Medicaid and Housing Related Services

Toolkit Fall, 2023

a stethoscope on a table

A growing number of states are using their Medicaid programs to address the Social Drivers of Health for Medicaid members. This trend includes Housing Related Services (HRS) such as Housing Navigation, Tenancy Sustaining Services and funds for move in costs. The referral processes and details will differ state to state and CSH is tracking those details with an eye to scaling supportive housing services in our communities.

Interest in these details vary by audience. State medicaid offices are interested in which Medicaid authority, delivery system or payment mechanism is used so they can develop their own programs and build on lessons learned of early adopter states. Health centers as referral sources for these services want to how what are the services, the target population and how to make referrals. Supportive housing providers want to know service definitions, provider requirements and rates to see if it makes sense for their agency to contract for these services.

CSH has summarized publicly available material in a system to answer the key questions via audience and state. The tool will be updated twice a year, as programs are evolving quickly. And if you see a section that requires updating, please contact CSH at health@csh.org.

What providers need to know about their state’s coverage of Housing Related Services via Medicaid.

Supportive Housing Providers

Program Name

Housing and Health Opportunities (H2O)

Status

State Planning Post CMS approval

Health-related Social Needs (HRSN) Waiver approved October 14, 2022.

Implementation Plan

Services Protocol

Services Include

Pre and Post tenancy services, 6 months housing costs including enhanced shelter and outreach

Key Administrative Details

The state is using a Third-Party Administrator.

Delivery System

Third Party Administrator (TPA). Statewide TPA expected to be on board as of 7/1/2024.

Provider Type:

TBD

Payment Methods and Rates

TBD

Program Name

MediCal Transformation

Status

Operating

The waiver was approved December 2021 with a January 1, 2022, start date.

Early outcomes reporting.

Services Include

Pre and Post tenancy services, 90 days of recuperative care, 6 months housing costs

Key Administrative Details

State using In Lieu of Services (ILOS) in which MCPs decide what services to offer and to whom.

Deliver System

Managed Care Plans (MCPs).

Provider Type:

Agencies can now enroll as a Community Based Organization (CBO) provider type. Providers will submit enrollment applications through the PAVE Provider Portal (ca.gov) online portal.

Payment Methods and Rates

State Non-Binding ILOS Pricing Guidance

Determined by MCPs.

Most plans are using Per Diem or PMPM but that is decided by MCPs.

Program Name

State Wide Supportive Housing Expansion (SWSHE)

Services Include

Pre and Post Tenancy Support Services

Key Administrative Details

The program is currently grant funded via HCBS ARPA funds with the state planning for a Medicaid financing method when grant funds run out in 2024.

Delivery System

Provider Type

Payment Methods and Rates

Web Resources

Program Name

The CT Housing Engagement and Support Services (CHESS) Initiative

Services Include

Pre and post tenancy support services

Key Administrative Details

Administered by Carelon Behavioral Health of Connecticut (ctbhp.com)

Delivery System

Carelon Behavioral Health of Connecticut (ctbhp.com) manages the benefit.

Provider Type

Payment Methods and Rates

Web Resources

State Initiative website

Program Name

Housing Supportive Services  | dhs (dc.gov), including Housing Stabilization Services and Housing Navigation Services

Status

Opertaing

SPA approved March 25, 2022

Services Include

Pre and post tenancy support services

Key Administrative Details

Assessment for the services is integrated into the Coordinated Entry process.
Providers are paid by DC Medicaid on a Per Member, Per Month (PMPM) basis. Rate raised to $770.31 in FY 2023.

Taxonomy Code- Case Management, 251B00000X

Procedures Codes

H00044 U1- Housing Navigation Services
H00044 U2- Housing Stabilization Services

Delivery System

Coordinated Entry is the access point to the benefit.

Coordinated Entry is the system by which all housing referrals are processed within a local Homeless Continuum of Care.

Provider Type

DC created a new Provider Type, Housing Supportive ServicesHousing Supportive Services

Payment Methods and Rates

Taxonomy Code Case Management, 251B00000X

Procedures Codes Housing Navigation H0044 U1; Housing Stabilization Services H00044 U2;

Web Resources

Housing Supportive Services | dhs (dc.gov)

Program Name

Housing Assistance Waiver

Pilot Program in HHS regions 5 and 7.

Status

Opertaing

Implementation starting.
CMS Approved Waiver amendment approved March 26, 2019.

Services Include

Pre and post tenancy support services

Key Administrative Details

Administered by the Managed Care Organizations (MCOs) in the pilot regions.
State Snapshot of MCOs

Delivery System

Community Mental Health Providers either offer services directly or subcontract with other agencies.

Provider Type

Unclear.  State Medicaid provider manual has not been updated online since before the program started.

Payment Methods and Rates

Program Name

Community Integration Services (CIS)

Status

Opertaing

Waiver approved by CMS October 31, 2018.

State Program Web page

Services Include

Pre and post tenancy support services

Key Administrative Details

Administered by state’s Medicaid Managed Care Organizations (MCOs). State MCO listing
State modifying implementation guidelines to improve access for target population.

Delivery System

Delivered via MCO health plans: AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan, and UnitedHealthcare Community Plan

Provider Type

Atypical Provider Enrollment is allowed and No NPI is required per
CIS PROVIDER ENROLLMENT Training.

Facility, Agency, or Organization (FAO) enrollment is also allowable for CIS services.

CIS Provider Types:
• PT A3 Community Service Agency
• PT 77 Mental Health Rehab Option (MRO)
-CCS provider
• PT 02 Hospital

Hawaii Online Kahu Utility or HOKU Provider Enrollment System

Payment Methods and Rates

Recommended CIS NPI Taxonomy Codes:
Primary 251S00000X Community/Behavioral Health Secondary 251B00000X Case Management

Outreach- T1023
Support- H0044

Web Resources

State Program Web page

Program Name

Permanent Supportive Housing (PSH) Initiative

Status

Opertaing

State PSH Website

Services Include

Pre and post tenancy support services

Key Administrative Details

State plan process integrated across housing and services sectors.

Delivery System

A mix of providers and the state. The state web site explains how to apply.

Provider Type

Permanent Supportive Housing Agency.  Provider requirements include that the agency must be a Medicaid enrolled provider of CPST and Psychosocial Rehabilitation services

Payment Methods and Rates

No specific taxonomy Code is recommended.

Under HCBS waivers, tenancy supports bill under G9012

State BH plan services

Tenancy Services under CPST-   H0036, TG; Tenancy Services under Psychosocial Rehab – H2017, TG;

Web Resources

State PSH website

Program Name

Assistance in Community Integration (ACIS) program

Status

Opertaing

State ACIS Project Website

State Report on program

An updated waiver in 2022 took the program statewide

Services Include

Pre and post tenancy support services

Key Administrative Details

Administered by the counties who are responsible to align with housing resources.

