1. Emily Rosenoff, HHS ASPE COSCDA Meeting March 16, 2015

2. Context and Opportunities Strong evidence base around PSH Affordable Care Act Greater focus on focusing on high-needs/high- utilizers Increased coordination between housing and health

3. Not all chronically homeless individuals have equal access to Medicaid Heterogeneous group Eligibility for programs vary Even within eligible groups, access to services varies depending on conditions Even with Medicaid expansion, individuals will have differing access for certain services

4. 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.

5. Other Affordable Care Act Opportunities Health Homes 1915i state plan home and community based services Accountable Care Organizations and other innovative service models

6. Options for Medicaid in PSH FQHCs providing services for PSH in some communities, using both HRSA funding and Medicaid Medicaid Rehabilitative Services Targeted Case Management (TCM) Home and Community-Based Services (HCBS) Health homes Managed care

7. Highlights from the Case Studies Huge variation across communities Most 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

8. Examples Louisiana: 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.

10. Recent documents: A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing http://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

11. For more information Emily Rosenoff U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) Emily.rosenoff@hhs.gov 202-690-5740