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Develop a Housing and Health Care Strategy for Complex Care Population

These key considerations help build the foundational elements of an overall housing as health care strategy.
(Click on each heading below for strategy details.)

How can we create more supportive housing?
Identify state, federal, local, and other capital funds currently financing developments in the state.
Determine the number of existing PSH units in the state, populations served and services attached to those units.
Assess surplus/shortage of non-PSH affordable housing units statewide and whether vacant units can fill the gap.
Assess gaps between where the homeless complex care individuals are, where the PSH and affordable units are and where the units need to be.
Engage developers to assess challenges to building new units.
Capital Strategy
How can we subsidize those units?
Identify existing state, federal, local and other funds currently financing operating subsidies in the state.
Define gaps, limitations and underused resources that can be leveraged.
Work with team and key stakeholders to fill gaps and leverage underused resources (including local PHAs and HUD field office).
Operating Strategy
How do we increase access to services?
Determine service needs of the target population by mapping population to evidence-based practices.
Determine whether services are currently provided, and by which entity and where.
Determine gaps in: access to services; service/housing co-location; and providers needed.
Finalize which services Medicaid will cover28 vs. other financing strategies and who can bill Medicaid for those services.
Services / Provider Strategy
How will we pay providers for these services?
Optimize service financing strategy to understand what Medicaid and other sources cover.
Consider applicable CMS guidance29 (e.g., supportive housing, superutilizer) to guide services approach.
Apply for and receive Medicaid authority to reimburse the full range of support services.
Establish payment strategy (e.g. MCOs, BHOs, value-based purchasing, direct billing).
Payment Strategy
What policies can support this work?
Inventory inclusionary zoning30, rent-control and other affordable housing development laws.
Assess implications of Olmstead31 on program design and whether governor or mayors have created initiatives to end homelessness. Align32 and leverage existing resources and policies.
Align policy with complex care needs program policies.
Policy Strategy

Key Considerations

  • Are the housing and services application and eligibility process streamlined?
  • Does my plan fully comply with Fair Housing laws?
  • Do I have a robust stakeholder engagement process in my state for other initiatives, such as the State Innovation Model?
  • What is the level of political support in my state?
  • How much support is there to increase Medicaid expenditures?
  • Is there initiative fatigue?
  • Does my state have a cabinet-level agency on housing? Do I know the executive director of my state's housing finance agency?

Key Decision and Outcomes

  • Establishment of capital, operating, services, provider and policy strategies
  • Thorough identification of financial resources and physical infrastructure
  • Understanding of the geographic connect or disconnect among the homeless, housing units and services