Delivery System

Counties/ Lead Entities to administer the program.  Only Baltimore City, Cecil, Montgomery and Prince George’s counties are participating.

Provider Type

Providers are not required to enroll in Medicaid, so provider type not required.

Payment Methods and Rates

Providers are not required to enroll in Medicaid, so taxonomy codes are not required.
HCPS codes are also not required in the billing between the providers and the lead entities. Providers are submitting invoices to the LE not claims.

Website Resources

State ACIS Project Website

Program Name

  1. Community Supports Program for Homeless Individuals (CSP-HI)
  2. Flexible Services to evolve to Health-Related Social Needs (HRSN) services

Opertaing

For CSP-HI- Code- H2016 Modifier HK and rate is a per diem of rate of $27.72

CSPECH Cost Savings Report- 2017

New Waiver approved 9/28/2022.

DSRIP HRSN Protocol Approved June, 2023

Services Include

Key Administrative Details

  1. Administered by state’s MCOs
  2. Administered by ACOs to members of their choosing to reduce costs and improve health

Delivery System

Administered by MCOs

MA ACO (Accountable Care Organization) and MCO (Managed care organizations) listing


Administered by state’s Accountable Care Organizations

Provider Type

Unclear till HRSN implementation plan is approved if CBOs will need to enroll as Medicaid providers, which requires a provider type.


 

Payment Methods & Rates

No specific taxonomy Code is recommended.
HCPCS code- H2016 HK


Unclear till HRSN implementation plan is approved, if CBOS need to enroll in Medicaid and what information CBOs will need to submit for payment including HCPCS codes.

Web Resources

Program Name

Housing Assistance


SDOH In Lieu of Services

Status

Opertaing

CMS approved 1915(i) SPA


MDHHS issues award recommendation for Michigan’s Medicaid Health Plans

Services Include

 


TBD

Key Administrative Details

Services are a component of the state’s Behavioral Health Transformation Plan. The benefit is offered through the Prepaid Inpatient Health Plans or PIHPs  that manage community behavioral health provider network.


Addressing SDOH needs including potentially Housing Related Services

Delivery System

Administered by the Prepaid Inpatient Health Plans (PHIPs) and in some cases by the Community Mental Health (CMH) clinics

Provider Type

Provider type is Community Mental Health Center

Payment Methods and Rates

No Taxonomy code is recommended in the  State Medicaid Provider Manual

HCPCS codes

Housing Assistance is T2038

Community Living Supports is H2015

Web Resources

Program Name

Housing Stabilization Services

Services Include

Pre and Post tenancy services

Key Administrative Details

Benefit administered by MCOs, approved by the state.

Housing Transition reimbursed at $17.17 per 15-minute increment. The code is H2015 U8.

Housing Sustaining reimbursed at $17.17 per 15-minute increment. Code- H2015 U8/TS.[1]

Delivery System

Services are authorized by DHS and managed and paid for by the MCOs.

Provider Type

Provider Type 18- HCBS provider

Payment Methods and Rates

Taxonomy code: 251B00000X – Case Management

Housing Transition code is H2015 U8.
Housing Sustaining Services code- H2015 U8/TS.

Housing Stabilization Services (state.mn.us)

Program Name

HEART Waiver (mt.gov)

Status

State Planning post CMS Approval

The Waiver amendment was approved 2/26/2024.

Services Include

Pre and Post tenancy services

Key Administrative Details

TBD-  Montana is one a few states that does not have Medicaid Managed Care

Delivery System

Provider Type

Provider Type

Payment Methods and Rates

Program Name

Housing Support Services

Status

Opertaing

For a Medicaid funded tenancy support services benefit.

Services Include

TBD

Key Administrative Details

Delivery System

Provider Type

TBD

Payment Methods and Rates

Web Resources

Program Name

Housing Stabilization Services

Status

State Planning post CMS approval

The State Plan Amendment is approved and the state is developing regulations to govern operations

Services Include

TBD

Program capped at 50 people

Key Administrative Details

Administration is TBD but the state’s current Home and Community Based Services programs is administered by Managed Care

Delivery System

State Medicaid Office, Department of Health and Human Services (DHHS)

Provider Type

Payment Methods and Rates

Web Resources

The State Plan Amendment

Program Name

Housing Transition and Tenancy Sustaining Services as part of a Health-Related Social Needs program

Status

State Planning post-CMS approval

The HRSN 1115 waiver is approved as of 3/30/2023 and the state is developing regulations to govern operations.

Services Include

TBD

Key Administrative Details

TBD

Delivery System

Managed Care

Provider Type

TBD in the implementation Plan

Payment Methods and Rates

TBD in the implementation Plan

Program Name

Supportive Housing Units, including capital funds

Status

Operating

Program is called Linkages and provides state funded rental assistance with Medicaid services for those with Behavioral health Challenges

Updated Centennial Care 2.0 waiver includes growing the program

Services Include

Pre and post tenancy services

Key Administrative Details

The Services are administered by Managed Care

Delivery System

Managed care

Provider Type

Limited to Behavioral Health Services Division and state approved providers

Payment Methods and Rates

State Linkages Policy Manual recommends Certified Peer Support Workers (CPSW) using a H0044 code but the Behavioral Health Billing Manual uses H00043.

Program Name

Social Determinants of Health (SDOH) Initiatives can include Housing Support Services.

Status

Operating

State Program Website

Services Definitions and Fee Schedules updated March, 2023

Services Include

Services Definitions

Key Administrative Details

Lead Pilot Entities (LPE) are operating as Community Care Hubs supporting CBOS administratively.

Delivery System

Pilot program administered by regional Healthy Opportunities Network Leads

Provider Type

Payment Methods and Rates

Taxonomy and HCPCS codes not included in the state’s Service Definition and Fee Schedules

Web Resources

Program Name

Housing Support Services

Status

Operating

The state has an approved 1915(i) SPA. Services began on February 2, 2021.

The rate is $10.49 per 15-minute increment. The code is H2021 U4.

Enrollment and Service Delivery Report

Services Include

Pre and post tenancy services

Key Administrative Details

Providers bill the state for the traditional Medicaid population or an MCO for those who are part of the Medicaid Expansion population.

Delivery System

Administered by the state for the Traditional Medicaid population and the MCO for the expansion population

Provider Type

Provider type 25, Provider Type 25- Agency

Payment Methods and Rates

Taxonomy Code 251B00000X

Web Resources

State Program web site

Program Name

Health-related services can include housing services. Housing services are optional for   Coordinated Care Organizations (CCOs) to fund.


