1. “Overview and Comments on HUD’s NoFA: Housing Vouchers for Non-Elderly Individuals with Disabilities“ Center for Medicare and Medicaid Services

2. 2 Background Historically, non-elderly persons with disabilities have sought to: Have access to affordable housing, Have access to affordable housing, Overcome housing barriers to transition back to the community, and Overcome housing barriers to transition back to the community, and Have choices about where they decide to live. Have choices about where they decide to live.

3. 3 Background The Department of Housing and Urban Development (HUD) and the Centers for Medicare & Medicaid Services (CMS) have established a working relationship to expand the availability of funding for accessible and affordable housing.

4. 4 Background On June 22, 2009, HUD posted in the Federal Register, a draft, proposed Notice of Funding Availability (NOFA) of $30M for: 4,000 new Housing Choice Vouchers 4,000 new Housing Choice Vouchers 1,000 of these vouchers target non-elderly persons with disabilities transitioning out of institutional settings. 1,000 of these vouchers target non-elderly persons with disabilities transitioning out of institutional settings.

5. 5 Background HUD’s “Proposed Notice of Funding Availability (NOFA) for Fiscal Year (FY) 2009 Rental Assistance for Non- Elderly Persons With Disabilities; Request for Comments”, is available at: http://edocket.access.gpo.gov/2009/pdf/E9- 14651.pdf http://edocket.access.gpo.gov/2009/pdf/E9- 14651.pdfhttp://edocket.access.gpo.gov/2009/pdf/E9- 14651.pdfhttp://edocket.access.gpo.gov/2009/pdf/E9- 14651.pdf Federal Register/Vol 74, No. 118/Monday, June 22, 2009/Notices. All page numbers in this presentation, unless otherwise specified, refer to this document.

6. 6 The Opportunity HUD’s Proposed NOFA identified two specific target groups for the vouchers: 1) Those with a disability, at risk of institutionalization, who are on a waiting list for subsidized housing, and 2) Those seeking to transition from a nursing facility or other institutional setting to the community.

7. 7 The Opportunity These Vouchers are described as: Category 1 vouchers “…enable non-elderly disabled families on a PHA’s waiting list to access affordable housing…” 1 and are targeted towards households at risk of institutionalization. Category 1 vouchers “…enable non-elderly disabled families on a PHA’s waiting list to access affordable housing…” 1 and are targeted towards households at risk of institutionalization. Category 2 vouchers “…enable non-elderly persons with disabilities to transition from nursing homes and other health care institutions into the community”. 2 Category 2 vouchers “…enable non-elderly persons with disabilities to transition from nursing homes and other health care institutions into the community”. 2 Seventy-five percent of the funds, or about 3,000 vouchers, support Category 1 recipients. 1 Federal Register/Vol. 74, No. 118/Monday, June 22, 2009, page 29504. 2 Federal Register/Vol. 74, No. 118/Monday, June 22, 2009, page 29504.

8. 8 The Opportunity Opportunity to address the housing needs of non-elderly persons with disabilities, Opportunity to address the housing needs of non-elderly persons with disabilities, Opportunity to increase number of actual transitions in your State, Opportunity to increase number of actual transitions in your State, Opportunity to further relationships with PHAs, and Opportunity to further relationships with PHAs, and Opportunity to prevent possible institutionalization of non- elderly individuals with disabilities who are “at risk” Opportunity to prevent possible institutionalization of non- elderly individuals with disabilities who are “at risk” Opportunity for more vouchers to be issued in the future. Opportunity for more vouchers to be issued in the future.

9. 9 HUD Requests Comments The proposed NOFA solicits comments on: Threshold factors Threshold factors Alternative distribution methods (performance based, for example) Alternative distribution methods (performance based, for example) How…”state institutional transition programs, such as the Money Follow the Person Demonstration, can work effectively with the PHAs that are awarded vouchers for this purpose.” How…”state institutional transition programs, such as the Money Follow the Person Demonstration, can work effectively with the PHAs that are awarded vouchers for this purpose.”

