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.

Dimensions of Quality Supportive Housing Guidebook

In creating and sharing the CSH Dimensions of Quality Supportive Housing, CSH strives to:

  • Build the capacity of the supportive and affordable housing industries to create and operate highquality,
    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

Integrated Healthcare & Supportive Housing: A Report on a PCDC/CSH Market Assessment & Convening

Poor health both contributes to homelessness and is exacerbated by prolonged periods of housing instability. Homelessness limits access to appropriate care, worsens pre-existing conditions, and adds new health challenges, causing many high-need homeless individuals to cycle between shelters, emergency rooms, hospitals, jails, and other institutions. Alternatively, supportive housing – affordable housing coupled with supportive services – is proven to help vulnerable people stay housed, improve their health, and stabilize their lives. While there is a robust body of literature that points to supportive housing’s efficacy, especially related to promoting housing stability, enhanced supportive housing models – linking supportive housing and community health providers – show even stronger outcomes, particularly around improving tenants’ health status and dramatically reducing their costly use of crisis and inpatient services. To address the specific challenges faced by chronically homeless and medically vulnerable individuals and families, FQHCs, hospitals, behavioral health providers, other health providers and health plans, are increasingly collaborating and forming new partnerships to more effectively coordinate client-centered, integrated healthcare in an effort to improve outcomes and reduce costs for supportive housing tenants.

With evidence of the effectiveness of the early health and housing coordination models, PCDC and CSH, collaborated to identify ways our resources and expertise can facilitate partnerships between FQHCs and supportive housing providers. With the support of The Kresge Foundation, we conducted an assessment of the environment in several states to determine the need and demand for lending or other financial tools to promote and expand FQHC coordination with supportive housing developments. To help identify ways our organizations can assist the field, we convened industry experts to explore both the challenges and the key factors that can foster greater opportunities for integration across the sectors. This report summarizes our findings.

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.

Health and Housing Partnerships: Strategic Guidance for Health Centers and Supportive Housing Providers

This paper offers strategic guidance in building, assessing and/or strengthening various types of partnerships between Health Center Program Grantees, behavioral health providers and supportive housing providers. Whether you represent one of these types of organizations or you are merely curious about health and housing partnerships, you can use this guide as your
roadmap.

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.

Health Outcomes & Data Measures: A Quick Guide for Health Center & Housing Partnerships

As more health centers look to establish partnerships with housing providers or even begin delivering services to residents in supportive housing , they are starting to look at which physical health outcomes to track as part of housing programs. This quick guide will help communities understand the key health conditions experienced by homeless individuals that may be positively impacted with stable housing and the data elements generally tracked within the homeless health and housing sectors. This guide is designed to increase familiarity with measures already being tracked, enabling health and housing partnerships to leverage existing data and reduce administrative burden related to developing new mechanisms to track and report data.