Coordinating Services and Accessing Resources Wednesday, November 16, 2016 Buffalo, NY

Rethinking Care for Medicaid's Highest-Need, Highest- Cost Populations Addressing the Social Determinants of Health Housing is Health Care! Targeting “high-cost” Medicaid members Demonstrating the cost-effectiveness of supportive housing First and foremost, I would like to thank you for inviting me to speak at today’s conference to discuss New York State’s Medicaid Redesign Team Supportive Housing Initiative; and how we are re-thinking the provision of care to our high need/high cost Medicaid members. Through the MRT SH Initiative, we are investing in the social determinants of health to improve the quality of care provided to our highest cost Medicaid members. New York State is investing state-only Medicaid dollars and matching our highest cost chronically homeless and unstably housed Medicaid members with appropriate supportive housing solutions. We function under the assumption that supportive housing is health care. 2

MRT Supportive Housing Initiative Capital Rent Support Services Service and Operating Tracking and Evaluation Medicaid Redesign Investment: $515 Million over 5 years. Funding is targeted to high-cost Medicaid members. MRT Supportive Housing investment targets capital construction, rental subsidies and supports, and operating dollars. Outcomes, measures, research and evaluation are key components. MRT SH Initiative funds capital construction, rental subsidies, support services, service and operating, as well as program tracking and evaluation.

MRT Supportive Housing: High Cost Medicaid Members Individuals transitioning out of nursing homes Chronic Homeless with HIV/AIDS, Mental Health and/or Substance Use Disorders Chronically Addicted Homeless or at risk of homelessness Developmentally Disabled Seniors in Shelter or low-income seniors in the community Physically Disabled Homeless MRT SH has expanded the populations of supportive housing participants beyond the traditional populations. We serve chronically homeless and unstably housed Medicaid members from the Frail Elder to individuals with Substance Use Disorder.

MRT Supportive Housing Initiative - Accomplishments Over the past four years, the MRT Supportive Housing Program: Created a new resource for capital construction, and rental and service subsidies; Provided supportive housing units to more populations (“high cost Medicaid users”) throughout the State Created a platform for stakeholder engagement (MRT Affordable Housing Work Group) Improved coordination across agencies (HCR, OTDA, OMH, OASAS, AIDS Institute, DOH Office of Long Term Care, OPWDD) Since the programs inception we have recognize major accomplishments. We have created a new resource for capital construction and rental and service subsidies. We have provided supportive housing units to more populations throughout the State. We have created a platform for stakeholder engagement and we have improved coordination across State agencies. Just to name a few.

MRT Supportive Housing: Multi-Agency Effort HCR OMH OPWDD OASAS AIDS Institute OTDA The participating State Agencies are New York State Home & Community Renewal, the Office of Mental Health, the Office of Person With Developmental Disabilities, the Office of Alcoholism and Substance Abuse Services and the Office of Temporary and Disability Assistance.

MRT Supportive Housing Initiative Medicaid Redesign Investment: $515 Million $75 million in 2012-13 $86 million in 2013-14 $100 million in 2014-15 $127 million in 2015-16 $127 million in 2016-17 Since FY 2012-13, Governor Cuomo has invested $515 million through the MRT SH Initiative.

DLTC – Supportive Housing Initiatives Program Description Eligibility Nursing Home Transition and Diversion Rental Subsidy Program Program provides rental subsidies to individuals enrolled in the NHTD Waiver Program. Must be in receipt of Medicaid Waiver Services (NTHD Participant) and capable of living safely in the community with needed assistance from available informal supports; At least 18 years of age or older. Health Homes Supportive Housing Program Program provides rental and services subsidies to supportive housing providers to house and serve unstably housed high cost Medicaid recipients. Medicaid Enrollee; Health Home Enrollee; Homeless or unstably housed; Two chronic conditions or SMI or HIV/AIDS; At least 18 years of age or older; Single Adult. Special Needs – Assisted Living Program Program provides capital and Training Grants Assisted Living Program to enhance the program ability to house residence with Special Needs Licensed SNALR I would like to take a moment to share a few of the programs administered by the NYS Department of Health, Bureau of Housing and Partnership for Long-Term Care.

DLTC – Supportive Housing Initiatives Program Description Eligibility Olmstead Housing Subsidy Program Program provides rental subsidies, community transitional services and environmental modifications. Participant must meet the following criteria: Medicaid Enrollee; Homeless or unstably housed; Nursing Home Level of Care as determined by the Uniform Assessment System (UAS); Must be able to live safely in the community with appropriate supports; Must have 120 consecutive days of nursing home placement within the last 2 years; At least 18 years of age or older; Must have a documented chronic disability (Age 18 – 54).

DLTC – Supportive Housing Initiatives Program Description Eligibility Access to Home for Medicaid Program This program provides financial assistance to property owners to make dwelling units accessible for low- and moderate-income persons receiving Medicaid and living with a disability. These can be owner-occupied or rental units. Providing assistance with the cost of adapting homes to meet the needs of those with disabilities will enable individuals to safely and comfortably continue to live in their residences and avoid institutional care. Homeowners and renters may qualify for loan assistance through the municipality or not-for-profit entity under the following criteria: The occupant is physically disabled or has substantial difficulty with an activity of daily living because of aging; Occupant is a Medicaid recipient; The dwelling unit is a permanent residence; and Total household income does not exceed 80 percent of area median income, or 120% of area median income if person in need of modifications is a disabled veteran.

Proposed New Initiatives DSRIP Supportive Housing Initiative Medical Village Initiative MMC/MLTC Supportive Housing Initiative Alternative Housing Initiative Housing Navigator Initiative Upstream or Social Determinants Initiative So what’s next? The MRT SH initiative is currently researching several initiatives for future funding. These initiative are: The DSRIP Supportive Housing Initiative, Medical Villages, Main Stream Manager Care and Managed Long-Term Care Housing Initiatives, Alternative Housing Initiative, Housing Navigator Initiative and Social Determinants Initiative.

To learn more about MRT Supportive Housing, please visit our website at: http://www.health.ny.gov/health_care/medicaid/redesign/supportive_housing_initiatives.htm