Meghan Davey, Medicaid Director Promising Practices Medicaid Innovator Accelerator: Housing Partnerships Meghan Davey, Medicaid Director Division of Medical Assistance and Health Services Department of Human Services March 28, 2017

Building the Case for Supportive Housing Studies that demonstrate successful community integration for individuals in need of long term services and supports who receive housing-related services: Money Follows the Person (MFP) Rebalancing Demonstration Program States providing specific housing-related services and activities had more success and a higher rate of transitioning individuals out of more costly nursing homes and other institutions and into community living than those programs without these services. Real Choice Systems Change Grant Showed that building relationships between state Medicaid agencies and state and local housing organizations and stakeholders resulted in the capacity to take advantage of other federal and state funding opportunities to expand community-based housing resources for Medicaid eligible populations. The lack of affordable and accessible housing is a significant barrier to community integration for people who use Long-Term Services and Supports (LTSS). CMCS Informational Bulletin, Coverage of Housing-Related Activities and Services fro Individuals with Disabilities, June 26, 2015.

Bending the Cost Curve: Health in Housing Studying the link between affordable housing and health care Housing with integrated health services was a key driver of health-care outcomes, suggesting that increasing these services may result in even greater cost savings. State can consider using supportive housing to bend the Medicaid cost curve, namely, by improving outcomes and reducing costs among homeless or precariously housed high-cost Medicaid beneficiaries. 20% Increase use of outpatient primary care 18% Decrease use of emergency department 40% Residents who reported improved access and quality after move-in A study was done that directly explores the link between affordable housing and health care through the lens of several national health reform metrics: better connection to primary care, fewer emergency department visits, improved access to and quality of care, and lower costs. Center for Outcomes Research & Education (CORE). Access to an Affordable Home Improves Health Care. March 9, 2016.

Driving Factors Behind the Medicaid Innovator Accelerator Program (IAP) Consistent with statute, CMS does not provide Federal Financial Participation (FFP) for room and board in home and community-based services, but can assist states with coverage of certain housing-related activities and services. A recent CMCS Information Bulletin articulated activities and services that Medicaid can provide to people who need home and community-based services (HCBS). Unprecedented Collaboration between CMS, SAMHSA, ASPE (Assistant Secretary for Planning & Evaluation), US Interagency Council on Homelessness (USICH), HUD and States CMCS Informational Bulletin, Coverage of Housing-Related Activities and Services fro Individuals with Disabilities, June 26, 2015.

New Jersey’s Medicaid IAP: Housing Partnership Workgroup Vision To conduct an environmental scan to identify best-practices or gaps under the current housing landscape. To work together to develop a comprehensive, permanent supportive housing package of services that builds upon work underway already in New Jersey. To identify funding opportunities to create new housing stock or additional housing vouchers that complement reimbursement for the permanent supportive housing services. Informed the 1115 Waiver Renewal Application Proposal

New Jersey’s Medicaid IAP: Housing Partnership Workgroup The workgroup represented the following Agencies, Departments, Divisions and Programs: Department of Community Affairs (DCA), New Jersey Housing and Mortgage Finance Agency (NJHMFA), Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS), Division of Mental Health and Addiction Services (DMHAS), Division of Aging Services (DoAS), Division of Developmental Disabilities (DDD), Department of Children and Families (DCF), Office of the Ombudsman for the Institutionalized Elderly (OOIE), and Money Follows the Person (MFP). Met bi-weekly then monthly Traveled to Washington D.C. for learning opportunities with federal partners and other State’s working on housing issues.

1115 Waiver Renewal Application New Jersey understands the direct link between people’s physical health and their housing needs. The state has a long history of funding supportive housing and recently has made critical investments in connection with its Olmstead program (i.e. Community Support Services offered through the Division of Mental Health and Addiction Services) There remains a significant need for attainable housing and supported housing-related activities and services.

Expanding the Use of High Fidelity Housing First Model Choice of Housing Separation of Housing and Services Decent, safe, and affordable housing Integration in the Community Rights of Tenancy Access to all housing options Flexible, voluntary services Substance Abuse and Mental Health Services Administration (SAMHSA) developed evidenced-based approach to end homelessness Meet the needs of individuals who are at-risk for homelessness or who are considered to be chronically homeless. Over a decade of independent research demonstrates that HFHF improves the health and well-being of consumers, while reducing costs, by avoiding reliance on expensive acute systems like hospitals, jails, and shelters.

Medicaid Permanent Supportive Housing Services New Jersey proposes to provide housing-related services to Medicaid recipients, including individuals who are homeless, chronically homeless and at-risk for homelessness as defined by the U.S. Department of Housing and Urban Development Populations of special interest will include repeat emergency shelter users and other housing service users with disabilities, behavioral health diagnoses, and multiple chronic physical health conditions. CMS is interested in pursuing detailed conversations around NJ’s MPSHS proposal. DMAHS is still working on how the MPSHS would be implemented and operationalized.

Moving Forward: External Partnerships DMAHS is considering opportunities for including external stakeholders in the discussions to implement and operationalize the program. Through its partnership with DCA and MFP, DMAHS will be participating in many housing Stakeholder meetings and looks forward to continuing to build relationships with DCA and MFP Stakeholders, such as the Continuums of Care and Housing Developers.

Next Steps Await CMS feedback on the 1115 Waiver Renewal Application. The Medicaid IAP Workgroup continues to meet and is working on developing: Contract language for July 2017 to strengthen the current requirement for MCO’s to employ a housing specialist. Detailed pre-tenancy, tenancy, and post tenancy definitions, assessments, etc. Ways to address gaps and challenges identified by the environmental scan. Ex: Availability of housing stock, identifying quality and monitoring measures, funding differences between similar programs, etc.