Health Talk: Examples of Medicaid funding services to sustain and expand supportive housing capacity

Let’s remind our readers again, that the CSH analysis regarding supportive housing indicates that we need 1.2 million units of supportive housing to meet the need of vulnerable Americans.  While a pipeline of tax credits and other financing mechanisms exist for affordable housing development, the road to funding the supportive services component of supportive housing is not as clear.

CSH has developed a summary of state strategies we believe can lead to sustainable pipelines of services funding for many communities.  These strategies illuminate how states are using Medicaid financing mechanisms to expand supportive housing capacity, sustain programs with more long-term sources of service funding and better serve supportive housing tenants who have changing service needs over time.  All are esteemed goals.  As health care and particularly Medicaid is different from state to state, some of these strategies might apply, others might not.

CSH has developed the following summary highlighting state strategies we believe can lead to sustainable pipelines of services funding for many communities.  These strategies illuminate how states are using Medicaid financing mechanisms to expand supportive housing capacity, sustain programs with more long-term sources of service funding and better serve supportive housing tenants who have changing service needs over time.  All are esteemed goals.  As health care and particularly Medicaid is different from state to state, some of these strategies might apply, others might not.

In this blog post, we will highlight the Community Support Program for people Experiencing Chronic Homelessness or CSPECH program.  Massachusetts  has used CSPECH services to increase their supply of supportive housing and work towards ending chronic homelessness for their state. Massachusetts began using Medicaid resources to fund services in supportive housing in 2006, in a partnership between the state’s Medicaid Plan, the statewide Behavioral Health Managed Care Organization and the Massachusetts  Housing and Shelter Alliance or MHSA.  MHSA used a number of strategies that CSH recommends as supportive housing advocates use as they engage their state Medicaid plans.

Those strategies include:

  1. Make the Business Case.
    Now more than ever, state Medicaid departments are looking for ways to save money. A solid business case analysis can win over skeptics such as key legislators and state Budget Offices.


  1. Align your ‘ask’ with your state’s priorities.
    Massachusetts had made addressing the homelessness crisis a state priority, so the requests and their priorities aligned. What are your state’s priorities?  Addressing Chronic Homelessness? Downsizing state institutions? Criminal Justice Reform with a focus on Re-Entry? Supportive housing is a solution to all these challenges.


  1. Join key stakeholder groups for your state’s Medicaid plan.
    Did you know that federal Medicaid law requires a public stakeholder committee that supportive housing providers should be represented on? There are often a variety of subcommittees as well that while time-consuming will often expand your network to key advocates and stakeholders in your state.


  1. Propose a pilot program that is set up to succeed.
    Your goals in the pilot are not only to serve your new tenants but to document success. Success is defined in housing stability but also proving decreased health care costs and positive health outcomes. The evaluation component of your pilot will be as key as your services. Targeting your supportive housing to those with the most challenging health care needs will set you up to succeed and to document health savings.  Consider partnering with local universities or other research experts to execute your evaluation and use the data to recommend expansion in the coming years.


Massachusetts’s plan was executed using their state’s 1115 Medicaid Research and Demonstration waiver and fit well with the priorities of their state and their Health Care Delivery System.  In the coming, weeks we will highlight other state’s efforts that matched with their state priorities and Health Care Delivery Systems.

Please see the short brief and infographic on the MHSA for more details.  If you have any questions, on this project, please contact Marcella Maguire, CSH Director of Health Systems Integration at  or Joe Finn, MHSA’s Executive Director at  We look forward to hearing from you.

Larry Oaks: New Eastern Region Managing Director

CSH President and CEO Deborah De Santis has announced the promotion of Larry Oaks, who served the past two years as CSH director in New England, to the position of Eastern Region Managing Director.

“Larry’s enthusiasm for supportive housing is infectious and he has infused a high degree of confidence among policymakers, leaders and providers in New England,” said De Santis. “I am confident he will carry his successes into the rest of the Eastern Region.”

Larry is a community development professional with over 20 years of experience in the areas of affordable housing finance and supportive housing development and operations.

