Housing as the Cornerstone of Recovery Lack of access to decent, safe and affordable housing interferes with positive treatment outcomes Stable housing as a therapeutic intervention Lack access to housing imposes tremendous costs BOTH the public health and behavioral health systems Housing as an investment that saves money and promotes recovery Separating housing from mental health services? Is it the responsibility of the public mental health system to provide housing for the clients it serves?

Permanent Supportive Housing (PSH) A cost effective intervention Numerous studies document cost effectiveness of providing permanent housing for people with disabilities: –New York/New York Culhane study on permanent supportive housing –University of Washington study in JAMA on “Housing First” –Massachusetts study on chronically homeless people –Health Affairs study on Medicaid long-term care costs

Legs of the PSH Stool 1.Capital –Investment to acquire or rehabilitate a property, “bricks and sticks” 2.Ongoing rent or operating subsidy –Difference between tenant contributions and housing operating costs (utilities, insurance, contribution to reserves, etc., NOT services) 3.Housing related support services –Case management, rehabilitation, etc., MediCal, Prop 63 Mental Health Services Act financing are critical

Housing First Effective tool in ending chronic homelessness Avoids “managing” chronic homelessness through institutional costs such as shelters, corrections, public and emergency services Building flexible, individualized services such as medical, mental health, substance abuse and vocational services around housing

Housing First (continued) Studies demonstrate that cost savings are dependent on housing stability Three major features 1.Simple expeditious application process, 2.No requirement for tenant to participate in or complete treatment prior to obtaining structured housing, intensive case management available once housed, 3.Conditions of tenancy do not exceed normal conditions for other leaseholders.

Where do People with Disabilities Live? TAC “Worst Case” Needs Report – million non-elderly adults renters with disabilities with very low incomes have “worst case” housing needs Paying more than 50% of income for rent and/or Living in seriously substandard housing 412,000 adults ages in nursing homes –125,000 adults between ages have mental illness (41% increase since 2002) In Adult Care Homes = 330,000 adults with mental illness In Group Homes = 500,000 adults with disabilities In Emergency Shelters = 180,000 adults with disabilities 7

Priced Out in 2010 Study Compares SSI income to HUD Fair Market Rents SSI = $674 monthly 1 Bedroom rent of $743 = 112% of monthly SSI Studio rent of $663 = 99% of monthly SSI In 218 communities across 42 states (including CA) 1-bedroom rents exceed 100% of monthly SSI SSI = 18.7% of average national AMI 61,915 non-elderly people with disabilities in California on SSI

Priced Out California State and Metropolitan Statistical Area SSI Monthly Payment SSI as % Median Income % SSI for Efficiency % SSI for 1- Bedroom NLIHC Housing Wage Bakersfield/Delano$ %73.0%78.0%$12.88 Los Angeles$ %115.0%139.0%$21.87 Orange County$ %139.0%157.0%$25.69 Riverside/San Bernadino$ %104.0%115.0%$18.08 State Average$ %112.0%131.0%$20.85

SSI Income Median Income 50% of Median Income SSI Benefits 18% of Median Income 30% of Median Income

Rent Subsidies Are Essential 30% of income towards housing costs according to federal housing affordability guidelines 30% of SSI = $200 National Average 1 BR rent = $742 “Housing Affordability Gap” = $542 “Gap” must be filled by an on-going rental subsidy Priced Out Message

HUD Rent Subsidy Programs Total units = 4.8 million Section 8 Housing Choice Vouchers = 2 million vouchers. –Only 19% assist people with disabilities Section 8 vouchers set aside for non-elderly disabled –Poor tracking, ineffective targeting upon turnover, no link to supportive housing Addressing the “Affordability Gap”

–50,000 “Frelinghuysen” vouchers linked to “elderly only” designation – can be project-based 175 with City of Anaheim 100 with Imperial Valley 300 with City of Los Angeles 100 with Los Angeles County 200 with City of Long Beach –14, “mainstream” vouchers – cannot be project-based 225 with City of Anaheim 75 with City of Los Angeles 175 with City of Oakland 100 with San Bernadino County 100 with City of Santa Barbara HUD Rent Subsidy Programs Addressing the “Affordability Gap”

Veterans Supportive Housing Vouchers: tenant-based, project-based and sponsor- based Targeted to veterans experiencing chronic homelessness $75 million in new funds expected in 2013 and beyond Combined with services from the VA VASH Vouchers in California: City of Los Angeles: 1,395Santa Clara County: 435 Los Angeles County: 655San Francisco: 275 San Diego Housing Commission: 230Santa Ana: 295 San Diego County: 230 VASH

Public housing units =1.1 million units (affect of “elderly only” housing policies) –Only 16% assist people with disabilities HUD “Assisted Housing” = 1.2 million units (affect of “elderly only” housing policies) –Only 17% assist people with disabilities Other programs = 443,000 units –Section 811 = 30,000 units –Homeless programs = 50,000 HUD Rent Subsidy Programs Addressing the “Affordability Gap”

Rent Subsidies Section 8 Vouchers targeted to people with disabilities –Three types of Section 8 vouchers: tenant-based sponsor-based project-based HUD Homeless Assistance programs HUD VASH Section 811 What Works

FY 2013 Funding HUD Section 811 $150 million request, $15 million cut below the FY 2012 level $85 million will be needed in FY 2012 to renew PRACs (project-based operating subsidies) for all of the existing 811 units $80 million was available in FY 2012 for the new “PRAC only” program –NOFA published on May 15, applications from states due July 31 Will fund as many as 2,500 new units of supportive housing in 2012, significantly more than 949 new units that were developed under 811 in 2010 and 2011 combined.