10. 10 HUD Requests Comments Proposed Threshold factors are: Standard threshold factors for PHAs Standard threshold factors for PHAs Written code of conduct in PHA Administrative Plan Written code of conduct in PHA Administrative Plan Affirmatively Furthering Fair Housing requirements Affirmatively Furthering Fair Housing requirements PHA must be in good standing with HUD and meet specific performance criteria (FR, page 29506). PHA must be in good standing with HUD and meet specific performance criteria (FR, page 29506). Experience serving persons with disabilities Experience serving persons with disabilities Resources for Supportive Services Resources for Supportive Services

11. 11 HUD Requests Comments Proposed Threshold factors – some details: Standard threshold factors for PHAs (Section III.C. of PHA General Section Federal Register “will be available” at www.grants.gov) Standard threshold factors for PHAs (Section III.C. of PHA General Section Federal Register “will be available” at www.grants.gov)www.grants.gov Affirmatively Furthering Fair Housing requirements, including an addendum outlining actions specific to this program. Must include informing applicants how to file a fair housing complaint. Affirmatively Furthering Fair Housing requirements, including an addendum outlining actions specific to this program. Must include informing applicants how to file a fair housing complaint. PHA must be in good standing with HUD and meet specific performance criteria (FR, page 29506). PHA must be in good standing with HUD and meet specific performance criteria (FR, page 29506).ll

12. 12 HUD Requests Comments Proposed Threshold factors – some details: Experience: PHAs must demonstrate experience via the following criteria: Experience: PHAs must demonstrate experience via the following criteria: –Document that at least 20% of the PHA’s current HCVs are used by “non-elderly disabled families”, or –Document that the PHA has established a preference for “non- elderly disabled families”, or –Document that the PHA has participated in specific programs: Rental Assistance for Non-Elderly Persons with Disabilities in Support of Designated Housing Plans; Rental Assistance for Non- Elderly Persons with Disabilities Related to Certain Types of Section 8 Project-Based Developments; Mainstream Housing Opportunities for Persons with Disabilities; Project Access Program. Page 29507 ll

13. Threshold Criteria Comment The Issue:PHAs are the only eligible applicants. Description of the Problem: - Programs seeking either category 1 and/or category 2 vouchers are at the mercy of the PHAs in their area. If a PHA chooses not to participate, there is no remedy. - Programs seeking either category 1 and/or category 2 vouchers are at the mercy of the PHAs in their area. If a PHA chooses not to participate, there is no remedy. Possible Comment: - Encourage HUD to allow non-PHA applicants under certain conditions (when a PHA in a jurisdiction is ineligible or will not apply). - Encourage HUD to allow non-PHA applicants under certain conditions (when a PHA in a jurisdiction is ineligible or will not apply).

14. 14 HUD Requests Comments Proposed Threshold factors – some details: Resources for supportive services Resources for supportive services –For category 1: must “…describe those resources in full detail…” –For category 2: must “…identify the partnering resource agency and describe the provision of supportive services for a transitioned person.” Page 29507 ll

15. 15 Threshold Criteria Comments The Issue: Only PHAs with specific experience may apply. Description of the Problem: - This could eliminate a friendly PHA (perhaps without the specific experience) that might be willing to partner with service providers capable of providing sufficient services to transition or maintain individuals in the community. Possible Comment: - Encourage HUD to accept applications from PHAs without the required experience where that PHA can document a working partnership with Medicaid-funded transition programs and/or other community-based programs capable of providing essential services and supports.

16. 16 Distribution Method Comments The Issue: The PHA voucher request is limited to 10% of its “…authorized baseline units or 200 vouchers, whichever is less.” Description of the Problem: -For category 2, the guiding factor should be the number of vouchers that can be used by the transition agency in the fiscal year. -For category 2, the guiding factor should be the number of vouchers that can be used by the transition agency in the fiscal year. Possible Comment: -For category 2, allow the provider requests to guide the number of vouchers requested. -For category 2, allow the provider requests to guide the number of vouchers requested.

17. 17 Distribution Method Comments The Issue – HUD’s requests for “alternative methods of distribution” Description of the Problem: –The overall number of vouchers in Category 1 is greater than Category 2, Possible Comment: - PHA baseline limits the number of vouchers that can be requested, and - Requirement that vouchers are intended for people on the PHA waiting list.

18. 18 Distribution Method Comments The Issue: Waiting List Requirement Description of the Problem: - There may be many “at risk” households that are not on a list now. - There may be many “at risk” households that are not on a list now. - Some PHA lists are closed now and have been closed for long - Some PHA lists are closed now and have been closed for long periods of time. periods of time. - For Category 2, people in institutions may not have - For Category 2, people in institutions may not have considered transition back to the community as an option, and may considered transition back to the community as an option, and may not be on any PHA lists. not be on any PHA lists. Possible Comment: - Requiring vouchers to be distributed to people based on their - Requiring vouchers to be distributed to people based on their presence on a waiting list will eliminate large numbers of otherwise presence on a waiting list will eliminate large numbers of otherwise eligible persons. eligible persons.

