We all know that ending homelessness is going to take more than what is available through HUD’s ESG and CoC Programs alone. We have been, as a homeless services provider community, collectively discussing for a long time how the use of mainstream resources – like mental health, substance abuse, health care and other benefits – can help both the people we serve and the system as a whole.
But something has shifted in this discussion. It now reaches beyond homeless service providers to the very programs and resources we have been working to engage in our mission. For the first time in my memory, we have intensive coordination and collaboration happening at the national level. The U.S. Interagency Council on Homelessness and our federal partners at VA, HHS, Education and others have worked tirelessly to create meaningful partnerships that we hope will be in place for years to come.
Now we need to figure out how to use that momentum to make the same conversations happen where we actually serve people experiencing homelessness – at the community level. And resources need to be part of that discussion.
There was a time when HUD awarded more funds for supportive services under the homeless assistance competition than on housing. By paying for services that should have been available to people experiencing homelessness through public systems, we were effectively reducing the potential stock of housing available to people experiencing homelessness. Tremendous progress has been made to shift this balance so that more of HUD’s funds are paying for housing costs than supportive services—however, close to 30 percent—or $460 million—of funds awarded through the competition are still for supportive services costs. While the CoC Program allows for the use of funds for services, HUD encourages CoCs to consider: 1) if the services being funded is also eligible under other mainstream Federal programs; and 2) whether they are essential to helping people connect to or maintain permanent housing.
USICH is working on a tool in coordination with HHS and other agencies that will make it easier for CoCs and homeless service providers to identify these resources. Individual projects should seek out these mainstream resources to pay for service costs currently charged to the CoC Program grant, which would free up CoC Program funds that could then be reallocated to create more units of housing. CoC leaders can help in this effort by ensuring that all recipients within the CoC are aware of other funding opportunities, and that programs already receiving funding from multiple sources maximize those resources.
Here are some examples of resources that CoCs and project recipients can consider regarding coordination of HUD housing resources and mainstream service dollars that would allow for a more efficient use of all of these limited resources.
The Affordable Care Act (ACA) increases opportunities to pay for services for people in supportive housing. Getting there is complicated but feasible. Here is some preliminary information to get you started.
ACA gives states the ability to extend Medicaid to all persons living under 133 percent of the Federal Poverty Level and expands services that can be funded by Medicaid. Even in states that have not yet opted into expansion, there may be opportunities to use Medicaid funding for services for people who are already Medicaid eligible.
Depending on what state you are in, Medicaid is a potential source of financing of: case management, life skills, health and behavioral health services in permanent supportive housing, and the formation of health care and social services partnerships.
The following is a menu of potential features (authorities) of your state Medicaid plan that may provide funding for the above services:
USICH has some great resources on this topic on their Using Medicaid to Fund Supportive Services page.
Home and Community Based Services,
Targeted Case Management
An important strategy for leveraging Medicaid is the forming partnerships between homeless services providers and health care entities that are credentialed to provide Medicaid services.
CoCs have an important role in ensuring that all who are eligible get enrolled in Medicaid, especially in states that are opting into expansion. In April 2013, CPD’s Office of HIV/AIDS Housing (OHH) and Office of Special Needs Assistance Programs (SNAPS) implemented an ACA Technical Assistance (TA) initiative through OneCPD TA. TA providers will research, develop, and disseminate information, resources and other technical assistance related to Medicaid Expansion and to new health insurance options under the ACA. Roll-out of these materials will be made available over the coming months. The information will also be posted online on the OneCPD Resource Exchange. This information will help HUD programs to assist beneficiaries in accessing health care and to enable beneficiaries to understand eligibility and health options so that they can obtain and retain appropriate, high quality coverage. It will also help both homeless and AIDS services providers to meet credentialing requirements to receive Medicaid funding for services.
HHS’s Health Resources and Services Administration’s (HRSA) Health Care for the Homeless program provides grants to community health centers to provide primary health care, substance abuse, emergency care with referrals to hospitals for in-patient care, and/or other needed services and outreach services to assist difficult-to-reach homeless persons in accessing care, and provide assistance in establishing eligibility for entitlement programs and housing. Many of the primary care and behavioral health care services currently funded by CoC grants may be services that Health Care for the Homeless grantees are already able to provide through their HRSA grants or through Medicaid reimbursement. In addition, community health centers that are not Health Care for the Homeless grantees, particularly those with Federally Qualified Health Center (FQHC) status, may be able to provide the same health care services to people experiencing homelessness. CoCs are encouraged to partner with Health Care for the Homeless and Federally Qualified community health centers. More information on where Health Care for the Homeless and other community health centers are located can be found on the Health Resources and Service Administration website.
A possible resource for CoC grantees that provide substance abuse treatment services is Access to Recovery (ATR). ATR is a program administered by HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) that is designed to provide client choice among substance abuse clinical treatment and recovery support service providers, expand access to a comprehensive array of clinical treatment and recovery support options (including faith-based programmatic options), and increase substance abuse treatment capacity. These funds are awarded to single-state substance abuse agencies to carry-out voucher programs for substance abuse clinical treatment and recovery support services. More information on Access to Recovery can be found on the SAMHSA website.
I hope that this list, while not exhaustive, will spark some good conversations in CoCs across the country on how to use these types of funding streams to free up CoC funds so we can increase the supply of housing for people experiencing homelessness.
Don’t forget to check back to SNAPS Weekly Focus page over the coming weeks as we will continue to post related materials and TA products related to each weekly focus, as they become available.
As always, we thank you for your commitment to ending homelessness.
Ann Marie Oliva
Director, Office of Special Needs Assistance Programs
Download this SNAPS Weekly Focus