The needs of people living in supportive housing have become increasingly complex, yet the systems, funding structures, and service models designed to support them have not always evolved at the same pace. This paper explores how changes across housing, healthcare, behavioral health, and homelessness response systems have contributed to growing challenges in serving individuals with high-acuity needs, particularly in Los Angeles County.
Developed through a partnership between CSH and Housing Works of California, the paper emerged from conversations among leaders from Los Angeles County’s housing, healthcare, behavioral health, and supportive housing sectors who recognized the need for a more coordinated and sustainable approach. Drawing on lessons from the Los Angeles Mobile Integrated Services Team (MIST) model, which closely reflects the evidence-based Pathways to Housing’s Housing First model, the authors developed a High Acuity Pilot Framework to improve outcomes for individuals with the most complex needs.
The paper examines the historical, policy, and operational factors shaping supportive housing today and offers recommendations to strengthen service delivery, workforce capacity, funding alignment, and cross-system coordination. It is intended as a resource for policymakers, funders, housing providers, healthcare partners, and community leaders working to build a more responsive and sustainable supportive housing system.
In addition to the full report (here and to download above), here is a short, executive summary.
The First Statewide Supportive Housing Forum of Its Kind in Maryland
More than a conference, the first-of-kind 2026 Maryland Supportive Housing Forum hosted by CSH served as a space for connection, problem-solving, and shared commitment to ensuring vulnerable Marylanders have access to stable housing and supportive services. The Forum comes at a critical time, with more than 17,000 people in Maryland in need of stable housing while federal cuts to affordable housing and Medicaid threaten the resources that help people secure and maintain housing.
Over two days, leaders representing supportive housing developers, service providers, healthcare partners, government agencies, advocates, philanthropic organizations, and community-based organizations came together to explore the policies, partnerships, and investments needed to strengthen supportive housing across Maryland. By bringing decision-makers together with practitioners and people with lived expertise, the Forum created opportunities for conversations that do not often happen across systems. Throughout the event, speakers reinforced a shared message: supportive housing is most effective when housing, healthcare, behavioral health, justice, and community partners work toward common goals.
Maryland Department of Housing and Community Development Secretary Jake Day
That need for coordinated action was echoed by Maryland Department of Housing and Community Development Secretary Jake Day, who acknowledged that Maryland continues to face problems that require cross-sector solutions for housing instability as a public health issue. “There is still a challenge [here] – a public health challenge and an individual health challenge,” he said.
A recurring theme throughout the Forum was partnership. When attendees were asked what ideas from the event were still resonating with them, responses repeatedly highlighted system alignment, cross-department collaboration, data sharing, healthcare and housing partnerships, coordinated funding strategies, and stronger connections among providers, developers, and government agencies.
Ernestina Simmons, Executive Director of Baltimore’s Mayor’s Office of Homeless Services, captured that spirit of collaboration, noting that state leaders, community partners, and developers are increasingly asking how they can work together to create impact at a larger scale.
Ernestina Simmons, Executive Director of Baltimore’s Mayor’s Office of Homeless Services
Attendees responded enthusiastically to the Forum experience. One participant described the event as an “absolutely incredible convening,” while another noted it was “great to see so many leaders speaking at the forum.” Others highlighted the relevance of the content and the value of bringing together stakeholders from different sectors to learn from one another and identify new opportunities for collaboration.
Kara Mergl, MsSP, MSW, Director, Policy and Government Affairs, CSH; Danielle Meister, Assistant Secretary for Homeless Solutions, Maryland Department of Housing and Community Development; Councilwoman Odette Ramos, Baltimore City Council, District 14; Deborah De Santis, President & CEO, CSH
Speakers also emphasized the importance of ensuring supportive housing efforts reach those with the greatest needs. As Danielle Meister, Assistant Secretary for Homeless Solutions at the Maryland Department of Housing and Community Development, noted, housing strategies must intentionally serve people with the lowest incomes, people with disabilities, and older adults to create stronger and more equitable communities.
The Forum concluded with a discussion about the future of the Maryland Alliance for Supportive Housing (MASH), a growing coalition CSH is leading that is focused on strengthening supportive housing throughout the state. During an interactive session, attendees identified building partnerships as the alliance’s highest priority, followed by coordinating advocacy efforts and sharing knowledge across sectors. Participants ranked connecting people and organizations as the most important first step for MASH’s work and reported a strong readiness to contribute to ongoing coalition-building efforts.
