Washington State Moves Forward to Help People with Pressing Health & Housing Needs

Vulnerable residents in Washington State received welcomed news this week when the federal government provided preliminary approval for the use of Medicaid dollars to create a supportive housing services benefit as part of an 1115 Waiver, effectively expanding opportunities to help people with the most complex health care and housing needs to access and remain in housing. WA_MAP_BLANK_BLUE

“In August of 2014, CSH, in partnership with the Washington Low Income Housing Alliance, issued a call to action encouraging states to apply to the national Centers for Medicare and Medicaid Services (CMS) to include supportive housing services in their state Medicaid programs,” said Deborah De Santis, President and CEO of CSH. “CMS last year publicly indicated that pre-tenancy and tenancy-sustaining services can and should be part of state Medicaid programs. Approving Washington State’s request this past Monday now backs up these words with concrete action that will make a difference in the lives of thousands of Washingtonians and pave the way for all states to create supportive housing services benefits.”

Supportive housing offers the most vulnerable people, including those experiencing homelessness, access to affordable rental units and services to keep them housed and healthy. A lack of reliable financing for the services in supportive housing has been identified as one of the biggest barriers to ending chronic homelessness in Washington State and throughout the country.

“This benefit will help bring the services to scale that are necessary for people experiencing chronic homelessness to access housing stability and better health,” said Kate Baber, Policy and Advocacy Specialist, Washington Low Income Housing Alliance.

By authorizing what is known as Washington State’s five-year demonstration waiver, CMS is allowing the State to establish a benefit to provide the core services in supportive housing so that it will be far less likely residents are turned away from key services because providers lack resources.

“It gives service providers an essential tool to expand or enhance what they are doing to create supportive housing,” said Debbie Thiele, Director of CSH National Consulting Team, who is based in Washington State. “Having a place to live is paramount for establishing stability for anyone, and tenancy-support services ensure that the most vulnerable people succeed in housing. Finally having the revenue to pay for these services will provide a platform from which people with the greatest needs can rebuild their lives.”

Thiele specifically called out the efforts of multiple partners in Washington State, specifically the Washington Low Income Housing Alliance, for generating the advocacy needed to produce state-wide support for the benefit and the State of Washington, for delivering the newly-approved waiver.

“The Alliance recognizes the integral role these services play in preventing people from re-entering homelessness, and their work on the ground was critical to the formation of the request and in convincing the State to submit the waiver application to CMS,” she said.

Show Me Healthy Housing Update

The Missouri Foundation for Health pilot program Show Me Healthy Housing continues to expand in size and scope. The effort provides funding to health-related nonprofit agencies for the construction of housing as well as the provision of case management and health care services for their clients. This project is based around the concept of supportive housing, a strategy which is growing in popularity, especially after high-profile successes in places like Utah.


The philosophy of supportive housing, which combines affordable housing with supportive services for individuals with one or more health conditions, is showing great promise in reducing Medicaid costs and improving health outcomes.

For the first time in the Foundation’s history, they have created a program-related investment (PRI) to help fund some of the work of their Show Me Healthy Housing partners. A PRI is a loan (at or below market rate) used to finance projects that might not come to fruition otherwise. PRIs offer certain benefits that regular grantmaking does not. Advantages include helping nonprofits establish credit, offering them experience with financial management, and attracting additional lenders to their projects. Not only that, since the loans are eventually repaid to the lending foundation, the money can be “recycled” to help even more people.

The Foundation’s $1.5 million, five-year PRI was given to the Corporation for Supportive Housing (CSH), a national nonprofit community development financial institution recognized for expertise in supportive housing and lending, to fund pre-development loans for nonprofits building supportive housing. The new Show Me Healthy Housing Loan Fund is combined with approximately $4 million that CSH set aside for work in Missouri.

CSH is an established partner in the Foundation’s supportive housing work, having joined forces to create the inaugural Missouri Supportive Housing Institute in 2015. During the four-month program, four nonprofit organizations met to learn and collaborate as they developed a detailed supportive housing plan to serve their target populations. In May of 2016, one of the participating groups, Gateway Housing First, became the first recipient of funding from the Show Me Healthy Housing Loan Fund.

Funding for Gateway Housing First will go toward the creation of Nathaniel Rivers Place, 32 proposed apartments that will offer permanent, affordable supportive housing for people with disabilities, serious health conditions, and histories of homelessness in St. Louis. It will include five separate buildings – one multi-family building containing 24 units of one- and two-bedroom apartments, common spaces, offices, and space to provide services. Across the street, there will be four duplex-style buildings, containing eight three-bedroom units.