Health Related Social Needs (HRSN) services including Housing Support Services

Status

Operating

The state is working to incentivize CCOS to offer tenancy supports to pair with new housing-related resources that are coming online.

State Health-Related Services Overview


State Planning post CMS approval

Housing Services GO LIVE, November 2024 for those at risk of Homelessness.


State submitted Implementation Plan in August 2023

Waiver approved 9/28/22

Services Include

TBD by the CCOs


Pre and post tenancy services


Rental Assistance


Housing Transition Costs

Key Administrative Details

Coordinated Care Organizations or CCOs are Oregon’s community focused evolution of Managed Care.


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State working with CCOs to implement and TPA for individuals who are not CCO members

Delivery System

Via Oregon’s Coordinated Care Organizations (CCOs)

Provider Type


TBD, needs additional state/CMS plans to be approved.

Payment Methods and Rates

TBD, needs additional state/CMS plans to be approved.


HCPCS codes- H0043 U1
$20.24 for a 15 minute increment

Program Name

Tenancy Support Services for intellectual or developmental disability/developmental disability (IDD/DD) populatio

Status

Operating

The state has added tenancy support services to the menu of services for persons eligible for the IDD waiver.

Services Include

Key Administrative Details

Delivery System

Via Managed Long-Term Services and Supports

Provider Type

Provider Type and Specialty Codes-

Home Finding-

Provider type- 51
Specialty code-571

Payment Methods and Rates

HCPCS codes- H0043  U1

$20.24 for a 15 minute increment

Program Name

Home Stabilization Services

Services Include

Home FIND and Home Stabilization Services

Key Administrative Details

The per month rate per member is $331.84 and the code is H0044

Delivery System

Services are provided in a Fee for Service System and providers bill the state.

Provider Type

Not required.

Payment Methods and Rates

The per month rate per member is $331.84

Program Name

Supported Home Living

Status

Operating

CMS approved SPA on August 31, 2020

Services Include

Supported home living services that could be used in Supportive Housing

Key Administrative Details

Delivery System

Provider Type

Payment Methods and Rates

TBD

Web Resources

Program Name

Housing Related Services and Supports

Services Include

Tenancy Support Services, Community Transition Services and Supportive Living Services

Key Administrative Details

Services are authorized by state HRSS staff

 

HCPCS Billing Code: T2024 – Tenancy Support Service – $18.37 per 15 minutes

HCPCS Billing Code: T2038 – Community Transition Services, 2 episodes per 5-year period per person up to $2,000 per each occurrence

HCPCS Billing Code: T2017 – Supportive Living Service – $18.37 per 15 minutes

 

Delivery System

Provider Type

TBD

Payment Methods and Rates

TBD

Web Resources

Program Name

Supportive Housing Assistance Pilot Program

Status

Operating

The state’s 1115 Waiver was approved on June 28, 2022, and includes a PSH Pilot

Services Include

Key Administrative Details

Delivery System

TBD- state operates most of the Medicaid program with a single state controlled MCO.

Provider Type

TBD

Payment Methods and Rates

TBD

Program Name

High Needs Support Benefit

Status

Planning

CMS approved the waiver as of July 9, 2020.

The state timeline for implementation is TBD.

High Needs Support (virginia.gov)

Services Include

Key Administrative Details

Delivery System

Provider Type

Program Name

Foundational Community Supports (FCS) for supportive housing and supportive employment services.

Status

Operating

The waiver was approved and implemented as of January 1, 2018.

State Program Website

 

State Planning post-CMS approval

Waiver renewal approved June 30, 2023

Services Include

Pre and Post tenancy services and supported employment services


A variety of Health-Related Social Needs services including pre and post tenancy services, housing transitional costs and rental assistance

Key Administrative Details

The state is using a Third-Party Administrator to simplify administrative processes.

Wellpoint (formerly Amerigroup) Provider Manual

Using Billing Codes H0043 Community Support services: daily rate of $112 with a benefit limitation of 30 days over 180 days.

Delivery System

The state is using a Third-Party Administrator to manage the program.  Amerigroup won a competitive bid for this contract.  Amerigroup is now called Wellpoint.

Wellpoint Provider Manual

Provider Type

Provider One Enrollment Guide


FCS Providers enroll as a facility, agency, organization or institution (FAOI) provider


The state’s third party administrator has a FCS Provider Application that that does not require a Provider Type but does require a Washington Medicaid Provider ID

Payment Methods and Rates

Per Diem rate of $112 with a benefit limitation of 30 days over 180 days.


ProviderOne billing and resource guide (wa.gov)

Web Resources

State Program Website

Program Name

CHIP Housing Support Initiative


Housing Support Services

Status

Start date was May 21, 2023


Negotiating with CMS

State Housing Supports web site.

Services Include

-Housing Consultation

-Transition Supports

-Sustaining Supports

-Relocation Supports


-Housing Consultation

-Transition Supports

-Sustaining Supports

-Relocation Supports

Key Administrative Details

State is granting funds to8 family supportive housing agencies in 4 COCs


 

Delivery System

Provider Type

Payment Methods and Rates

Web Resources

What Health Centers Need to Know to Support Patients

As of early 2024, twenty-three states are covering or in the process of implementing Housing Related Services (HRS) to help Medicaid recipients obtain and maintain housing in their community. It is understood that housing status has a significant impact on a person’s ability to effectively connect with the healthcare system and maintain good health and as such, Federally Qualified Health Centers serving individuals experiencing homelessness or housing instability will want to assist their patients with accessing these services. Communities wishing to improve health equity will also need a specific equity strategy to ensure access to services for BIPOC (Black, Indigenous, and People of Color), considering that these populations suffer from higher rates of homelessness, housing instability and institutionalization.

CSH provides regular updates in a state by state Policy Brief with analysis on HRS program implementation. This brief builds on that analysis with focus on accessing these services for health center patients and other health care and community systems now screening for the Social Drivers of Health (SDOH). While waivers may have broad populations listed as eligible, our analysis will focus on state’s implementation plans and what populations are eligible for these services and when.

a health worker putting on gloves

Most states cover a similar range of services including pre-tenancy or housing navigation services, tenancy sustaining services and move in assistance. Some states are covering short term rental assistance via Health-Related Social Needs Waivers as an additional service.

As health system providers learn of their patient’s Health-Related Social Needs, they will want to have on hand easy ways to refer for assistance.

Access and Referral Services

Program Name

Housing and Health Opportunities (H2O)

Target Population

People experiencing homelessness, those leaving institutions or congregate care and child welfare involved families.

Eligibility

State’s initial focus is on people who are experiencing homelessness with serious mental illness.