Participants also shared concrete actions they plan to take following the Forum, including strengthening local partnerships, engaging with state policy efforts, participating in MASH, advancing housing and healthcare collaborations, and bringing new stakeholders into supportive housing conversations. Across responses, a clear message emerged: people are ready to move from conversation to action.
As attendees looked ahead to the future of supportive housing in Maryland, Councilwoman Odette Ramos offered a reminder of what is ultimately at stake:
“If we can’t, as a society, provide the care and support to our veterans and those who need it most, we shouldn’t be here.”
Thank You to Our Partners and Sponsors
The Maryland Supportive Housing Forum would not have been possible without the support of our partners and sponsors. We extend our sincere gratitude to The Harry and Jeanette Weinberg Foundation and the Maryland Department of Housing and Community Development for their generous support and partnership in helping bring this first-of-its-kind statewide convening to life.
We also thank our sponsors for their commitment to advancing supportive housing across Maryland: Foliot Furniture, Southway Builders, Inc., Enterprise Community Partners, The Zanvyl and Isabelle Krieger Fund, Homes for America, LifeStyles, Inc., Jaydot, Blue Beacon Advisors, Amanda J. Harris Consulting, and Episcopal Housing Corporation. Their support and partnership helped create meaningful opportunities for learning, connection, and collaboration among leaders from across the state.
As Maryland continues to expand and strengthen supportive housing opportunities, the relationships built and ideas generated during this year’s Forum provide a strong foundation for future collaboration. We are grateful to every speaker, sponsor, planning committee member, and attendee who contributed their time, expertise, and commitment to creating a Maryland where everyone has the opportunity to thrive.
This August, supportive housing providers welcomed 21 policymakers for tours, conversations with residents, ribbon cuttings, and community events The visits were part of CSH’s inaugural Supportive Housing Week and gave members of congress and other public officials a closer look at how supportive housing works in the communities they represent. Across 11 states and more than 12 supportive housing communities, local partners showed how supportive housing can help people with disabilities find and keep stable homes, improve their health and independence, and stay connected to their communities. Local leaders in two communities announced proclamations recognizing the week.
One message remained constant and prominent throughout the week: supportive housing works.
Supportive Housing Works
At its core, supportive housing is a proven, cost-effective approach that helps people break cycles of homelessness and maintain stable housing. While every supportive housing community is unique, the goal is the same: helping people find and keep a home.
During the week, providers shared how supportive housing residents who have strengthened their health, made progress through treatment, gained independence, and built more stable futures. Communities showed how housing paired with services can help people remain housed and connected to their neighborhoods and support networks.
The week also highlighted the broader community benefits of supportive housing. Across urban, suburban, and rural communities, supportive housing developments demonstrated how investments in housing can create safe, thriving neighborhoods.
From newly opened developments to long-standing supportive housing communities, local organizations gave policymakers and community leaders a closer look at their work. The stories shared throughout the week reinforced a simple but important truth: when people have access to stable housing and the services they need, individuals and communities both benefit.
Communities Across the Country Opened Their Doors
Supportive Housing Week came to life through site visits, community celebrations, ribbon cuttings, and conversations with policymakers. The examples below represent just a few of the many events that took place during the week.
In Pennsylvania, partners and community leaders visited supportive housing programs and discussed the role housing plays in helping individuals and families thrive.
In New York, policymakers and community leaders toured supportive housing communities in Westchester County and the borough of Brooklyn and engaged with providers and residents about the impact of housing with services.
In Nevada, community stakeholders toured supportive housing developments and learned more about efforts to address homelessness through housing and services.
In Illinois, providers welcomed visitors to supportive housing communities as part of broader Supportive Housing Week celebrations.
In Ohio and Kentucky, ribbon-cutting events highlighted new supportive housing developments and expanded opportunities for people with disabilities and others with complex needs.
A Bipartisan Show of Support
Supportive Housing Week brought together Republican and Democratic leaders at the federal, state, and local levels. Participants included members of Congress, congressional staff, mayors, and county leaders.