“Both the institute and the loan fund are already helping build capacity in the supportive housing field in our service area,” explained Jean Freeman-Crawford, a program officer at the Foundation. “We worked to establish a pipeline where nonprofits learn how to create supportive housing at the institute, and then can obtain financing for that project from the loan fund. That pre-development financing is a critical need, especially for those nonprofits who have never previously built supportive housing.”

In addition to CSH’s supportive housing investments in our region, we will collaborate with the Foundation again in 2017 with an expanded Missouri Supportive Housing Institute. Thanks to new partnerships in its second year, the institute will accept participants from anywhere in Missouri, not just in our service area. The Institute is tentatively scheduled for March through June of 2017 in Jefferson City. Join our mailing list to keep up with this and other upcoming MFH opportunities.

Nina Mason Pulliam Charitable Trust

SiNMPCTLogoWEBnce 2012, the Nina Mason Pulliam Charitable Trust has been a valuable partner with CSH, bringing hope to vulnerable people in Arizona and Indiana.

The Nina Mason Pulliam Charitable Trust seeks to help people in need, especially women, children and families; and to enrich community life in the metropolitan areas of Indianapolis and Phoenix.

Three of their grants awarded to CSH underpin our collaboration with the Valley of the Sun United Way, and its community partners in Phoenix, to create and manage up to 300 supportive housing units for chronically homeless individuals. The Valley of the Sun United Way committed to developing a total of 1000 supportive housing units, and thanks to partners and supporters such as the Nina Mason Pulliam Charitable Trust, they are nearly three quarters of the way to achieving their goal. Hundreds of formerly chronic homeless individuals in Phoenix now have a safe place to call home and are on the path to regain stability and independence because of this progress.

In Indianapolis, a grant awarded to CSH from the Nina Mason Pulliam Charitable Trust in 2015 helped ensure the opening of Penn Place, a 38-unit supportive housing apartment complex that serves people facing chronic homelessness and those who are frequent users of emergency, crisis services.

At Penn Place, the most vulnerable are housed first and surrounded by the support services they need to manage chronic health conditions, including mental health and substance use, navigate the red tape involved in getting veterans benefits or other entitlements, and learn how to live in a community setting again, with its rights and responsibilities. Because housing at Penn Place is used as a platform for recovery and well-being, there are on-site clinics operated by Eskenazi Pedigo Health Center and Midtown Mental Health.

Penn Place incorporates the harm reduction approach, which helps residents of supportive housing reduce the harm associated with risky activities by incorporating practical techniques and strategies. While it is most often associated with substance use, harm reduction encompasses a wide range of recovery-oriented goals. While many conventional shelters or housing have rigid intake processes focused on “screening out” residents, harm reduction in supportive housing emphasizes inclusive, direct access to a home, switching the emphasis from program-centric to person-centric.

The coordinated care found at Penn Place and in the supportive housing in Phoenix gives the residents the best chance for success by addressing the root causes of their homelessness in a safe, stable environment, providing them a firm foundation for recovery.

Thanks to generous investments from the Nina Mason Pulliam Charitable Trust, new supportive housing units in Phoenix and Indianapolis are becoming the homes people have hoped for and changing the trajectory of their lives.

Using Medicaid to Pay for Services

We are excited to introduce a new resource on Medicaid that outlines basic steps Continuum of Care (CoC) leads can take to advance their efforts to secure Medicaid as a resource as part of the local system of services. Using Medicaid to Pay for Services in PSH: Steps for CoC Leads to Get Started was created by the National Alliance to End Homelessness in conjunction with Technical Assistance Collaborative (TAC) and CSH.


Medicaid is very complicated. For those in the housing world it is important to become conversant enough in Medicaid without having to become an expert. So what should you know?

  • Securing Medicaid resources is worth the effort. Yes it is complicated and it will not pay for everything but it can make a big difference and the process to restructure Medicaid can form some important partnerships along the way.
  • You can still use Medicaid to pay for services even if you are not in an expansion state. Medicaid expansion allows for more people to have health insurance but states can seek new authorities to allow them to cover more people and more services even without expansion.
  • Everyone has a part to play. There are lots of things everyone can be doing to help this effort, whether you are a case manager, program manager, or CoC lead. Our new resource covers what each of these positions can do to further efforts to incorporate Medicaid funding into their system of services.
  • Find a local expert. Medicaid differs by state making it difficult to outline all the facets of this insurance program in a guide. We have laid out the important questions to ask of your state’s Medicaid program and it will be most useful to you to find a local expert to help you answer these questions.

