1. Action Coalition to Ensure Stability (ACES Project, Indianapolis, IN) Brent Matthews Choices, Inc. July 17, 2006 Using Medicaid* to End Homelessness *and whatever else you can find

2. Brent Matthews, Choices, Inc. AGENDA   What is ACES   Who ACES serves   How ACES works   Funding Approaches for Permanent Supported Housing

3. Brent Matthews, Choices, Inc. What is ACES BASICS (1999) ACES serves homeless adults with co- occurring mental health and substance use disorders ACES promotes a Housing First recovery model that supports members in increased periods of sobriety and mental stability Focus is placed upon member strengths

4. Brent Matthews, Choices, Inc. What is ACES 2002: ACES/Choices and Health and Hospital Corporation, receive $1.5 million federal grant to serve an additional 120 members Lilly Endowment funds an additional 100 2003: ACES recognized with Exemplary Award from SAMHSA, CMHS, Homeless Programs Branch. 2005 Eli Lilly & Co.1 st Place Clinical Medicine Reintegration Award

5. Brent Matthews, Choices, Inc. Who ACES serves DEMOGRAPHICS ACES has served nearly homeless adults ACES has served nearly homeless adults –57.5% Female –58.1% African American; 37.4 Caucasian –69.9% ages 35-54 (avg. 41) –Only 46% completed GED or High School

6. Brent Matthews, Choices, Inc. LEGAL MEDICAL WORK FAMILY HOUSING SCHOOL TRANSPORTATION FUN! ACES Members Systems of Care

7. Brent Matthews, Choices, Inc. HOUSING FIRST

8. Brent Matthews, Choices, Inc. THE MOST SIGNIFICANT PREDICTOR OF TREATMENT SUCCESS Treatment success derives from the implementation of an empathic, hopeful, continuous treatment relationship, which provides integrated treatment and coordination of care through the course of multiple treatment episodes in the process of dual recovery. SAMHSA consultant, Dr. Ken Minkoff, CCISOC

9. Brent Matthews, Choices, Inc. “The civil rights view of disability focuses on how society has failed people with disabilities. Like everyone else people with disabilities want to be seen like regular people, not labels. …” From Advocating Change Together, Tools for Change website 2004 Serving the Dislabeled

10. System of Care Wraparound & Strengths Assertive Case Management- Resource Coordination Stages of Change Motivational Enhancement THE ACES SHIELD ACES MERGES MODELS!

11. Brent Matthews, Choices, Inc. New and Innovative Service Delivery Processes Require New and Innovative Collaborations, Funding Streams and Accounting Processes.

12.   System of Care Principles Clinical   Member Directed   Wraparound Values & A.C.C.M.   Multi-system Coordinated Care   Care Management Technologies Fiscal   Capitated/Case Rate   Outcome Based   Flexible Funding   Technology that blends the Clinical & Fiscal (TCM) PARTICIPATORY CARE MANAGEMENT

13. Brent Matthews, Choices, Inc. How ACES works

14. Brent Matthews, Choices, Inc. Midtown CMHC Leveraged Staff 1 Clinical Manager 2 Lead Resource Coordinators 22 Resource Coordinators Annualized: *25 FTE x $35,000 x 24% Fringe = $1, 085,000 We used grant and local dollars to pay for infrastructure support

15. Brent Matthews, Choices, Inc. If you Need to Think Outside the Bucks $ You Must be Able to Spend Outside the Box. FLEX FUNDS

16. Brent Matthews, Choices, Inc. Why ACES is different

17. Brent Matthews, Choices, Inc. Pre-authorization of Funds by the Worker Closest to the Consumer, that is the Result of a Team Process, is the Preferred Modality. Care Management Community Resourcing

18. Brent Matthews, Choices, Inc. FUNDING POOLS, STREAMS & GEYSERS United Way agencies, county contract providers, indigent care, University Hospitals, Faith Community, Animal Clubs: (Elks, Eagles, Moose, Lions), Masons, Exchange Club, PIC, Rotary, Optimist/Soroptimist, Urban League, Junior League... THE CLIENT, EXTENDED FAMILY, NON-BLOOD RELATIVES, AND ALL OF THEIR STRENGTHS and INTERNAL & EXTERNAL RESOURCES

19. Brent Matthews, Choices, Inc. How ACES works ACES has worked with Over 60 single housing providers for Scattered site housing. This a shift away from NIMBY to the normality of In Everyone’s Back Yard (IEBY). We use to call it Community!

20. Brent Matthews, Choices, Inc. Ending Homelessness with ACES PUBLIC FUNDING NOW PUBLIC FUNDED NOW - MRO COULD BE PUBLIC FUNDED ( CMHCS) PRIVATE TBRA GRANT

21. Brent Matthews, Choices, Inc. Member Funding Sources ENTITLEMENTS Medicaid*32.9% Medicaid Pending*38.6% Wishard Advantage*14.6% Social Security20.9% Medicare0.6% Public Aid38.6% Housing3.8% Transportation68.4% Pensions (empl/VA)3.2% Other (incl. VA)2.5% 89% of members obtained access to at least one public entitlement through their involvement in ACES Average income increased from $285.27/month at enrollment to $479.53 per month at twelve months

22. Brent Matthews, Choices, Inc. Case Rate Case Rate $344 per client per month ($11.30/day) $344 per client per month ($11.30/day) Serving 200 monthly x 12 = $825,600 Serving 200 monthly x 12 = $825,600 We will apply for CSAT $400k/5yr that begins October, 1, 2006 (If Awarded) We will apply for CSAT $400k/5yr that begins October, 1, 2006 (If Awarded) We will promote discussions for public funding We will promote discussions for public funding TBRA $250,000 TBRA $250,000

23. Brent Matthews, Choices, Inc. If you have come to help me, You’re wasting your time. But if you have come because your liberation is bound up with mine, Come, let us work together. ---Aboriginal Quote