Their participation reflected a shared interest in how supportive housing helps people achieve stability. Local leaders in Kansas and North Carolina also issued proclamations recognizing Supportive Housing Week.
Partners Leading the Way
Supportive housing providers, developers, and community partners hosted events and shared stories, photos, videos, and resident successes that showed the impact of supportive housing.
Together, these efforts helped amplify a simple message: supportive housing works. CSH is grateful to every organization that participated and helped make the inaugural Supportive Housing Week a success.
Supportive Housing Week in the News
Supportive Housing Week generated attention from policymakers, housing leaders, and media outlets across the country. Highlights included:
SunHaven opens in Las Vegas as 50-unit supportive housing community (News 3 Las Vegas)
New Jersey Department of Community Affairs participates in Nationwide Supportive Housing Week to highlight the impact of collaborative housing initiatives (NJ DCA)
Rep. Mike Lawler tours Homes for Heroes in Tappan, New York during Supportive Housing Week (YouTube)
Community Block Party celebrates Supportive Housing Week in Illinois, bringing residents, providers, and community members together (Illinois Partners for Human Service)
Minnesota Senator Grant Hauschild attends Supportive Housing Week event in Grand Rapids, including a discussion with housing providers and a tour of Aurora Heights supportive housing community (Cook County News Herald)
Douglas County Kansas published a series of articles during the week to highlight programs and tenants thriving in supportive housing. (Douglas County Kansas website)
The Work Continues
Supportive Housing Week 2026 was designed to spark ongoing engagement between providers and policymakers, not just a single week of events. CSH encourages providers and partners to continue developing the relationships built through site visits and the community conversations to keep leaders connected to the housing needs and successes in their communities.
Save the date for Supportive Housing Week 2027 – August 23-27, 2027!
CSH is grateful to every provider, partner, resident, and public leader who helped make this first year a success and looks forward to building on this momentum in the years ahead. Thank you.
This Crosswalk examines how Illinois Medicaid services align with the supportive housing services needed to help people experiencing homelessness, housing instability, and complex health needs achieve long-term housing stability. The report analyzes existing Medicaid authorities, highlights promising opportunities within Illinois’ new 1115 waiver Housing Supports benefit, identifies remaining service and funding gaps, and offers recommendations to better coordinate housing, healthcare, and supportive services. Designed for housing providers, healthcare partners, policymakers, and advocates, the Crosswalk outlines practical strategies to expand supportive housing capacity and improve outcomes for Illinois residents with the greatest needs.
CSH applauds Governor Whitmer and the state legislature for their continued bipartisan support of this funding, which has delivered measurable results, helping more than 1,800 individuals secure and maintain housing while accessing supportive services.
Michigan Governor Gretchen Whitmer signed the FY27 state budget this week, which includes a $5 million investment in supportive housing services to help individuals and families achieve long-term housing stability. Administered by the Michigan Department of Health and Human Services, the funding will enable supportive housing providers statewide to add capacity and provide intensive, person-centered services to residents. Supportive housing combines stable, affordable housing with services for people with disabilities and long histories of homelessness. It is a proven, accountable, and cost-effective approach to lasting stability.
This funding follows previous appropriations totaling $31 million for supportive housing services between FY2023 and FY2026. The impact of that investment is measurable, transparent, and already evident: 98% of residents served through this funding have remained stably housed, and 63% have maintained or increased their income. These results show that when people receive the help they need, they can break the cycle of homelessness, achieve better health outcomes, and reduce reliance on costly public systems. State lawmakers are making public investments that produce lasting stability while reducing reliance on more expensive emergency and crisis services.
CSH thanks state Senators Jeff Irwin, Sylvia Santana, and Sarah Anthony, state Representative John Roth, and House and Senate leadership for their continued bipartisan support for this impactful investment.
CSH is also grateful to all the individuals and organizations in the state who have advocated for supportive housing, in particular, Avalon Housing, Communities First, Faith in Action, Goodwill of Northern MI, ICCF Community Homes, and Room at the Inn, all of which hosted tours for legislators this year or provided committee testimony.
“Every dollar Michigan invests in supportive services goes toward something measurable: helping people obtain stable housing and build healthier, more secure futures,” said Catherine Distelrath, Michigan Director at CSH. “We look forward to continuing our partnership with state leaders, providers, and advocates to expand these measurable results across the state.
