1. Using Medicaid with HUD’s Homeless Assistance Programs
Roula K. Sweis M.A., Psy.D
Supervisory Program Advisor
HUD’s Office of the Assistant Secretary for
Community Planning and Development

2. Strategies for Coordinating and Integrating Medicaid Reimbursable Services with Homeless Assistance

4. Presentation Outline Overview of the H² TA Approach and Initiative
Onsite Action Planning Events
Framework Used to Structure Events
Tools and Handouts

5. Overview of the H² TA Approach
Data Analysis Identified Gaps and Challenges
2. Gaps and Challenges Pronged TA Proposal
Consultations on Proposal Finalized TA and Built Coalition
4. Implementation Constant Feedback Loop and Refinement

6. Data Analysis
Most CoCs (79% or greater) did not report a relationship with the federally-defined entities designated to support ACA implementation in local communities. The most commonly-reported relationship was with in-person assisters (IPAs), who are trained to help individuals enroll in ACA-related programs, followed by certified enrollment counselors (CECs). Least common was the use of Certified Enrollment Entities/Agencies (CEE/CEA) and federally-qualified health centers (FQHCs).

7. Data Analysis (Cont.)
More than half of all CoCs (59%) did not mention the use of Navigators in their responses to the ACA enrollment question. Of those who mentioned Navigators, most described a relationship of partnership between the CoC and a local or state organization who had one or more navigators. It was rare to find CoCs referring clients to navigators with whom the CoC had no relationship. Only a small number of CoC-funded agencies (32) were home to ACA navigators.

8. Data Analysis (Cont.)
Very few CoCs reported planning or providing training for their staff or their clients to prepare for ACA enrollment. In addition, about 10% of CoCs reported receiving training through a mandatory state-driven training mechanism, and in most of these cases (9% of the 10%) this was the only ACA training the CoC members received. Almost no CoCs (96%) reported planning or holding trainings for their clients and just over two-thirds of CoCs (68%) made no mention of training their agencies or staff to prepare for ACA implementation.

9. Data Analysis (Cont.)
The most common enrollment strategy utilized by CoCs was referral to an outside agency that specialized in ACA/medicaid enrollment. About 20% of CoCs (82) were not able to articulate any strategies being used to enroll clients in ACA coverage. Not surprisingly, most of these CoCs (52%) came from non-expansion locations.

10. Data Analysis (Cont.)
The most common community strategies for enrolling clients in ACA services were using existing public health or social service entities(e.g., hospitals, clinics, Social Security), followed by having public events such as enrollment fairs and training other local human service providers to assist with the enrollment process.

11. H² - A 5 Pronged TA Initiative
Listserv Messages and ACA Website Enhancement
Webinars
Homeless & Healthcare Systems Integration Action Planning Sessions
Assessment (Case studies/tools and products for widespread
dissemination)
Health Insurance Data Collection & Quality Improvement

12. Framework Used to Structure Events
Five Healthcare Related Model Strategies to Consider in Developing an Action Plan:
Enrollment: Facilitate enrollment of people who are homeless and at-risk in Medicaid;
Access: Facilitate access to care, engagement with providers, and appropriate use of health services;
Integration: Integrate housing, health and other services to facilitate housing retention and ongoing wellness;
Data: Develop data-driven service interventions targeted to priority sub-populations;
Resource Maximization: Maximize use of Medicaid to finance homeless housing and services, including PSH and recuperative/transition care.

13. Framework Used to Structure Events
Cross-Cutting Issues to be considered as part of the implementation:
Training: What training will be needed for staff?
Partnerships: What partnerships are needed and how can they be forged?
Targeting: Should particular sub-populations be targeted and how should they be identified?
Scale: What will be needed to bring the strategy to a scale appropriate to meet the need?
Systems: How can individual programmatic efforts be aligned into a unified system working toward shared outcomes?

14. Action Planning Schedule
Pilot Sites: State of Nevada; State of Virginia
Utah: March 4-5
Connecticut: March 18 – 19
North Carolina: April 28 – 30
New Mexico: May 13 – 14
Idaho: May 27 – 28
Tennessee: June 9-10
Chicago, Illinois: July 8-9
Texas: TBD

15. Tools and Handouts Overview of On-Site Action Planning Session
Agenda Topics for Action Planning Sessions
Model Strategies Checklist
Stakeholder Outreach List

16. Resources HUD https://www.hudexchange.info/aca/ CMS
Medicaid and Chip basics:
Supporting enrollment efforts:
ASPE
Let’s Get Everyone Covered:
HRSA
Find a health center:
SAMHSA
Homeless and Housing Resource Network (HHRN):
SOAR works:
Administration for Children and Families:
Information on youth accessing healthcare:

17. Resources (Cont.)
National Health Care for the Homeless Council NHCHC outreach information: NHCHC enrollment toolkit: NHCHC training website: NHCHC website including policy briefs: Families USA State private insurance checklist: Medicaid Expansion helps low-wage workers:

18. Questions/Comments
Roula K. Sweis HUD – Community Planning and Development Supervisory Program Advisor