19. Timetable Applications will be due 60 days after publication of the final NOFA. So be ready to… 19

20. 20 ACT NOW Approach the PHAs Contact your Resources Train your Coordinators Network with your Stakeholders Open doors to Communication Work to make it happen

21. 21 Next Steps State Medicaid agencies and other stakeholders representing services and supports for individuals with disabilities can take some immediate next steps to make this opportunity more beneficial for non-elderly individuals with disabilities.

22. 22 Next Steps – Related to Proposed NOFA Organizations seeking category 1 or category 2 HCVs can ensure they are ready to take advantage of these opportunities by: Making sure that people seeking transitions are on the PHA waiting list where possible. Making sure that people seeking transitions are on the PHA waiting list where possible. Initiating conversations with PHA Partners about these opportunities. Initiating conversations with PHA Partners about these opportunities. Identifying communities with effective transition coordinators and case managers, and matching them with PHAs. Identifying communities with effective transition coordinators and case managers, and matching them with PHAs.

23. 23 Next Steps – Preparation Steps For those communities, estimate the number of HCVs that can reasonably be used within the next 12 months, where possible. For those communities, estimate the number of HCVs that can reasonably be used within the next 12 months, where possible. –How many people are ready to exit the institution and lack ONLY funding for housing? –How many people plan to transition within the next 90 days, and lack ONLY funding for housing? –These two groups provide a reasonable estimate of the number of vouchers that could be used within the time frame.

24. 24 Next Steps – Preparation Steps Review HUD’s Suggested Preference Language for PHAs: Review HUD’s Suggested Preference Language for PHAs: Persons Transitioning from Institutional Settings: Under the category of local preferences, a PHA may choose to provide a preference to people transitioning from institutional settings into independent, community-based living. Institutional settings include hospitals, nursing homes, and institutions for individuals with developmental disabilities. Some people transitioning may reside in one of the 29 States or the District of Columbia that have received specific funding for transitioning persons from institutions through a demonstration called Money Follows the Person (MFP). MFP is administered by the Centers for Medicare & Medicaid Services (http://www.cms.hhs.gov/RealChoice/downloads/MFP.pdf). The demonstration provides the necessary health and social services that people will require upon transitioning from an institution and thereafter to live independently in the community. http://www.cms.hhs.gov/RealChoice/downloads/MFP.pdf

25. 25 Next Steps – Preparation Steps Describe and document available supportive services: Describe and document available supportive services: –care management, and –needed health and social services. Prepare a general template, applicable to any community likely to participate. Assess the readiness of transition coordinators and case managers to make successful applications for HCV. Prepare a general template, applicable to any community likely to participate. Assess the readiness of transition coordinators and case managers to make successful applications for HCV. –Obtain needed documentation (i.e. award letter, birth certificates) –Completed application Provide training and support where needed. Provide training and support where needed.

26. 26 Talking Points – Reaching out to PHAs Why should PHAs participate? This activity helps them meet their legal and ethical obligations under Olmstead. This activity helps them meet their legal and ethical obligations under Olmstead. National Movement towards Home and Community- Based Health Care and Living. National Movement towards Home and Community- Based Health Care and Living. Compliance with Americans with Disabilities Act. Compliance with Americans with Disabilities Act. It’s the right thing to do. It’s the right thing to do.

27. Talking Points – Reaching out to PHAs Why should PHAs partner with MFP? Medicaid-funded case managers and transition coordinators will bring qualified customers with well-prepared applications for consideration. Medicaid-funded case managers and transition coordinators will bring qualified customers with well-prepared applications for consideration. Housing is one of the biggest barriers to realizing the Rebalancing of Long-Term Care Services and Programs. Housing is one of the biggest barriers to realizing the Rebalancing of Long-Term Care Services and Programs. 27

28. Talking Points – Reaching out to PHAs Why should PHAs partner with MFP? Medicaid waivers and other Medicaid-funded coordinated services can assure funding for supports and services. Medicaid waivers and other Medicaid-funded coordinated services can assure funding for supports and services. Transition coordinators and other service providers ensure all necessary supports and services. Transition coordinators and other service providers ensure all necessary supports and services. –PHA staff have no additional burden. 28