As director in CSH’s New England program, he oversaw lending, training, technical assistance and systems change work throughout Connecticut, Rhode Island,  Massachusetts, New Hampshire and Vermont.

Prior to joining CSH, Larry was Vice President for Housing at the Local Initiatives Support Corporation (LISC) in New York. Before LISC, he served as Sr. Project Manager with the Boston-based, for-profit affordable housing developer Peabody Properties. At Peabody, he spearheaded a successful development effort that led to the creation of five new supportive housing developments for individuals and families in Massachusetts and New Jersey.

During the first twelve years of his career, Larry held a series of leadership positions at Housing & Services, Inc., a non-profit developer of supportive housing in New York City. From 2004 to 2008, he served as the organization’s Executive Director.

Larry studied public administration at the Harriman School of Management and Policy at Stony Brook University, and holds a bachelor’s degree in political science from the State University of New York College at Oneonta.

The Boston Foundation Releases Report on Homelessness

The report was prepared by Westat with data from the Massachusetts Department of Housing and Community DevelopmentHomelessness Report 2017 cover

The Boston Foundation, in partnership with the independent research firm Westat and the Massachusetts Department of Housing and Community Development (DHCD), has released a report analyzing nine years of data on homelessness assistance in Massachusetts. The research, which was shared at a forum last week attended by CSH staff, sheds light on the number of families who need Emergency Assistance—in the form of direct shelter or programs that help them remain housed outside of the shelter system.
Access the full report by clicking here.

A Roadmap to End Homelessness in Vermont

“Is it actually possible to end homelessness in Vermont? A new report prepared for the legislature looks at whether the state is on the right track in tackling the problem, and maps out what it would take to make homelessness a thing of the past.” Vermont Public Radio and NPR looked at the report’s conclusions, the progress that’s been made, and what’s still to be done.

Listen to the interview with Larry Oaks, who led the team from CSH that prepared the report, and Vermont Secretary of Human Services Al Gobeille. Click here for access to the full recording. And click here to read more about how Vermont Governor Phil Scott is now leveraging the CSH recommendations to create affordable housing in his state.

Download the full report, Vermont Roadmap to End Homelessness.

New Hampshire’s Frequent Service Utilizers Issue Brief

NHIn 2016, communities in New Hampshire saw an increase in the number of individuals experiencing homelessness with significant health issues that often require a higher level of care. Advocates quickly realized that the current systems lacked the appropriate housing and services capacities to meet the growing needs. These gaps resulted in prolonged suffering for individuals faced with housing instability and chronic health conditions, and in significant financial costs for communities in the state.

Recognizing the problems required identification and a  policy strategy based on collaboration and cooperation, advocates joined together and created a report on high-utilizer case studies and possible solutions, including supportive housing.

The Frequent Service Utilizers Issue Brief illustrates the complexities in serving high-need populations, the financial implications of inadequate care, and highlights successful solutions seen across the country such as supportive housing.

Information and case studies were compiled by New Hampshire Coalition to End Homelessness, Mental Health Center of Greater Manchester, Families in Transition, and New Horizons for New Hampshire.

Read more about the case studies and findings by accessing the Frequent Service Utilizers Issue Brief.

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.

Leaders in New England Discuss Solutions to Opioid-Heroin Epidemic

Today, public and private sector leaders from throughout New England and upstate New York will convene at the invitation of CSH to focus on the addiction epidemic in their region. This event will provide an opportunity for state and local officials and providers from NY, CT, RI, MA, NH, VT and ME to come together to discuss and learn the various responses to the opioid crisis.  This convening also will explore how treatment and supportive housing systems can coordinate and collaborate to help people struggling with substance use.

WHAT:            New England Convening on the Heroin-Opioid Epidemic

WHEN:           Tuesday, July 19, 2016, 10am – 3:30pm

WHERE:         The Boston Foundation Headquarters, 75 Arlington Street, 10th Floor Boston, MA. Convening sponsored by Santander Bank.