Services Include

Pre and Post tenancy services, 6 months housing costs including enhanced shelter and outreach

Key Administrative Details

The state is using a Third-Party Administrator.

Recommended referral action

State “GO LIVE” date to offer HRS is 10/1/2024.  Contact the TPA AFTER this date for a referral.

Target Population

People experiencing homelessness is one of many priority populations

Eligibility

MCPs decide on what services are offered, to what populations and process.

Services Include

Pre and Post tenancy services, 6 months housing costs

Key Administrative Details

State using In Lieu of Services (ILOS) in which MCPs decide what services to offer and to whom.

Recommended referral action

Contact member’s MCP to determine if the person is eligible and how to access services.

Program Name

The CT Housing Engagement and Support Services (CHESS) Initiative

Target Population

Homeless and higher health care utilization than to be expected based on diagnosis

Eligibility

For Patients 18+

HUD Homeless or HUD homeless prior to institutionalization.

Individuals have a higher-than-expected inpatient rate based upon a state predictive analytics score of expected health care usage, called the HEDIS ALL Cause Readmission measure.

1 Critical need or difficulty with Activities of Daily Living (ADL).

Services Include

Pre and post tenancy support services

Key Administrative Details

Administered by Carelon Behavioral Health of Connecticut (ctbhp.com)Carelon Behavioral Health of Connecticut (ctbhp.com)

Recommended referral action

Apply CT CHESS – Home (ctchessdss.com)

For people without an Intensive Case Manager or ICM[JB1] , contact Carelon.
What does this acronym stand for? [JB1]

Web Resources

State Initiative website

Program Name

Housing Supportive Services | dhs (dc.gov), including Housing Stabilization Services and Housing Navigation Services

Target Population

Homeless as identified by the city’s Coordinated Entry System

Eligibility

Patient must require assistance with maintaining housing due to issues with:

  1. mobility,
  2. decision making,
  3. healthy social relationships
  4. help with one basic need such as self-care or money management AND

Is experiencing or at risk for chronic homelessness, homelessness or housing instability

Services Include

Pre and post tenancy support services

Key Administrative Details

Assessment for the services is integrated into the Coordinated Entry process.
Providers are paid by DC Medicaid on a Per Member, Per Month (PMPM) basis. Rate raised to $770.31 in FY 2023.


Taxonomy Code- Case Management, 251B00000X


Procedures Codes H00044 U1- Housing Navigation Services


H00044 U2- Housing Stabilization Services

Recommended referral action

Contact the City’s Coordinated Entry System or collaborate with an agency that offers homeless outreach services.

Web Resources

Housing Supportive Services | dhs (dc.gov)

Program Name

Housing Assistance Waiver

Pilot Program in HHS regions 5 and 7.

Target Population includes

Homelessness

Eligibility

Persons who are homeless or at risk of homeless and suffer from a serious mental illness and/or substance use disorder

Services Include

Pre and post tenancy services

Key Administrative Details

Administered by the Managed Care Organizations (MCOs) in the pilot regions.
State Snapshot of MCOs

Recommended referral action

Ensure the patient is connected to the local behavioral health system services.  If you are not sure, contact the local Managing EntityManaging Entity for your county.

Program Name

Community Integration Services (CIS)

Target Population includes

Individuals with a behavioral health, physical illness, or substance use diagnosis and are chronically homeless.

Eligibility

Individuals with a behavioral health, physical illness, or substance use diagnosis and are chronically homeless.

Services Include

Pre and post tenancy services

Key Administrative Details

Administered by state’s Medicaid Managed Care Organizations (MCOs). State MCO listing

State modifying implementation guidelines to improve access for target population.

Recommended referral action

Submit Referral Form  and CIS-Consent-Form to individual’s Health Plan.

Web Resources

State Program Web page

Program Name

Permanent Supportive Housing (PSH) Initiative

Target Population includes

Low-income populations with disabilities.

Eligibility

Low-income populations with disabilities.

Services Include

Pre and Post tenancy Services

Key Administrative Details

State plan process integrated across housing and services sectors.

Recommended referral action

Process differs for south and north Louisiana. Contact info and process for each is found on the State PSH websiteState PSH website

Web Resources

State PSH website

Program Name

Assistance in Community Integration (ACIS) program

Target Population includes

Homeless or at risk, institution or high risk of institutional placement AND 4 or more hospital visits in a year & 2+ chronic conditions.

Eligibility

Homeless or at risk, institution or high risk of institutional placement AND 4 or more hospital visits in a year & 2+ chronic conditions.

Services Include

Key Administrative Details

Administered by the counties who are responsible to align with housing resources.

Recommended referral action

In Baltimore City, contact the Mayor’s Office of Homeless Services.
In the other three counties, contact the local Health department and ask how to access the ACIS program.

Website Resources

State ACIS Project Website

Program Name

Community Supports Program for Homeless Individuals (CSP-HI)

  1. Flexible Services to evolve to Health-Related Social Needs (HRSN) services

Target Population includes

  1. Chronically Homeless and being expanded to homeless in the new waiver
  2. TBD by each ACO and their community partners.

MA ACO and MCO listing.

Eligibility

  1. Persons experiencing homelessness or housing instability with behavioral health challenges that interfere with their ability to access health care services.
  2. TBD by the ACOs (Accountable Care Organizations).

Services Include

Key Administrative Details

  1. Administered by state’s MCOs
  2. Administered by MCOs and ACOs to members of their choosing to reduce costs and improve health

Recommended referral action

  1. Contact MCO or ACO that covers the individual.
  2. Contact the ACO that covers the individual you are serving.

Web Resources

Program Name

Housing Assistance

SDOH In Lieu of Services

Target Population includes

Persons with serious mental illness, serious emotional disturbance and/or intellectual/developmental disabilities.


TBD by MCOs

Eligibility

Persons with serious behavioral health challenges.
Process and other eligibility criteria determined by the PHIPs.

Services Include


TBD

Key Administrative Details

Services are a component of the state’s Behavioral Health Transformation Plan. The benefit is offered through the Prepaid Inpatient Health Plans or PIHPs that manage community behavioral health provider network.


Addressing SDOH needs including potentially Housing Related Services

Recommended referral action

Contact your local Prepaid Inpatient Health plans

Web Resources

Program Name

Housing Stabilization Services

Target Population includes

People with disabilities, homeless or housing unstable.

Eligibility

  • Medicaid eligible
  • 18 and older Documented disability

    Need assistance with in at least one of the following areas

  • Mobility
  • Communication

Managing Challenging Behaviors or Decision Making

Services Include

Pre and Post tenancy services

Key Administrative Details

Benefit administered by MCOs, approved by the state.

