Partnerships in Community Integrated Housing Workshop NC Department of Health and Human Services NC Housing Finance Agency Property Managers Local Management Entities/Managed Care Organizations

Department of Health and Human Services Budget Item Implementation Joint Legislative Oversight Committee on Health and Human Services January 12, 2016 Department of Health and Human Services Budget Item Implementation

Important Milestones in Long-Term Services and Supports Transition Activities

Game-Changing Milestones in Long-Term Services and Supports Medicaid and Medicare begin, and states begin operationalizing Medicaid waivers become available Americans with Disabilities Act (ADA) signed US Supreme Court’s Olmstead Decision Renewed federal effort to support and enforce Olmstead Compliance 1965 and1970s 1980s 1990s 1999 2000s

Medicare and Medicaid Begin Pre 1980s: Long Term Services and Supports (ongoing support with activities of daily living) were largely provided in facilities or by family members. Medicaid LTSS was limited to facility- based care. Medicare still does not provide LTSS (short-term home health only). Housing not coverable.

Medicaid Funds LTSS 1980s: Advocacy efforts push for increased parity of LTSS public dollars and the “Medicaid Waiver” concept emerges.

Expanded Legal Protections for People with Disabilities 1990s: The ADA and Olmstead Mandate

The Congressional Motivation for the ADA…. “historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem.” 42 U.S.C. Section 12101(a)(2).

Americans with Disabilities Act (ADA) Signed by President George Bush in 1990. The ADA is a federal civil rights law for people with disabilities. It covers employment, state and local government services, public accommodations, and telecommunications for the deaf. The ADA is designed to remove barriers which prevent qualified individuals with disabilities from enjoying the same opportunities that are available to persons without disabilities. Trish

There are Five “Titles” to the ADA Title I: Employment Title II: Public Services Title III: Public Accommodation Title IV: Telecommunication Title V: Miscellaneous

Two Women, A State, and A Landmark Deciseion In 1999, the Supreme Court of the US held in Olmstead v. L.C., that under Title II of the ADA, states were required to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs. (extracted from ADA.gov)

Renewed Enforcement 2000s: Both the Bush and Obama Administrations Promote Initiatives that facilitate transitions to community living, including: New Freedom Initiative Money Follows the Person Expanded federal collaboration between housing, disability and Medicaid partners Year of Community Living Increased oversight and enforcement activity by the US Department of Justice Recognition of the role of Housing in LTSS

NC Housing Finance Agency Targeting Program Key Rental Assistance Program Transitions to Community Living Initiative Transitions to Community Living Voucher Program

Targeting Program Used currently in NCHFA LIHTC program. Landlord agrees to ‘reserve’ a specific number of units for referral network, per a Targeting Agreement on property by property basis. This number capped at 20% of total units. Landlord notifies Regional Housing Coordinator/DHHS of vacancy. Regional Housing Coordinator/DHHS responds with applicants or releases unit. Landlord notification requirement is suspended once “Targeted Units” filled.

What’s in it for you? Known Referral Network Reduced Credit Exposure State pays security deposit State pays majority of rent State pays damages if incurred State pays for broken leases State pays for eviction costs under specific circumstances Supported Tenants

Key Rental Assistance (PBRA Option) Key only works within the Targeting Program. A Key Payment Standard is agreed to per an Owners Agreement to Participate agreement. DHHS or Regional Housing Coordinator sends over applicant with referral form. Verify applicant has disability income.

Key Payments Request Key via on-line portal with supporting documentation Key will pay security deposit. Key will pay for damages, not to exceed $2500 Key will pay for uncollected tenant portion of rent, not to exceed 3 months Key will pay for remaining lease period, not to exceed 2 months Key will pay for eviction costs, if chance for remediation steps are taken, not to exceed $1000

Transitions to Community Living Initiative created by North Carolina Housing Finance Agency 92016

What is Transitions to Community Living Initiative? The Transitions to Community Living Initiative (TCLI) provides integrated housing opportunities, supportive services, and supportive employment for people identified by North Carolina Health and Human Services(NC DHHS) who are transitioning from: Adult Care Homes State Hospitals (Broughton, Central Regional, Cherry) or Diverted from Adult Care Homes

What is the Transitions to Community Living Voucher? The state’s Local Management Entities/Managed Care Organizations (LME/MCOs) operate the TCLV program as rental assistance for TCLI participants TCLV is a tenant-based voucher program: the tenant can use the voucher with any landlord who accepts the voucher

Transitions to Community Living Voucher (TBRA Option) TCLV works throughout private market. Referral network will send over potential applicants. Referral network will support applicant throughout the leasing and move-in process. Rent is negotiated, and outlined with a housing assistance payment contract. A Housing Quality Standard inspection is required.

TCLV Features Rent Subsidy Voucher capped at $600 Tenants have access to move-in funds for security, utility, and other move-in expenses Hold Fees Are supported by team of people Security Deposit paid directly by program

Risk Mitigation Tools – Reducing Risk to Landlords One way the Transitions to Community Living Voucher program supports tenants is by reducing (or mitigating) the risk taken on by landlords Satisfied landlords are likely to remain engaged with the TCLV Program, helping assure housing options for future tenants

Risk Mitigation Tools - Reimbursement of Unpaid Damages after Tenant Move-Out Reimbursement of Unpaid Tenant Portion of Rent and Late Fees Reimbursement for Vacancy Due to Tenant Abandonment of Unit Reimbursement for Successful Eviction Costs