Read Using Medicaid to Pay for Services in PSH for more information.

MA Pay for Success Milestone

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

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

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

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

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

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

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

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

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

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

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

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

Colorado Medicaid Academy Kicks Off

Last week in Denver, the Office of Colorado Governor John Hickenlooper opened the state’s Medicaid Academy with CSH as the trainer of 11 Supportive Housing agencies. In order to leverage existing resources, CSH is helping supportive housing providers in Colorado understand and navigate the requirements of becoming Medicaid billers through the behavioral health system. Colorado Medicaid Academy

The majority of individuals who need and do not yet have supportive housing in Colorado are homeless and/or living in institutions. Most have behavioral health care needs and lack access to preventative and ongoing healthcare services. The health care that is most accessible to them is often in the form of expensive, emergency responses that have high costs and don’t result in long-term health improvements. As a result, state Medicaid costs go up, and people with housing instability and the most complex health conditions continue to have unmet needs.

Supportive housing service providers in Colorado know supportive housing is the solution. These providers help people access and remain in housing. Supportive housing is a platform from which people can access and receive the services they need to stabilize their lives.

Nearly everyone who needs supportive housing in Colorado is now Medicaid-eligible as a result of the state’s Medicaid expansion.

The Centers for Medicare and Medicaid Services have identified housing stabilization services as eligible services under Medicaid. Supportive housing service providers in Colorado want to learn to provide and document supportive housing services in a way that is covered by Medicaid. Doing so will both increase their ability to serve more people and allow the state and behavioral health managed care organizations to provide additional strategic interventions for people with the greatest needs.

Becoming a Medicaid biller requires agencies to align the work they do with strict requirements related to service-delivery and documentation. Through the Academy, CSH is training supportive housing providers on the technical aspects of billing Medicaid to ensure they have the capacity to expand and enhance the delivery of supportive housing services.

The Colorado Academy opening included two days of in-person training last week. Going forward, it will consist of five online self-paced, tutorials, two additional days of in-person training in late September, and likely one or more additional sessions in November and then February 2017. The Academy also includes agency-specific one-on-one technical assistance provided by CSH.

Learn more (read background materials by clicking links below):

Colorado Medicaid Crosswalk

Colorado Crosswalk: Services Preventing Homelessness

Colorado Crosswalk: Expanding & Improving Services

Medicaid Crosswalk Released for Pennsylvania

Housing as Health

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

To this end, CSH has worked in many jurisdictions, including Pennsylvania, to maximize use of Medicaid resources for services. In an effort to increase the availability of services to formerly homeless Pennsylvanians and expand access to supportive housing, the PA Housing as Health Coalition partnered with CSH to explore ways to make intense services like substance use treatment and mental health recovery more available and accessible. The CSH Pennsylvania Medicaid Crosswalk provides the State, managed care entities, and service providers with a valuable tool that could help them access additional resources to support programs that are proven to help those experiencing homelessness attain stability and life-long success. Read the blog about the Crosswalk posted by the Pennsylvania Health Access Network.

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

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

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

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


Pennsylvania Medicaid Supportive Housing Services Crosswalk

As evidence continues to establish supportive housing as an intervention that stabilizes people with chronic illnesses, providers and states are exploring ways to ensure Medicaid programs cover the services that supportive housing residents need. To this end, CSH has worked in many jurisdictions, including Pennsylvania, to maximize use of Medicaid resources for services. In an effort to increase the availability of services to formerly homeless Pennsylvanians and expand access to supportive housing, the PA Housing as Health Coalition partnered with CSH to explore ways to make intense services like substance use treatment and mental health recovery more available and accessible. The newly released Pennsylvania Medicaid Crosswalk provides the State, managed care entities, and service providers with a valuable tool that could help them access additional resources to support programs that are proven to help those experiencing homelessness attain stability and life-long success. Read the blog about the Crosswalk posted by the Pennsylvania Health Access Network.

CSH & Partners to NY: Expedite Plan to Create Affordable Housing

Dear Governor Cuomo, Majority Leader Flanagan and Speaker Heastie:

Our coalition of New York’s leading housing organizations applaud your recent approval of nearly $2 billion for affordable housing in the 2016-2017 state budget. Your commitment was a powerful step in advancing the State’s unprecedented $20 billion plan to build and preserve affordable housing and combat homelessness.

