Financing Supportive Housing Services Lori Shmulewitz Kelley, MPH Social Determinants of Health & Housing Manager Health Systems Division Oregon Health Authority

CCO 2.0: Opportunities for Housing Supports in PSH and Beyond In 2020 OHA will be entering into a new round of contracts with CCOs. New contracts include a variety of mechanisms to increase community collaboration around housing and other social supports… Statewide Priority of Housing CCOs were required to prioritize housing along with other community needs in their response to the RFA CCO 2.0 RFA specifically referenced the Statewide Housing Plan and asked CCOs to comment on their plans to address housing OHA will be working with CCOs to ensure housing is a priority as we move forward This represents a new level of collaboration between the housing and health world Expectations have been raised for healthcare partners

CCO 2.0: Opportunities for Housing Supports in PSH and Beyond In 2020 OHA will be entering into a new round of contracts with CCOs. New contracts include a variety of mechanisms to increase community collaboration around housing and other social supports… Increase spending on SDOH and health equity Require CCOs direct portion of spending (aligned with HB 4018) to partners through transparent process Require role for CAC and tribes in directing/tracking spending Increase CCO spending on health-related services (HRS) Align HRS community benefit initiatives with community priorities Require role for CAC and tribes in spending decisions 1) Implement HB 4018: Require CCOs to spend portion of net income or reserves on SDOH (including supportive population health policy and systems change), and health equity/health disparities, consistent with the CCO community health improvement plan (CHP) Require CCOs to hold contracts or other formal agreements with and direct a portion of required SDOH and health equity spending to SDOH partners  through a transparent process Require CCOs to designate role for CAC, and tribes and/or Tribal Advisory Committee if applicable (see policy #4d)  in directing and tracking/reviewing spending. Years 1 & 2: Concurrent with implementation of HB 4018 spending requirements, OHA will evaluate the global budget rate methodology and will seek to build in a specific amount of SDOH and health equity investment intended to advance CCOs’ efforts to address their members’ SDOH and establish their internal infrastructure and processes for ongoing reinvestment of a portion of net income or reserves in social determinants of health and health equity. Require one statewide priority – housing-related supports and services – in addition to community priority(ies)  This will include tribes. 2) Increase strategic spending by CCOs on health-related services (HRS) by: Encouraging HRS community benefit initiatives to align with community priorities, such as those from the Community Health Assessment and Community Health Improvement Plans; and Requiring CCOs' HRS policies to include a role for the CAC and tribes and/or Tribal Advisory committee if applicable (see policy #4d)  in making decisions about how community benefit HRS investments are made.

Health Related Services (HRS) HRS funding is included in a CCO’s global budget, HRS does not represent a new funding source. CCOs determine process for how providers or community partners can request HRS funding for a member. Decisions about whether to fund individual requests, are made by each CCO. Two key areas of HRS: Flexible services: Services delivered to an individual member to improve their health and well-being Community benefit initiatives: Community-level interventions that include (but not limited to) members and are focused on improving population health and health care quality. What this means for housing: This might mean partnering with a CCO to design a program suite certain services are covered directly through the CCO by flexible services 2. This might involve entering into a partnership with your CCO to secure funding on the program level as a community benefit initiative

HRS Guides on Housing Supports The MAC recently approved an HRS and Housing Guide https://www.oregon.gov/oha/HPA/dsi-tc/Pages/Health-Related-Services.aspx Help CCOs determine processes for how housing or health care providers can request HRS funding for a member. Highlight housing-related services covered through various Medicaid waivers and/or for specific populations can act as a template for CCOs to use HRS to expand access to housing-related services for their members. This guide includes several standalone appendices to provide innovative examples and enhances housing/health fluency across markets: Appendix A: Evidence on housing-related services and supports related to housing affordability and stability to improve health Appendix B: Organizations that support housing as a strategy to improve health and/or health equity Appendix C: Housing-related services coverage in current waivers and potential for HRS coverage Appendix D: Innovative CCO examples of housing related-programs in Oregon Appendix E: Glossary of housing terms We recognize this is new territory for a lot of CCOs… This guide will clarify how both Flexible Services and Community benefit Initiative dollars have been used in the part to fund housing interventions, and how they might be used in the futire This guide also provides a glossary to encourage fluency of housing terms within the healthcare arena

Other HRS Guides related to Housing The Transformation Center is working on a variety of other HRS guides Care coordination / Case management Traditional Health Workers Supporting healthy housing and addressing environmental concerns Health Information Technology Home and Community Based Services (HCBS) Community Benefit Initiative As you can see, many of these services intersect with necessary housing supports…and while they are covered for some populations, HRS gives an opportunity to fund areas not already covered by Medicaid or to expand services in areas traditionally difficult to get adequate funding for…

Other Medicaid Funding Streams In Addition to HRS, OHA will be focusing on clearer guidance on how to utilize current funding streams in Medicaid Publishing Clear Guidance on Fee for Service Billing of Housing Supports Technical Assistance regarding behavioral health and DHS benefits for population who already qualify for supportive services While most OHA members receive benefits through a CCO 15% are still fee for service. This guide can help them, as well as establish expectations or a floor for CCOs. This also gives partners documentation to discussed when approaching CCOs in an effort to bill these services It is also important to realize that many support services are already covered within SPMI and addictions services through OHA, and that DHS covered many benefits for IDD populations, Ensuring coverage is clear will leverage the funding we have set aside.

Other Medicaid Funding Streams OHA is also exploring waiver future waiver authorities to provide more flexibility in providing housing supports New Substance Use Disorders Waiver Researching other state waivers to inform renewal of 1115 Waiver

Enhancing Partnerships and Technical Assistance OHA will be partnering with OHCS around their PSH Institute Transformation Center exploring options provide housing specific TA around supports to cohorts Focused TA on projects to advise around braiding HRS, Medicaid and Housing funding, and partnering with community Learning collaboratives that explore braiding funding streams to establish reliable budgets and to maximize earmarked funds NASHP Learning Collaborative: Includes staff from OHA and OHCS to explore collaborative solutions Statewide Health Value Strategies workgroup highlights other state initiatives and waiver authorities OHA and OHCS are actively participating in collaborative opportunities to explore ways other communities are providing housing & health opportunities. These include data sharing options, ways in which Waivers and other Medicaid options are blended with housing dollars.