health home network.


  • Additional Medicaid waiver opportunities, including  the 1115 waiver, Targeted Case Management benefit, and the Medicaid rehabilitation state plan option, provide states flexibility to pilot initiatives that target the most vulnerable and often most expensive Medicaid beneficiaries, many of whom require supportive housing and the services that come with it. 

As we continue to sort through the Supreme Court’s rule and understand its implications, we’ll provide additional guidance and identify next steps as we push to expand access to care for supportive housing tenants.  Meanwhile, advocates should be organizing, reaching out and building coalitions with other partners working to expand Medicaid coverage for those with incomes below 138% FPL.

CSH looks forward to working with all of you to capitalize on the tremendous opportunity the Court’s ruling avails us all to expand coverage and ensure that everyone, including our most vulnerable people, have access to quality and affordable health care.

 

 

CSH Comments on Federal Home and Community Based Services Rule

In May, the Centers for Medicare and Medicaid Services (CMS), the federal agency who administers Medicaid, released a proposed rule to states clarifying two Medicaid provisions in the Affordable Care Act. The Medicaid provisions addressed are the Home and Community Based Services State Plan Option (1915i) and the Community First Choice program (1915k), which provide states ways to target benefits to people in or at-risk of being in institutional care. CMS’s proposed rule explains which services states can reimburse providers for and still receive federal Medicaid matching funding in both programs. It also details required housing settings for eligible recipients—an important part of ensuring that Medicaid reimbursements help keep people out of institutional care.

Supportive housing can help people avoid unnecessary stays in nursing homes or state hospitals, and CSH believes this proposed rule goes a long way toward helping states provide coordinated care for residents in a range of supportive housing models that are integrated in the community. CSH provided comments. With minor changes, these programs will be excellent opportunities for states to align Medicaid benefits with the services in supportive housing so that providers can access Medicaid reimbursement. CMS is expected to issue a final rule at the end of this year.

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Supreme Court Ruling on The Affordable Care Act

CSH is delighted with the U.S. Supreme Court’s decision to uphold the individual mandate and the expansion of Medicaid health insurance coverage for millions of low-income Americans. With this landmark decision, CSH looks forward to continuing our work with states to connect their highest cost, most-vulnerable Medicaid beneficiaries with the housing and services they need to reduce inappropriate use of expensive health services and lower health system costs. “We’re pleased that the court upheld the expansion of Medicaid coverage because now all supportive housing residents have a chance to access the high-quality care they need to improve their health and stabilize their lives,” said Deborah De Santis, CSH President and CEO.

In coming days, we will look at the Supreme Court’s decision, what it means for Medicaid expansion across the country and in individual states. What we do know is today’s ruling allows for states to opt out of the expansion without penalty to their current Medicaid programs. That means CSH will be working tirelessly with our local partners throughout the country to ensure state participation. Keep an eye on The Pipeline for next week’s Homefront (scheduled for Tuesday due to the July 4th holiday) to hear more from CSH on this monumental decision.

 

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CSH and the National Association of Counties Advance Supportive Housing Initiatives for Frequent Users of County Public Systems

On June 7-8, CSH and NACo joined forces to co-host a day-and-a-half long forum to showcase how counties can advance supportive housing initiatives for individuals involved in the criminal justice system and other county public systems.  Held at the beautiful Hennepin County Library in Minneapolis, MN, county representatives from more than 20 counties and 11 states attended.  The forum highlighted how the Frequent Users Systems Engagement (FUSE) model and its three essential pillars – data driven problem solving, policy and systems reform, and targeted housing and services – can help communities break the cycle of incarceration and homelessness among individuals with behavioral health needs.  We were also delighted that Commissioner Chris Rodgers from Douglas County, NE, the incoming President of NACo, joined us for the event as well.  CSH looks forward to working with county officials from states like Texas and Nebraska as they begin to plan and implement frequent user supportive housing initiatives in their counties.

VISIT NACO’S WEBSITE FOR THE agenda and slides from sessions,

Read more about CSH's Partnership with NACO.

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CSH Hosts Supportive Housing Leadership Forum

Last week in Chicago, CSH hosted a Supportive Housing Leadership Forum titled Managing Costs and Improving Outcomes through Integrated Housing and Health Innovations. The event was meant to highlight the role supportive housing can play in improving health and reducing costs, and to identify concrete strategies and opportunities for integrating housing and health care financing.

Approximately 90 partners attended from across the country, representing hospitals; FQHCs; behavioral health clinics; managed care companies; housing providers; federal, state and local government agency staff; and other supportive housing stakeholders--including CSH board members Linda Rosenberg and Fred Karnas. The day-long event gave people a unique opportunity to network with peers and discuss promising practices taking place throughout the country.

As part of this event, CSH and the Center for Health Care Strategies released a new paper explaining the financial reasons for states to ensure that services in supportive housing are Medicaid reimbursable. The issue brief, Medicaid-Financed Services in Supportive Housing for High-Need, Homeless Beneficiaries: The Business Case, articulates the arguments housing providers can use to engage potential health service agencies partners and explains to services agencies what can be gained by integrating housing into their programs. It also explains the financial gains for states if Medicaid policy accommodates comprehensive services reimbursements for high-need, high-cost homeless populations.

We are excited that several managed care organizations participated in the forum in addition to our traditional supportive housing partners. Representatives explained how health reform and rising health system costs are driving innovation in their organizations, and encouraged supportive housing stakeholders to engage managed care in their work. Moving Medicaid beneficiaries to managed care health plans is often met with concern and apprehension, but it also presents an opportunity to educate managed care organization on the benefits of supportive housing and how they can engage providers to serve a very vulnerable population that’s often difficult to reach.

The Supportive Housing Leadership Forum kicked off a larger conversation that CSH will continue to foster in coming weeks and months. It’s clear that creating intentional connections between supportive housing and health care will allow us to bring supportive housing to a scale that will end homelessness and reduce health system costs.

Sign up for our newsletter to stay informed about the latest news and innovations from CSH.

 

CSH Welcomes Langeloth Foundation as Newest Funder for Social Innovation Fund

CSH welcomes The Jacob & Valeria Langeloth Foundation as the most recent funder pledging support to our Social Innovation Fund Initiative. CSH is working with subgrantees in four communities to carry out pilot programs that will result in a model of supportive housing linked to health services that saves public dollars and improves lives.

The Foundation supports demonstration projects and advocacy efforts to improve the health and well-being of underserved individuals and communities. “We are proud to support CSH and its groundbreaking initiative,” said Scott Moyer, President of The Jacob and Valeria Langeloth Foundation. “This national demonstration will provide compelling evidence that we need solutions that combine primary care, housing and other social services to address the health needs of the most vulnerable people.”

Additional funders of the CSH Social Innovation Fund Initiative include The Conrad N. Hilton Foundation, the Melville Charitable Trust and Fannie Mae.

 Learn more about the CSH Social Innovation Fund Initiative 

Visit the Langeloth Foundation’s website

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New Paper Available: The Business Case for Medicaid-Financed Services in Supportive Housing

Medicaid expansion under the Affordable Care Act will provide new insurance coverage to nearly all of the 1.2 million individuals who are homeless. This new brief outlines the rationale for states to consider designing Medicaid-financed, supportive housing-based care management services to improve care for high-need beneficiaries who are homeless.

The brief, by CSH and the Center for Health Care Strategies was released today at CSH’s Supportive Housing Leadership Forum in Chicago and was supported by Robert Wood Johnson Foundation.

read the business case for medicaid-financed services in supportive housing 

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