Emily Rosenoff, HHS ASPE COSCDA Meeting March 16, 2015.
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Chronic Homelessness, Medicaid and Permanent Supportive Housing Emily Rosenoff, HHS ASPE COSCDA Meeting March 16, 2015
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Transcript of Emily Rosenoff, HHS ASPE COSCDA Meeting March 16, 2015.
Chronic Homelessness, Medicaid and Permanent Supportive Housing
Emily Rosenoff, HHS ASPECOSCDA Meeting
March 16, 2015
Context and OpportunitiesStrong evidence base around PSHAffordable Care Act Greater focus on focusing on
high-needs/high-utilizersIncreased coordination between housing and
health
Not all chronically homeless individuals have equal access to Medicaid
Heterogeneous groupEligibility for programs varyEven within eligible groups, access to
services varies depending on conditionsEven with Medicaid expansion,
individuals will have differing access for certain services
Affordable Care Act Medicaid Expansions
Essential Benefits include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services laboratory services, preventive and wellness services, chronic disease management,
Many states using Medicaid state plans as their Alternative Benefit Plan.
Expansion benefit does not need to include home and community-based services or long-term care.
Other Affordable Care Act OpportunitiesHealth Homes1915i state plan home and community based
servicesAccountable Care Organizations and other
innovative service models
Options for Medicaid in PSH FQHCs providing services for PSH in some
communities, using both HRSA funding and Medicaid
Medicaid Rehabilitative ServicesTargeted Case Management (TCM)Home and Community-Based Services
(HCBS)Health homesManaged care
Highlights from the Case StudiesHuge variation across communitiesMost PSH programs created without
Medicaid, there are opportunities to bring new funding into system
Even with Medicaid, still need additional funding to cover things that Medicaid can’t, including “glue” to link services and providers
ExamplesLouisiana:
Using 1915i for PSH for individuals experiencing homelessness and for individuals transitioning from institutions
LA County:With early Medicaid expansion, were able
to reinvest local (county) funds that otherwise would have gone to covering uncompensated care.
Recent documents:A Primer on Using Medicaid for People Experiencing Chronic Homelessness
and Tenants in Permanent Supportive Housinghttp://aspe.hhs.gov/daltcp/reports/2014/PSHprimer.pdf
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field
http://aspe.hhs.gov/daltcp/reports/2014/EmergPrac.pdf
Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People
http://aspe.hhs.gov/daltcp/reports/2012/ChrHomls4.pdf
Authors: Carol Wilkins, Marti Burt and Gretchen Locke
For more information
Emily RosenoffU.S. Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation (ASPE)