FY 2013 Funding McKinney-Vento Homeless Assistance Act $2.23 billion request for FY 2013, $330 million increase over FY 2012 Draft Senate bill -- $2.146 billion House bill -- $2.005 billion $1.6 billion needed to renew existing PSH units $286 million for ESG (Emergency Solutions Grants for states) $75 million in new funding for VASH vouchers for FY 2012 – chronically homeless veterans (10,000 new supportive housing units)

FY 2013 Funding McKinney-Vento Homeless Assistance Act (continued) VA Homelessness $333 million proposed for FY 2013 for outreach and services $1.352 billion for the agency for homeless initiatives as part of Secretary Shinseki’s plans to end homelessness among veterans in 5 years. This includes funding for the VA portion of VASH program and for the grant and per diem program.

Frank Melville Supportive Housing Investment Act P.L , signed by the President on January 4, 2011 Reforms existing 811 Capital/PRAC program Shifts appropriations for “broken” 811 voucher program to the Section 8 appropriation Creates new Demonstration program to leverage integrated affordable housing units financed with mainstream housing funding (tax credits, HOME funds, new National Housing Trust Fund, etc.) Funds 3, ,000 units with same appropriation level Cross-disability approach focused on priority Medicaid populations

Goal = Integrated scattered site 811 units Create small set-asides of supportive housing units (e.g units in a 100 unit project) Eliminate need for Section 811 capital advance Ensure affordability (30% of income for rent) Capital provided through Low Income Housing Tax Credits, HOME, mortgage revenue bonds, Housing Trust Fund, or other capital sources Ensure links to state Medicaid policies and service providers 2,500-3,000+ new 811 units every year with $80 million Program applicants would be state housing finance agencies PRAC Only Demonstration Program

(PRA) Demonstration New project-based rental assistance approach Helps states systematically and efficiently create integrated and highly cost-effective supportive housing units Requires structured state-level partnership linking affordable housing with community-based services and supports Services are elective not mandatory for tenant Offers people with significant disabilities the opportunity to live in high quality rental housing alongside other tenants who do not have disabilities NOFA deadline was August 7 – California is applying!!! New Section 811 Project-Based Assistance

PRA Demo Goals Supporting State Housing and Health and Human Service/Medicaid agency collaborations that have or will result in increased access to affordable permanent housing units combined with access to appropriate and voluntary supports and services Seeking innovative, replicable approaches Seeking cross-disability, mixed income approaches to develop integrated housing for people with disabilities Creating more efficient and effective uses of housing and health care resources Source: TAC

Critical ElementSourceExamples CapitalHFA State or local govt. Private foundation Low Income Housing Tax Credits Bonds/Trust Funds HOME Foundation Funds Operating SubsidyHUDSection 811 PRA Demo S+C PBA Section 8 PBV Support ServicesState Medicaid Agency State Human Services Agency Money Follows Person Home and Community-based Waiver Services State services funds Rehab option Supportive Housing Partnership Source: TAC

McKinney-Vento Homeless Assistance Act Provides permanent supportive housing for homeless people with disabilities Shelter Plus Care program Supportive Housing Program (SHP) Section 8 Single Room Occupancy program Coordinated through local Continuum of Care groups 8,000 new permanent supportive housing units funded in 2005 for people with disabilities who are chronically homeless $1.5 billion for Homelessness Prevention and Rapid Re-Housing Program (HPRP) Housing relocation and stabilization funding (housing search, mediation, credit repair, security deposits, moving out costs, etc.) Must be spent within 24 months Tenants must meet federal definition of homeless

HEARTH Act Signed by President Obama on May 20, 2009 Consolidates HUD’s Continuum of Care Programs (Supportive Housing Program, Shelter Plus Care, and Moderate Rehabilitation/SRO) into a single Community Homeless Assistance Program. Continue incentives for permanent housing and serving people who experience chronic homelessness (adding families to the definition of chronic homelessness). Funds renewals of permanent housing out of the same account that funds Section 8

HEARTH Act Adds an incentive to serve homeless families using rapid re-housing programs. Expands the Emergency Shelter Grants program to include significant resources for prevention and re- housing. Modestly expands the definition of homelessness to include people who are losing their housing in the next 14 days, and who lack resources or support networks to obtain housing, as well as families and youth who are persistently unstable and lack independent housing and will continue to do so.