WHO (Main Speakers):

Convening Welcoming Remarks

  • Dr. Jim O’Connell, CSH Board Member and President, Boston Health Care for the Homeless Program

Convening Keynote Speaker

  • Marylou Sudders, Secretary, MA Executive Office of Health and Human Services

Multi-State Panels

  • Miriam Delphin-Rittmon, Commissioner, Connecticut Department of Mental Health and Addiction Services
  • Barbara Cimaglio, Deputy Commissioner, Alcohol and Drug Abuse Program, Vermont Department of Health
  • Rebecca Boss, Acting Director, Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals
  • Timothy Rourke, Chair, New Hampshire Governor’s Commission on Alcohol and Drug Abuse Prevention and Director of Substance Use Grantmaking, New Hampshire Charitable Foundation
  • Dr. Monica Bharel, Commissioner, Massachusetts Department of Public Health
  • Tracie Gardner, Assistant Secretary for Health, New York State Office of the Governor

White House Office of National Drug Policy Presentation

  • Katherine Klem, Senior Policy Advisor, White House Office of National Drug Policy

Housing and Treatment Panel

  • Hal Cohen, Secretary, Vermont Agency of Human Services
  • Becky Vaughn, Vice President for Addictions, National Council for Behavioral Health
  • Melissa Skahan, Vice President of Mission Integration, Mercy Hospital

Harvard Releases Supportive Housing Report

Building on Success: Strengthening Provider Capability to Provide Permanent Supportive Housing (Publication of the Joint Center for Housing Studies, Harvard University)

Building on Success: Strengthening Provider Capability to Provide Permanent Supportive Housing

MASH-PFS Provider Learning Collaborative

The Commonwealth of Massachusetts, in partnership with CSH, Massachusetts Housing and Shelter Alliance, the United Way of Massachusetts Bay and Merrimack Valley, and Santander Bank, launched the Massachusetts Pay For Success Initiative in June of 2015. Sixteen participating housing and service agencies across the state of Massachusetts are aiming to house 500 to 800 chronically and “high-use” homeless individuals with an 85% continuous sustained housing rate over five years.

deb and joe

CSH CEO & President Deb De Santis with MHSA President & Executive Director Joe Finn

One year later, providers participating in the Initiative have housed half of the initial 500 person goal and continue to outreach and engage additional chronic and high-use individuals experiencing homelessness.

The Pay For Success Initiative leverages significant public and private funding along with the Massachusetts Housing and Shelter Alliance’s (MHSA) Home & Healthy for Good (HHG) housing and service model. HHG demonstrates that providing housing and supportive services to chronically homeless individuals through a low-threshold, Housing First model is less costly and more effective than managing their homelessness and health problems on the street or in shelter. Additionally, roughly three quarters of the Pay For Success tenants are enrolled in the Community Support Program for People Experiencing Chronic Homelessness (CSPECH) program. CSPECH was designed by the the Massachusetts Behavioral Health Partnership (MBHP) and MHSA, and is a proven model of Medicaid reimbursement that help funds permanent supportive housing for chronically homeless individuals.

As a member of the Massachusetts Alliance for Supportive Housing, and investor in the Initiative, CSH provides advisory services and best practices to enhance service providers’ performance, and the success of the initiative overall. CSH developed a multi-year, multi-level, logic-model driven Provider Learning Collaborative, which kicked off in February 2016. The Provider Learning Collaborative supports participating providers in developing and strengthening their networks, sharing best practices, and building their capacity. Case Managers, supervisors, and provider leadership have gathered to discuss their participation in the initiative, challenges, and successes. Specific sessions have addressed housing search and placement, eviction prevention, and motivational interviewing.

To date, over 80 professionals across the 16 participating agencies have attended and contributed to collaborative discussions and peer-to-peer learnings.

CSH will continue to convene learning collaborative sessions throughout the Initiative, covering topics ranging from addressing active substance use, to self-care and preventing employee burnout.

CSH also is launching an online community where participating providers can connect between sessions to share content and ask questions.

CSH will continue to provide local and national best practices and guide discussions around opportunities for change and improvement as our Massachusetts partners work to house those in need of housing and services.