On June 19th, just days before the 27th anniversary of the Supreme Court’s decision in Olmstead v. L.C., the Department of Justice (DOJ) issued a memo advancing an interpretation of the Olmstead decision that breaks from decades of established precedent. The memo questions whether the Olmstead decision requires states to serve people with disabilities in the most integrated setting appropriate to their needs. As the DOJ acknowledged, the new interpretation is out of step with how federal courts have understood Olmstead since 1999.
CSH is deeply concerned about this departure. Defending and advancing Olmstead is central to our work. The core principle— that people with disabilities should be able to live, work, and thrive in the community of their choice — is the foundation of supportive housing. At its heart, Olmstead recognized that no one should be cut off from their families, friends, and people they love simply to receive the care they need.
Olmstead has shaped how states support people with disabilities for nearly three decades. Courts across the country have consistently affirmed its core principle: that unnecessary isolation is a form of discrimination. That principle has guided state investment and practice. It has moved systems toward community-based housing and services that help people achieve stability, health, and independence.
This does not mean that treatment and housing are at odds. Some people, at some point in their lives, need intensive clinical care, including time-limited stays in hospitals or residential settings. A strong system includes that full continuum, but those settings work best as a bridge to stable community living, not a substitute for it. The choice is not between treatment and housing. Both are essential, and neither works in isolation.
The harder truth is that legal standards are only part of what stands between a person and a life of their choosing in the community. America faces a severe shortage of affordable housing and wide gaps in access to care. Efforts to expand access to evidence-based treatment supports, particularly community-based models, would be more effective than focusing on compelling services that simply are not available. These realities do more than any legal interpretation to determine whether someone with any disability including serious mental illness stays housed or falls into homelessness. Without a stable home, too many people either languish in institutional care or leave institutional care only to cycle back through emergency rooms, shelters, and jails.
Our FUSE work had demonstrated for more than two decades that when communities prioritize intensive services with housing, even people with the most complex needs find stability and recovery while communities enjoy reduced homelessness and costs associated with institutionalization.
North Carolina shows what is possible and what it takes to ensure that people have freedom of choice and the opportunity to thrive. Before 2012, the state relied on large, segregated adult care homes to serve people with serious mental illnesses. Those conditions resemble what this memo would now treat as legally acceptable. The DOJ found that this reliance violated the ADA and Olmstead, and that the resulting agreement required the state to build supportive housing and community-based services.
Building that capacity took the state more than a decade, several extensions, and sustained public investment, and the work continues today. The work required new levels of cross-sector collaboration between the housing and health sector state and community leaders. That investment has helped thousands of North Carolinians leave institutional settings for homes of their own.
The DOJ memo targets the very tool that drove progress. North Carolina’s problem was a shortage of housing and services. The legal expectation to integrate is what finally pushed the state to address the shortage. Removing that expectation, while the capacity gap remains, abandons people in the middle of a transition that is finally helping them.
Stepping back from community-based housing and services will push more people, and more cost, onto public systems. Institutional and crisis care is much more expensive than supportive housing, by many estimates more than three times as much per person. Without stable housing to exit to, that spending recirculates through repeated hospitalizations, law enforcement contacts, and time in jail, with little lasting stability to show for it.
The evidence of the last quarter century points in one direction. Supportive housing and community-based care improve health, strengthen communities, and reduce reliance on costly crisis systems. As policymakers and state leaders study this memo, the strongest path forward is to follow the evidence and build on community integration for people with disabilities by: expanding supportive housing, strengthening access to mental health and substance use care, and ensuring a full continuum of support that meets people where they are.
CSH remains committed to working with federal, state, and local partners so that every person has access to safe, stable housing and the support they need to thrive in the community.
Since 2020, CSH has used our Los Angeles Supportive Housing Loan Fund to test an important question: Can modular construction meaningfully reduce the time and cost required to deliver supportive housing at scale?
This work began in response to the City of Los Angeles’ 2019 Housing Innovation Challenge, a $120 million initiative designed to encourage new approaches to accelerate housing production. CSH partnered with BlueHub Capital to support this effort, providing acquisition, predevelopment, and construction financing for a pipeline of modular projects. Along the way, we have not only deployed capital, but we have also refined how we underwrite modular deals and learned what it takes to make these projects successful.
