Promoting Recovery & Housing Retention
Bringing Together Behavioral Health
& Housing Systems and Services
Jake Bowling, Assistant Vice President, Practice Improvement
The National Council for Behavioral Health
In 2015, Florida had a homeless population
of 41,542 individuals.
What do you hope to
learn today?
What Does it Take?
Housing Prep
Move-in
Maintenance
• How can we provide supportive services to
make it successful?
• What is a business model that makes those
services sustainable?
• What is our role in advancing supportive
housing?
• How do we get our clients into that housing?
What is Permanent Supportive Housing
http://www.thenationalcouncil.org/wp-content/uploads/2016/03/UsingMedicaid-to-Finance-and-Deliver-Services-in-Supportive-Housing.pdf
Policy Drivers
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Olmstead
Medicaid Expansion
1115 Waivers
1915 HCBS Waivers
1915b Waivers (Managed Care)
Health Homes
Rehab Option
Move toward PSH
Medicaid
• Main public health insurance program for lowincome Americans, covering 70 million lives
nationally
• Single largest payer for behavioral health services
in the U.S., covering a quarter of all addictions
services
• Jointly financed by federal government and states
• Mandatory and optional eligibility groups
(categorical eligibility)
Who is Covered by Medicaid?
• Low-income families with children
• Persons receiving Supplemental Security Income (SSI)
• Infants born to Medicaid-eligible pregnant women, birth
through age 1, if the woman remains eligible or would be
eligible if she were still pregnant
• Children under age 6 and pregnant women whose family
income is at or below 133% of Federal Poverty Level (FPL)
• Recipients of adoption assistance or foster care under Title IVE of SSA
• “Dual eligible” Medicare beneficiaries
• Special protected groups
Optional Eligibility Groups
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Medically Needy Groups
“Katie Beckett Option”
Pregnant Women with incomes 150-185% of FPL
Optional, targeted low-income children (state determines limit)
Individuals needing Hospice care (and up to 300% SSI benefit
rate)
“special income group”
Medicaid “buy-in program” (Ticket to Work)
Low-income Breast and Cervical Cancer Program treatment
recipients
State supplementary payment recipients
How to Apply for Medicaid
• Through the Marketplace
– The Marketplace will send information to state Medicaid
agency and they’ll contact individuals regarding
enrollment.
• Through State Medicaid Agency (SMA)
• Through Supplemental Security Income (SSI) Disability
– Some states trigger automatic Medicaid enrollment
– Some states guarantee Medicaid eligibility, but
beneficiaries must still sign up
– Some states do not guarantee Medicaid eligibility, but most
individuals on SSI qualify
Marketplace
• Commonly known as the “Exchange” or “Health Insurance
Marketplace”
• Authorized by the ACA
• Enrollment began in Oct of 2013, plans began in January of
2014
• A set of government-regulated and standardized health plans;
subsidies for low-income Americans
• Operated as a State-Based Marketplace, Federally-Supported
State-Based Marketplace; State-Partnership Marketplace, or
Federally-facilitated Marketplace
• Includes individual and Small Business Health Options
Programs (SHOP) Marketplaces
Who is Eligible for the Marketplace?
• Must live in the United States
• Must be a U.S. citizen or national (or be
lawfully present)
• Can’t be incarcerated
The “Medicaid Gap”
What barriers do you see to Medicaid enrollment
for individuals experiencing homelessness?
https://soarworks.prainc.com/
• Prevent churn by building strong protocols for re-enrollment
• Advocate for Medicaid suspension vs. termination for individuals who are
incarcerated.
https://aspe.hhs.gov/sites/default/files/pdf/77121/PSHprimer.pdf
Stages of PSH
Housing Prep
Move-in
Maintenance
Crosswalk
• What existing services do you provide that
incorporate these functions? What are the
provider and client requirements?
• Who is eligible for these services?
• Are there care coordination functions to “glue”
services together?
• What are the gaps and opportunities (e.g.
service type, categorical limits, time limits,
continuity issues)?
Potential Partnership Scenarios:
• PSH provider actually bills Medicaid directly (if
that provider has the business sophistication
and operations to do so).
• PSH provider works with the CBHO to serve as
a fiscal/administrative agent to bill through the
CBHO.
• CBHO partners with the PSH provider to
provide Medicaid billable services to the PSH
provider’s clients
What is a Continuum of Care?
A Continuum of Care (CoC) is a regional or local planning
body that coordinates housing and services funding for
homeless families and individuals.
Outreach, intake, and
assessment
Emergency shelter
Transitional housing
and supportive services
Permanent, affordable
housing
Strategy
• Who is your local Continuum of Care?
• Are you engaged in their planning efforts?
• Are you advocating for services that work for
individuals with behavioral health conditions?
• Is your local or state association at the table?
• Are there opportunities for partnership?
Understanding Housing Systems/Options
• HUD-funded Continuums of Care
(CoCs)
• Section 811, Section 8, HCV
• State and local housing trust funds
• LIHTC
• Inclusionary zoning laws
• BH residential systems
State Snapshots
• Ceased development congregate settings
• ACT and TCM
• CSS services added to state plan
• State-funded PSH program for
people with SUDs
• Supportive Housing Connection
• Considering 1115 waiver
State Snapshots
• Pennsylvania Housing Finance Agency
partnership
• Health Choices reinvestment funds
Talk about the critical link between housing and
recovery, and the business case for housing
services.
Understand your in-plan Medicaid benefits and
waivers and how they overlap with housingrelated services and supports.
Cross-walk current service array and services
eligible for reimbursement through Medicaid.
Get folks enrolled (and keep them enrolled) in
Medicaid.
Work with state Medicaid office to advocate for
waivers and other funding streams that expand
eligibility and services to individuals
experiencing homelessness.
Get at the table with your local continuum of
care and learn their language and processes.
Don’t stop at the Continuum of Care.
Understand other housing finance options, like
housing trust funds, housing finance
organizations, other HUD funding streams, and
your public housing authority.
Work with managed care entities and other
payers to reinvest dollars into
housing/homelessness services.
Get resources.
Be entrepreneurial and establish partnerships.
Thank You!
Jake Bowling, MSW
Assistant Vice President, Practice Improvement
jakeb@thenationalcouncil.org