Housing Transition reimbursed at $17.17 per 15-minute increment. The code is H2015 U8.
Housing Sustaining reimbursed at $17.17 per 15-minute increment. Code- H2015 U8/TS.

Recommended referral action

Submit the DHS-7948-ENG (Housing Stabilization Services Eligibility Request) (mn.gov) to DHS

Program Name

Housing Stabilization Services

Target Population includes

Homeless or at risk of homelessness and needing assistance for community living.

Eligibility

Needs assistance in maintaining housing due to a disability and needs assistance in:
1.    Mobility
2.    Decision Making
3.    Relationships
At least one basic need

Services Include

TBD Program capped at 50 people

Key Administrative Details

Administration is TBD but the state’s current Home and Community Based Services programs is administered by Managed Care

Recommended referral action

Not clear at this time.

Program Name

Housing Transition and Tenancy Sustaining Services as part of a Health-Related Social Needs waiver

Target Population includes

Persons with disabilities, formerly incarcerated, formerly homeless or at risk of homelessness, transitioning from institution and/or beneficiaries who are transitioning out of high-risk or unstable housing situations.

Eligibility

  • Homeless or at risk of homeless
  • Transitioning from Institution to community
  • Released from Correctional settings
  • At risk of institutionalization due to SMI (Serious Mental Illnesses) or SUD (Substance Use Disorder)
  • Transitioning out of unstable housing
  • M-LTSS MCOs can identify

Services Include

TBD

Key Administrative Details

TBD

Recommended referral action

GO Live date has not been set as of early, 2024, however will be administered by MCOs, so likely contact the person’s MCO.

Program Name

Supportive Housing Units, including capital funds

Target Population includes

Those with Serious Mental Illness

Eligibility

Persons with Behavioral Health Challenges identified by MCOs

Services Include

Pre and post tenancy services

Key Administrative Details

The services are administered by Managed Care

Recommended referral action

Contact the person’s MCO

Program Name

Social Determinants of Health (SDOH) Initiatives can include Housing Support Services.

Target Population includes

Three regions in the state, all rural, were awarded funding to operate Healthy Opportunities Pilots to offer SDOH services.

Eligibility

Have a qualifying diagnosis and a qualifying social risk factor

Services Include

Services Definitions

Key Administrative Details

Lead Pilot Entities (LPE) are operating as Community Care Hubs supporting CBOS administratively.

Recommended referral action

If the person lives in a Healthy Opportunities Pilot Region, contact the local Network Lead

Web Resources

Program Name

Housing Support Services

Target Population includes

People with behavioral health challenges who are experiencing homelessness and housing instability.

Eligibility

Persons with behavioral health challenges

Services Include

Pre and post tenancy services

Key Administrative Details

Providers bill the state for the traditional Medicaid population or an MCO for those who are part of the Medicaid Expansion population.

Recommended referral action

Contact Blue Cross for expansion population members.
For Traditional Medicaid, apply through the State portal.State portal.

Web Resources

State Program web site

Program Name

Health-related services can include housing services. Housing services are optional for Coordinated Care Organizations (CCOs) to fund.


Health Related Social Needs (HRSN) services including Housing Support Services

Target Population includes

The target population is not specified in the waiver. CCOs can choose to include services as an optional benefit under health-related services.


People at risk of homelessness, those leaving institutions or congregate care and child welfare involved families.

Services for those experiencing homelessness do not have a GO LIVE date set.

Eligibility

OHA members who are in a variety of Life Transitions.

Services Include

TBD by the CCOs


Pre and post tenancy services
Rental Assistance
Housing Transition Costs

Key Administrative Details

Coordinated Care Organizations or CCOs are Oregon’s community focused evolution of Managed Care.


State working with CCOs to implement and TPA for individuals who are not CCO members

Recommended referral action

Referral forms will be standard statewide but differ according to HRSN service.


Referral forms for Climate Related Services are available

Program Name

Tenancy Support Services for intellectual or developmental disability/developmental disability (IDD/DD) population

Target Population includes

Those already eligible for IDD waivers. The process remains the same as before the waiver.

Eligibility

Persons with Intellectual and Developmental Disabilities and registered with the state system.

Services Include

Key Administrative Details

Recommended referral action

Contact the person’s Community Health Choices MCO.

Program Name

Home Stabilization Services

Target Population includes

Persons with behavioral health or intellectual disabilities and those institutionalized or at risk of institutionalization

Eligibility

Medicaid enrolled patients

Services Include

Home FIND and Home Stabilization Services

Key Administrative Details

The per month rate per member is $331.84 and the code is H0044.

Recommended referral action

Complete and submit a Home Stabilization Prior Authorization Form to the state.

Program Name

Supportive Housing Assistance Pilot Program

Target Population includes

Persons who are 18 and older and need assistance with at least one needs-based criteria and have one or more risk factors.

Eligibility

TBD

Services Include

TBD

Key Administrative Details

TBD

Recommended referral action

TBD

Program Name

Foundational Community Supports (FCS) for supportive housing and supportive employment services.


Continuation of the FCS program described above AND expansion of Health-Related Social Needs Services including housing

Target Population includes

People experiencing chronic homelessness, individuals with frequent or lengthy adult residential care stays, individuals with frequent turnover of in-home caregivers, and those at highest risk for expensive care and adverse outcomes.


Populations include chronic homeless, institutionalized or at risk of institutionalization

Eligibility

FCS referral guide

18 and older Medicaid eligible

(1) assessed health needs-based criteria

(1) risk factor including homelessness

Services Include

Pre and Post tenancy services and supported employment services


A variety of Health-Related Social Needs services including pre and post tenancy services, housing transitional costs and rental assistance

Key Administrative Details

The state is using a Third-Party Administrator to simplify administrative processes

Wellpoint (formerly Amerigroup) Provider Manual

Using Billing Codes H0043 Community Support services: daily rate of $112 with a benefit limitation of 30 days over 180 days.


State will continue to use a TPA for FCS, as well as work with their Accountable Communities of Health (ACHs) to roll out the services via Community Based Organizations or CBOs

Recommended referral action

Submit the Foundational Community Supports Referral Form to the Third-Party Administrator, Wellpoint

Web Resources

State Program Website

Medicaid Offices

What state Medicaid officials can learn from other early adopter states regarding key policy and implementation details. 

Medicaid Offices

Program Name

High Needs Support Benefit

Status

Planning

CMS approved the waiver as of July 9, 2020.

The state timeline for implementation is TBD.

High Needs Support (virginia.gov)

Medicaid Authority

1115 Waiver

Target Population include

State to develop target criteria that include health-related needs-based measures and risk factors

Delivery System

Provider Type

Policy documents

Program Name

Foundational Community Supports (FCS) for supportive housing and supportive employment services.

