1. AFFORDABLE ASSISTED HOUSING PROJECT Affordable Assisted Housing Project Oakland County, Michigan Partners: Michigan State Housing Development Authority American House Retirement Residences Area Agency on Aging 1-B (AAA 1-B) Macomb Oakland Regional Center (MORC) US Congressman Joe Knollenberg 100 Tenant-Based Vouchers

2. Assisted Living Facilities Models in Public Housing 2 AFFORDABLE ASSISTED HOUSING PROJECT Assisted Living demonstration program using Housing Choice Voucher and Medicaid Waiver Programs State Housing Authority, Local Medicaid Agencies and U.S. Congressman worked together to develop program Partnership monitored progress of demonstration and made program and policy changes where needed The result: a successful and expanding program BACKGROUND MICHIGAN

3. Assisted Living Facilities Models in Public Housing 3 Participating County HA declares a preference for households with Medicaid Waivers Medicaid agencies identify Medicaid Waiver eligible individuals and assist with voucher application Qualifying households use voucher and Medicaid subsidies to afford rent in an ALF DESIGN AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

4. Assisted Living Facilities Models in Public Housing 4 Participating PHA adopts preference for Medicaid Waiver households and opens waiting list (if closed) Medicaid agency reviews PHA waiting list for Medicaid Waiver clients Marketing letters sent to the remainder of waiting list Medicaid agency markets program to area nursing homes and current clients Pool of applicants identified and interviewed for HCV eligibility PROCESS AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

5. Assisted Living Facilities Models in Public Housing 5 Initial phase of the demonstration not successful: 40% of income in rent rule limited ALF selection Payment standard too low for ALFs Need for increased communication and education between partner agencies CHALLENGES/FAILURES/LESSONS LEARNED AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

6. Assisted Living Facilities Models in Public Housing 6 Partnership addressed these issues: Congressman Knollenberg sponsored legislation in FY 02 and 03 Appropriations Act allowing MI to exceed 40% of income limit MSDHA increased payment standard to 110% Improved communication and program knowledge between partners CHALLENGES/FAILURES/LESSONS LEARNED AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

7. Assisted Living Facilities Models in Public Housing 7 Program Today: 60 (out of 100 possible) households housed in ALF 8% of participants are former nursing home residents Program costs State 50% less than nursing homes ACCOMPLISHMENTS/SUCCESSES/HIGHLIGHTS AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

8. Assisted Living Facilities Models in Public Housing 8 Program Limitations: Medicaid Waiver enrollment closed for past two years New Governor committed to opening enrollment Use of 110% FMR reduces subsidy dollars for other families CHALLENGES/FAILURES/LESSONS LEARNED AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

9. Assisted Living Facilities Models in Public Housing 9 Pairing tenant-based vouchers and Medicaid Waiver programs = Assisted Living affordable Effective use of vouchers for ALFs requires a change in the 40% of income in rent limitation To increase affordability, PHAs can base payment standard on 110% of FMR or ask HUD for an exception payment standard SUMMATION (Continued) AFFORDABLE ASSISTED HOUSING PROJECTMICHIGAN

10. Assisted Living Facilities Models in Public Housing 10 Program under HANF: 40% of Income in Rent rule – States decide the limitation of the % of income in rent Payment Standards – States have flexibility to set payment standard to meet local market needs Increased coordination with the State Medicaid Program SUMMATION AFFODABLE ASSISTED HOUSING PROJECTMICHIGAN