Social Workgroup October 10, 2013

Housing needs to be flexible and accessible Affordable housing stock for consumers is insufficient Consumers want to move from a structured provider setting to housing of their choice Homeownership is not for everyone

Lack of affordable housing stock in many areas of MD Olmstead decision – State’s continued commitment to support individual’s in the least restrictive environment Judicial system insist people be in structured supervised housing Forensic histories and federal restrictions Credit histories Poverty – SSI Maximum benefit $710/month Arrearages in utility Restrictions due to funding requirements Loss of Medicaid as a person moves out of RRP Access to services due to transportation barriers

“[N]o qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.” 42 U.S.C (1990).  Title I – access to employment  Title II – access to public entities and the services, programs, and activities they deliver  Title III – access to public accommodations

 Title II requires states to provide services “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” 28 C.F.R. § (d) (2010)  Most integrated setting is one “that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.” 28 C.F.R. Pt. 35, App. A (2010).

 Located in mainstream society  Offers access to community activities and opportunities at times, frequencies, and with people of an individual’s choosing  Affords individuals choice in daily life activities  Provides individuals with disabilities the opportunity to interact with non-disabled people to the fullest extent possible

 Residential Rehabilitation programs (RRP) – 40 providers throughout the state with a total of 2500 beds that served 4,020 individuals in 2012 with serious mental illness/co- occurring disorders (some are specialized).  Supported Housing – Currently over 8 providers have developed, own, or lease units to support consumers in moving to their own independent housing from RRP or other housing with Psychiatric Rehabilitation Program (PRP) services provided either on/off site if requested by the consumer.  Crisis Beds used to divert individuals from hospital and emergency rooms.  Local County programs flexible housing vouchers (Main Street).  Continuum of Care Programs (Shelter Plus Care)  Alcohol Tax Rental Subsidies.

 Since 2002, collaboration with the Maryland Association of Housing and Redevelopment Agencies (MAHRA), the member organization of Public Housing Authorities (PHAs) resulted in ongoing cross-training efforts and chair of Special Needs Advisory committee.  Publication in 2003/2001 of a Housing and Disability Services Resource Guide (DHMH/MHA website).  Convened a Maryland Department of Disabilities (MDOD) Statewide Housing Task Force to assist PHAs to apply for Non-elderly disabled vouchers ( ) – disability partnerships resulted in 260 Category 1 and 112 Category 2 vouchers in MD.  Creation of the “Affordable Rental Housing Opportunities for Persons with Disabilities” in $1 million grant from the Weinberg Foundation to develop apartments for persons with disabilities at 15-30%AMI – partner with MHA, DHCD, DHMH, MDOD.

 Olmstead initiatives to transition community ready consumers from the hospital  Since 2009, MHA conducts a group representing providers, CSAs and state hospitals to reduce the length of time an RRP vacancy remains open, develop a manual to detail the process for provider in-reaching, reduce barriers to referrals, problem solve around getting benefits/paperwork completed.  Olmstead Policy Academy – September 2013  SOAR Training conducted with case managers to assist consumers in accessing federal and state benefits for disability, health insurance and other services.

 Several housing programs available under the HUD Continuum of Care Programs- (Shelter Plus Care Housing and Supportive Housing Program).  Since 1995, MHA has used Shelter Plus Care to provide rental and some utility assistance to individuals who are homeless and have a serious mental illness with criminal justice backgrounds  MHA receives $4.8 million annually to fund 317 units. Over 1,000 Shelter Plus Care funded units statewide  Two type of models used by MHA - Sponsor-based model – nonprofit agency lease the unit and sublease with a consumer - Tenant-based model – lease is in the consumer’s name

Housing is matched with supportive services 90% of the participants maintain permanent housing 85% of the participants have some source of income Grant funds are accessed through 16 local Continuum of Care Planning Groups (Special Populations) HEARTH Act has expanded the definitions of homelessness which has made more people eligible for program Continuum of Care Program (continued)

 The CSAs agreed to develop housing and services for consumers the state hospitals identified. Services were then contracted with community providers. The services were regional in order for patients to be served by providers that they chose and best met their needs.  Baltimore Mental Health Systems (BMHS)contracted with People Encouraging People (PEP) to expand the Baltimore County Assertive Community Treatment (ACT) Team to serve 35 additional individuals at Spring Grove and to include additional flexible supports and housing costs.  In addition to PEP, BMHS contracted with Mosaic to convert the Mobile Treatment Team to an ACT model. Once the team has met ACT standards they will provide housing to 10 individuals.  Mosaic Residential Rehabilitation Program (RRP) developed 6 new RRP beds for individuals in their current program and converted 6 residential crisis beds in Mount Airy and Weinberg House to intensive 24 hour 7 day a week, to include nursing support.

 Keypoint in Baltimore City upgraded three of its RRP beds from General to Intensive to serve 3 individuals from Spring Grove.  Anne Arundel County CSA contracted with Prologue to develop 2 new RRP beds and upgrade one RRP bed to intensive for a total of 3 RRP intensive beds with additional support for 3 individuals at Spring Grove.  Arundel Lodge developed 6 new RRP services for individuals with mental health and mild intellectual disabilities.  The CSA also contracted for startup funds for 6 new RRP beds at Guide and Vesta in Prince Georges County. These resources have been targeted for individuals at Springfield.  Harford County CSA contracted with Alliance’s ACT program to serve 4 individuals at Spring Grove. The ACT team received funds for additional peer support and housing for the 4 individuals.

 Implementation began in 2011 with funding from the Real Choice Systems Change Grant from the Centers for Medicare and Medicaid.  Partners include DHMH, DHCD, MDOD, MCDD, Centers for Independent Living (CILS), consumer organizations and housing developers.  Implementation and maintenance of an internet- based affordable housing registry through DHCD and MDOD at  Applied for HUD 811 PRA Demonstration Project in 2012 and waiting on awards to be announced by HUD in 2013

 Tenant training  Where do they want to live? (near family, friends, activities)  How much will it cost? (budget, start up costs)  Roommate, sharing (pros and cons)  Review possible places to look for housing  Complete application for voucher/public housing – find out about RAP, Mainstream Voucher program, preferences for persons with disabilities, veteran programs (MD’s Commitment to Veterans/VASH)  Transportation, shopping, employment, church, social  Review issues that have triggered problems in the past (MH, SA, Lack of privacy, people moving in, hoarding, other)

 or  Are you on the list of contacts with access?  HUD Announcement about Vouchers specific to persons with disabilities)  HUD 811 – PRAC Pilot will increase the availability of rental assistance in tax credit units and other properties (Frank Melville Supportive Housing Investment Act HR 1675) – NOFA came out in spring 2013 (voucher tied to the property and not the person)  Ongoing coordination with DHCD on the use of tax credits to developers to integrate in general occupancy development – Weinberg Foundation – recently increased another $1 million in December 2012  Join forces – create a 501(C)3 to apply for funding through MD-DHCD (Department of Housing & Community Development) – several examples in MD – transitional housing, rural development

Marian Bland, Director, Office of Special Needs Populations, Mental Hygiene Administration Russell Springham, Case Management and Housing Coordinator, Mental Hygiene Administration John Brennan, Chief of Staff/Dir. of Housing Policy and Programs, Maryland Department of Disabilities