Status

Operating

The waiver was approved and implemented as of January 1, 2018.

State Program Website

 

State Planning post-CMS approval

Waiver renewal approved June 30, 2023

Medicaid Authority

1115 Waiver


1115 Waiver Renewal

Target Population include

People experiencing chronic homelessness, individuals with frequent or lengthy adult residential care stays, individuals with frequent turnover of in-home caregivers, and those at highest risk for expensive care and adverse outcomes.

Populations include chronic homeless, institutionalized or at risk of institutionalization

Delivery System

The state is using a Third-Party Administrator to manage the program.  Amerigroup won a competitive bid for this contract.  Amerigroup is now called Wellpoint.

Wellpoint Provider Manual

Provider Type

Provider One Enrollment Guide


FCS Providers enroll as a facility, agency, organization or institution (FAOI) provider


The state’s third party administrator has a FCS Provider Application that that does not require a Provider Type but does require a Washington Medicaid Provider ID

Taxonomy and HCPCS Codes

Taxonomy Code- Case Management 251B0000X


HCPCS codes- Using Billing Codes H0043 Community Support services:

Payment Methods and Rates

Per Diem rate of $112 with a benefit limitation of 30 days over 180 days.


ProviderOne billing and resource guide (wa.gov)

Policy documents

State Program Website

Program Name

CHIP Housing Support Initiative


Housing Support Services

Status

Start date was May 21, 2023


Negotiating with CMS

State Housing Supports web site.

Medicaid Authority

Children’s Health Insurance Program (CHIP)


1915(i) SPA

Target Population include

Low-income families experiencing homelessness to address equity issues in both health and homeless assistance systems.


Medicaid beneficiaries with Behavioral Health needs, who are experiencing homelessness or at imminent risk of homelessness

Delivery System

Provider Type

Taxonomy and HCPCS Codes

Payment Methods and Rates

Policy documents

Program Name

Housing and Health Opportunities (H2O)

Status

State Planning Post CMS approval

Health-related Social Needs (HRSN) Waiver approved October 14, 2022.

Implementation Plan

Services Protocol

Medicaid Authority

1115 Waiver

Target Population includes

People experiencing homelessness, those leaving institutions or congregate care and child welfare involved families

Delivery System

Third Party Administrator (TPA). Statewide TPA expected to be on board as of 7/1/2024.

Provider Type:

TBD

Taxonomy and HCPCS Codes

TBD

Payment Methods and Rates

TBD

Policy documents

Draft Implementation Protocol

Program Name

MediCal Transformation

Status

Operating

The waiver was approved December 2021 with a January 1, 2022, start date.

Early outcomes reporting.

Medicaid Authority

1115 waiver and 1915(b) State Plan Amendment

Target Population includes

People experiencing homelessness is one of many priority populations

Deliver System

Managed Care Plans (MCPs).

Provider Type:

Agencies can now enroll as a Community Based Organization (CBO) provider type. Providers will submit enrollment applications through the PAVE Provider Portal (ca.gov) online portal.

Taxonomy and HCPCS Codes

State Guidance recommends a taxonomy code of 251X00000X – Supports Brokerage

State guidance -Housing Transition and Navigation H0043, U6; Housing Deposits H0044, U2;  Housing Sustaining Services T2014,  U6 or T2051, U6.

Payment Methods and Rates

State Non-Binding ILOS Pricing Guidance

Determined by MCPs.

Most plans are using Per Diem or PMPM but that is decided by MCPs.

Policy documents

DHCS Community Supports Policy Guide (ca.gov)– updated July, 2023

Program Name

State Wide Supportive Housing Expansion (SWSHE)

Medicaid Authority

ARPA HCBS Plan for services and HUD Emergency Housing Vouchers (EHV) for housing subsidies.

Persons experiencing homelessness, multiple disabling conditions, and high health/crisis system utilization.

Delivery System

Provider Type

Taxonomy and HCPCS Codes

Payment Methods and Rates

Policy documents

Program Name

The CT Housing Engagement and Support Services (CHESS) Initiative

Medicaid Authority

1915 (i) State Plan Amendment (SPA)

Target Population includes

Homeless and higher health care utilization than to be expected based on diagnosis

Delivery System

Carelon Behavioral Health of Connecticut (ctbhp.com) manages the benefit.

Provider

Taxonomy and HCPCS Codes

Payment Methods and Rates

Program Name

Housing Supportive Services  | dhs (dc.gov), including Housing Stabilization Services and Housing Navigation Services

Status

Opertaing

SPA approved March 25, 2022

Medicaid Authority

1915(i) SPA

Target Population includes

Homeless as identified by the city’s Coordinated Entry System

Delivery System

Coordinated Entry is the access point to the benefit.

Coordinated Entry is the system by which all housing referrals are processed within a local Homeless Continuum of Care.

Provider Type

DC created a new Provider Type, Housing Supportive ServicesHousing Supportive Services

Taxonomy and HCPCS Codes

Taxonomy Code Case Management, 251B00000X

Procedures Codes Housing Navigation H0044 U1; Housing Stabilization Services H00044 U2;

Payment Methods and Rates

Taxonomy Code Case Management, 251B00000X

Procedures Codes Housing Navigation H0044 U1; Housing Stabilization Services H00044 U2;

Program Name

Housing Assistance Waiver

Pilot Program in HHS regions 5 and 7.

Status

Opertaing

Implementation starting.
CMS Approved Waiver amendment approved March 26, 2019.

Medicaid Authority

1115 Waiver Amendment

Target Population includes

Homelessness

Delivery System

Community Mental Health Providers either offer services directly or subcontract with other agencies.

Provider Type

Unclear.  State Medicaid provider manual has not been updated online since before the program started.

Taxonomy and HCPCS Codes

Payment Methods and Rates

Policy documents

Housing Assistance Waiver

Program Name

Community Integration Services (CIS)

Status

Opertaing

Waiver approved by CMS October 31, 2018.

State Program Web page

Medicaid Authority

1115 Waiver

Target Population includes

Individuals with a behavioral health, physical illness, or substance use diagnosis and are chronically homeless.

Delivery System

Delivered via MCO health plans: AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan, and UnitedHealthcare Community Plan

Provider Type

Atypical Provider Enrollment is allowed and No NPI is required per
CIS PROVIDER ENROLLMENT Training.

Facility, Agency, or Organization (FAO) enrollment is also allowable for CIS services.