Since 2020, CSH has invested over $23 million in predevelopment, acquisition and construction financing for developments using modular construction methods.
A Portfolio Designed to Test Innovation
From 2020 through 2025, CSH supported a cohort of modular developments across Los Angeles County. Projects were initially selected based on strong financing and support from the City of Los Angeles.
Over time, the cohort showed that the greatest time and cost savings were achieved by projects that combined streamlined financing, standardized design, coordinated permitting and expediting, and experienced development teams. These outcomes were often reinforced through collaboration and replication: shared project teams, cross-site coordination, and financing partners working across multiple deals to reduce complexity.
Two projects in particular demonstrate how these factors translate into measurable results.
Project Spotlight: Western Landing
Harbor City, CA | 81 units
Western Landing, developed by Abode Communities, represents one of the strongest examples of modular success within the portfolio.
CSH investment: $5.6 million (acquisition & predevelopment, with BlueHub Capital)
Construction timeline: 16 months
Total development cost: $49.7 million (~$613,580 per unit)
Abode Communities’ second modular project, Western Landing benefited from lessons learned on earlier developments. By maintaining alignment across the design team, manufacturer, property management, and service delivery partners, the project achieved both time savings and cost efficiencies, helping establish a replicable model for future developments.
Project Spotlight: Sherman Way
Los Angeles, CA | 64 units
Sherman Way, developed by LA Family Housing, followed a similar approach and achieved similarly accelerated timelines.
CSH investment: $5.8 million (acquisition & predevelopment, with BlueHub Capital)
Construction timeline: 16 months
Total development cost: $46.3 million (~$723,438 per unit)
Status: Lease-up, with grand opening expected Fall 2026
The project was initially designed to mirror Western Landing’s model, using the same design team and modular manufacturer. However, when the original manufacturer underwent internal restructuring, the development team pivoted quickly to a new partner to maintain momentum.
This experience highlights both the flexibility required in modular development and one of the sector’s key risks: manufacturer instability.
What Worked: Early Signals of Success
Since 2020, CSH has underwritten 14 loans across 12 modular developments in Los Angeles County, deploying capital at multiple stages of the development lifecycle. This includes 10 acquisition and predevelopment loans to help projects get off the ground, as well as 4 construction loans to address late-stage financing gaps driven by rising costs. To date, 8 of the 12 projects have been completed, delivering 468 units of affordable and supportive housing, providing an early but important proof point that modular construction, when paired with the right financing, local permits coordination, and partners, can help bring housing online more quickly.
Across the portfolio, several consistent themes emerged:
Accelerated construction timelines
Several projects reduced construction to approximately 16 months, compared to the typical 18–24 months for similar developments.
Shortened predevelopment phase
Timelines were compressed to roughly 22 months, versus 36 months or more, due to early-stage financing, upfront modular deposits, and coordinated project planning.
Strategic use of early capital
Access to acquisition and predevelopment financing enabled developers to move quickly, while funding for modular deposits helped expedite manufacturing and construction timelines.
System-wide coordination improved efficiency
Alignment across developers, lenders, and City agencies—particularly around permitting and design approvals—helped projects advance more quickly.
New financing tools unlocked progress
The creation of new financing tools helped address a critical early barrier to modular development. CSH’s Supportive Housing Loan Fund, alongside LA LISC’s Modular Housing Fund (developed with philanthropic partners), provided early-stage capital for land acquisition, pre-development activities and modular deposits, giving construction lenders time to get comfortable and allowing projects to move forward during predevelopment.
While these outcomes demonstrate the potential for modular construction to accelerate housing delivery, they were made possible in part by critical early interventions led by CSH and CDFI partners, including LA LISC. These efforts helped fill key financing gaps and de-risk projects at pivotal moments. At the same time, this work has surfaced important lessons about the risks and complexities that must be addressed to scale this approach effectively.
What We Learned: Key Risks and Considerations
While modular construction shows real promise, our experience also underscores that it introduces new complexities. These lessons are now central to how CSH evaluates and structures future investments.
1. Manufacturer Stability Is a Systemic Risk
One of the most significant challenges we observed was the instability of modular manufacturers.