We are also writing to urge you to expedite the disbursement of this new budget funding, including the housing funding subject to a memorandum of understanding to be agreed upon by you, in order to address the affordable housing crisis that affects millions of New Yorkers.

New York’s housing crisis is becoming more urgent with each passing day. More than half of renters across the state are rent-burdened and pay more than 30 percent of their income on housing costs.  More than 80,000 New Yorkers are homeless on any given night and many are in desperate need of supportive housing to achieve housing stability. The statewide senior population is expected to increase by 40 percent by 2040 and hundreds of thousands of seniors are already severely rent-burdened. The foreclosure crisis has resulted in tens of thousands of foreclosures in New York State and still more homeowners are struggling to make monthly mortgage payments.

Our coalition stands ready to partner with you to ensure these funds are used expeditiously and cost-effectively to address this crisis, especially for low- and middle-income housing, supportive housing and senior housing programs across the state. We welcome the opportunity to work with you to develop a comprehensive action plan for the new budget funding as quickly as possible.  The sooner we put together a plan, the sooner those resources can be put to work in communities that need them the most.

While we appreciate that there are many issues to be considered prior to the conclusion of the legislative session, we believe housing is a fundamental need critical to our economy and the welfare of all New Yorkers, especially vulnerable populations of children, seniors and low and middle income families. Due to your recent historic commitment of State funding, we know you agree, and we look forward to working with you to quickly put this funding to work to address New York’s housing crisis.

Thank you for your strong support for affordable housing. If you have any questions, please do not hesitate to contact us.


NY Plea Logos










Subcontracting Opportunity: Coordinated Access System Navigation in Chicago

Due May 11, 2016


CSH is seeking subcontractors to provide support to Veteran households and households experiencing chronic homelessness in need of coordinated access system navigation support. Subcontractors provide direct services to households that have been assessed with a coordinated access tool and matched to a permanent housing provider. The System Navigators (SN) will work collaboratively with the Ending Veterans Homelessness Initiative (EVHI) and partners to implement strategies to end veteran homelessness by the end of the year. SN may also provide support to initiatives ending homelessness for vulnerable populations.  Funding is provided by the United States Department of Housing and Urban Development’s Emergency Solutions Grant Program through the Chicago Department of Family and Support Services.

Planned Activities

  • Search for and engage households who have been assessed and received a housing match.
  • Provide support to households in meeting housing provider requirements, inclusive of attending housing intake meetings, attainment of homelessness and/or disability documentation.
  • Complete coordinated access assessments, as needed.

Expected Deliverables

Deliverable 1: Provide system navigation activities to homeless households with a housing match.

Deliverable 2: Participate in system integration team meetings and work collaboratively with initiative partners.

Deliverable 3: Maintain and report data on system navigation activities.

Funding Available

A total of $300,000 is available for this project. Subcontracts will not exceed $100,000 and will have an end date of December 31, 2016. Agencies may include expenses for travel and equipment. Subcontractors will bill CSH at an hourly rate, not to exceed $125/hour.  No increment above cost can be included in the hourly rate provided to CSH and the hourly rate must be consistent with the best (lowest) customary rate that has been negotiated with other clients.  Selected subcontractors will be required to provide evidence of past compensation consistent with the rate provided to CSH.

Application Process and Vendor Requirements

Agencies will need the capacity to enter and receive information from Chicago’s Homeless Management Information System (HMIS). Training to selected agencies will be provided.

CSH will hold a Q&A session about this subcontracting opportunity on Wednesday, May 4th, 2016 at 1:00 pm. The session will be held at CSH – 205 W. Randolph, 23rd Floor; Chicago, IL 60606.

To apply for this opportunity email Christine Haley at christine.haley@csh.org for an application, and the application will be due on May 11th,  2016 at 5:00pm CST.

Applications received before the deadline will be evaluated based on the following criteria:

  • Demonstrated successful performance of substantially similar work
  • Relevant project work
  • Experience and expertise
  • Years of relevant experience
  • Rate reasonableness and overall cost of services

Please note that CSH requires subcontractors, including individuals and sole proprietors, to carry workers’ compensation insurance while performing work under a CSH subcontract. CSH subcontractors cannot have existing, pending or expired debarments that preclude them from doing business with the United States government and cannot have convictions for, nor have any pending indictments for, fraud or a criminal offense in connection with a public contract or subcontract.