CIS Provider Types:
• PT A3 Community Service Agency
• PT 77 Mental Health Rehab Option (MRO)
-CCS provider
• PT 02 Hospital

Hawaii Online Kahu Utility or HOKU Provider Enrollment System

Taxonomy and HCPCS Codes

Recommended CIS NPI Taxonomy Codes:
Primary 251S00000X Community/Behavioral Health Secondary 251B00000X Case Management

Outreach- T1023
Support- H0044

Payment Methods and Rates

Recommended CIS NPI Taxonomy Codes:
Primary 251S00000X Community/Behavioral Health Secondary 251B00000X Case Management

Outreach- T1023
Support- H0044

Program Name

Permanent Supportive Housing (PSH) Initiative

Status

Opertaing

State PSH Website

Medicaid Authority

State Plan Services

Target Population includes

Low-income populations with disabilities.

Delivery System

A mix of providers and the state. The state web site explains how to apply.

Provider Type

Permanent Supportive Housing Agency.  Provider requirements include that the agency must be a Medicaid enrolled provider of CPST and Psychosocial Rehabilitation services

Taxonomy and HCPCS Codes

No specific taxonomy Code is recommended.

Under HCBS waivers, tenancy supports bill under G9012

State BH plan services

Tenancy Services under CPST-   H0036, TG; Tenancy Services under Psychosocial Rehab – H2017, TG;

Payment Methods and Rates

No specific taxonomy Code is recommended.

Under HCBS waivers, tenancy supports bill under G9012

State BH plan services

Tenancy Services under CPST-   H0036, TG; Tenancy Services under Psychosocial Rehab – H2017, TG;

Program Name

Assistance in Community Integration (ACIS) program

Status

Opertaing

State ACIS Project Website

State Report on program

An updated waiver in 2022 took the program statewide

Medicaid Authority

1115 Waiver

Target Population includes

Homeless or at risk, institution or high risk of institutional placement AND 4 or more hospital visits in a year & 2+ chronic conditions.

Delivery System

Counties/ Lead Entities to administer the program.  Only Baltimore City, Cecil, Montgomery and Prince George’s counties are participating.

Provider Type

Providers are not required to enroll in Medicaid, so provider type not required.

Taxonomy and HCPCS Codes

Providers are not required to enroll in Medicaid, so taxonomy codes are not required.
HCPS codes are also not required in the billing between the providers and the lead entities. Providers are submitting invoices to the LE not claims.

Payment Methods and Rates

Providers are not required to enroll in Medicaid, so taxonomy codes are not required.
HCPS codes are also not required in the billing between the providers and the lead entities. Providers are submitting invoices to the LE not claims.

Program Name

  1. Community Supports Program for Homeless Individuals (CSP-HI)
  2. Flexible Services to evolve to Health-Related Social Needs (HRSN) services

Opertaing

For CSP-HI- Code- H2016 Modifier HK and rate is a per diem of rate of $27.72

CSPECH Cost Savings Report- 2017

New Waiver approved 9/28/2022.

DSRIP HRSN Protocol Approved June, 2023

Target Population includes

  1. Chronically Homeless and being expanded to homeless in the new waiver
  2. TBD by each ACO and their community partners.

MA ACO and MCO listing.

Delivery System

Administered by MCOs

MA ACO (Accountable Care Organization) and MCO (Managed care organizations) listing


Administered by state’s Accountable Care Organizations

Provider Type

Unclear till HRSN implementation plan is approved if CBOs will need to enroll as Medicaid providers, which requires a provider type.


 

Taxonomy and HCPCS Codes

No specific taxonomy Code is recommended.


HCPCS code- H2016 HK


Unclear till HRSN implementation plan is approved, if CBOS need to enroll in Medicaid and what information CBOs will need to submit for payment including HCPCS codes.

Payment Methods & Rates

No specific taxonomy Code is recommended.
HCPCS code- H2016 HK


Unclear till HRSN implementation plan is approved, if CBOS need to enroll in Medicaid and what information CBOs will need to submit for payment including HCPCS codes.

Program Name

Housing Assistance


SDOH In Lieu of Services

Status

Opertaing

CMS approved 1915(i) SPA


MDHHS issues award recommendation for Michigan’s Medicaid Health Plans

Medicaid Authority

1915 (i) SPA as of October 2023


Via Managed Care Contracts

Target Population includes

Persons with serious mental illness, serious emotional disturbance and/or intellectual/developmental disabilities.


TBD by MCOs

Delivery System

Administered by the Prepaid Inpatient Health Plans (PHIPs) and in some cases by the Community Mental Health (CMH) clinics

Provider Type

Provider type is Community Mental Health Center

Taxonomy and HCPCS Codes

No Taxonomy code is recommended in the State Medicaid Provider Manual

HCPCS codes

Housing Assistance is T2038

Community Living Supports is H2015

Payment Methods and Rates

No Taxonomy code is recommended in the  State Medicaid Provider Manual

HCPCS codes

Housing Assistance is T2038

Community Living Supports is H2015

Policy documents

Program Name

Housing Stabilization Services

Medicaid Authority

1915 (i) SPA

Target Population includes

People with disabilities, homeless or housing unstable.

Delivery System

Services are authorized by DHS and managed and paid for by the MCOs.

Provider Type

Provider Type 18- HCBS provider

Taxonomy and HCPCS Codes

Taxonomy code: 251B00000X – Case Management

Housing Transition code is H2015 U8.
Housing Sustaining Services code- H2015 U8/TS.

Payment Methods and Rates

Taxonomy code: 251B00000X – Case Management

Housing Transition code is H2015 U8.
Housing Sustaining Services code- H2015 U8/TS.

Housing Stabilization Services (state.mn.us)

Program Name

HEART Waiver (mt.gov)

Status

State Planning post CMS Approval

The Waiver amendment was approved 2/26/2024.

Medicaid Authority

1115 Waiver

Target Population includes

People with behavioral health challenges who are experiencing homelessness or housing instability.

Delivery System

Provider Type

Provider Type

Taxonomy and HCPCS Codes

Payment Methods and Rates

Program Name

Housing Support Services

Status

Opertaing

For a Medicaid funded tenancy support services benefit.

Medicaid Authority

1915(i) SPA

Target Population includes

TBD

Delivery System

Provider Type

TBD

Taxonomy and HCPCS Codes

Payment Methods and Rates

Policy documents

Program Name

Housing Stabilization Services

Status

State Planning post CMS approval

The State Plan Amendment is approved and the state is developing regulations to govern operations

Medicaid Authority

1915(i) SPA, which is a Home and Community Based Services (HCBS) program

Target Population includes

Homeless or at risk of homelessness and needing assistance for community living.