A major California manufacturer underwent a structural transition during the development of one of our projects, forcing teams to pivot midstream. More broadly, modular factories often struggle to remain financially viable without a steady pipeline of projects, which can lead to closures, restructuring, or changes in delivery timelines.
CSH now places greater emphasis on:
Evaluating manufacturer pipelines and financial health
Understanding production capacity and backlog
Assessing contingency plans if a manufacturer fails to deliver
Encouragingly, California policymakers are considering proposals to create insurance backstops for factory-built housing, which would help mitigate this risk at a system level.
2. Coordination Across Teams Is Critical
Modular construction requires a higher degree of coordination than traditional building.
Developers consistently cited misalignment between design teams, manufacturers, and general contractors as a top challenge. Because modular units are fabricated off-site while site work occurs simultaneously, any disconnect can result in delays or costly redesigns.
The strongest-performing projects:
Used teams with prior experience working together
Integrated modular considerations into design from the outset
Maintained clear communication across on-site and off-site workstreams
As a result, CSH now requires more detailed vetting of team experience and works closely with developers to strengthen team composition during underwriting.
3. Storage and Transportation Risks Must Be Managed
Three projects in the portfolio experienced water damage to modular units during on-site storage, before roofing systems were installed.
These incidents:
Triggered millions of dollars in insurance claims
Delayed construction timelines
Highlighted vulnerabilities during the period between delivery and installation
Projects that successfully avoided these issues planned for:
Robust waterproofing strategies
Efficient sequencing to minimize onsite exposure
Clear protocols for transport and storage
Going forward, CSH works with developers to evaluate these logistics early in the process.
4. Permitting and Inspections Are Improving—But Still Evolving
All projects in this portfolio were in Los Angeles, providing a consistent regulatory environment, but also revealing how local processes are still adapting to modular construction.
Positive developments include:
Increased familiarity among city departments
Faster inspections as agencies gain experience
State-level support through California’s Factory Built Housing Program
At the same time, developers continue to face:
Inconsistent interpretations of building codes
Delays tied to inspection coordination
In response, California has introduced several policy proposals aimed at:
Standardizing building code interpretations statewide
Allowing developers to use state-certified inspectors
Aligning local requirements more closely with state standards
5. Insurance Costs Are Rising
Insurance has emerged as a growing cost pressure across all affordable housing, but particularly for modular projects.
Builder’s risk insurance has become:
More expensive
More difficult to obtain
This is largely due to concerns about water damage and construction-phase risks. Projects must now:
Budget for higher premiums and deductibles
Plan for potential delays tied to claims
Engage insurers early in the development process
Looking Ahead: Policy Momentum and Market Potential
California continues to position itself as a leader in housing innovation. As of 2026, policymakers are advancing a suite of proposals to support factory-built housing, including:
Standardizing building codes across jurisdictions
Reducing module transportation costs
Expanding access to experienced inspectors
Creating insurance protections tied to manufacturer risk
Aligning state funding programs with modular development needs
These efforts reflect a growing recognition that, while modular construction is not a universal solution, it can play a meaningful role in addressing the state’s housing shortage.
Five years into this work, one conclusion is clear: Modular construction can deliver real time savings, but only when supported by strong partnerships, coordinated systems, and proactive risk management.
For CSH, these lessons are already shaping how we invest, ensuring that future projects not only move faster, but are also better positioned to succeed.
This paper published with the generous support from The Harry and Jeanette Weinberg Foundation shares critical information about the Home and Community Based Services (HCBS) program and how it can boost ‘services’ in supportive housing. HCBS services help individuals live comfortably in their own homes, despite challenges commonly faced by people with disabilities and all of us as we age. HCBS will be an essential supplementary resource to help supportive housing tenants thrive in their community at all ages.
The number of older adults in New Jersey is steadily growing, yet the demand for affordable, accessible housing and services far outpaces the supply. Our report, “Assessing New Jersey’s Need for Supportive Housing for an Aging Population,” examines how many additional units of supportive housing the state currently needs to meet the demand. It also highlights the demographics of those in need of supportive housing, and the specific needs of each population.
This guide is for anyone who will be renting an apartment for the first time. The information here is intended to make the transition to this new lifestyle easier. In this guide book you will find helpful tips on apartment living like housekeeping issues, keys to a successful relationship with your landlord and other resources.
