Addressing Health Equity through Health and Housing Partnerships

This resource developed by CSH and the National Healthcare for the Homeless Council is intended to provide background information on health disparities, particularly for people of color, and the goal of health equity, with a focus on people who are experiencing or have experienced homelessness; explore how health centers and supportive housing providers, both of which target underserved populations and operate with holistic, client-centered approach to care, are uniquely positioned to advance health equity; offer suggestions for how health centers and supportive housing providers can work together and on their own to identify and address disparities and advance health equity.

While this paper will focus specifically on the roles of health centers and supportive housing providers, many suggestions can be generalized to other organizations in the health and housing fields, and there are roles for many other types of health and housing partners to play in advancing health equity.

Tri-County Equitable Housing Strategy to Expand Supportive Housing for People Experiencing Chronic Homelessness

This strategic plan provides recommendations to reduce chronic or long-term homelessness for people with complex health conditions through a scaled, blended service and housing system that provides flexible service dollars and ensures a stable, long-term stock of supportive housing adequate to meet the regional need in Clackamas, Multnomah and Washington Counties in Oregon and was made possible with financial support from Metro (www.metro.gov).

Download the companion Executive Summary here.

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In San Diego, there really is ‘No Place Like Home’

With the highest national percentage of homeless and four of its cities on the Top 10 most expensive list, California has the on-going challenge of meeting the emergency resource needs of those on the streets while increasing the availability of affordable housing for individuals and families on fixed or low incomes. San Diego, in particular, has a tight 3% vacancy rate with rents increasing by over 4% in a recent one month period. It has the second highest percentage of homeless in the state. With barriers like these, renters from all income levels find it difficult or near impossible to secure stable, permanent housing, and are looking for light at the end of the tunnel.

That light just may be No Place Like Home (Proposition 2), a $2 billion bond that successfully passed last November with over 63% of California voters supporting it. No Place Like Home will fund capital projects that include very affordable supportive housing units for homeless individuals and families with serious mental illness within small and large affordable housing communities, opening doors for permanent homes for a variety of San Diegans. The units funded through No Place Like Home will be located close to transportation and community-based services, and offer access to mental health programs appropriate to the level of need.

The funding for No Place Like Home is based on a formula factoring each county’s population and Point in Time Count, and in some cases the amount of households paying more than 50% of their income toward housing. With Proposition 2, San Diego County will stand to receive over $100 million in funds to create, rehabilitate or preserve supportive housing units. Development criteria for No Place Like Home communities and units follow similar standards established for the Mental Health Services Act housing program. Such requirements as limiting the number of program units within a development to ensure mixed population and mixed income communities, and prevent segregation of individuals with disabilities.

The need for supportive housing is clear and urgent with 29% of adult/older adults and 3% of children/youth/families connected to San Diego County's Behavioral Health Services reporting they are homeless.

For more information on No Place Like Home, contact Amaris Sanchez, Senior Program Manager in the CSH San Diego office, at Amaris.Sanchez@csh.org.

HUD Policy Brief on Data Matching: Understanding the Impact And Potential for Health Centers

Health centers are increasingly addressing the social determinants of health for their patient population through partnerships and linkages to local housing and service resources. In this continuous effort to improve health outcomes for patients, there are many resources that exist through partner federal, state, and mainstream infrastructures that should be part of a health center’s “toolbox” to aid in linking patients to local housing. Matching data from the homeless crisis response system to claims data from health centers is one way to identify and engage individuals in both systems who are experiencing homelessness and medically vulnerable. Health centers can be key partners in linking eligible individuals who are experiencing homelessness to sustainable affordable housing and providing integrated care.

A Quick Guide to Medicaid Waivers and State Plan Amendments

Medicaid is public health insurance. It pays for medically-necessary healthcare services. States provide Medicaid through a contract with the Centers for Medicare and Medicaid Services (CMS) called a Medicaid State Plan. There are specific federal guidelines that every state plan must include; however states may apply to CMS to create new benefits and serve specific populations under specific authorities called waivers and plan amendments. Many states are seeking waivers and/or plan amendments in order to pay for pre-tenancy and tenancy-sustaining services in supportive housing. This Quick Guide provides an overview of the Medicaid authorities most suitable for creating Medicaid Supportive Housing Services Benefits.

CSH tracks the progress of states that are pursuing and implementing Supportive Housing Services Benefits. Check out the federal and state policy section of csh.org/health for the latest updates

Using Medicaid to Pay for Services in Permanent Supportive Housing: Steps for CoC Leads to Get Started

The Homeless Systems and Continuums of Care have been focused on engaging mainstream resources. This “How To” guide offers a framework and concrete strategies for programs and COCs to consider Medicaid funding to sustain and expand their capacity in supportive housing.

This publication was co-authored with the National Alliance to End Homelessness and Technical Assistance Collaborative.

Standards for Quality Supportive Housing Guidebook

In creating and sharing the CSH Standards for Quality Supportive Housing, CSH strives to:

  • Build the capacity of the supportive and affordable housing industries to create and operate high quality,
    effective, and sustainable supportive housing units
  • Encourage the investment of adequate resources, especially from public systems, to support that
    capacity
  • Ensure that existing resources for supportive housing are being used efficiently and effectively,
    and support the allocation of new resources
  • Create better outcomes for supportive housing tenants, especially those with multiple barriers to
    housing stability

Health and Housing Partnerships: Overview of Opportunities and Challenges for Health Centers

This paper describes the existing barriers health center grantees face as they target  services to frequent users of other health systems and link them with housing. Our description of the barriers is based on what CSH has learned through years of creating supportive housing, with references to a range of papers documenting our work, combined with information gleaned from a recently performed needs assessment survey answered by health center staff and conducted through a National Cooperative Agreement (NCA) with the federal Department of Health and Human Services, Health Resources and Services Administration (HRSA). We believe it is important to articulate these issues so that over the next three years CSH can prioritize our work and measure progress as we improve health and housing coordination for the most vulnerable.

On the Ground Floor: Housing First Frequent Users of Health Systems Initiative Common Challenges & Promising Community Practices

In this brief, we document some of the common dynamics communities face when advancing supportive housing and health center partnerships that target homeless individuals who frequently use hospital and emergency departments for preventable reasons in four leading communities across the country: Los Angeles, CA (10th Decile Project); Camden, NJ (Camden Housing First Pilot); Orlando, FL (Housing the First 100); and Indianapolis, IN (Penn Place). In February 2016, CSH and the National Health Care for the Homeless Council (NHCHC) convened a virtual roundtable with these four communities.

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