PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE ENVIRONMENT Pamela S. Hyde, J.D. SAMHSA Administrator National Alliance to End Homelessness U.S. Interagency Council on Homelessness Washington, DC July 16, 2012

BEHAVIORAL HEALTH AND HOMELESSNESS  Among sheltered homeless adults (HUD, 2010 Point-in-Time):  34.7 percent (~552,000) with substance used disorders (SUD)  26.2 percent (~417,000) with serious mental illness (SMI)  46 percent (~732,000) with co-occurring disorders (COD)  Of those using homeless residential services in 2010: 6.4 percent (>100,000) reported a psychiatric facility, SA treatment facility, or hospital as their living arrangement the night before entry  TEDS, 2010: Of the ~1.8 million treatment admissions aged 12 or ↑, 12.7 percent were homeless at time of admission 3

RECOVERY REQUIRES HOUSING 4 4 Individuals and Families HOME ↑ Permanent Housing COMMUNITY ↑ Peer/Family/ Recovery Network Supports PURPOSE ↑ Employment/ Education HEALTH ↓ Symptoms & Distress ↑ Abstinence, Self-Care & Resilience

2014 – MORE AMERICANS WILL HAVE HEALTH COVERAGE OPPORTUNITIES  Currently, 37.9 million are uninsured <400% FPL* 18.0 M – Medicaid expansion eligible 19.9 M – ACA exchange eligible** M (29%) – Have BH condition(s) * Source: 2010 NSDUH ** Eligible for premium tax credits and not eligible for Medicaid 5

PREVALENCE OF BH CONDITIONS AMONG MEDICAID EXPANSION POP CI = Confidence Interval Sources: 2008 – 2010 National Survey of Drug Use and Health 2010 American Community Survey 6

PROVIDERS ACCEPTING HEALTH INSURANCE PAYMENTS  Primary MH plus some SA: 85 percent  Primary SA: 56 percent  Other (homeless shelters and social services): 37 percent  Residential SA: 54 percent  Inpatient: 95 percent  Outpatient: 68 percent Source: NSATSS 7

SAMHSA ENROLLMENT ACTIVITIES  Consumer Enrollment Assistance (thru BRSS TACS) Outreach/public education Enrollment/re-determination assistance Plan comparison and selection Grievance procedures Eligibility/enrollment communication materials  Enrollment Assistance Best Practices TA – Toolkits  Communication Strategy – Message Testing, Outreach to Stakeholder Groups, Webinars/Training Opportunities  SOAR Changes to Address New Environment  Data Work with ASPE and CMS 8

SAMHSA PROVIDER CAPACITY EFFORTS  Provider Business Operations Contract Billing Electronic Health Records Compliance Business Planning Being in a Provider Network  Technical Assistance and Training  Workforce Issues

SAMHSA FUNDING TO ADDRESS HOMELESSNESS  SAMHSA’s 2012 homeless programs budget (PATH, GBHI & SSH) is ~$139 million  Support for 220 direct grantees and > 600 PATH provider agencies in 50 states  93 active grantees: GBHI, including CABHI and CSAT’s Services in Supportive Housing (SSH) and general grantees  71 active grantees: SSH programs, supported by CMHS 10

SAMHSA’S CABHI PROGRAM  Subprogram of GBHI A 3-year program that began in September active CABHI grants  CABHI Grantees: Development/implementation of programs integrating services and treatment for individuals who are chronically homeless ↑ number of individuals who are placed in permanent housing with supportive services ↑ provider capabilities to enroll individuals in mainstream benefit programs (e.g., Medicaid, SSI/SSDI, SNAP) 11

CABHI COLLABORATION WITH HOUSING PARTNERS  First 6 months, CABHI grantees placed > 300 individuals into housing  Funding sources U.S. Department of Housing and Urban Development:  Supportive Housing Program  Project-based vouchers  Shelter Plus Care vouchers  Section 8 vouchers U.S. Department of Veterans Affairs Supportive Housing Vouchers Public and private program partnerships Local housing authorities 12

COMMUNITY LIVING INITIATIVE (CLI)  HHS’s CLI promotes federal partnerships in support of the 1999 Olmstead decision  As part of the CLI, HUD and HHS cooperated in the Housing Capacity Building Initiative for Community Living  Combines efforts among HUD, CMS and SAMHSA  Encourages public housing agencies to establish persons transitioning from institutions as a priority population for public housing and Housing Choice vouchers  Awarded ~ 1,000 of the 5,400 new Non-Elderly Disabled (NED) vouchers to individuals leaving institutions, including many in the CMS Money Follows the Person program 13

2013: SAMHSA POLICY ACADEMY  Focus on states or cities with high rates of chronic homelessness  Federal partners include HRSA, HUD, VA, CMS and ASPE  Process will rely heavily on web technology in providing TA and communicating with teams  Teams will include policymakers in housing, BH, Medicaid, criminal justice, labor, and veterans affairs  Consumer leaders and members of State Interagency Councils, Continuums of Care, and Coalitions for the Homeless will participate 14