Delivery System

State Medicaid Office, Department of Health and Human Services (DHHS)

Provider Type

Taxonomy and HCPCS Codes

Payment Methods and Rates

Policy documents

 The State Plan Amendment

Program Name

Social Determinants of Health (SDOH) Initiatives can include Housing Support Services.

Status

Operating

State Program Website

Services Definitions and Fee Schedules updated March, 2023

Medicaid Authority

1115 Waiver

Target Population include

Three regions in the state, all rural, were awarded funding to operate Healthy Opportunities Pilots to offer SDOH services.

Delivery System

Pilot program administered by regional Healthy Opportunities Network Leads

Provider Type

Taxonomy and HCPCS Codes

Taxonomy and HCPCS codes not included in the state’s Service Definition and Fee Schedules

Payment Methods and Rates

Taxonomy and HCPCS codes not included in the state’s Service Definition and Fee Schedules

Policy documents

Program Name

Housing Support Services

Status

Operating

The state has an approved 1915(i) SPA. Services began on February 2, 2021.

The rate is $10.49 per 15-minute increment. The code is H2021 U4.

Enrollment and Service Delivery Report

Medicaid Authority

1915 (i) SPA

Target Population include

People with behavioral health challenges who are experiencing homelessness and housing instability.

Delivery System

Administered by the state for the Traditional Medicaid population and the MCO for the expansion population

Taxonomy and HCPCS Codes

Taxonomy Code 251B00000X

Provider Type

Provider type 25, Provider Type 25- Agency

Payment Methods and Rates

Taxonomy Code 251B00000X

Policy documents

State Program web site

Program Name

Housing Transition and Tenancy Sustaining Services as part of a Health-Related Social Needs program

Status

State Planning post-CMS approval

The HRSN 1115 waiver is approved as of 3/30/2023 and the state is developing regulations to govern operations.

Medicaid Authority

1115 Waiver

Target Population includes

Persons with disabilities, formerly incarcerated, formerly homeless or at risk of homelessness, transitioning from institution and/or beneficiaries who are transitioning out of high-risk or unstable housing situations.

Delivery System

Managed Care

Provider Type

TBD in the implementation Plan

Taxonomy and HCPCS Codes

TBD in the implementation Plan

Payment Methods and Rates

TBD in the implementation Plan

Policy documents

New Jersey Approved Waiver

Program Name

Supportive Housing Units, including capital funds

Status

Operating

Program is called Linkages and provides state funded rental assistance with Medicaid services for those with Behavioral health Challenges

Updated Centennial Care 2.0 waiver includes growing the program

Medicaid Authority

1115 waiver

Target Population include

Those with Serious Mental Illness

Delivery System

Managed care

Provider Type

Limited to Behavioral Health Services Division and state approved providers

Taxonomy and HCPCS Codes

State Linkages Policy Manual recommends Certified Peer Support Workers (CPSW) using a H0044 code but the Behavioral Health Billing Manual uses H00043.

Payment Methods and Rates

State Linkages Policy Manual recommends Certified Peer Support Workers (CPSW) using a H0044 code but the Behavioral Health Billing Manual uses H00043.

Program Name

Health-related services can include housing services. Housing services are optional for   Coordinated Care Organizations (CCOs) to fund.


Health Related Social Needs (HRSN) services including Housing Support Services

Status

Operating

The state is working to incentivize CCOS to offer tenancy supports to pair with new housing-related resources that are coming online.

State Health-Related Services Overview


State Planning post CMS approval

Housing Services GO LIVE, November 2024 for those at risk of Homelessness.


State submitted Implementation Plan in August 2023.

Medicaid Authority

1115 Waiver that creates Coordinated Care Organizations (CCOs)


1115 Waiver

Target Population include

The target population is not specified in the waiver. CCOs can choose to include services as an optional benefit under health-related services.


People at risk of homelessness, those leaving institutions or congregate care and child welfare involved families


Services for those experiencing homelessness do not have a GO LIVE date set

Delivery System

Via Oregon’s Coordinated Care Organizations (CCOs)

Provider Type


TBD, needs additional state/CMS plans to be approved.

Taxonomy and HCPCS Codes


TBD, needs additional state/CMS plans to be approved.

Payment Methods and Rates

TBD, needs additional state/CMS plans to be approved.


HCPCS codes- H0043 U1
$20.24 for a 15 minute increment

Program Name

Tenancy Support Services for intellectual or developmental disability/developmental disability (IDD/DD) population

Status

Operating

The state has added tenancy support services to the menu of services for persons eligible for the IDD waiver.

Medicaid Authority

1915 (i) SPA

Target Population include

Those already eligible for IDD waivers. The process remains the same as before the waiver

Delivery System

Via Managed Long-Term Services and Supports

Provider Type

Provider Type and Specialty Codes-

Home Finding-

Provider type- 51
Specialty code-571

Taxonomy and HCPCS Codes

State does not weigh in on this, but

Case Management or Care Coordinator- (171M00000X)  OR

In Home Supportive Care Agency  (253Z00000X)  seem most appropriate

Payment Methods and Rates

HCPCS codes- H0043  U1

$20.24 for a 15 minute increment

Policy documents

CHC Provider-Main (pa.gov)

Program Name

Home Stabilization Services

Medicaid Authority

1115 waiver

Target Population include

Persons with behavioral health or intellectual disabilities and those institutionalized or at risk of institutionalization

Delivery System

Services are provided in a Fee for Service System and providers bill the state.

Provider Type

Not required.

Taxonomy and HCPCS Codes

No state recommended Taxonomy Code
HCPCS- H0044 for Home Tenancy and H0044 u1 for Home Find

Payment Methods and Rates

The per month rate per member is $331.84

Program Name

Supported Home Living

Status

Operating

CMS approved SPA on August 31, 2020

Medicaid Authority

1915(i) SPA

Target Population include

Persons with serious mental illness.

Delivery System

Provider Type

Taxonomy and HCPCS Codes

Payment Methods and Rates

TBD

Policy documents

Program Name

Housing Related Services and Supports

Medicaid Authority

1115 Waiver

Target Population include

Generally, has a Behavioral Health challenge and is homeless or at risk of homelessness.

Delivery System

Provider Type

TBD

Taxonomy and HCPCS Codes

Payment Methods and Rates

TBD

Policy documents

Program Name

Supportive Housing Assistance Pilot Program

Status

Operating

The state’s 1115 Waiver was approved on June 28, 2022, and includes a PSH Pilot

Medicaid Authority

1115 Waiver

Target Population include

Persons who are 18 and older and need assistance with at least one needs-based criteria and have one or more risk factors.

Delivery System

TBD- state operates most of the Medicaid program with a single state controlled MCO.

Provider Type

TBD

Taxonomy and HCPCS Codes

TBD

Payment Methods and Rates

TBD